Kidney Stone Pain

What kidney stone pain feels like

People often call it the worst pain they have ever had, and many women compare it to childbirth. Typical features:

• Sudden onset, often at night or early morning, building over minutes to a peak
• Colicky: it comes in waves of severe pain lasting 20 to 60 minutes, with easier spells in between, though a background ache remains
• Restlessness: unlike appendicitis or peritonitis, where people lie still, people with renal colic writhe, pace and cannot find a comfortable position
• Nausea and vomiting in about half of people, because the kidney and gut share nerve pathways
• Sweating and pallor during waves

The pain is caused by the stone blocking the ureter (the tube from kidney to bladder). Pressure builds behind it, stretching the kidney's capsule, and the ureter spasms as it tries to push the stone along. The size of the stone does not predict how bad the pain is.

Where kidney stone pain is located

The location shifts as the stone moves down the ureter:

Kidney stone pain is almost always on one side. Pain in the middle of the back that changes with movement is more likely muscular.

Kidney stone pain in men and women

In men, pain often radiates to the testicle, which can be confused with testicular torsion. In women, it can spread to the labia and may be mistaken for ovarian or gynecological pain. Women of childbearing age should have a pregnancy test, because ectopic pregnancy and ovarian torsion can cause similar one-sided pain.

Other kidney stone symptoms

• Blood in the urine: pink, red or brown, or only seen on a urine test
• Burning or painful urination
• Needing to urinate often or urgently, passing small amounts
• Cloudy or foul-smelling urine (suggests infection)
• Fever and chills (infection above the stone, an emergency)
• Passing gravel or a small stone

Conditions that can feel like kidney stone pain

• Kidney infection (pyelonephritis): constant side pain with fever, rather than waves
• Appendicitis: pain starts around the navel, moves to the lower right belly, worse with movement
• Gallbladder attack: upper right belly pain after fatty meals
• Abdominal aortic aneurysm: sudden back or belly pain in an older person, especially a smoker
• Muscle strain: pain with movement and tenderness of the back muscles
• Shingles: burning pain in a band before a rash appears
• Testicular torsion and ovarian problems: as above

How doctors confirm a kidney stone

• Urine test: blood is present in most cases. Signs of infection change urgency
• Blood tests: kidney function, white blood cells, calcium and uric acid
• Low-dose CT scan without contrast: the most accurate test. It shows stone size and position and any swelling of the kidney (hydronephrosis)
• Ultrasound: used first in pregnancy and children, and often in people with known stones, to avoid radiation

How long kidney stone pain lasts

A single attack lasts hours. The whole episode lasts until the stone passes or is removed. How long that takes depends mainly on size:

Pain usually stops suddenly once the stone drops into the bladder. Passing it out through the urethra is usually much less painful.

Relief for kidney stone pain

At home, with a known small stone

• Pain relief: NSAIDs such as ibuprofen or naproxen are the most effective first-line pain relievers for renal colic, following the label dose. Avoid them if you have kidney disease, stomach ulcers or take blood thinners, and check with your doctor if you are unsure. Acetaminophen (paracetamol) can be added.
• Fluids: drink enough to keep urine pale, about 2.5 to 3 liters (roughly 10 to 12 cups) a day, but forcing very large amounts does not speed passage.
• Heat: a heating pad on the back or side can ease spasm.
• Stay active: walking may help the stone move.
• Strain your urine through a strainer or coffee filter to catch the stone so it can be analyzed.

Medical treatment

• Alpha-blockers such as tamsulosin relax the ureter and help stones of 5 to 10 mm in the lower ureter pass faster.
• Anti-nausea medicine and intravenous fluids in the ER.
• Stronger pain relief for severe attacks.
• Procedures for stones that will not pass, cause infection or block a single kidney: a stent or drainage tube to relieve blockage, then ureteroscopy or shock wave lithotripsy. See kidney stones for treatment options and prevention.

Frequently asked questions

Where is kidney stone pain located?

It usually starts in the side or back below the ribs on one side, then moves toward the lower belly and groin as the stone travels down. Men may feel it in the testicle and women in the labia. Near the bladder, it causes urgency and burning.

How long does kidney stone pain last?

Each wave of pain lasts 20 to 60 minutes, and attacks can continue on and off for days. Small stones usually pass within 1 to 2 weeks, larger ones can take 4 weeks or need treatment. Pain typically stops once the stone reaches the bladder.

What does kidney stone pain feel like?

It is a sudden, intense, cramping pain that comes in waves, often with nausea and vomiting. Most people cannot keep still. It is often described as the worst pain they have felt, and it is felt on one side of the back or belly.

What helps kidney stone pain fast?

Anti-inflammatory painkillers such as ibuprofen are the most effective over-the-counter option, following the label dose, along with a heating pad and fluids. If pain is not controlled, you have a fever or you are vomiting, go to the ER.

When should I go to the ER for kidney stone pain?

Go to the ER for fever or chills, pain that painkillers do not relieve, repeated vomiting, inability to pass urine, a single kidney, pregnancy, or if this is your first episode and the cause is uncertain. A blocked, infected kidney can cause sepsis quickly.

Can kidney stone pain come and go?

Yes. Pain often comes in waves as the ureter spasms, and may stop for hours or days while the stone sits still, then return when it moves again. A painless period does not always mean the stone has passed, so follow-up imaging may be needed.