Stones

Posted by Nurse Linda in Life After Paralysis on August 26, 2020 # Health

Stones in the body can be quite an issue. Commonly found areas for stones to form are in the tonsils, mouth, nose, veins, gall bladder, pancreas, kidneys, bladder, bowel, and prostate. Who knew there were so many locations! Stones are the result of minerals that build up in areas of the body. They can block passages and cause pain. Getting treatment for stones is important to maintaining your health and avoiding complications.

Some Lesser Known Locations for Stone Formation

Most people do not think about stone formation in the mouth. However, stones can develop in the tonsils and the mouth in general. The purpose of the tonsils is to help filter debris in your mouth from entering your digestive system and especially into your lungs. Symptoms of stones in the tonsils are sore throat, bad breath, and swollen tonsils with white spots. These can usually be removed by gargling with salt water, a mouth rinse, or the use of a mouth swab to remove them. They can be confused with an infection of your tonsils such as bacteria like strep throat, so be sure to have them checked before treatment.

Stones can also appear as a small whiteish patch randomly located in your mouth. There may be no symptoms, or they can be hard and painful. Sometimes, a stone can form in one of your saliva glands that will block the production of saliva. These should not be confused with canker sores. You can try rinsing with salt water, which will help a canker sore. A stone will probably need treatment by your dentist or healthcare professional for removal. Again, they should not be ignored but checked to make sure it is not something else, like oral cancer.doctor with patient

In both the tonsils and mouth, stones will probably be felt by an individual unless you have a spinal cord injury at the C1 or C2 level. You might not feel the stone area but may first notice it when you or a caregiver looks in your mouth while providing oral care. Spots or swelling in the mouth should always be examined by your dentist or healthcare professional to ensure it is not an infection or something more, like oral cancer. You do not want to initiate a treatment that will make the issue worse. Generally, the treatments for oral stones can include rinsing with salt water, increasing fluids, or an incision by a healthcare professional to free the stone.

Nose stones are extremely rare. Typically, they start with a foreign object in the nose, so no picking. Over time, the body will ‘wall off’ the offending particle. A hard piece of mucous is essentially a stone. Cleaning the nose after a spinal cord injury can be a challenge if you do not have enough exhalation pressure to blow your nose. Light suctioning can be used in the nasal passages. A bulb syringe helps accomplish this task gently.

Veins are another odd area to find a stone, but it does occur. Stones in the veins generally begin as a blood clot. They could also start in a weakened part of the vein wall where blood and debris are trapped, unable to move along in the circulatory system. The body will ‘wall off’ anything unusual that cannot be carried away by blood flow or the lymph system. This is the natural way the body protects itself. A stone in a vein can cause the blood to be unable to flow through that vessel. A small stone could feel like a pinch inside your body if it is in an area of sensation. You might see discoloration in a part of your body that is not receiving enough blood. The area may feel cool to touch. The treatment will be to remove the clot or stone. Do not rub the area because that could dislodge the clot or stone, causing more damage or even a heart attack, pulmonary embolism in the lungs, or a stroke.

Common Locations for Stones

Stones are more well-known lower in the body. In the abdomen, stones are well known in the gall bladder. This organ is located under the liver in the upper right of your abdomen. The gall bladder stores bile (digestive juices) that are squirted out as needed for digestion. Stones can form here from a combination of cholesterol and bilirubin. Often, stones are small, allowing them to pass through the bile duct freely. They move through your bowel without difficulty and are expelled through stool unnoticed. When the stones become large, they may clog the bile duct. This causes a backup in the system because bile will still be produced when needed for digestion, but the bile cannot be released due to the stone in the duct. Other times, many stones collect in the gall bladder over filling and overstretching the gall bladder. Bile can back up into other organs. All these causes lead to pain.

The spinal cord levels that innervate the gall bladder are T7 to T10. Gall bladder pain may not be felt if your spinal cord injury includes levels T7 to T10. You might recognize something is wrong but might not be able to localize the pain. Since gall bladder disease occurs 3.4 times more often in individuals with SCI, it is important to report even vague sensations to your healthcare professional. Keep a recording of your sensations, the time, and how you felt. Gall bladder disease in SCI is often diagnosed by documentation. Nausea and vomiting, especially vomiting green bile, is a symptom of gall bladder disease. Other symptoms include fever, fast pulse, nausea, and belly pain that’s worse after meals and radiates to your back. You might not feel the pain if you have decreased sensation. In spinal cord injury, referred pain to the shoulder or jaw is also a symptom that something is wrong but might not pinpoint the location. Imaging studies to view the gall bladder will be needed for diagnosis. Treatment is to remove the stones or the entire gall bladder.

Gall stones can easily pass to the pancreas. The pancreas is an organ in the center of the body that makes hormones, especially for food digestion and regulates your blood sugar. Gall stones can collect in the pancreas, causing inflammation, infection, and pain. The symptoms of stones in your pancreas are the same as in your gall bladder. Treatment includes antibiotics, removal of the stones, or surgery to remove the source of the problem, the gall bladder.

Other all too familiar areas for the development of stones are the kidneys and bladder. Minerals, especially calcium, can collect in your kidneys, creating a stone. The kidney stone can become large enough to block urine from being eliminated into the ureters, which carry the urine to the bladder. When urine cannot exit the kidney, it dangerously stores within it. There is no room for urine to be stored in the kidney. The pressure of the build-up of urine presses on the delicate kidney tissue causing damage. This decreases the overall kidney function. If left unattended, the damage is permanent. It is, therefore, critical to detect kidney stones early. The traditional symptoms of kidney stones include pain in the lower back or hip, bloody or cloudy urine, and low urine output. If you have a spinal cord injury, you may not feel pain but may have referred pain or episodes of autonomic dysreflexia. Notice the color of your urine and average output to assess changes. You could feel run down or generally just unwell. Seeking medical help can assist in the isolation of the problem.

Stones can form indirectly in the bladder or can be passed through the ureters from the kidneys. You may develop lower abdominal pain, especially when voiding or if the sensation is decreased, referred pain, or AD. Your urine may have some small stones that you can see, and it can be cloudy or bloody. This is more easily seen if you catheterize using a collection bag and can view your urine without dilution in toilet water. Sediment in urine and stones can be easily confused. Look at your urine so you can see if there is a change from the usual amount of sediment you might typically produce. Stones in the bladder are either removed by introducing a small scope into the bladder or broken up with lasers or shockwaves to reduce their size and pass naturally.

Bowel stones typically form if there are other issues with your bowel. Stones generally form in the bowel because of other diseases or genetic tendencies. This can include diverticulitis, where debris gets caught in the small outpouching of the bowel wall or inflammatory bowel disease. Symptoms of stones in the bowel include bloody stool, pain/referred pain, and perhaps AD. Symptoms of stones in the bowel mimic many other bowel issues. Imaging or a colonoscopy may be needed for a diagnosis. Getting to the root of the reason for the development of stones in the bowel is needed for treatment.

The prostate gland is found in men near the bladder. It creates fluid to protect sperm. Occasionally, the smallest of stones collect there in middle-aged to older men. Most often, these stones go undetected; however, they can become infected. At this point, treatment with antibiotics is given. Symptoms of infection include fever, and you could have urinary problems as well. Testing and imaging will have to be conducted to locate the source of this issue.

With spinal cord injury, locating pain within the body can be difficult because the source may not be able to be immediately identified. Symptoms of stones anywhere may include fever, decreased function, or output of the affected organ and pain. After SCI, pain may be referred to as a part of your body where you do have sensations such as the shoulder or jaw or as episodes(s) of autonomic dysreflexia. Keeping a journal when you suspect anything is out of your normal is critical for the diagnosis of stones or other internal ailments. Note the time and duration of when symptoms occur, such as before or after eating, during catheterization or bowel program, during exercise, when sleeping. Note what the symptom is like, pain where do you have sensation, increased episodes, or new episodes of AD, low urine output, numbness, tingling, feeling of impending doom, or just feeling weird.

Preventing the development of stones might be done by keeping yourself hydrated, following a healthy diet with roughage, but cutting down on red meat. If you take dietary supplements, be sure you discuss them with your healthcare professional to ensure you are not inadvertently increasing your risk of stones. Discuss calcium supplements with your healthcare professional. Ironically, taking calcium supplements can reduce your risk of developing stones. Exercise to keep your bone minerals healthy. Reduce sodium (salt) intake. Avoid foods that have related to stone development: beets, chocolate, spinach, rhubarb, tea, nuts that are rich in oxalate, and colas are rich in phosphate, both of which can contribute to kidney stones.

Talk with your healthcare professional when you suspect something is not right. Let them use their knowledge and expertise to help you. Get appropriate testing as needed. Stones can be a challenge to diagnose after a spinal cord injury, as are other internal issues. Know your body so you can communicate effectively. Nurse Linda

Pediatric Consideration: Most young children do not have stones. Teens do more often but still it is rare. However, like all health issues that were related to elderly or adults, these ailments are sliding down the chronologic scale to younger people.

The young child might not be able to tell you something is wrong inside their body. Know your child’s normal behavior and note changes along with physical changes as with adults. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

Reference:

Apstein MD and Dalecki-Chipperfield K. Spinal Cord Injury Is a Risk Factor for Gallstone Disease. GASTROENTEROLOGY 1987;92:966-8.