Did you know that the most common cause of abdominal pain during the pregnancy is urinary stones which are also known as urolithiasis? Though kidney stones during pregnancy are a rare occurrence this condition can be dangerous for the female. Kidney stones in pregnancy need a proper diagnosis in order to rule out any further complications and choose a treatment option. Most of the stones are small enough to pass via the urinary tract but larger stones will require medical intervention.
Also Read: Know About The Types of Kidney Stones
Urinary stones are an aggregation of the chemical substances dissolved in the urine. When the concentration level of these substances reaches a point and form stones. Kidney stones can be of small size or bigger in size depending on the complexity.
Physiological changes which lead to kidney stones in pregnant women
Given below are physiological changes, a pregnant woman will face. These changes usually occur in the second trimester and decrease after delivery:
- There are some changes that occur in the woman’s physiology during pregnancy which may affect the urinary tract leading to increased chances of problems with already present urinary stones or these changes can even increase the chance of formation of new kidney stones.
- Later in pregnancy, the size of the uterus can restrict the flow of urine. The ureters get dilated in pregnancy and may not eliminate urine completely which can lead to hydronephrosis. The ureters can increase in size due to increased renal vascular during pregnancy. The collecting system and ureters also decrease their ability to contract which results in dilation and sometimes pain.
- During pregnancy, a variety of changes happening with vitamins and minerals can cause the formation of kidney stones. During this state, the body tends to handle calcium less effectively, leading to the onset of kidney stones.
- Urinary tract infection is also seen during pregnancy which can contribute to the formation of kidney stones. Also, in some cases, a person with kidney stones becomes more prone to developing catch frequent UTI’s.
Also Read- How does Pregnancy change the female body
Clinical presentation of kidney stones
Pain due to kidney stones is often misdiagnosed as appendicitis or placental abruption. The stones occur in the ureter twice as often as in the kidney and it can affect both ureters in equal frequency. Here are some of the symptoms of kidney stones:
- Radiating pain to the groin
- Renal colic or flank pain
- Dysuria or painful urination
- Blood in urine or hematuria
- Frequent vomiting and nausea
If kidney stones in pregnancy do not pass on their own, it might initiate premature labor, produce intractable pain, cause urinary tract infection or it can interfere with the progress of normal labor.
Diagnosis of kidney stones during pregnancy
Urolithiasis in pregnancy is often a diagnostic challenge. Approximately 80-90% of urinary stones are diagnosed after the first trimester completes. Here are various ways to diagnose kidney stones during the pregnancy:
- Urine Culture: A laboratory assessment of urine culture will confirm the infection. Blood work can check the kidney function and increased serum calcium requires investigation.
- Radiological diagnosis of kidney stones: It includes magnetic resonance imaging, the risks from radiation are dependent on fetus age. Obtaining the imaging with the lower dose to treat kidney stone is done in some cases. X-rays are absolutely contraindicated as they are risky to the fetus.
- Ultrasonography for kidney stones: This is the first option for diagnosing kidney stones present in pregnant women. Only specialists can perform the procedure. However, ultrasound does not always show the presence of stones.
- CT scanning: If the symptoms of kidney stones persist and they are causing complex problems, then CT scanning used for a pregnant woman.
- Nuclear renography: A radioisotope is injected into a vein which allows the radiologist to look at the kidneys. Nuclear renography allows a radiologist to clearly visualize the kidneys and check their functioning.
Treatment for kidney stones during pregnancy
Let’s check out the kidney stone treatment during pregnancy.
- Conservative management: The doctor advises the patient for bed rest. The patient should take proper fluid intake and medications to manage the problem of kidney stones. Most of the stones pass normally with conservative treatment.
- Invasive treatment: Any type of manipulation in the pelvis, bladder or ureter could result in premature labor. That is why they are known as invasive treatments for kidney stones. However, these treatments for kidney stones include:
- Stenting: A stent is placed in the ureter. The tube passes the urine which lessens the burden on the contraction of the urinary tract. The tube won’t be removed till the end of pregnancy. This decreases the chances of kidney stones obstructing the ureter and causing pain.
- ESWL (Extracorporeal Shock Wave Lithotripsy): ESWL uses ultrasonic pulses to break the stones. It’s contradicted during pregnancy as it can cause fetal damage and death. But ESWL is highly recommended for non-pregnant women to treat the complicated kidney stones.
- URS (Ureteroscopy): URS is the recommended method for pregnant women when it is necessary to remove the kidney stone. Holmium is used in ureteroscopy to break down kidney stones. URS is used as an alternative to ESWL in pregnant women.
- PCNL (Percutaneous Nephrolithotomy): In PCNL, an access tract is created in the kidney’s collecting system. PCNL’s safety makes it a good treatment option for non-pregnant women. However, PCNL is not recommended during pregnancy. The major reasons to avoid PCNL during pregnancy are because it involves anesthesia and prone position. The prone position is dangerous for a pregnant woman as it requires the patient to lie down with on the stomach. Hence, PCNL cannot be carried out in pregnant women to treat kidney stones.
Prevention of urinary stones during pregnancy
As we know that prevention is better than cure. So, if you are pregnant and want to stay away from the troubles of kidney stones, prevention is definitely the best remedy.
Here are some tips to keep you safe from kidney stones during pregnancy and otherwise also:
- Drink plenty of healthy fluids which include water and keep your body hydrated.
- Have citrus fruits such as lemon, kiwi, grapefruit, etc. These fruits prevent the formation of kidney stones.
- Don’t hold the urge to pass urine, even if it means frequent trips to the washroom.
- Avoid caffeinated and carbonated drinks such as tea, coffee, and cola drinks. Excess consumption of these drinks can escalate the formation of kidney stones.
- Reduce your intake of high oxalate foods like nuts, dark green leafy vegetables, and berries.
- Do exercise and yoga regularly according to doctor’s advice.
- Quickly consult a doctor in case of severe abdominal pain.