Hollywood leans toward gunshots, heart attacks and childbirth when depicting people in pain. Movies and TV shows mostly avoid showing people with kidney stones. Ian McShane’s performance as Al Swearengen in Deadwood, though, made it excruciatingly clear how painful it can be to pass one of these stones. 

That portrayal may be accurate — a US News & World Report list puts kidney stones at the top of a list of the most painful conditions, ahead of childbirth and shingles

Luckily, we know more about how to prevent and treat kidney stones today than we did in Deadwood, South Dakota, in the 1870s. Mike Spigler, the American Kidney Fund’s vice president of patient services and kidney disease education, shares some key facts about the condition.

1. Kidney stones are common

More than 200,000 people have a kidney stone every year in the U.S. You have a one in 10 lifetime risk of developing a kidney stone, and your odds are higher if you’re male. Kidney stones most often affect people between age 30 and 60.

2. Kidney stones are likely to strike more than once

“Once you’ve had a kidney stone, you’re more likely to have another one,” Spigler says. If you get multiple stones, it’s important to try to capture one so your doctor can find out what it is and help put together a treatment plan. 

3. Kidney stones can be very painful

The smallest kidney stones are as small as a grain of sand, and they might move through your urinary tract without you realizing you had one. 

With a larger kidney stone, though, you might notice pain in your lower back, blood in your urine, nausea, and vomiting. “Most people describe the pain as pretty excruciating,” Spigler says.

4. Kidney stones come in four types

Different types of stones have different causes:

  • Calcium stones are the most common and are linked with foods like sweet potatoes, peanuts, and chocolate.
  • Uric acid stones are often found in people who have gout or kidney problems. “One of the things the kidneys do is get rid of urea and uric acid, so when they’re not working well you can get these kidney stones,” Spigler says. 
  • Struvite stones most often strike women. That’s because they are associated with urinary tract infections, which are more common in women.
  • Cystine stones are rare and stem from a genetic disorder. 

5. Kidney stones can be prevented

Changing your diet can help. Avoiding foods high in purine could make a difference. That includes alcohol, some seafood, and some meats. And add in foods that are high in citric acid like lemons and limes—they may help prevent kidney stones.

Dehydration can increase your likelihood of developing kidney stones, so make sure you drink plenty of water, Spigler says. Kidney stones are more common in people who are overweight, so losing a few pounds can help.

For cystine stones, your doctor can help you manage the underlying health condition. 

6. Kidney stones can be treated

Your doctor can prescribe pain medication for smaller stones, and they should pass on their own. For larger stones, there are two main treatments. 

Shock wave therapy uses seismic waves transmitted through your back to break up a kidney stone so the smaller pieces can pass more easily. It’s typically done under general anesthesia. 

If that doesn’t work, surgery is an option. With ureteroscopy, doctors use a long tool inserted through the urethra to remove or break up the stone. For the most challenging stones, a surgery called percutaneous nephrolithotomy removes the stone from the kidney.