Few things announce themselves quite as dramatically as a kidney stone. One minute you are getting on with your day, the next you are doubled over with a pain in your side that arrives in waves and refuses to be talked out of. People who have had one rarely forget it.
They are common: around one in ten people will have one, and first stones peak between 40 and 60. After 50 the picture shifts, with stones becoming more closely tied to type 2 diabetes, raised blood pressure, gout and the medicines we take for other conditions. The good news is that they are among the more preventable problems in this age group.
TL;DR
- Around one in ten people develop a kidney stone, with first stones peaking between 40 and 60. Roughly half will have another within five to ten years.
- Renal colic is severe, wave-like pain from the loin to the groin. Fever or shivering alongside it is an emergency: call 112 or 999.
- Cutting dietary calcium is the most persistent prevention myth, and it usually makes things worse. Normal calcium with meals is protective.
- Fluid is the single most effective prevention step: enough to produce about two to two and a half litres of pale urine daily.
- Most small stones pass on their own. Larger ones are treated with shockwave lithotripsy, ureteroscopy or keyhole surgery, accessed via a GP urology referral.
What a kidney stone actually is
Urine carries dissolved minerals and salts, and when the concentration climbs too high, crystals form and clump together. Roughly eight in ten stones are calcium oxalate; uric acid stones come next and are more frequent in people with gout, obesity or type 2 diabetes. A stone sitting quietly in the kidney often causes nothing at all. The trouble starts when one moves into the ureter, the narrow tube carrying urine to the bladder, and blocks it.
Recognising renal colic
The classic presentation is sudden severe pain starting in the flank or back and radiating towards the groin in waves. One telling detail is that people cannot get comfortable: they pace and shift and cannot settle, unlike the stillness of most other abdominal pain. Nausea is common, and urine may look pink or tea-coloured, though the blood is often visible only under a microscope.
Some symptoms mean you should not wait. Fever or shivering alongside the pain suggests an infected, obstructed kidney, which can tip into sepsis quickly and is a genuine emergency. Call 112 or 999. The same applies if you cannot pass urine at all, if the pain is unmanageable, or if you have only one working kidney.
Getting a diagnosis in Ireland
Renal colic usually brings people to an emergency department, and rightly so, as injury units are not set up for it. Expect a urine dipstick looking for blood, blood tests for kidney function, calcium and urate, and imaging. A low-dose CT of the kidneys, ureters and bladder is the most accurate test, with ultrasound sometimes used first where there is reason to limit radiation. Under Ireland’s 2018 medical exposure regulations, overseen by HIQA, every scan must be justified rather than routine, which matters if you are a repeat stone former facing several CTs. Before you leave, ask whether you need a urology referral.
Treatment options
Stones under about 5mm usually pass on their own within a few weeks. Anti-inflammatory painkillers work better than opioids for renal colic, but this is where being over 50 changes the calculation: they can strain kidney function, raise blood pressure and interact badly with ACE inhibitors, ARBs and diuretics. Make sure whoever prescribes has your full medication list; your community pharmacist can review it free of charge.
For stones in the lower ureter, an alpha-blocker such as tamsulosin is sometimes prescribed to relax the tube; men already taking one for an enlarged prostate should say so. Larger or stuck stones need intervention: shockwave lithotripsy breaks the stone up using focused sound waves from outside the body, ureteroscopy fragments it with a laser through a fine telescope, and keyhole surgery through the back is reserved for large or branching stones. A temporary JJ stent is often left in place afterwards, and while safe, stents are genuinely uncomfortable, causing urgency and flank discomfort.
Public urology access runs through your GP and waiting times vary by hospital, so if you face a long wait for a non-urgent procedure, ask about the National Treatment Purchase Fund.
Preventing the next one
This is where effort pays off, because recurrence is the rule rather than the exception.
Drink more, consistently. The target is output, not input: enough fluid to produce about two to two and a half litres of pale urine daily, which for most people means two and a half to three litres of drinks. Spread it across the day and drink extra in hot weather or during illness. Thirst becomes a less reliable signal with age, so do not wait to feel thirsty.
Do not cut calcium. Restricting dietary calcium leaves more oxalate free to be absorbed from the gut and excreted into the urine, raising stone risk rather than lowering it. Aim for normal calcium intake with meals, so it binds oxalate where you want it. This matters doubly after 50, when bone health is already a concern.
Watch the salt, moderate the oxalate. High sodium pushes more calcium into the urine. Spinach, rhubarb, beetroot, nuts, chocolate and strong tea are high in oxalate, but you do not need to banish them: eat them with a source of calcium and keep portions sensible. Lemon juice in water is a cheap, low-risk habit, as citrate inhibits crystal formation.
Review your medicines. Some drugs raise stone risk, including topiramate, acetazolamide and excessive vitamin D. Others reduce it: thiazide diuretics lower urinary calcium and are sometimes prescribed for prevention, and allopurinol has a role in uric acid stones. If you have had two or more stones, ask about a 24-hour urine collection: prevention aimed at the wrong target does not work.
One local worry is worth putting to bed: hard water has not been shown to be a meaningful driver of stones. How much you drink matters enormously; what is dissolved in it, at Irish tap water levels, does not.
The longer view
Repeated stones are not simply a painful nuisance. Recurrent obstruction and infection can damage kidney tissue and are associated with a higher risk of chronic kidney disease. If you have diabetes or cardiovascular disease, your annual Chronic Disease Management Programme reviews already include kidney function checks, so make sure your stone history is on record.
Kidney stones are unusual among the problems that show up after 50, in that ordinary daily habits really do change the odds. A water bottle you actually refill, a lighter hand with the salt, and a medication review will do more than most people expect. At Críonna Health we cover the practical side of ageing well in Ireland, from understanding test results to knowing which service to ring and when.
This article is for general information and is not a substitute for individual medical advice. If you have severe pain, fever alongside urinary symptoms, or difficulty passing urine, seek medical attention immediately.
📷 Photo by engin akyurt on Unsplash
