Bladder Stones: Symptoms, Causes & Treatment

What Are Bladder Stones?

Bladder stones (cystolithiasis) are hard mineral deposits that form in the urinary bladder when urine is not completely emptied. They develop when minerals in concentrated urine crystallize and clump together, ranging in size from a few millimeters to several centimeters. Both men and women can develop bladder stones, though they are more common in men over 50.

Bladder stones are a type of urinary tract stone that specifically forms within the bladder itself, distinguishing them from kidney stones that form in the kidneys and may travel down to the bladder. The condition occurs when the bladder cannot completely empty itself during urination, leaving residual urine that becomes concentrated over time. As this concentrated urine sits in the bladder, minerals begin to crystallize and gradually accumulate into stones of varying sizes.

The composition of bladder stones varies depending on the underlying cause and the individual's metabolic factors. The most common types include calcium oxalate stones, calcium phosphate stones, uric acid stones, and struvite stones (also called infection stones because they form in response to urinary tract infections). Understanding the stone composition is important for treatment planning and prevention strategies.

Bladder stones account for approximately 5% of all urinary tract stones diagnosed worldwide. While they can occur at any age, they are significantly more prevalent in men over 50 years of age, primarily due to the high incidence of benign prostatic hyperplasia (enlarged prostate) in this population. In developing countries, bladder stones are also seen in children, often related to dietary factors and dehydration, but this is rare in industrialized nations.

How do bladder stones form?

The formation of bladder stones is a gradual process that typically occurs over months or years. When urine cannot fully drain from the bladder, the residual urine becomes increasingly concentrated as water is reabsorbed by the bladder wall. This supersaturation of minerals creates ideal conditions for crystallization. Initially, microscopic crystals form and then progressively aggregate, growing larger over time as more mineral deposits accumulate on their surface.

Several factors accelerate this process, including chronic dehydration, high dietary intake of stone-forming substances, certain medications, and metabolic disorders. The bladder's natural defense mechanisms, including the production of mucin and other inhibitors of crystallization, may also be compromised in certain conditions, further promoting stone formation.

What Causes Bladder Stones?

The primary cause of bladder stones is incomplete bladder emptying, which allows urine to become concentrated and minerals to crystallize. Common underlying conditions include enlarged prostate (the most frequent cause in men), bladder prolapse in women, neurogenic bladder from nerve damage, urinary catheter use, and bladder diverticula.

Understanding the underlying cause of bladder stones is essential for effective treatment and prevention of recurrence. While the immediate mechanism is always the same—concentration of urine leading to mineral crystallization—the factors that prevent complete bladder emptying vary significantly among individuals. Identifying and addressing these underlying causes is just as important as removing the stones themselves.

Enlarged prostate (Benign Prostatic Hyperplasia)

In men, benign prostatic hyperplasia (BPH) is by far the most common cause of bladder stones. As men age, the prostate gland naturally enlarges, and this enlargement can compress the urethra—the tube that carries urine from the bladder out of the body. This compression creates an obstruction that prevents the bladder from fully emptying, leaving residual urine that can form stones over time.

The relationship between prostate size and bladder stone formation is well-established, with studies showing that men with significant prostatic enlargement have substantially higher rates of bladder stone development. The degree of obstruction, rather than the absolute size of the prostate, is the key determinant of stone risk.

Bladder prolapse and pelvic organ prolapse

In women, bladder prolapse (cystocele) is a leading cause of bladder stones. This condition occurs when the supportive tissues between the bladder and vaginal wall weaken, allowing the bladder to descend into the vagina. This anatomical change can create a pouch where urine pools and cannot completely drain during urination.

Pelvic organ prolapse often results from childbirth, chronic straining (such as from chronic constipation), obesity, or the natural weakening of pelvic tissues with age. Women with significant prolapse may benefit from pelvic floor exercises, pessary use, or surgical repair to reduce their risk of bladder stone formation.

Neurogenic bladder

Neurogenic bladder refers to bladder dysfunction caused by damage to the nerves that control bladder function. This can result from various conditions including spinal cord injury, multiple sclerosis, Parkinson's disease, diabetes-related neuropathy, and stroke. When the nerves cannot properly signal the bladder to contract and empty, residual urine accumulates and creates conditions favorable for stone formation.

Patients with neurogenic bladder often require intermittent catheterization or indwelling catheters to empty their bladders, which introduces additional risk factors for stone formation, including catheter-associated infections and the presence of a foreign body that can serve as a nucleus for crystallization.

Urinary catheter use

Both short-term and long-term urinary catheter use significantly increases the risk of bladder stones. Catheters can introduce bacteria into the bladder, leading to infections that promote struvite stone formation. Additionally, mineral deposits can accumulate on the catheter surface itself, and incomplete drainage can occur if the catheter becomes blocked or improperly positioned.

Patients who require long-term catheterization should work closely with their healthcare providers to minimize stone risk through proper catheter care, regular catheter changes, adequate hydration, and prompt treatment of urinary tract infections.

Other contributing factors

Additional factors that can contribute to bladder stone formation include:

• Bladder diverticula: Pouches that form in the bladder wall where urine can collect and stagnate
• Chronic urinary tract infections: Certain bacteria can split urea in urine, creating alkaline conditions that promote struvite stone formation
• Previous bladder surgery: Sutures or mesh materials can serve as a nucleus for stone formation
• Dehydration: Consistently inadequate fluid intake leads to concentrated urine
• Dietary factors: High intake of animal protein, sodium, or oxalate-rich foods may increase risk
• Metabolic disorders: Conditions affecting calcium, uric acid, or cystine metabolism

What Are the Symptoms of Bladder Stones?

Common bladder stone symptoms include frequent urination, painful or burning urination, blood in urine (hematuria), interrupted or weak urine stream, difficulty starting urination, lower abdominal pain, and recurrent urinary tract infections. However, some people may have bladder stones for years without experiencing any symptoms.

The symptoms of bladder stones can vary considerably depending on the size and number of stones, their location within the bladder, and whether they cause obstruction or irritation. Smaller stones may produce no symptoms at all, while larger stones or those that move to block the bladder outlet can cause significant discomfort and urinary dysfunction.

Urinary symptoms

The most characteristic symptoms of bladder stones relate to changes in urination patterns and comfort. These symptoms occur because the stones irritate the bladder lining, cause inflammation, or physically interfere with normal urine flow. Many patients first notice these changes gradually, initially attributing them to other causes before seeking medical evaluation.

Typical urinary symptoms include:

• Frequent urination: Feeling the need to urinate more often than usual, including during the night (nocturia)
• Painful urination (dysuria): Burning or discomfort during urination, often felt in the lower abdomen or urethra
• Interrupted urine stream: The stream may stop and start, or suddenly cut off when a stone moves to block the bladder outlet
• Weak urine stream: Reduced force or flow of urine
• Difficulty initiating urination: Having to wait or strain before urine begins to flow
• Feeling of incomplete emptying: The sensation that the bladder is not fully empty after urination

Blood in urine (hematuria)

Blood in the urine is a common finding in patients with bladder stones. The stones can irritate and abrade the bladder lining as they move within the bladder, causing small blood vessels to bleed. This bleeding may be visible to the naked eye (gross hematuria), giving the urine a pink, red, or brown color, or it may only be detectable through laboratory testing (microscopic hematuria).

While blood in urine is common with bladder stones, it's important to recognize that hematuria can have many other causes, some of which are more serious. Any instance of visible blood in the urine should prompt medical evaluation to determine the underlying cause.

Pain and discomfort

Bladder stones can cause various types of pain and discomfort. Lower abdominal pain or pressure is common, particularly when the bladder is full. Some patients experience pain that radiates to the genitals, inner thighs, or lower back. In men, pain at the tip of the penis may occur, especially at the end of urination when the bladder contracts most strongly against the stone.

Pain tends to be most pronounced when stones move within the bladder or temporarily block the bladder outlet. Sudden, severe pain may indicate acute obstruction requiring urgent medical attention.

Recurrent urinary tract infections

Bladder stones create an ideal environment for bacterial growth. The rough surface of stones can harbor bacteria that are protected from both the body's immune system and antibiotic treatment. Additionally, the incomplete bladder emptying that caused the stones in the first place also promotes infection by allowing bacteria to multiply in stagnant urine.

Patients who experience frequent urinary tract infections, especially infections that recur shortly after completing antibiotic treatment, should be evaluated for the possibility of bladder stones.

Asymptomatic bladder stones

It's worth noting that many bladder stones cause no symptoms at all and may be discovered incidentally during imaging studies performed for other reasons. These asymptomatic stones can remain in the bladder for years without causing problems. However, they should typically still be addressed because they can suddenly cause symptoms, grow larger, lead to infections, or cause bladder damage over time.

When Should You See a Doctor for Bladder Stones?

Contact a healthcare provider if you experience persistent urinary symptoms such as frequent urination, pain during urination, blood in urine, or interrupted urine stream. Seek urgent medical care if you cannot urinate at all, have severe pain, or develop signs of infection such as fever, chills, or confusion. Early evaluation can prevent complications.

Recognizing when to seek medical care for bladder stone symptoms is important for preventing complications and obtaining timely treatment. While bladder stones rarely cause life-threatening emergencies, certain symptoms warrant prompt medical attention to prevent serious complications such as complete urinary obstruction or severe infection.

Routine medical consultation

You should schedule an appointment with your healthcare provider if you experience:

• Changes in your normal urination pattern that persist for more than a few days
• Mild to moderate discomfort during urination
• A sensation of not completely emptying your bladder
• Recurrent urinary tract infections (more than 2-3 per year)
• Visible blood in your urine, even if it only happens once

Urgent medical care

Seek same-day medical care or visit an urgent care facility if you experience:

• Sudden severe abdominal or pelvic pain
• Significant blood in your urine making it appear red or dark
• Urinary symptoms accompanied by fever or chills
• Marked difficulty urinating or very weak stream
• Pain that is not relieved by over-the-counter pain medications

How Are Bladder Stones Diagnosed?

Bladder stones are diagnosed through imaging tests including ultrasound, X-ray, and CT scan. Cystoscopy, where a thin camera is inserted into the bladder through the urethra, provides direct visualization and can often diagnose and treat stones in the same procedure. Urinalysis helps detect signs of infection or blood.

Accurate diagnosis of bladder stones requires a combination of clinical evaluation, laboratory tests, and imaging studies. The diagnostic process not only confirms the presence of stones but also helps identify the underlying cause and guides treatment planning. Modern diagnostic techniques allow for accurate stone detection with minimal invasiveness.

Medical history and physical examination

The diagnostic process begins with a thorough medical history and physical examination. Your healthcare provider will ask about your symptoms, their duration and severity, your urination patterns, and any risk factors such as enlarged prostate, previous urinary problems, or catheter use. A physical examination may include an abdominal exam to check for bladder distension and, in men, a digital rectal exam to assess the prostate.

Urinalysis and laboratory tests

Urinalysis is typically the first laboratory test performed. This simple test can detect blood in the urine (even microscopic amounts), signs of infection (white blood cells, bacteria), and crystals that may indicate stone formation. A urine culture may be performed if infection is suspected to identify the specific bacteria and guide antibiotic selection.

Blood tests may be ordered to assess kidney function, check for signs of infection, and evaluate metabolic factors that could contribute to stone formation, such as calcium, uric acid, or parathyroid hormone levels.

Imaging studies

Several imaging modalities can detect bladder stones, each with its own advantages:

Ultrasound: This non-invasive, radiation-free imaging technique is often the first-line diagnostic tool. Ultrasound can detect most bladder stones and also assess residual urine volume after voiding, which helps identify incomplete bladder emptying. It's particularly useful for initial screening and follow-up.

X-ray (KUB - Kidney, Ureter, Bladder): Plain X-rays can detect calcium-containing stones, which appear as bright white objects on the image. However, some types of stones (such as uric acid stones) may not be visible on X-ray. This limitation makes X-ray less reliable as a sole diagnostic tool.

CT scan (Computed Tomography): CT scanning is the most sensitive imaging test for detecting urinary stones of all types and sizes. A non-contrast CT of the abdomen and pelvis can visualize stones that might be missed on X-ray or ultrasound. CT also provides detailed information about the stone's size, location, and density, which helps guide treatment planning.

Cystoscopy

Cystoscopy is a procedure in which a thin, flexible or rigid tube with a camera (cystoscope) is inserted through the urethra into the bladder. This allows direct visualization of the bladder interior and any stones present. Cystoscopy is often both diagnostic and therapeutic—if stones are found, they can frequently be removed during the same procedure.

Before cystoscopy, the urethra is numbed with a local anesthetic gel to minimize discomfort. The procedure is typically performed on an outpatient basis and takes about 15-30 minutes for diagnostic purposes. Most patients experience only mild discomfort and can return to normal activities within a day or two.

How Are Bladder Stones Treated?

The most common treatment is cystolitholapaxy, where stones are broken up and removed through a scope inserted into the bladder via the urethra. For larger or very hard stones, open surgery (cystolithotomy) may be needed. Treating the underlying cause, such as enlarged prostate or bladder prolapse, is essential to prevent recurrence.

Treatment of bladder stones has evolved significantly with advances in endoscopic and laser technology. Today, most bladder stones can be treated through minimally invasive procedures with excellent success rates and rapid recovery. The choice of treatment depends on stone size, composition, and hardness, as well as the patient's overall health and the underlying cause of stone formation.

Cystolitholapaxy

Cystolitholapaxy is the most commonly performed procedure for bladder stones and represents the gold standard of treatment. During this procedure, a cystoscope is inserted through the urethra into the bladder. Once the stones are visualized, specialized instruments are introduced through the cystoscope to fragment and remove the stones.

Fragmentation can be achieved using various energy sources:

• Mechanical lithotripsy: Stones are grasped and crushed using specialized mechanical devices
• Laser lithotripsy: A laser fiber delivers energy to break stones into small fragments; holmium laser is most commonly used
• Pneumatic lithotripsy: A probe delivers rapid pneumatic impulses to fragment stones
• Ultrasonic lithotripsy: High-frequency ultrasound waves break up stones

Once fragmented, the stone pieces are irrigated out of the bladder or removed with grasping instruments. The procedure typically takes 30-60 minutes and is performed under local, spinal, or general anesthesia. Most patients go home the same day and experience only mild discomfort for a few days afterward.

Post-procedure recovery

After cystolitholapaxy, you may experience some burning or discomfort when urinating for the first few days. This is normal and typically improves quickly. Drinking plenty of water (at least 2 liters per day) helps dilute the urine and reduce discomfort while also flushing out any small stone fragments. Some blood in the urine is common for a few days and gradually clears.

Occasionally, a urinary catheter is left in place for a short time after the procedure, particularly if there was significant bleeding or if the prostate was also treated. Your healthcare provider will give you specific instructions about activity restrictions, which are typically minimal, and when to follow up.

Open cystolithotomy

In some cases, stones are too large or too hard to be removed through the urethra. When this occurs, open surgical removal (cystolithotomy) may be necessary. This involves making a small incision in the lower abdomen and directly opening the bladder to remove the stone or stones.

Open surgery is also sometimes preferred when the underlying cause (such as severe prostatic enlargement) requires simultaneous surgical treatment, or when there are anatomical factors that make endoscopic access difficult. While open surgery involves a longer recovery period than cystolitholapaxy, it remains a safe and effective option when needed.

Treating the underlying cause

Removing bladder stones without addressing the underlying cause often leads to recurrence. Therefore, treatment planning must include evaluation and management of any conditions contributing to incomplete bladder emptying:

Enlarged prostate: Options include medications (alpha-blockers, 5-alpha reductase inhibitors) or surgical procedures (TURP - transurethral resection of the prostate, laser prostatectomy, or other minimally invasive techniques). Sometimes prostate treatment is performed at the same time as stone removal.

Bladder prolapse: Treatment may include pelvic floor exercises, pessary devices, or surgical repair depending on severity and patient preference.

Neurogenic bladder: Management typically involves intermittent catheterization, medications to improve bladder function, or in some cases, surgical procedures to improve bladder emptying.

Catheter-related stones: Optimization of catheter care, regular catheter changes, and consideration of alternative methods of bladder management.

How Can You Prevent Bladder Stones?

Prevention includes drinking at least 2 liters of water daily, completely emptying your bladder when urinating (using double voiding technique if needed), treating underlying conditions like enlarged prostate or prolapse, and maintaining good catheter hygiene if you use one. Regular follow-up is important for those at high risk.

Preventing bladder stone recurrence requires addressing both the immediate factors that promote stone formation and the underlying conditions that cause incomplete bladder emptying. Patients who have had one bladder stone have an increased risk of developing another, making prevention efforts particularly important.

Increase fluid intake

Adequate hydration is the cornerstone of bladder stone prevention. Drinking at least 2 liters (about 8 glasses) of fluids per day produces dilute urine that is less likely to form crystals and stones. Water is the best choice, though other beverages contribute to fluid intake as well.

Sufficient fluid intake serves multiple purposes: it dilutes the concentration of stone-forming minerals, promotes more frequent urination which helps flush the bladder, and reduces the time that urine sits in the bladder. Patients in hot climates or those who exercise heavily may need to drink even more to compensate for fluid losses through sweating.

Double voiding technique

For individuals who have difficulty completely emptying their bladder, the double voiding technique can help reduce residual urine volume:

1. Urinate normally until you feel your bladder is empty
2. Stand up from the toilet and wait for 30-60 seconds
3. Sit back down and try to urinate again
4. Repeat until no more urine comes out

This simple technique can significantly reduce the amount of residual urine and is particularly helpful for men with enlarged prostate or women with prolapse. Making double voiding a consistent habit can make a meaningful difference in stone prevention.

Treat underlying conditions

Working with your healthcare provider to manage conditions that contribute to incomplete bladder emptying is essential for long-term prevention. This may involve:

• Regular monitoring and treatment of prostate enlargement
• Pelvic floor rehabilitation for prolapse
• Optimizing bladder management strategies for neurogenic bladder
• Proper catheter care and regular catheter changes if catheterization is needed

Dietary considerations

While dietary changes are more important for kidney stone prevention than bladder stone prevention, general healthy eating habits may help reduce stone risk. This includes:

• Moderate protein intake (especially animal protein)
• Limiting sodium (salt) intake
• Getting adequate calcium from food (not supplements)
• Limiting foods high in oxalate if you form calcium oxalate stones

What Complications Can Bladder Stones Cause?

Untreated bladder stones can lead to recurrent urinary tract infections, chronic bladder irritation and damage, and in severe cases, kidney damage from backing up of urine. Infections can progress to serious conditions like pyelonephritis (kidney infection) requiring hospitalization and intravenous antibiotics.

While bladder stones are rarely life-threatening, they can lead to significant complications if left untreated. Understanding these potential complications underscores the importance of seeking timely medical evaluation and treatment.

Recurrent urinary tract infections

The most common complication of bladder stones is recurrent urinary tract infections. Bacteria can colonize the irregular surface of stones, creating a protected environment where they can multiply and resist antibiotic treatment. These infections often recur shortly after completing a course of antibiotics because the bacteria harbored in the stone are not fully eliminated.

Symptoms of urinary tract infection include burning during urination, frequent urination, urgency, cloudy or foul-smelling urine, and sometimes fever. While most UTIs can be treated with oral antibiotics, repeated infections can become increasingly difficult to manage.

Kidney infection (pyelonephritis)

If a urinary tract infection is not adequately treated or if stones cause significant obstruction, the infection can ascend to the kidneys, causing pyelonephritis. This is a more serious condition characterized by high fever, chills, severe back or side pain, nausea, and vomiting. Pyelonephritis typically requires more aggressive treatment, often including intravenous antibiotics in a hospital setting.

Chronic bladder dysfunction

Long-standing bladder stones can cause chronic irritation and inflammation of the bladder wall. Over time, this can lead to permanent changes in bladder function, including reduced bladder capacity, persistent urinary urgency and frequency, and thickening of the bladder wall. In severe cases, the bladder may lose some of its ability to contract effectively, worsening the problem of incomplete emptying.

Urinary retention

If a stone moves to block the bladder outlet, it can cause acute urinary retention—the sudden inability to urinate despite having a full bladder. This is a urological emergency that requires immediate catheterization to drain the bladder. While uncomfortable and distressing, acute retention is treatable and usually resolves once the obstruction is relieved.

Understanding the Urinary System

The urinary system includes the kidneys, ureters, bladder, and urethra. Understanding how this system works helps explain why bladder stones form and how they can be prevented. The bladder is a muscular organ that stores urine until it's convenient to empty, normally holding 400-600 mL of urine.

The urinary system plays a vital role in filtering waste products from the blood and maintaining fluid and electrolyte balance in the body. Understanding its normal function helps explain why problems with bladder emptying lead to stone formation and how various conditions affect urinary health.

The kidneys continuously filter blood, producing urine that travels down two tubes called ureters to the bladder. The bladder is a hollow, muscular organ located in the pelvis that serves as a reservoir for urine. When the bladder fills to a certain level, stretch receptors in its wall signal the brain that it's time to urinate. During urination, the bladder muscle contracts while the sphincter muscles relax, allowing urine to flow out through the urethra.

This coordinated process normally results in complete emptying of the bladder. However, when any part of this system is disrupted—whether by prostatic obstruction, neurological problems, or anatomical changes like prolapse—urine can remain in the bladder, setting the stage for stone formation.