Sarah Gold was in her 20s when she first noticed strange white deposits appearing in her mouth.
‘I thought they were old bits of food,’ she says. ‘But then they’d start appearing even if I hadn’t been eating.’
The fragments – although painless – seemed to come from her throat, where she could feel something that often made her gag.
‘It was annoying and I could sense something there when I talked,’ says Sarah, 39, an aspiring photographer and photobooth business owner who lives in the New Forest.
Finally, after three months, Sarah Gold saw her GP, who ‘looked in my mouth and diagnosed tonsil stones’
Thinking they were bits of food, Sarah would try to swallow them or spit them out. ‘But this was hard to do – I had to cough or make a strange noise to get them out,’ she says. ‘And after some time, they would be back again – they were tiny, but definitely visible.’
Finally, after three months, Sarah saw her GP, who ‘looked in my mouth and diagnosed tonsil stones,’ she says.
‘I’d only ever heard of kidney stones – I had no idea stones could form in your mouth.’
Tonsil stones are small hardened balls of debris and bacteria that accumulate on tonsils. They are harmless and while some people report bad breath, they don’t typically lead to long-term health issues.
Costa Repanos, a consultant ear, nose and throat surgeon at Queen Alexandra Hospital in Portsmouth and Spire Portsmouth Hospital in Havant, explains: ‘Tonsils are made of lymphoid tissue and are part of the immune system – they help to mobilise the body’s defences against infection.
‘We are born with smooth tonsils, but as we age and if we develop repeated bouts of tonsillitis, little pits form in the tonsil tissue as a result of the scarring from infections.
‘Then – because tonsils regularly shed their lining, in order to regenerate – the old tissue gets stuck in these pits, trapping bacteria that then flourish,’ he says.
‘Eventually this debris builds up and hardens to form stones – and can become quite smelly if it’s got bacteria in it. It’s a normal part of the tonsils’ function but some people’s stones are more problematic than others.’
Sarah’s GP said there was no need to take any action as they weren’t causing her a problem but to come back if they grew larger or changed texture.
But they returned again and again.
‘It’s embarrassing and a bit disgusting – I always brush my teeth and have good mouth hygiene, so I don’t understand how I get them,’ she says.
‘If they are big enough they make me feel like I may be sick if I try and dislodge with my tongue or a cotton bud, so I have to really strain to cough them out.
‘But apart from that I’m reassured they’re not dangerous or sinister so I just ignore them,’ she says.
Mr Repanos says: ‘For most people tonsil stones are not problematic – they tend to be small and shed on their own accord.
‘But in people with bigger tonsil pits they can be an issue – they can cause repeated tonsillitis, a sore throat or bad breath, for instance.
‘For these patients, the best treatment is a tonsillectomy [surgery to remove the tonsils] – and I see a few dozen a month at my hospital alone who require this treatment for tonsil stones.’
But the tonsils aren’t the only place where stones can accumulate and could be the cause of common symptoms – as experts explain here…
Constantly blocked nose
IT COULD BE: Nasal stones
Nasal stones are hard lumps – ranging from 5mm in diameter to 20mm – caused by the build up of mucosa, the lining inside the nose. Symptoms include recurrent sinusitis, a blocked nose or an unpleasant smell in the nose or mouth. But they can also be symptomless.
‘Mostly, these stones stay lodged in the nose and cause nasal obstruction and a foul smell due to bacterial infection,’ says Mr Repanos.
Nasal stone symptoms include recurrent sinusitis, a blocked nose or an unpleasant smell in the nose or mouth
WHAT CAUSES IT? ‘Nasal stones are similar to tonsil stones, in that they are concretions – i.e. a hard mass – that are made from either secretions from the nose that have become hard or, very occasionally, a foreign body.
‘An example would be a child putting a tiny bead up their nose – perhaps it’s never found and then 25 years later we find a rock-hard pellet that has become covered with the tissue lining the inside of the nose.’
These stones are also common in elderly patients who may not look after themselves or who are not regularly blowing their nose – a bit of dried mucus, a small foreign body or a bit of dried blood can then develop into a stone.
HOW IT’S TREATED: Removal of the stones is usually straightforward with an endoscope – a thin probe with a miniature camera on the tip. This doesn’t normally require an anaesthetic – though this can be given if the stone is large and might be more difficult to remove.
Abdominal pain
IT COULD BE: Gallstones
One in ten people are thought to have gallstones – caused by a build-up of deposits in the gallbladder – but most only find out when they cause pain, or are found incidentally on a scan.
Many sufferers get no get pain until the gallbladder attempts to pass gallstones – then many women describe it as ‘worse than childbirth’. And as the pain is found in the centre of the abdomen, some people mistakenly think they are having a heart attack.
WHAT CAUSES IT? They’re thought to develop as a result of a chemical imbalance in the bile (which the gallbladder produces to help with digestion) – in many cases it is due to excess cholesterol in the bile, which gradually hardens into fatty lumps or stones.
Middle-aged women are one of the groups most at risk as it’s known that the female hormone oestrogen can stimulate the release of cholesterol in bile.
If the pain from gallstones mild and infrequent, you may be prescribed painkillers, but if your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended
HOW IT’S TREATED: If you don’t have any symptoms, doctors will usually recommend monitoring the stone and no treatment is required until it starts causing any problems.
If the pain is mild and infrequent, you may be prescribed painkillers, but if your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended.
‘We do not need our gallbladder and this is a very common procedure, usually done via keyhole surgery,’ says Christian Macutkiewicz, a consultant general and hepato-pancreatico-biliary surgeon at Spire Manchester Hospital and Manchester Royal Infirmary.
Women’s pain during sex
IT COULD BE: Vaginal stones
Also known as colpolithiasis, these are hard, rock-like masses that can be felt in the vaginal wall or even – in severe cases – protruding from the vagina itself. The most common signs are pain in the vagina or more generally around the abdomen, as well as during sex.
But they’re very rare; most gynaecologists never see a single case throughout their entire career.
WHAT CAUSES IT? They can form due to hardened tissue that grows around a foreign body, such as tiny pieces of surgical gauze or mesh left behind after an operation, says Dr Shazia Malik, a consultant obstetrician and gynaecologist and UK medical director at Daye, a virtual women’s health clinic.
But in most cases they’re due to urine leaking into the vagina and depositing urinary salts that gradually crystallise into tiny rock-like lumps.
This is normally due to a condition called urethrovaginal fistulas – where an abnormal connection develops between the urethra (the tube which carries urine out of the body) and the vagina. These connections are like tiny tubes and can form as a result of injury, surgery or inflammation due to infection.
HOW IT’S TREATED: Surgical removal of the vaginal stones can be performed, usually via a minimally invasive cystolitholapaxy (ultra-sonic waves delivered through a ‘cytoscope’).
Dr Malik says: ‘Any fistulas are typically repaired with further surgery a few months after stone removal.’
Prostate problems
IT COULD BE: Prostate stones
Ranging from less than 1mm to 5mm in diameter, these are small deposits of calcium in the prostate gland, which usually form from middle age onwards. Often symptomless, they are usually found during other tests for prostate problems.
Tim Dudderidge, a consultant urologist at the Focal Therapy Clinic, Spire Southampton Hospital, says: ‘Men are usually found to have prostatic calculi [i.e. prostate stones] when they have tests for prostate enlargement or prostate cancer.
‘Prostatic stones don’t usually cause problems but can occur because of prostate enlargement and inflammation, otherwise known as chronic prostatitis.’ It’s usually a side issue and nothing to worry about, he adds – often men pass the stones without knowing they had them.
WHAT CAUSES IT? Usually urine leaking into the prostate due to the bladder not emptying properly. Calcium salts in the urine then slowly form hard deposits.
HOW IT’S TREATED: ‘Ultrasound is frequently used to measure the prostate size and guide prostate biopsies and prostate treatments,’ says Mr Dudderidge.
‘During these scans, stones can be identified in the prostate.’ However, they usually only require surgical treatment if they interfere with other prostate treatments – such as high-intensity focused ultrasound for prostate cancer – or because they are causing a blockage which prevents ejaculation.
Unexplained diarrhoea and weight loss
IT COULD BE: Pancreatic stones
Pancreatic stones are small at first – less than 5mm in diameter – but grow larger over time and can block the pancreatic ducts which release enzymes and other compounds to help with digestion.
Symptoms can include abdominal pain, diarrhoea and weight loss, caused by the body’s inability to digest food.
WHAT CAUSES IT? Inflammation of the pancreas, or pancreatitis, reduces the pancreas’s function so there are less of the normal digestive juices it produces and more of the calcium that’s usually dissolved in those digestive juices.
This leads to the accumulation or calcium carbonate deposits, explains Mr Macutkiewicz, ‘and it’s calcium carbonate that makes stones hard and brittle’.
If they block the pancreatic duct they can cause a serious infection which normally results in hospital admission for a week or so.
But they’re extremely rare – only 12 in 100,000 adults will get pancreatitis, and half of those will get stones.
The other at-risk group are children with rare pancreatic disorders, or conditions such as cystic fibrosis – where small tubes that transport enzymes out of the pancreas become blocked with mucus.
HOW IT’S TREATED: ‘If patients have problems with digestion, then there are pancreatic enzyme supplements that are given,’ says Mr Macutkiewicz. These help the body process foods and absorb nutrients.
Pancreatic stones can be difficult to remove, but if they block a duct or patients are in a lot of pain, part of the pancreas may have to be surgically removed, he adds.
Urge to pee
IT COULD BE: Bladder stones
These are hard stones that form inside the bladder due to some sort of obstruction in a duct that expels urine from the body. The blockage means urine pools inside the bladder and isn’t drained away as it should be – salts in the urine then crystalise and form these deposits. As well as an incredible urge to pee and nothing coming out, they can cause pain, blood in the urine and repeat urinary infections.
WHAT CAUSES IT? Bladder obstruction can be caused by a range of factors – such as an enlarged prostate in men (which presses on the tube that expels urine from the body, causing it to back up into the bladder).
In rarer cases, says Mr Dudderidge, a foreign body – such as a catheter or a stent that has not been removed after a procedure – can trigger stone formation around them.
HOW IT’S TREATED: ‘Typically these are treated with fragmentation procedures using lasers, for instance (which break up the stones to pieces so tiny they can be flushed out in urine),’ says Mr Dudderidge.
‘But if the underlying cause is, for example, an enlarged prostate, that too will need treating with surgery to shrink it down.’
Groin pain
IT COULD BE: Kidney stones
Perhaps the most well known, around one in ten people in the UK will develop kidney stones at some point.
All patients with suspected stones need a CT scan to pinpoint where the stone is and how big it is
They most commonly cause severe pain in loin region that travels into groin and pelvis – and might trigger urinary symptoms and an urge to go to the bathroom if the stone is trying to escape.
‘If they get a fever alongside that, it’s concerning,’ says Mr Dudderidge. ‘Some also have blood in the urine.’
WHAT CAUSES IT? Not drinking enough water is the main culprit – but eating too much ultraprocessed foods may also be a factor, says Mr Dudderidge, as excess salt is known to contribute to the formation of calcium, the mineral which makes up kidney stones.
HOW IT’S TREATED: All patients with suspected stones need a CT scan to pinpoint where the stone is and how big it is.
A small tube called a stent can be put in to allow the kidneys to drain and shockwave treatment – which smashes the stone into tiny fragments – used to break it up, says Mr Dudderidge, ‘but small stones don’t need treatment at all and can be managed with painkillers’.
