Backache, nausea and dodgy tonsils – these are just some of the symptoms caused by stones in your body. Astonishingly, millions of us have them.
But despite being incredibly common, they can often go misdiagnosed – simply because they are little understood by many GPs.
Here, with the help of leading ‘stone’ experts, ANGELA EPSTEIN explains what you should look out for, and their treatment…
Weighed down: Stones can cause marked symptoms from vomiting to spots and intense pain
GALLSTONES
SYMPTOMS: Nausea, vomiting and sharp pain in the right upper-hand side of the stomach just below the ribcage (the pain can also spread to the right shoulder); an attack can last for a few minutes or up to three hours. It can be difficult to distinguish the pain from several other conditions, including back problems and pneumonia.
CAUSES: Gallstones are lumps of solid material such as cholesterol or calcium that form in the gallbladder or the bile duct (which connects the gallbladder to the small intestine). This occurs when chemicals stored in the gallbladder harden into a mass. Patients may develop one large stone or a lot of tiny ones.
About 5.5 million Britons suffer from gallstones. ‘You can get gallstones at any age, but your chances increase as you get older due to increased cholesterol levels,’ explains Anton Emmanuel, a gastroenterologist at University College Hospital in London. ‘Women are more at risk than men due to having too much oestrogen in the body. High fat diets and excess weight also increases the risk as they lead to high cholesterol.’
TREATMENT: If your gallstones aren’t causing you any symptoms, they can usually be left alone, as most won’t go on to cause problems. Drinking plenty of liquid will help them pass out; a lowfat diet and painkillers can also help.
Small to medium-size stones can be dissolved with drugs. Large stones need to be removed because they can cause infections and blockages of your digestive tract, explains Dr Emmanuel.
If the stones have already moved from the gallbladder to the bile duct they can be located using an endoscope (a form of telescope) in the gut, with an attached instrument to break down and remove the stones. This is done under general anaesthetic.
Removing large stones usually involves removing the gallbladder too. This is known as a cholecystectomy and is one of the most commonly performed operations in the UK. Though it can be done as an open operation through a cut in the abdomen, it is now much more common as a keyhole procedure, under general anaesthetic.
PREVENTION: Eating a low-fat diet and keeping weight down will help.
A disposal bag, left, is good for people with gallstones who may suffer from nausea and vomiting. Tonsil stones, right, appear as white spots and can be confused with a sore throat
TONSIL STONES
SYMPTOMS: Small white spots on the tonsils (although these may not always be visible); difficulty or pain when swallowing; bad breath; metallic taste in the mouth.
CAUSES: Tonsil stones affect an estimated seven million Britons, although may often be misdiagnosed as a throat infection. They occur when lumps of calcified food, mucus and bacteria get trapped in pits in the tonsils, explains Anastasia Rachmanidou, a consultant ear, nose and throat surgeon at University Hospital Lewisham, South-East London.
‘This debris then attracts bacteria, which hardens and starts to decay.’ Adults are more at risk simply because they have bigger tonsils; the tonsils have a naturally pitted surface like the moon and, as we grow, these pits or crypts also get bigger, making them more likely to harbour food.
Anyone who’s ever had tonsillitis is also at risk, as the illness can scar the tonsil. Taking certain prescription medicines, such as high blood-pressure tablets, painkillers and antidepressants, can also cause tonsil stones. This is because a common side- effect is dry mouth, which means there isn’t enough saliva to wash food and bacteria away.
TREATMENT: ‘It’s vital to get any white spots on your tonsils checked out by your GP, as rarely a lesion, spot or white patch can be a sign of cancer,’ says Ms Rachmanidou.
Chewing a dry cracker daily may help remove the stones, as can pushing the tongue out hard (this pushes the muscles at the side of the throat to dislodge them).
Ms Rachmanidou also suggests trying to flush them out with warm salt water. Get an empty nasal spray bottle and fill it with warm water and half a teaspoon of salt to spray on to the tonsils.
‘If you have particularly craggy tonsils, it is possible to have laser treatment to smooth the nooks that trap food in the tonsils,’ she says.
A more drastic option is to have the tonsils removed. However, London dentist Phil Stemmer says this is not something he would routinely recommend, as it involves having a general anaesthetic, which always carries a certain risk.
‘The tonsils are also very important to prevent infection, as they trap bacteria before it can reach the upper respiratory tract,’ he says. ‘And like any operation, there can be complications, such as bleeding.’
PREVENTION: Good oral hygiene, brushing your teeth, flossing and using a non-alcoholic mouthwash twice a day will help to flush the food away. Drink plenty of water to keep saliva moving throughout the area.
KIDNEY STONES
SYMPTOMS: Intense unbearable back pain that spreads to the groin, comes on without warning and can last up to three hours without treatment; bloody or cloudy urine; feeling sick or vomiting; a frequent urge to urinate, or a burning sensation during urination.
CAUSES: Kidney stones come in a variety of shapes and colours and range in size from a grain of sand to a golf ball. They are extremely common, affecting around 1.8million men and 600,000 women. They form when waste products, that are usually dissolved in the fluids that form urine, crystallise and collect around the inside of the kidney.
Kidney stones fall into four main types, says Robert Calvert, a urological surgeon at the Royal Liverpool University Hospital. Calcium stones are made from calcium and phosphate, or calcium and oxalate.
Struvite stones contain magnesium and ammonia, and are often hornshaped and quite large. Uric acid stones are usually smooth, brown and softer than other forms of kidney stones, while cystine stones are often yellow and resemble crystals rather than stones.
Taking too many laxatives, eating a diet high in protein and not drinking enough increase risk, as can frequent urinary tract infections.
If you have previously had a kidney stone, then you will have a 50 per cent chance of developing another one within five years.
After a kidney stone has formed, it will stay in or near the kidney or travel through the urinary system as it tries to be passed in urine. It is fairly common for a stone to block part of the urinary system.
TREATMENT: Often the stone will pass spontaneously. ‘The moderate pain from smaller kidney stones may last only a few hours and can stop instantly when the stone has passed in the urine,’ explains Jonathan Glass, a consultant urologist at the Stone Unit at Guy’s Hospital in London.
Stones that don’t pass can be treated by extracorporeal shock wave lithotripsy (ESWL) X-rays. Ultrasound is used to pin-point the stone, then a machine sends shock waves of energy to the stone to break it into smaller pieces so that it can be passed in your urine. This is done under local anaesthetic.
For larger stones, there is a procedure called lithotripsy in which the stone is broken down with a laser and then grabbed with a little basket. Large stones can also be surgically removed from the kidney.
PREVENTION: ‘Drink two to four litres of water every 24 hours, or at least enough to make your urine clear rather than yellow,’ says Mr Calvert. ‘Cutting down on all meat – red and white – will help, as this will reduce acidity in urine.’
BLADDER STONES
SYMPTOMS: Difficulty urinating or a frequent need to urinate; blood in the urine; irritation and sometimes infection; dull or sharp pain in the back or hip, end of the penis, scrotum or perineum, which is made worse by sudden movements and exercise.
Classic sign: Bladder stones can cause difficulty urinating
CAUSES: They are made of calcium and form when waste products crystallise because the bladder hasn’t emptied properly.
A common cause is prostate gland enlargement, usually due to age. That’s why bladder stones mostly occur in men.
Stones can also form because of a change in urine acidity due to not drinking enough fluid. People who suffer recurrent urine infections are more likely to develop bladder stones, as bacteria encourages the stones to form.
TREATMENT: Bladder stones are usually between 0.2cm and 2cm, though can be much bigger. They are diagnosed via urine tests, blood tests, X-rays and ultrasound scans. Smaller stones can pass from the body without causing any problems.
For larger stones, a procedure called cystoscopy is used. A fibre- optic camera, called a cystoscope, is inserted into the bladder via the urethra. Stones are broken up and then washed out.
PREVENTION: ‘Drink plenty of water – at least ten glasses a day,’ says Professor Roger Kirby of the London Prostate Centre. A diet low in calcium can help prevent a recurrence if you’ve already had them.
SALIVARY STONES
Protection: Drinking frequently can help protect against salivary stones
SYMPTOMS: Pain and swelling, which can cause difficulty eating.
CAUSE: Salivary stones affect 300,000 people. They occur when dead cells react with chemicals in the saliva; this crystallises into a stone that can block salivary ducts, obstructing the flow of saliva.
TREATMENT: Small stones can be flushed out by stimulating saliva by sucking on a sour sweet or eating citrus fruit combined with fluids and facial massage.
The traditional treatment is an operation under general anaesthetic, during which a surgeon cuts through the cheek to remove the gland.
This can cause scarring and has a high risk of damaging nerves that give the face its movement and expression.
There are several new techniques. For small stones (less than 4mm), a tiny tube with a camera and light at the tip is passed into the blocked duct to locate the stone. Then a basket attached to the tube grabs the stone and pulls it out. This is done under local anaesthetic.
Medium stones (around 5mm) can be destroyed by acoustic shockwaves, a bit like intense ultrasound. The procedure is also performed under local anaesthetic.
For larger stones (1cm), surgery under general anaesthetic involves cutting under the tongue to remove the stone with miniature forceps.
PREVENTION: Keeping the mouth moist and hydrated by drinking frequently may help.
