Most kidney stones pass spontaneously without the need for medical intervention. Stones as large as 3 to 4mm may pass through uninhibited but larger stones may result in obstructions. Increasing fluid intake to push out the stone is essential. If the pain is severe, analgesics may be necessary. These measures may be all that is needed to manage the pain while the urinary system passes out the kidney stone. In certain cases, other treatment options maybe necessary to remove the stone.
- Analgesics. Tablets or suppositories are usually prescribed for the pain but if necessary IV (intravenous) administration or an intramuscular injection may be a better option. Many NSAID’s (non-steroidal anti-inflammatory drugs) can be purchased without a prescription. Stronger pain relieving drugs like opioids may be needed for severe kidney stone pain.
- Antibiotics may be required if there is an infection, especially in a case of struvite stones.
- Corticosteroids may be prescribed to ease the inflammation of the urinary tract. Inflammation results in swelling of the ureteral walls and narrowing of the lumen. By reducing the inflammation, the stone can pass through.
- Smooth muscle relaxants like like alpha blockers and calcium channel blockers help to relax the smooth muscle of the ureters. This expands the ureteral lumen and allows the stone to pass with less resistance.
- Diuretics, particularly thiazide diuretics, reduce calcium excretion (calcium stones). These drugs also help increase urine output. *
- Allopurinol may be used for short periods to reduce uric acid levels in the blood and urine. This is useful for uric acid stones but hyperuricosuria (high uric acid levels in the urine) should first be confirmed. *
- Supplements and binding agents. Vitamin B6 (pyridoxine) may help decrease oxalate production within the body while calcium supplements will bind oxalate in the gut. This is helpful for calcium oxalate stones. Chelating agents like penicillamine help to bind cystine (cystine stones).
- Alkalizing agents are helpful in preventing the urine from becoming too acidic. This is useful for uric acid stones as a urine pH greater than 6 makes it more soluble. Sodium bicarbonate may be used but this can increase sodium in the urine (hypernatriuria) which should be avoided (Refer to Kidney Stone Causes). Potassium citrate may be a better option for alkalizing the urine.
* Loop diuretics and long term use of allopurinol should be avoided in recurrent cases of certain types of kidney stones. Discuss this with your doctor.