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Interviewer: It never used to happen but now you have to get up and go to the bathroom once or maybe even more times every night. Dr. Gary Faerber is a urologist. What could be going on with that? Could it be one thing or is it a lot of things?

Dr. Faerber: Well, it could be a number of things. Probably the most common along these lines comes from older men who can . . . you know, who are worried that these might be the signs of prostate cancer. That's the most sinister, you know, thing that they can think about.

Interviewer: So we're talking older, how old, 50?

Dr. Faerber: Oh, yeah, men in their 50's, 60's, 70's, yeah.

Interviewer: So like up until this point, they could sleep through the night and not need to go to the bathroom and all of a sudden now . . .

Dr. Faerber: Right.

Interviewer: Does it just kind of happen all of a sudden or is it just kind of over time like . . .

Dr. Faerber: Oftentimes, it's a gradual thing, you know. Initially, they may get up once a night and then it's two times and three times and . . .

Interviewer: So if that starts happening, then there could be something going on?

Dr. Faerber: Absolutely, yeah.

Interviewer: Could it just be that they've started drinking water late at night?

Dr. Faerber: That's . . .

Interviewer: Is that the first thing you look at?

Dr. Faerber: Sure. We certainly do keep track of how much fluid they take and when they take it in just to get a sense of whether this is a normal thing just because the amount of fluids that they drink, or is this, you know, not quite so normal.

Interviewer: All right. So if it turns out to be not quite so normal, let's talk about what some of the possibilities could be.

Dr. Faerber: It's probably related to their prostate. And it's not because they have prostate cancer but in most cases, it's because they have benign or normal enlargement of the prostate gland. And when that happens, it causes some changes in how the bladder functions. And they may not be emptying all the way. The bladder may become a little bit more overactive and therefore, they can't hold the urine as much as they used to when they were younger. And all of those reasons may result in them having to get up at night.

Interviewer: So an enlarging prostate's just part of life. As you age, it's going to happen, if I understand correctly.

Dr. Faerber: Yes.

Interviewer: So nothing to be concerned about really?

Dr. Faerber: That is exactly right. If you're 80 years old, 100% of you men will have benign enlargement of the prostate. So it is a normal aging process.

Interviewer: All right. So that's kind of the most common thing. What do you for that then?

Dr. Faerber: It depends on how bad it is. For example, if it's not too bad, you can do some behavioral changes. For example, just don't have that big glass of water before you go to bed or don't have a lot to drink in the evening. And to be honest with you, most men try that initially. You know, they experiment a little bit and they said, "Yes, I've done that."

Interviewer: Yeah, by the time they get to you, right?

Dr. Faerber: Right, exactly. And then, I'll do an exam on a gentleman and see how big his prostate gland is. And then, we then also look to see how well he empties. So we'll have a gentleman void and then we can do an ultrasound of the bladder to see how much urine is left in because we want to see whether or not they're emptying all the way or whether they're just sort of emptying a little bit but most of the urine is left in the bladder. And if that's the case, then you can understand that it doesn't take very long for the bladder to refill and then they feel the urge that they have to go again and . . .

Interviewer: All right. And that is caused by the . . . not emptying all the way is caused by the enlarged prostate?

Dr. Faerber: That's exactly right.

Interviewer: So if they're not emptying all the way, is there anything you can do?

Dr. Faerber: I tell men that enlarging prostate is sort of like, you're sort of pinching off a garden hose where the prostate, as it enlarges, it narrows the channel where the urine comes out of the bladder. And there are different ways of managing that and there are different types of medications that are available nowadays.

Interviewer: Do some men choose to do nothing and just continue to get up at night?

Dr. Faerber: Yes.

Interviewer: And that's completely acceptable as well?

Dr. Faerber: Yes. You know, if we find that they're actually emptying their bladder, then that's perfectly fine. And I would assume there are a lot of men out there who are very comfortable at getting up once or twice a night, and it's really not affecting them physically or emotionally or socially.

Interviewer: So that need to get up and go to the bathroom once or more each night could be an enlarged prostate. What are some of the other things? Let's not go too in-depth but I just kind of want to do a quick of what else it could be.

Dr. Faerber: Right. We do know that as we all get older, and this has to do with not only with men, but with women too, is that the bladder becomes overactive. We all know, myself included, that when I was 18 years old, I didn't have to pay attention to my bladder when my bladder told me it was full.

Interviewer: Right. Twelve-hour road trip, 8 hours in, you could still go another 4 hours, yeah.

Dr. Faerber: Right. It was no big deal. And I was always that, you know, chuckling at my mom and dad who had to make these more frequent bathroom breaks.

Interviewer: You chuckle no more.

Dr. Faerber: Right. Exactly. I do not chuckle anymore. I understand completely. So as we get older, our functional bladder capacity goes down. And that's a normal aging process. There are some medications which can help with some of those patients where it's really a problem. But in most cases, we don't need to really do anything about it. Oftentimes, if I can just reassure patients that, "If it's not bothering you, it's not bothering me so we don't need to do anything about that." So normal aging process is one.

Two is could there be something within the bladder which makes the bladder more irritable, for example, bladder tumor or a bladder stone or something else like that, that may need to be checked. Oftentimes, if that's the case, it's associated not just with having to get up at night but there may be blood in the urine or they may have frequent urinary tract infections, or something else like that which would tell us that there may be something more going on than just an overactive bladder.

Interviewer: Yeah. And of course, if the bladder symptoms accompany any other symptoms like you said, that's when, probably . . .

Dr. Faerber: . . . you really need to get concerned. Yes, absolutely.

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updated: May 1, 2019
originally published: April 12, 2017

Interviewer: Your young child has abdominal pain? It could be kidney stones. We'll find out more about that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Gary Faerber is a urologist at University of Utah Health Care. And if your child has abdominal pain, it could be a lot of different things, but one of the things it could be that is sometimes not diagnosed properly is kidney stones because the incidents of kidney stones in kids in increasing and increasing. That's incredible. First of all, why is that? Why are kids getting kidney stones? That doesn't seem like something that I would expect.

Gary: You're right. Most people wouldn't expect that kids should be getting kidney stones. Most people think of kidney stones as happening in somebody who is in their 40s and 50s, and not . . .

Interviewer: Yeah, guys like us.

Gary: . . . absolutely, guys like us and not young kids. But there's no question that the incidence and prevalence of kidney stones in the pediatric population has gone up, and it's gone up quite dramatically. Probably over the last 15 years, it's gone up almost two-fold. So it's not that really rare thing that happens anymore, it's what I would call commonly uncommon.

Interviewer: So if a child has abdominal pain, it could possibly be kidney stones?

Gary: Yes, absolutely. There's no question about it. It, obviously, probably wouldn't be the first thing on my differential diagnosis list.

Interviewer: Yeah, it would be a little ways down.

Gary: Right, absolutely. But it's something that I think caregivers would and should think of. For example, in the pre-pubescent age group, the most common presenting signs or symptom of a kidney stone in a young child is abdominal pain. And that's seen in up to 75% of those children who present with a kidney stone.

Interviewer: And that's different than how adults present?

Gary: Yes. Adults typically present with a terrible flank pain. Why kids don't get the flank pain is not quite clear and it's clear that they get sort of abdominal pain, which is odd. The one thing that may tip a provider off, in that it might be a kidney stone, is the abdominal pain is often associated with blood in the urine. So if a child has blood in the urine and is having abdominal pain, that certainly would make me concerned that they might be having a symptomatic kidney stone.

Interviewer: Is the increase in children pretty much the same reason for the increase in adults? They're not getting enough water, which, drinking enough water is so important in preventing kidney stones. Their diet, that sort of thing?

Gary: Absolutely. Kids are just like their adult parents, where they don't drink enough fluids. Specifically, they don't drink enough water, and it's important that they do. I would love to have my listeners think that having sugary drinks is probably not a really good thing for kids. Water's a great thing and milk and all the healthy stuff is probably better for them than the sugary drinks, that's for sure.

Interviewer: Yeah. For a whole variety of reasons, not just getting kidney stones. So it's fascinating some parents might be dealing with a child that has a kidney stone. Is the treatment the same as it would be an adult, then?

Gary: Surprisingly, yes. And the good news about most kidney stones that both children and adults present with is that the vast majority of these will pass on their own, and there are medications that we can provide both adults and children that facilitate them passing the stone. In those patients, adults and children who don't pass their stone, there are very effective surgical management strategies that are available that we can treat these stones.

Interviewer: So if you take your child to the doctor and it's abdominal pain and you have to go back a couple of times, then you might want to start considering kidney stones. If you have that conversation, how would they find out for sure whether or not that was what was causing it?

Gary: There are a number of x-ray studies that are available now. I think if a child presents to the emergency room, for example, or to their pediatrician or primary care provider, either an abdominal ultrasound exam or, in some cases, a CT scan can be done. And both of those studies are very good in identifying a kidney stone.

Interviewer: Just something else a parent and a kid has to deal with in today's age, I guess, huh?

Gary: That's exactly right.

Interviewer: Or hopefully not, if you do the right lifestyle things.

Gary: Right.

Interviewer: Yeah. Any final thoughts?

Gary: Make sure that your kids drink plenty of water, especially during these hot summertimes in Utah.

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Interviewer: You had kidney stones once in your life, what you need to know going forward. That's next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: So you already went through the process once, the excruciating pain, then the re-passing of the stone or the operation to remove the kidney stone. Does that change how you need to look at your life from that point on? Well, we're going to find out right now. Doctor Gary Faerber is a urologist at University of Utah Health Care. If somebody has a kidney stone once, are they inclined to have another one?

Dr. Faerber: Yes, they are. If you have a kidney stone and you make no changes in your lifestyle or anything else like that, you have a 50% chance of forming another stone within five years.

Interviewer: So I suppose the general advice would go, regardless of the stone, you need to drink more water, you need to watch your diet, the salts, the sugars, reduce that kind of stuff. Does that apply across the board?

Dr. Faerber: That really applies across the board and of all of the things that you've mentioned there, keeping yourself well hydrated is the most important aspect of prevention of kidney stones. And I think in patients who have risk factors, for example, if they have a family history of stones, if this isn't their first stone and they've had several others, or if they have on their imaging studies more than one stone, those people really need to have an evaluation to figure out why they may be forming stones and what can we do to prevent them.

So in those patients, they'll get some blood test to look at their overall kidney function, we'll get serum calcium levels and if that's elevated we may get a parathyroid hormone level. And then above that, we'll also have them collect urine over a 24-hour period and look at the chemical composition of the 24-hour urine. And that will help us direct what medical therapies and dietary therapies would be appropriate for the folk.

Interviewer: So you might prescribe some sort of medication to help as well?

Dr. Faerber: Yes, absolutely.

Interviewer: Yeah. And would you prescribe a very restrictive diet more so than just eating healthy?

Dr. Faerber: I often will tell patients that a really good, healthy, what they call the DASH diet, which is used for patients who have cardiac disease, the DASH diet is a good diet to prevent kidney stones. It's made up of fruits and vegetables, low sodium, limitations of red meat, mainly poultry and fish, legumes and whole grains. Eating a diet like that, especially if you manage your calories and you're not eating too much compared to your activity levels, that's a great way to start limiting or restricting your incidence of forming stones in the future.

Interviewer: So you do the analysis, the tests, based on that result, you might prescribe a medication. Is there anything else that you would tell somebody that just had a kidney stone going forward?

Dr. Faerber: Well, if they have a family history, where their mom or dad or grandfather or grandmother or a brother and sister have a kidney stone, I often tell them, "Listen, you can't run away from your genes and you're sort of stuck with who you're with." And in that case, I will really push them to make sure that they keep their fluids up. I think the only other thing that is really important is to limit the amount of salt intake that you have, watch the potato chips and move that salt shaker away from the kitchen table.

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Interviewer: Kidney stones, could they happen to you? And what can you do to prevent them? We'll examine that next on the scope.

Announcer: Health tips, medical news, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is the scope.

Interviewer: Dr. Gary Faerber is a urologist at the University of Utah Health Care. Dr. Ferber, do you get a lot of patients with kidney stones? I hear it's on the rise like 30% in the last 30 years.

Dr. Faerber: Yes, it is. Absolutely, there's no question about it. And people with kidney stones probably make up a good . . . almost half of my practice.

Interviewer: Wow, you deal with them a lot.

Dr. Faerber: Absolutely. And if you look at urologists across the country, about 20 to 30% of their practice is managing patients with kidney stones. So it's a big, big job for all of us.

Interviewer: So why the increase in the past 30 years? Thirty percent in 30 years, that's quite a bit.

Dr. Faerber: It is. And there probably . . . it's multi-factorial, to be honest with you. I think obviously, one of the reasons why is because Americans tend to be dehydrated. They don't drink enough water.

Interviewer: You're kidding me. You can't go outside without seeing somebody with a water bottle.

Dr. Faerber: I know, and it's crazy. About one in 10 patients are people that are in the United States drink the right amount of water.

Interviewer: Just one in 10?

Dr. Faerber: One in 10.

Interviewer: Okay.

Dr. Faerber: A full quarter percent or a 25% don't drink any water at all in the day.

Interviewer: They're just getting their water from sodas, and juices, and stuff like that?

Dr. Faerber: Right. Which is not a good thing, to honest with you.

Interviewer: So it's . . . dehydration is a big part of it. So just by drinking more water, it helps your system flush that stuff out and prevents it from kind of building up into those stones?

Dr. Faerber: That's absolutely right. If you can recall back to your grade school experiments where you would put the string in a bowl of sugar water and then you'd see the sugar precipitate out on the string. Well, the same thing sort of happens in a kidney. When the water or the urine isn't concentrated, then those crystals can't form. But when urine is concentrated, that's when you get the crystals forming, and then those crystals grow into stones.

Interviewer: Okay. So . . .

Dr. Faerber: Same thing happens.

Interviewer: If I want to prevent kidney stones, drink water. Be sure that I'm getting the right amount. What is the right amount, by the way? We were having a debate about this other day. Is it eight glasses a day?

Dr. Faerber: I tell people six to eight glasses of water a day.

Interviewer: And if that's just a normal person. If you're doing outside stuff sweating a lot, exercising a lot, even more?

Dr. Faerber: You obviously need to drink more. And I think probably a good rule of thumb is that if the urine looks yellow, you're probably not drinking enough. If it's nice and clear, then you're probably just fine.

Interviewer: All right. So what else could cause kidney stones? Like if I'm drinking the right amount of water, am I immune now?

Dr. Faerber: No.

Interviewer: Okay. I've got a better chance, but . . .

Dr. Faerber: You have a better chance. The other thing is that what diet you eat certainly affects your chances of forming kidney stones. The American diet is really conducive to forming kidney stones. We eat way too much salt. We have a lot of animal protein in our diet, and we have a relatively high amount of fats.

Of all those things, probably the most worrisome is the amount of salt that we ingest. The kidneys, when they see all that salt, excrete calcium in the urine, and that calcium in the urine forms kidney stones. Calcium oxalate are the most common kidney stones that we see in the US. So by limiting salt, we can certainly reduce the amount of calcium that you see in the urine.

Interviewer: If I have a relative that had kidney stones, am I my more likely?

Dr. Faerber: Yes. You can't run away from your genes, unfortunately. So . . .

Interviewer: So that's just the way my body works is . . .

Dr. Faerber: It's . . . clearly, there's a significant familial component to the risk of forming kidney stones.

Interviewer: So if you have a family history, then it's really important to watch your diet, drink water.

Dr. Faerber: Yes, absolutely. There is no question about it.

Interviewer: And when you finally find out if you have them, there's no real lead up, is there? You don't . . . there aren't any symptoms that present till the excruciating pain comes along?

Dr. Faerber: Typically, what you describe is the most common thing is that people are perfectly fine, and then they suddenly develop this quite severe flank pain that is really debilitating. If you speak to women who've undergone childbirth and who have also had the unfortunate episode of having a kidney stone, they would say that having a child is much, much easier than trying to pass a kidney stone. So yeah, on a scale of one to 10, with 10 being the worst pain, most people say it's around a 12.

Interviewer: Wow. Other than the pain, and you have to go to the ER to have them removed, can there be long-term damage caused by kidney stones? Because there might be somebody that says, " You know, I really like my energy drinks. I can deal with every few years having a stone, even though they're excruciatingly painful."

Dr. Faerber: Fortunately, the chances of having a permanent injury secondary to the stone are relatively small. Most people, when they're in a significant amount of pain, would like to have the stone removed. Fortunately, most patients who have the typical kidney stone will pass the stone on their own.

It may take some help, but certainly, they can pass it on their own. Those who can't, we have very minimally invasive ways of taking care of those stones. If patients pass them on their own or they're treated effectively, the long-term damage to the kidney is really quite small, which is fortunate.

Interviewer: Is there evidence that supports the correlation with sugary drinks, salt, diet, that sort of thing? Do have like a number that if I have that kind of lifestyle, I've got three X or four X times more chance to get kidney stones?

Dr. Faerber: There are some . . . there are some numbers. The relative risks of those who drink sugary drinks, for example, their risk might be more than . . . more than double. It's really true of those who have a high salt rate intake. Their risk is three to four times that of someone who has a normal intake of sodium. So there are studies that have shown the significant risks of kidney stone formation in patients who eat too much sodium and drink too much soft drinks.

Interviewer: And the more of those things you do, it just keeps building upon that multiplying and multiplying

Dr. Faerber: Right.

Interviewer: So if you drink sugary stuff but, boy, I'm in the sodium and sugary stuff, that just means I have even more of a chance.

Dr. Faerber: That's exactly right. Which factor is the most important is unclear at this point, but certainly, if you have a family history, you're overweight, you drink sugary drinks, high sodium, you're at significant risk of forming a kidney stone.

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