In my 25 years of working with stone formers, as a nurse in residence at Litholink Corporation and in my own practice, the number one question has always been: ‘How much water do I really need to drink?’ Maybe as important is: ‘How Do I Do It?’
Tread Slowly
Many patients leave their doctor’s office with the vague instruction to increase their water input. How much are you supposed to drink to reduce your stone risk?
Even more, patients are told to go home and start drinking a gallon of water a day. If you don’t drink more than a couple of glasses per day now, how are you supposed to drink a gallon tomorrow?
Drinking more water is a simple way to reduce your stone risk, but simple does not mean easy. Most of you find this task extremely hard. I tell everyone to start out slowly. If you drink one glass per day now, then drink two tomorrow. Set new goals to increase your water consumption each week. I have seen people go from 1 glass per day to 10 glasses per day within a month.
Spend Time to Avoid Pain
I can hear you saying now; “I don’t have enough time in the day to spend it in the washroom”.
This is a legitimate response and one I have heard many times throughout my career. I will not lie. You will spend more time in the bathroom, but you will get accustomed to your more frequent bathroom visits. The bigger picture is the one to focus on. Better hydration means you will be less likely to form more stones; this means that water can reduce ER and doctor visits, and lost time away from work. What is going to the bathroom a few more times a day compared to all of the pain, suffering, and expense you will endure if you don’t drink more water?
Be Willful
I have seen my share of pilots, teachers, surgeons, nurses, and traveling salesman all increase water intake despite the time constraints of their occupations. The one thing they all do is make the time.
I have worked with surgeons and surgical nurses before and it is true that they cannot leave the OR to use the bathroom during an 8 hour open heart surgery. Intermittent dehydration can be a real problem in this case. My clients who work in the OR do their best to drink for the rest of the day to try and make up for the loss. Sometimes there is really no choice. Thankfully this is the exception, not the rule.
Once you make up your mind that you do not want to suffer with the severe consequences that kidney stones bring to your life, you will find a way to incorporate more water into your daily routine. It is your choice, your commitment to your health that creates a one day at a time habit of drinking more water.
How Much?
Under the usual conditions of life, 3 – 4 liters of fluids a day will provide 2.5 to 3 liters of urine volume, and this is enough. The average healthy adult bladder holds about 1/2 liter, so this means 7 – 9 bathroom trips in 24 hours.
Input Doesn’t Always Equal Output
Four factors make the answer harder to come by: sodium intake, geographical location, occupation, and exercise.
Sodium intake
High sodium intake can confuse people. It is does not by itself change how much you need to drink, but salt intake can shift the timing of water loss so you think you are not increasing your urine volume even though you are drinking. It does something more. It increases urine calcium losses, a matter we will come back to at a later time.
When you eat a meal that is high in salt, you can count on it decreasing your urine output. I have clients tell me that they drink “a ton” of water but they never have to use the bathroom. The reason is that water is retained with the excess sodium. High sodium meals will decrease urine output that day and even that night, thus causing bloating, worsened hypertension, and higher risk for stones because of higher urine calcium.
But a steady high sodium intake, not just the effects of one meal, will cause a steady water retention and stable weight gain so after a while the extra water you drink will appear in the urine. In fact, when people lower their salt intake they become less thirsty so they have to focus more on drinking or they will ‘forget’.
Even so, keeping your water intake high and lowering your sodium consumption is best. Stone formers who have no medical contraindications to lower salt diets should be aiming for about 1500 mg of sodium per day. People become accustomed to high water intake and low sodium intake, and can benefit not only from the stone prevention but often from a lower blood pressure. How you lower your sodium intake to this number will be discussed in a future post.
Geographical location
There are actually places on the map that we who deal with kidney stones call the “stone belt”. Basically these are the states that are consistently hot and humid or hot and dry. Why is where you live a problem? Simply put, you sweat more. If you sweat more, you run the risk of becoming dehydrated, and being dehydrated reduces your urine volume and makes you more prone to form a stone. If you live in a hot, humid or dry state, you need to drink more to compensate.
Occupation
Are you working construction in the summer in Texas? Are you a camp counselor in Arizona? Do you wash windows for a living in Florida? Your occupation can be the increased risk factor for your stone disease. The reason is the same as above. You are sweating more and need to drink more than the office worker seated in the air conditioned office whose windows you are washing.
Exercise
I am very proud of you that you are doing your daily exercise. We all know how important that is to maintain good health. Exercise plays an important part in stone prevention so make sure you do it. Just remember to hydrate before, during, and after to balance the water lost from sweating!
Tricks
Here are few ways to make water drinking more enjoyable.
Stylish water bottle
Find a water bottle http://www.zazzle.com/fun+water+bottles that you really like carrying around. Seems like such a silly thing, but it really does help. I like big ones so I don’t have to keep getting up to fill it and it makes me very proud to see it empty. You may find smaller ones keep you inspired and you can easily go refill it as you make your bathroom pit stop. Here is an awesome water bottle I have found to help http://www.amazon.com/Basily-Infuser-Bottle-Around-Hydrated/dp/B00M1UOF3K/ref=dp_ob_title_sports
Make Tasty
Add fruit to your water. Adding lemons to your water has the added benefit of increasing your citrate level which is a natural inhibitor of stones, but use fruit that makes you smile most.
Using the product Mio http://www.makeitmio.com/ has helped many patients who constantly tell me that water is BORING. My reply is always, “better boring water than excruciating stones”. It is at that point that they take another sip.
Water is the most benign way to increase fluid intake, but don’t forget to include other beverages in your daily intake: Green tea, lemonade (no sugar), flavored waters, even fruit like watermelon, grapes, etc. will be helpful.
Be Techy
If you’re a phone app geek like me, download this app and track your progress https://itunes.apple.com/us/app/waterlogged-drink-more-water/id352199775?mt=8
Treats
Eat Your Water
Here is a list of foods that are made up of at least 90% water. Be careful. Some of them are high in oxalate and for those of you who need to limit your oxalate intake I have asterisked them: cucumbers, radishes, iceberg lettuce celery*, tomato*, green peppers, cauliflower, spinach*, starfruit, strawberries, broccoli, grapefruit, baby carrots*, and watermelon.
Channel Your Inner Child
I have straws on my counter top in a cute container. They add color, fun, and make drinking water a much more whimsical experience. They also makes the water go down a bit faster. I find myself downing a glass with ease when I have a straw. My son likes it too. No matter what your age or disposition, straws add fun to an otherwise boring activity.
If you are enjoying some grape or apple juice, dilute it with half water. You will cut down on your sugar and increase your water intake. This is a win-win.
A neat way to add color and zest to your water without added calories or artificial flavors: Freeze grapes, or lemon, lime, or orange peels, and add to your water instead of boring ‘ole ice cubes.
Make new habits
Every time you reach for a diet soda, replace it with water. Soon you will just reach for water and your old diet soda will be a long forgotten bad habit.
Upon waking, drink a glass or two of water with lemon. This helps keep your urine alkaline and gets you feeling ready for the day.
In winter, get some hot water, lemon and honey. It will warm you up on a cold day.
Green tea (yes, low in oxalate).
Le Croix. For those of you who are addicted to bubbles. Try this no calorie, carbonated water. It comes in many flavors and has been a staple in my house for the past year. There are generic versions of it for budget conscience stone formers.
Drink a glass of water before and after a meal. Drink water. Eat less. Yet another win, win. Who knew it would be this fun?
Be Patient and Persist
I want you to know that incorporating large amounts of water into your life takes a bit of time. New habits are built with commitment, patience, and an understanding that you are not perfect. You will have days that you cannot get in the amount of water that you would like to. It is ok. Your goal is to do your best on more days than not. And when you don’t, you can get back on track the next day.
Drinking more water is the number one thing you can do to help prevent further stone formation. It also has no bad side effects. So what do you say? Let’s raise a glass, a refreshing, ice cold glass of water. It might just save you from your next ER visit.
A Reservation
Water is always the first line of treatment for stones.The most important thing to do about supersaturation is lower it, and water will do just that. In relation to kidney stone prevention, more is better. In a perfectly healthy younger (below age 50) person taking no medications, up to 5 or even 6 liters a day is safe provided it is consumed over the whole day and never all at once. But if you have heart disease, kidney disease, or liver disease, or are elderly, great caution is important and the amount of water needs to be determined individually for you. When diuretic drugs are being used, to lower urine calcium excretion for stone prevention or for blood pressure control, water intake needs to be no more than 3-4 liters a day and testing is necessary at intervals to be sure blood sodium levels have not fallen. Many other medications interfere with water excretion; psychoactive drugs can do this, for example. All drugs in use must be reviewed with your physician before drinking large volumes of water, above 2.5 liters daily. It is true that most people can easily and safely drink the extra water needed for stone prevention, but the reservations are important, always.
I have recently put together a private FB page called THE Kidney Stone Diet. It is a group that helps educate you on your physician prescribed treatment plans. I moderate it to keep it clinically sound. Come on over and join the discussion!
More You Might Like
Four years ago I had lithotripsy to break up stones two large to pass. On my follow up appt I still had a smaller stone in the upper right pole. Two years ago I was experiencing pain again and the CT scan showed the exact same stone was now 5mm in size. I was told at that time it could not be causing pain. I have just dealt with the on again off again pain. I was diagnosed in January for a UTI and then again in April. I was experiencing severe right groin pain and right back flank pain recently which landed me in the hospital. They did an ultra sound and pap smear but said they could not find anything except the urine culture came back and they put me on Cipro for an infection. Went to Urologist and had another CT scan and I have a 10mm stone lodged in my upper right pole of kidney, same exact spot where the 5mm stone was. The urologist again is stating that this can not be causing the pain. I drink 64 -94 oz of water a day and keep forming calcium stones. What would you recommend my coarse of action would be at this time? Why would they not do lithotripsy again?
Hi Pam, It is very hard for me to tell if the enlarging stone is the cause of your pain, but it certainly could be doing so. The episode of flank and groin pain sounds like stone passage, perhaps a small fragment. Lithotripsy would no longer be the single choice for your stone, if any procedure were indicated; flexible digital ureteroscopy might be preferable, depending on the details of location and anatomy. If you have a lot of pain, and your personal physicians are not sure about the best course, I would think they might want to help you seek a second opinion about treatment options. You have growth of a stone, but you speak of forming calcium stones – are you indeed making new ones. If so, you need prevention measures to stop that process. Regards, Fred Coe
Try Chanca Piedra “stone Breaker” herbal supplement (pure stuff without a whole lot of additives!). I took 2 500mg pills every 6-8 hours for a week along with 2 tablespoons of Braggs Apple cider vinegar 2-3 times daily and passed a 7mm CALCIUM stone … the stone actually came out 7X3X2 mm and was very brittle and porous and seemed to be kind of slimy when I passed it. Also my pain level went from a 9 to a max of 4-6 and usually just annoying while on this protocol. I drank a lot of water and stopped adding salt to food. So do some research …. also you may want to start off with a lower dosage of the Chanca Piedra but still take the Braggs vinegar. I still take 1 Chanca Piedra daily at night on an empty stomach. You may want to try this for awhile and then go get another CT scan to see if it helped … Also this worked for a Calcium stone … if you have a different type then I don’t know if it will work …. Best of luck
Hi Jeff, I am happy to post this, but I have to make clear as a professor and physician that I do not know anything about it and can neither endorse it or raise objections to it as a treatment. If we find a number of people using it, I will try to get some research on it and post an opinion. Best, Fred Coe
I have a stone in my left kidiney about 10 years l have pain inmy
Kidney and if i sit on the toilet and move to the left or lie down i have pain most of the time i have microscope blood in my urine.
Hi Marie, Perhaps the stone is indeed causing pain – it certainly could cause bleeding. If the pain is very bothersome, it consider having it removed. The fact that the pain is related to movement makes me wonder if it is really from the kidney or from the back muscles. Kidney pain is not usually affected by movement or posture. As for the blood, you should have a urologist be sure it is indeed from the stone; I would much advise you do that. Almost all the time it is, but as you point out above sometimes a very early cancer can be present – even the beginnings of a cancer. These are easily cured at the beginning. Regards, Fred Coe
Do you think it could be cancer
Hi Marie, It can always be a tumor as I noted below. Usually not, but have your physician make sure. I deleted the duplicate of this question for you. Regards, Fred Coe
I noticed that you list spinach and strawberries in the section “Eat Your Water”. Just FYI, these are both foods that can cause calcium stones! I used to make strawberry and spinach salads to take with me to work almost every weekday during the summer months until I ended up with kidney stones and had to take several weeks off work to recover after lithotripsy 🙁
Hi Tali,
Yes, we are very aware that those foods are high in oxalate, as we noted in the article. People who don’t have oxalate issues but need to find more inventive ways to get more water will benefit. Those that have high oxalate levels will not!
Thanks for writing!
Jill
For a middle-aged person staying in India, doing moderate daily exercises (equivalent to 20-30 mins brisk walking), and used to having 3 to 3.5 litres of water every day: is it okay to drink 3-4 glasses of water (nearly one litre) at a time? thanks in advance.
Hi-
If it is not causing you ill effects to drink that much at one time, I don’t see the harm in it. Don’t drink it terribly fast is the only thing I would advise.
Thanks for writing-
Jill
Hi dear Jeff.
I’m suffering from kidney stone tell me the quantity of water and other fruites to avoid kidney stone and to rectify this problem , I’m feeling so pained !!!!
Hi Majid, Prevention is not simple and food choices almost never enough. Take a look at a prevention plan and see if you can do the steps. Regards, Fred Coe
Hello Jill,
If an egg white is 88-90 water, would you include consuming egg whites as an effective way to eat your water?
Alex
Hi Alex, We need liters of water, and if you use egg white you get massive amounts of protein. In a liter of water – 1000 mg of water – there will be 10% protein or 100 gm. That is more than one would eat of protein in a whole day! So, no. Regards, Fred Coe
Thank you, Frederic. I understand what you’re saying but my question wasn’t clear enough. If a kidney stone former was eating a much smaller number of egg whites and getting most of their water by drinking straight water, would you count the water content of the egg whites as part of the daily amount needed to protect the kidneys?
Alex
Hi Alex, you could but it would be too small to matter. An egg has perhaps 10 ml of white, giving 8 ml of water which is 1.5 teaspoons. If you fry the egg the water is gone, so it would have to be boiled or raw. Regards, Fred
I recently had a second kidney stone… So with the advice of the doctor I have increase my water intake. Over about the past 3 months of doing this i have added about 8 pounds of weight…. Water Retention? How do i deal with that? if i keep adding 2 to 3 pounds a month i will be ginormous in a short while.
thanks,
ray
Hi Ray,
Love your frankness…. the world needs more of that. So, about your weight gain (which is also a problem for kidney stone formers)- You are adding weight because you are eating too much salt. Water likes to follow salt. Too much salt, too much bloating, too much weight, too much Ray. Many women know this, drink more water, lessen salt, and you will lose weight. That 8 pounds will be lost as fast as you gained it, actually it will come off much faster.
Lessen your sodium intake to 1500 mg/day and you will be peeing like a champ! No point in drinking more water if you are not going to pee it out. So do that. Watch your sodium intake and when I say that I mean start looking at all the labels. If you are eating out a lot, then you are eating tons of sodium. It is in everything from cereal to mustard to just about everything you put in your mouth.
Do this and I promise you you will feel lighter in a couple of days. Keep drinking, lessen salt, you will be less ginormous quickly.
Best,
Jill
P.S.
Let us know your outcome. I would like you to be our latest role model!
does the consumption of beer helps in removing the stone from kidney?do beer have any sideeffects if consumed by kidney stone patient?faithfully
Hi Sandip, Beer use is associated with less stones on average, so it is fine. Nothing I know of beside surgery will remove stones. Regards, Fred Coe
I have stones in both kidneys but the pain is bearable how many liters of water intake and what medicine and tips please
Hi Atif, Prevention of more stones is not hard but needs a plan. Here is the best one I know. Treatment follow the outcome of the evaluation. Regards, Fred Coe
Hi there!
I have a question about family history and the possibility of stones. I’m 30 and have never had a stone but I know that my grandfather on my mother’s side suffered with them. My mom also had one a few years ago, though the doctor believed it was due to taking huge amount of calcium supplements and that they had built up over time. Once she cut back on those she’s thankfully had no issues. My father and sister have never had one either, yet I’ve been doing some research and found that family history can play a big role in how susceptible you are to stones. Once I learned this I panicked and have been doing everything I can do watch what I eat, from cutting back on meat and sodium to drinking 3-5 liters of water a day.
I’m not a health nut but I do try to take care of myself but I’m worried that all of this may be for nothing if it’s something that’s inherited. I’ve been losing sleep and stressing out over the thought of being unable to do anything about. Is there anything else I can do? Thanks!
Hi back Austin-
I understand your stress regarding family history and stones. The best advice I can give is to you is to keep on doing what you are doing for drinking. Sodium consumption should be limited to 1,500 mg/day. You can also ask your doc to order a 24 hour urine collection to see what your values look like just to keep on top of it. I would not do anything else with your diet until you know for sure. The less meat is always a good thing as we tend to overeat it. Anything other than that could be in vain and I don’t want you to avoid healthy foods when you don’t know if you need to.
Hope this makes sense. If not, I’m here.
Jill
Thanks Jill. I try to keep an eye on the nutrition contents on what I eat and to make sure everything is balanced. I feel like I’m going crazy but I believe the horror stories and want to do whatever it takes to prevent it.
Water is your very best bet, and the least invasive. Keep it up. The salt is imperative too. Do these two things for now and you will be doing everything you possibly can.
Good luck-
Jill
Hi I have a question too. I recently started having high bp 160-130/110-90 for the last month. It keeps varying. Few months ago my bp spiked when I had fever. It came normal later on. I had done tests, ecg and echo to check my heart function, which seems to be fine. My cholesterol is also ok. Doc says I don’t have ashma. Sometimes I keep getting breathless. How woken up at night a few times due to it. I took a urine test and scan which showed 2-3 kidney stones biggest of which was 3mm.
My questions are: does high bp cause breathlessness? Does high bp cause stones or is it beacouse of high bp that i got stones?
Also, recently I have been under stress. Had a loss in the family. My dad had cardiovascular problems. His bp was normal though. My cousins from mother s side have kidney stones previously.
Please reply.
Thanks in advance,
Reka
Hi Reka, The stones should not be causing high blood pressure nor will high blood pressure cause stones; I assume your kidneys function normally as your physicians have been careful about your care. The intermittent breathlessness with high pressure, also intermittent, coupled with stress in the family could be panic attacks – they mimic heart disease. Your doctors would have thought of pheochromocytoma, a rare benign endocrine tumor that raises blood pressure. I think panic attacks are worth thinking about with your physicians although at this distance I am just guessing. Be sure and seek prevention against more stones. Regards, Fred Coe
Hello Dear jharris,
Hope you are doing well. I am 38 year old male, On 25/5/2016 i got sudden pain in right kidney when i did the ultra sound i found 2mm stone there. i was very worried but the doctor told me no medication at this point just take more and more water daily. So from 1/6/2016 to 31/8/2016 in my daily diet i include almost 5-6 litter bottle water . The water which is available in our market mostly bottle and almost every brand have such composition like Bicorbanates. 26, Sulphates,26,Cholorides,19.Calcium,11,Magensium,3.4, sodium,17. During 1/6/2016-31/8/2016 my salt intake was normal . on 1/9/2016 i did my ultra sound again and was surprise bcz stone size was now 3.7mm in right kidney i am very worried now bcz i was thinking since i m drinking water daily so might be stone will be gone but its actually increase.
In short now my dr told me that i should not eat salt at all.
My question is:
should i stop eating salt at all?
can i continue to drink bottle water with above mentioned composition? is it safe ?
In vegitable and in fruits which exact things i should NOT EAT AT ALL?
Just for your kind ref i am taking mutton only once in a month and chicken once in a week
Your advise will be so appreciate.
Reg
Hi!
First off- you know I am going to ask this question- have you done a 24 hour irine collection to see if you need diet alterations? You need to if you haven’t.
I cannot recommend any diets to you until we know that vital information!
Whether you make stones or not, limiting sodium to 1,500 mg/day is best for stone prevention and general good health.
As far as fruits and veggies you need to do a collection to see if these healthy foods need to be limited. Come back and let us know that answer to that.
Thanks for writing!
Jill
Hello! I am a 13 year old girl and this advice will be helping me! I first learned about My kidneys being in danger when I was at my doctor. Now I am drinking fluently of water. But my problem until now was: It was not helping much! It will be a pain to eat vegetables, but I will live through it. I already spin in a circle for 40 or 30 minutes, but I will pick it up. And I am now saying it: NO MORE SODAS!
Hi Bella, It is unusual for stones to damage kidneys so I wonder what it is your physicians have found that puts them in danger. The only thing I know about like that is very high urine oxalate. Is that what you have??
Regards, Fred Coe
Every morning I drink 2 liters of water at the same time. is there any other side effect for kidney?
Hi Sailon,
I think it is great you are drinking so much in the morning, but does this mean you don’t drink anything else for the day? I always say that each of you needs to find out what works for you best, that is the only way you stay on your treatment plans. But I think that although you are doing an excellent job in the am, you might want to think about incorporating more fluid throughout the day.
Let me know what you do for fluids after the morning.
Best,
Jill
I’ve suffered from kidney stones. Since my last attack, I drink at least 84 oz of water a day. I started drinking decaf green tea but was told not to by my doctor because it could cause stones. Is this true? I enjoyed the tea but don’t want to go thru that pain again. I would appreciate your input
Linda!
Green tea is the lowest of the teas and ok to drink not only for stones, but for other good properties as well. Check out this link: http://apjcn.nhri.org.tw/server/APJCN/11/4/298.pdf
Cheers-
Jill
I have kidney stone of 6mm and 6.9uric acid blood but very good in 24hr urine collection but my protein level in24hr urine collection is 156 .is it the singn kidney failure
Hi Ashok, Protein in the urine can be from blood. Stones cause blood in the urine. As a first step check the report and see if the protein was measured in a urine sample that tested positive for blood. Repeat the measurement using a sample that tests negative for blood. Regards, Fred Coe
Your style is really unique in comparison to other
people I have read stuff from. Thank you for posting when you’ve got the
opportunity, Guess I will just bookmark this
page.
Hi Nolan,
Thanks for taking the time to write. Glad you are finding the articles useful. Let us know if you need anything-
Jill
Hi I am a procedural nurse, and have had two very large stones, in 2002, passed one and had lithotripsy for the other large one. The small stones in my left kidney didn’t respond to lithotripsy- With working in the OR I am often frustrated that there is no time in between cases to void. I do drink an average of about 3.5 liters of water daily. At my annual check up, in September the UA was positive for blood, rechecked a week later and was also positive. CT showed tiny stones in the left kidney, I think they are the same ones that did not respond to lithotripsy. 24 hour urine was output of about 2500 cc- elevated calcium at 318 , low phos 0.5 and low protein 26. I am unconvinced that these are new stones. I have had two UA negative for blood. I am pretty disciplined about keeping my fluids to between 3000-4000 cc /day. I eat very few carbohydrates, limit salt, and am wondering if I should be on hydrochlorthyazide? My urologist is keen to do a cystoscopy, I am normal weight, take wellbutrin, no other meds, and am experiencing NO symptoms. NL BP, no diabetes… not really wanting a cystoscopy …. since my UA’s have shown no blood ? What are your thoughts?
Hi Erin, You have hypercalciuria presumably idiopathic, and a job that may lead to periodic and repeated low urine volumes within a day that is overall marked by high urine flow. Those dips in flow in the OR – if any – are an opportunity for increased supersaturation and crystal formation. You did not mention your urine sodium; given the urine calcium is quite high I wonder if the sodium is really as low as you might like it. The stones may well be calcium oxalate being small, and one wonders if the oxalate is higher than is ideal, and likewise about citrate. Here is an article you might find useful. Here is another. As for small stones in kidneys sans symptoms, I know of no evidence supporting removal just because they are there. Regards, Fred Coe
Hi, I just have a question! My grandpa has had a kidney stone, only one. He was a big fan of nuts, and I heard nuts can cause stones. My dad formed two stones b/c he constantly had a half gallon of Wawa iced tea everyday. I’m 18, and a male, I was hoping that drinking enough water a day and watching sodium and oxalate input will lower my chances of kidney stones. There is no past of family health problems with stones. And I wanna know if drinking enough water will severely lower my chances of a kidney stone. I really don’t want one. Please help!
I’m a type 2 diabetic. I drink a lot of water which causes me to urinate alot. Recently I started having a lot of urination even though I’m drinking a large amount of water. What could be the cause of this?
Hi SG, If you drink a lot of water you will excrete it, so urine volume will rise. Your question says you are having a lot of urination even though you are drinking a lot of water; I presume you mean even though you are not drinking a lot of water. If that is what you mean, and you are a diabetic, the usual cause is that your blood glucose is high and you are losing excess glucose in your urine. Glucose is a diuretic. You need to let your physician know right away and without fail so things can be checked and if abnormal treated before something unfortunate occurs. Regards, Fred Coe
Hello,
I endured my first stone 5 months ago. I didn’t know what was going on and went to the E.R. I’ve had spiral fractures, diverticulitis, ruptured discs, and nothing compared to this. The CT scan showed a 4.5MM stone , which I passed about 14 hrs later in the hospital, and several stones in both kidneys. I have passed 6 more stones since then, at home, at an average of one per month. Most took about 4-8 hrs of agony to pass, with the help of drinking a glass of water every 30 mins. My question is how can I find out how many are left my kidneys??? I understand just because they are there doesn’t mean I will ever pass them, but I would like to know what to expect because having this happen every month is giving me severe anxiety. I asked my doctor and all he would tell me is the report said there were several in both kidneys. I know CT scans are expensive, but is there any way to convince them to give me another one and maybe count the stones that are left just for peace-of-mind? I’d like to get them all out and have a clean slate to work with.
Thank You,
Jeff
Hi Jeff, You are passing many stones and need to know why. Here is a good plan. Be sure and analyse the stones – all of them – to know what you are trying to prevent. As for the CT, of course you need it. How else to know what is in the kidneys as a baseline for prevention. As for removing them, No; until you know what is causing the stones, removal is foolish; they will come back. Regards, Fred Coe
Hello and thank you for this article. At the age of 18 I have just been diagnosed with one kidney stone (0.5 x 0.5 cm) but other than that I’m “clean”. I have never drunken al lot of water or fluids ever. In fact I only drink water and sometimes juices (never sodas). But still I have always seemed to dehydrate myself up to the point where I had headaches and needed to vomit (with the age of four I started to hesitate to drink enough fluids). I will be trying to drink more (using the tips listed above) but I still feel like it is more to it. Why would I never drink enough? My doctor told me that it is rare to have kidney stones at my age. So there has to be a reason for my “not drinking”. They have not removed the stone yet (and once they remove it they will analyse where it came from) so do you think it could be something special other than a calcium stone? Thank you for you time and help here.
Best wishes
Aleksandar
Hi Aleksandar, There probably is more to it. People who make stones usually harbor more causes than just low fluid intake. Low intake is habitual and you can change that habit but only over a long time and slowly. Make slight increases and hope for perhaps an extra liter of intake over a year. Whatever else caused your stone proper testing can disclose – here is a good plan of action. One removes stones for a reason – pain, bleeding, obstruction, infection, so there is no need to do so if it is not disturbing you or your kidney. Finding the cause is important and so is a gradual increase of fluids. Regards, Fred Coe
Thank you very much for your kind support!
Hi Fred. Am slightly confused as to why they didn’t test for oxalate, given my stones are calcium oxalate. I have asked. Anyway, thanks for your comments, good to know it looks normal.
Hi Rich, I cannot find the thread for this. Most 24 hour urine packages include urine oxalate. I must have seen results and commented but cannot find where I wrote it on the post noted above. Regards, Fred
Hi Fred, turns out they did test for oxalate but neglected to send me the result! Just received it; 375 umol/24h.
That value is mid range normal and of little import. Regards, Fred
How to drink enough: chug 16.9 ounce bottles of water 4-8 times a day. Four 16.9 ounce bottles of water is exactly 2 liters and is roughly the minimum amount of water people should drink daily. It’s really that simple. There are no tricks needed. Fear of pain should be enough motivation. 😂
Hi A, This is not bad advice but hardly sufficient for stone formers in general. Stone risk begins at a urine volume of below 2.25 liters/d which would be a fluid intake of 2.75 liter/day. two liters of intake will yeild less than 2 liters of urine, often, and is therefore not ideal. Regards, Fred Coe
I am prone to get stones and trying to drink more water
I am drinking Deer Park spring water. Is this good or bad got stones?
Hi Carol, It is just water, from a spring. Municipal water probably is about as good and has fluoride for your teeth. Regards, Fred Coe
Hi Carol,
It is fine. Just drink enough if it to produce 2.5 liters of urine a day.
Jill
I am a kidney stone patient (had 2 stones, 1 is now gone after shockwave treatment; other one is not causing problems now). I am trying to work up to drinking at least 2.5 liters of water a day. So far I have only gotten up to about 60 ounces, and that is hard enough. My problem is that I get an uncomfortable abdominal bloated feeling by the end of the day from so much water. Is there anything i can do to prevent this or remedy it? Thanks very much.
Hi Sherry, You need an organized prevention program. Here is a good plan. If you can try to follow it and find out what is best for you to prevent more stones. Water alone is cumbersome because if it is your only protection you need so much. It is better to look at all the stone factors and improve each one a little bit to achieve protection. Regards, Fred Coe
Hi Sherry,
Many times drinking water and being bloated is bc you are eating too much salt. Lessen your salt to 1,500 mg/day and you will definitely feel less bloated.
Jill
Hello, I have been a stone former for 33 years now and have have had upwards of 38 ESWL and my nephrologist says absolutely no more of them. I am sitting here today with not only stones but MSK and PCK which upon reading of the CT with and without contrast the techs stopped counting at 12 obviously huge cysts (over 12 cm each) The stones I have now are all sitting in the lower pole and unable to pass. The hydronephrosis has dissipated this week but is likely to return at any time. I have high BUN and Creatinine and my eGFR is down in the upper 40’s most times. I follow protocol and was taken off hydrochlorothiazide and put on chlorthalidone as I was told this was better for stone formers, and had been stone free for 3 years. My new primary care took me off the chlorthalidone in January and within 3 months I was back forming the stones. The only change was the removal of the diuretic so I can only assume that is the problem. I am also now a full member of the osteoporosis club and osteoarthritis clan. She wanted me to take calcium but my nephrologist was adamant about not taking calcium at all. I am confused on this aspect having read so many responses where you say taking calcium is better to bind the oxalates for removal. What are the next steps for someone who can no longer have the ESWL with all the side issues I have. Oh and I am going to say I only drink water (infused with fruit or lemons) and nothing else. But I do drink 5/30oz cups a day or more depending on my thirst level.
Hi Tina, If you have PCK – polycystic kidney disease this site may not serve your needs well. That disease causes stones but is quite specialized. I am not sure about why your drugs are changed but perhaps your nephrologist can help. In terms of using supplements, have you been evaluated to determine your urine oxalate – is it high? Do you need something to lower it. Given kidney disease, bone disease becomes complex in its causes. My suggestion is to discuss with your nephrologist what it is you really have; if it is PCKD with significant kidney insufficiency your treatment must focus there – on those diseases. If any confusions exist, perhaps you might seek consultation at a university center that specializes in PCKD management. Given 38 SWL treatments, however, I wonder if your kidney disease may not reflect effects of so much shock wave exposure. Regards, Fred Coe
I was diagnosed with a 3.4 mm stone in ultrasound which was sitting in calyx , right kidney. Few days later I had severe pains running thru kidney, stomach and the abdomen. I got my CT scan done on that day and was told that the stone is somewhere in the bladder junction. The pains were miserable and stopped by end of the day. I guess I passed the stone as I could notice some particles.
A week later after I had my ultrasound done, a stone sized 3.6 mm was found sitting in calyx of right kidney. I am bit confused as to whether this is a new stone formed or the same one with increased size. Additionally, the stone was found in bladder thru CT scan. Is it possible that a stone may not be detected in either of the tests even if it existed?
What home remedies would you advice for less painful passing the stone? And of course I have been drinking a lot of water.
Hi, Saket, No home remedies in this kind of complicated situation. You may have two stones, one in the kidney and one near the bladder. Only your physicians – who can see your scan images – can tell, and you need to be sure from them. The kidney stone would not form in a few days, and CT scans far surpass ultrasound in stone detection, so the story does not seem quite right as it stands. As for prevention, here is a good plan. Nothing but fluids and, where needed, medications matter for passing stones. The key is prevention of more. Regards, Fred Coe
hey im drinking a lot of water but its really hard to pee and when i drink so much water it causes me to vomit. The doctor said he’s seeing small crystals on my kidney when i went to have an ultrasound. I’m still trying to drink as much water as I can to somewhat remove the thing that blocks when im trying to urinate. If there’s any advice you can give to me that will be helpful.
Hi Mark, You are a poster child for why stone prevention cannot rest on one modality. Increased urine volume to 2.5 liters a day is one measure. How about urine calcium, oxalate, citrate, pH? WHat are your supersaturations for the stone crystals you make. Are you an active stone former. The advice ‘Drink more water’ is barren and doomed. Here is a pretty good article on treatment of the common calcium stone former. Here is one on how to be sure you have been properly evaluated. Regards, Fred Coe
Hello,
I have just had my first experience with kidney stones, calcium oxalate, and had a laser lithotripsy procedure which went very well. My stones were attributed to a vegetarian diet extremely high in oxalate. all these foods were in my diet on a daily basis – spinach (at least 2 servings per day), almonds, cashews, peanut butter, carrots, tomatoes, black tea, etc. I also didn’t consume much calcium, or water, and I am now seeing a nutritionist and she has created a plan to balance my diet. My problem continues to be water consumption. I am committed to doing all I can to prevent future stones, but I am not sure how much to drink. My nutritionist established a range for me, and also advised that I be guided by the color of my urine as a gauge of whether I’m staying well hydrated. I have been consuming between 50 and 70 oz. per day, and keeping track of it on an app, but I really don’t feel well over the course of the day when I drink this much. My urine is usually very light to almost clear by early to mid afternoon, and sometimes I feel dizzy when I reach this point. Does this mean I’m consuming too much water? I spread it out over the course of the day, learning my lesson after feeling awful after consuming 88 oz. by noon several days after my procedure. I only weigh 97 lbs. and I’ve read that a person should consume ounces about half of their body weight. I don’t know how much I should be drinking, so that it’s enough to help prevent stones but not too much to create other problems. Also, how would I accurately measure output? Thanks for your help, I really need some guidance!
Hi Susan, You are encountering the problems with a single modality treatment – just fluids have proven inadequate and cumbersome. Take a look at what it did indeed do and fail to do. You presume your diet caused the stones and maybe it did, but be sure you really know what is the cause. Here is a plan. Assuming you are a common CaOx stone former, here are the treatment data and how that kind of person can treat stones without drowning. Good Luck, Fred Coe
Hi Susan, You are encountering the problems with a single modality treatment – just fluids have proven inadequate and cumbersome. Take a look at what it did indeed do and fail to do. You presume your diet caused the stones and maybe it did, but be sure you really know what is the cause. Here is a plan. Assuming you are a common CaOx stone former, here are the treatment data and how that kind of person can treat stones without drowning. Good Luck, Fred Coe
Thank you, Dr. Coe,
This is fantastic information I will be reading several times, as there is so much to learn and balance. I will definitely be implementing more changes in what I need to do in my quest for no more stones. Again, thank you!
Susan
Hi Susan,
I am happy to hear that your procedure went well. Have you done a 24 hour urine collection to see precisely why you made kidney stones?
Typically you want to be having 2.5 liters of output to decrease your risk of new stones. As funny as it may seem you can track how much you are peeing by using a “hat” underneath your toilet seat like they use in hospitals and measure how much urine you are producing every day. Look on Amazon or your nearest medical pharmacy. Use this link for Amazon: https://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=urine+hat
As far as you feeling dizzy, you should report this to your doc.
Best,
Jill
Hi Jill,
Thanks so much for your reply. I have had a 24 hour urine with a urologist I wasn’t particularly happy with, and at that time, I had another appointment scheduled with a different urologist who would be doing my procedure, so I didn’t ask any questions beyond what the first doc told me about my test. Frankly, I didn’t know what to ask and he didn’t go over each value with me. The urologist who did my procedure didn’t give me feedback on the 24 hour urine ordered by the other doctor, and I will contact him to explain these values to me because your question about the 24 hour collection prompted me to look at the results and there are are three that appear to be out of range. What is Dietary P24, PCR, and CA24/CR24? My risk factor profile looks okay, the only value being toward the right as a higher risk value was Ph. I fault myself for not pursuing more details about my test results, I am usually one who wants all the information, but I didn’t pursue further answers in this situation. I will definitely do that now. Thanks again for your reply, and link to the hat. I’ll get one and see how I’m doing!
Susan
Susan,
Good to hear. Think about taking The Kidney Stone Prevention Course that Dr. Coe and I put on. Go to my website to check it out- jillharriscoaching.com/course. New course is starting next week. You will find it very helpful!
Jill
Thanks for the great Idea and that’s useful for kidney stone, nowadays I feel good the whole day after I drink more than 3 litres a day compared to those days I used to drink only one glass per day.
Thanks a lot.
Hi, can water flavoring packets cause stones ? is there an ingrediant that i should look out for in the packets ?
thank you !
Hi Robert,
Not a problem. You can use them.
Cheers!
Jill
Americans who are honest about this will admit to confusion by the jumble of terminology: liters, gallons, ounces, and glasses. A writer, as well as a doctor, should be specific and consistent. My recommendation: First of all PLEASE, PLEASE use American vocabulary of gallons and ounces consistently. Second, do not use the term “glasses,” because household water glasses easily range from 8 ounces to 16 ounces. I suggest that writers and physicians simply tell us HOW MANY OUNCES per day. Readers and patients are very capable of using an American measuring cup from the kitchen, and then choosing appropriate glasses or other vessels to use for drinking!
Hi Alfred, thanks for the serious and important comment. You are right about glasses and also about the problem of US vis. much of the world in terms of units. I am asking Jill to read this, too, and perhaps we can go back into the key articles and be sure US units are available throughout. Regards, Fred Coe
Dear Dr. Reed,
I not only appreciate your feedback, but know you are absolutely right. We will go back and edit our articles.
Many thanks-
Jill
thanks for article …
I just want to know that is there any connection between kidney & testicles ..
bcoz I’m having pain in my kidney ,, which is now almost cured after taking many water ,,, but I also have a slight pain in my one testicle
Hi Awais, Pain from the kidney can radiate into the testicle on that side – shared nerves. So be wary the pain is not from a stone blocking the kidney on that side. Regards, Fred Coe
Thank you four your sharing this great idea !!
Thank you for this information, I’m currently going through the pain. This guidelines are very helpful.
Hi RosReeAnn,
I wish you were not in pain. If it get bad and/or you get a fever seek medical attention.
All the best,
Jill
Hello please guide me,
I have gone through USG test, dictated 8 mm stone in my in left Vesicoureteric junction.
So, do need to go for any surgery and if not to pass it how much water I should have in one day?
Please help!!!
Hi Anantha, A stone that large has a low probability of passage and your personal physician may well have to remove it. Water is fine, and the amount of 3 liters a day seems reasonable but the surgical decision belongs entirely to the urologist responsible for your care. Regards, Fred Coe
Hi i have been told that i need to drink 3 to 4 literes per day but i am not able to do it , i am puking all water i am consuming. Please can ypu help me as to how i go about this.
Thanks in advance
Gu Shreyas, Your traetment relies too much on one thing. Take a look at how to sort things out. Fred Coe
Hello pls i went for a urine test and few crystals was found in my urine result i did the doctor also said i hv no infection. Nd my kidney is healthy because i conducted also blood test pls how do i eliminate those few crystals i dont like to hear anything that makes uncomfortable thanks
Hi Anikwe, A few crystals mean nothing by themselves. If that is all, I would do nothing. But ask what kind of crystals. If they are struvite, or calcium oxalate dihydrate, then you may have some issues – your physician will know. Regards, Fred Coe
hello
recently i had flank pain in left kidney and after ultra sound found has stone show size 2 to 3 mm and after CT scan show 5mm two weeks before . please help how much water need to intake to pass the stone and what treatment need to take like any Shock Wave Lithotripsy.
thank you.
Hi Hussan, These stones in the kidney are small enough to pass. Water alone is not much of a treatment. Take a look at how to think about stone prevention. SHock wave treatment of small stones has no obvious merit as they may pass and the procedure may be more burdensome than the stones. Regards, Fred Coe
Hi, very nice article, loved it. I just had a question for you since you have had so much experience being around stone-forming patients. Can a person even after consuming say around 5-6 liters of water a day form a stone?.. Love to see your reply on this, thanks !
Hi Sean,
Although water is an important piece of stone prevention, it is only that, a piece. You need to do all the things necessary to prevent stones. Have you done a urine collection to see what your particular issues are? Remember there are other dietary changes that are just as important. Read this:
Thanks for writing,
Jill
SOME PEOPLE CAN. In theory, fewer, but absolutely. And for the record, not all urologists care to test your stones or urine (or blood) for whatever is causing the stones to form (and apparently some people make different types of stones each time!). Also, even tiny stones that don’t show up on xray and thus “cannot be treated” can cause increasingly frequent, and significant, pain, and for a long time (like over a year long time) depending on where they are. My hope is that these generic guidelines apply to most people, because they certainly didn’t apply to me. 🙁 If you don’t fit in the mold, know that you’re not alone but you’ll probably have to figure a lot out on your own. Also, despite the pain and frustration, know that long-term use of ibuprofen and naproxen (Advil and Aleve, for example) (both nsaid’s) can reduce kidney function so you may wish to get that checked by your physician. As far as how to get water intake up, this article gives lots of awesome ideas.
Hi WHitney, Thanks for sharing your experience and knowledge. Fred Coe
Your suggestion:
“Upon waking, drink a glass or two of water with lemon. This helps keep your urine alkaline and gets you feeling ready for the day.”
Isn’t lemon acidic? How does this keep urine alkaline?
Also, my husband and I drink alkaline water at 9.5 ph. Is this a good thing for kidney stones? He is supposed to be on a low oxalate diet.
Thank you.
Hi Kathy, Lemon contains molecules that are metabolized in such a way as to increase bicarbonate and therefore urine pH and citrate. But I never advocated for lemon except for flavor. Alkaline waters often contain high amounts of sodium salts – I am not much in favor. The electrolysis machines seem dubious to me, and adding alkaline salts is a mistake. So no. Regards, Fred Coe
Hi, can water break down stones already formed in kidney??
Hi Kansay, I am afraid not. But prevention is effective. Start here. Regards, Fred Coe
My stone size is 6-8 mm can it will be removed through water
Hi Hemanth, No. Water will do nothing. If it is obstructing your kidney your surgeon needs to take care of it. If it is just in the kidney, nothing needs to be done. But prevention is important as more can form.
What if all you drink is bottled water, could this be harmful due to the minerals and salts that are added.
Hi Sherry, I doubt that commercial bottled water is harmful. But I am not a public health expert. Regards, Fred Coe
I’m having 3-4mm kidney stone, and it seems urine is not passing through kidney, is it due to Stones, can milk with soda will cure my problem?
Hi Burhanuddin, If a stone is passing it can obstruct the kidney. Your physician will know to remove it as obstruction can damage kidneys. Mile and soda have no place in all this – you need a skilled urologist. Regards, Fred Coe
Will adding some baking soda to water help prevent stones? I take it for heartburn sometimes.
Hi Stacy, No. If you have stones, take a look here. It is very much a place to start. Best, Fred Coe
Hi i was told after taking a ct scan that I have 3-4 kidney stones of each kidney about 3mm I believe I had these about a years ago when I last had a ct scan and first found out that I had stones they said they were really small it was probably genetic and they can stay like this forever without any problem or medication to help pass them through so now obviously I had not try to do anything to get rid of them so now i had a ct scan at the ER. And it show up again so they prescribe me flomax 0.4 mg to help pass them through but read side affects got a little worried cause not nit will I be in so much pain but have to worry about possibility of other so my question is how much water or what can I eat to help pass these through without medications and is it even possible thanks.
Hi Laura, I gather one of your past stones is passing, thence the ER visit and Flomax. For passing stones, water is nice, Flomax sometimes speeds things up. But in the long term you need prevention against yet more. Take a look here at what you can do when the current episode is over. Regards, Fred Coe
Hi. I have a history of kidney stones, ulcerative colitis, and dairy allergy. 24 hour urines which led to dx of IH, placing me on 1200mg sodium restricted diet, (344mg of the 1200 consumed by meds that Gastroenterologist doesn’t want decreased), an increase of daily fluids to 2-2.5L, and Chlorthalidone 25mg which I was unable to tolerate. (nausea, vertigo, loss of balance despite dose reduction). Follow up 24hr urines indicated increased stone risk due to elevated oxalates, probably due to all the nuts, nut butter and cinnamon harvest Kashi cereal I was consuming, daily, in an effort to avoid sodium. Between the diet restrictions, ulcerative colitis and dairy allergy I am struggling to balance it all. If I keep the oxalates in check then my sodium level is probably lower than recommended at <1000mg/day and I'm having difficulty getting enough calcium and calories. Losing weight and really don't want to lose any more. Any help would be greatly appreciated. Also, gastro recommended I take turmeric several times a day. Also, do you know the oxalate value of turmeric compared to that of turmeric extract? Thank you in advance.
Hi Karen, Your situation is genuinely complex because of the ulcerative colitis. I presume the stones are calcium oxalate and you do not take steroids, the latter will raise urine calcium and could lead to a false diagnosis of IH. Given your diet restrictions, perhaps you may be one of those who need calcium supplements, and these are tricky because they have to coincide with your main sources of oxalate. I cannot help much from so far away. Someone like Jill Harris might be helpful about diet details and turmeric, as well. If you were near I could help directly, but I doubt you are. At this distance any detailed advice from me would be improper and probably off the mark. Regards, Fred Coe
Great article! I was wondering if adding apple cider vinegar to water would help as well? A friend of mine is a producer of kidney stones but said his episodes with them have dropped since adding apple cider vinegar to his water. I got my first kidney stone in November and recently just had another one, even with all of the water I drink. I never drink soda or anything with sugar in it and have significantly cut down on sodium and added sugar intake in my food as well.
Hi Dana, Better than guessing at a remedy, you could use a plan. Here is a nice start. Regards, Fred Coe