Why Do Kidney Stones Cause Pain?

P6140312Agonizing, intolerable, miserable, excruciating, stabbed with a knife, worse than childbirth.

As a urologist specializing in the treatment of patients with kidney stones I have learned a new lexicon exclusive to stone formers describing bouts of renal colic.

Pain, the hallmark symptom of stone disease, accounts for over one million emergency room visits by such patients in the United States each year.

Over the past several decades considerable progress has been made gaining insight into the physiology of renal colic and optimizing methods to treat it. However, despite improved scientific explanations we as clinicians still lack a perfect understanding of why it occurs.

PAIN FROM STONE PASSAGE

Patients have been suffering from renal colic secondary to stone disease for over two thousand years. As a matter of fact, it is remarkable how little has changed in its clinical presentation over this time period. In 400 B.C. Hippocrates referred to it as first disease of the kidneys. He was one of the initial observers to comprehend the association between urinary obstruction and pain, writing:

An acute pain is felt in the kidney, the loins, the flank and the testis of the affected side; the patient passes urine frequently; gradually the urine is suppressed. With the urine, sand is passed; as the sand passes along the urethra, it causes severe pain which is relieved when it is expelled; then the same sufferings begin again.

We have since come to appreciate the complex physiologic basis for this relationship at a much deeper level.

How Pain Begins

renal-stonesThe first step in this process is acute obstruction, most commonly from a stone. But in stone formers masses of crystals can create obstruction, as can blood clots if bleeding is particularly brisk.

Urine from the kidney can no longer pass to the bladder and as a result builds up and stretches the proximal – closest to the kidney – ureter and renal collecting system. This stretch activates nociceptive nerve fibers – fibers which sense injury – within an entire neuronal network located submucosally in the renal pelvis, calyces, capsule and ureter.

Figure 1 (left) – Example of obstructing proximal ureteral stone with dilation and stretch of the collecting system above the level of obstruction.

These fibers then transmit afferent signals to the T11 – L1 spinal cord which the body interprets as pain at the corresponding level of neuronal activation. As the stone migrates from the kidney down the ureter and towards the bladder, pain usually shifts downward as well. It is commonly sensed as high as the upper flank when the stone is lodged in the proximal ureter and as low as the labia/testicle when down near the uretero-vesical junction at the entry to the bladder.

Patients passing stones may experience other symptoms in addition to pain.  Many of the nerves involved in the process of obstruction are intimately linked to innervation of adjacent organs, for example the gastrointestinal tract. Cross activation of these associated nerve fibers has been proposed as an explanation for the nausea and vomiting which so often occurs in the setting of an acute episode of renal colic.

In rare instances patients may even have alternative symptoms without any pain at all. In some cases, particularly when the stone is at the uretero-vesical junction, urinary symptoms predominate and the only appreciable symptoms are urinary frequency, urgency and discomfort while voiding. These symptoms mimic urinary infection and often result in temporary mis-treatment with antibiotics until the correct diagnosis is made.

What Happens Later

Increasing renal pelvis pressure from persistent obstruction causes a release of prostaglandin E2. This chemical mediator of injury response produces a perfect storm.

It causes ureteral hyperperistalsis (increased intensity of the waves of coordinated ureteral contractions which normally drive urine down to the bladder) and eventually even ureteral spasm. It also leads to dilation of the afferent arterioles – those tiny resistance vessels which control the flow of blood into the capillaries of the kidneys.

The arteriolar dilation increases blood flow to the kidney and promotes a temporary diuresis just as ureteral smooth muscle hyperperistalsis and ultimately spasm tighten the ureter around the stone and worsen obstruction. Spasm leads to lactic acid build up, as occurs when any muscle is over-exercised, and sets off an inflammatory cascade that itself can worsen pain.

With time, blood flow to the affected kidney falls, even though the arterioles which let blood into the renal capillaries remain dilated. It falls because the efferent arterioles, which let blood out of the capillaries where filtration occurs, begin to constrict and raise filtration by the renal glomerulae. The increased filtration maintains and can even raise pressures.

glomerulus copy

Figure 2 – Diagram of blood flow to the nephron.  Blood enters through the afferent arteriole and is then filtered within the glomerulus, producing urine in the process. Blood exits through the efferent arteriole. Both the afferent and efferent arteriole are able to dilate and constrict in order to regulate pressure and ultimately filtration via urine production.

In many ways, this complex system is analogous to the soaker hoses many people use to water their lawns. The afferent arterioles are the faucet the hose is connected to and the efferent arterioles are the opening at the end of the hose which can be closed or left open into a sprinkler.

Filtration is the many tiny flows of water all along the hose which keep the grass growing.

When working appropriately, the faucet and the end are both open and water (urine) is produced at a slow, constant rate (Figure 4 – left). With an obstructing stone the faucet – so to speak – is opened more and the end clamped more so more fluid – water – is filtered out along the length of the hose at high pressure (Figure 4 – right). In the kidney this filtration is into the nephrons and raises pressure. When the clamp is tightened, the total amount of flow through the hose can fall just as the amount of water filtered out along the hose rises.

Figure 4 – Soaker Hose Analogy to Renal Blood Flow and Filtration. On the left, there is little pressure in the system and water (urine) seeps out slowly from along its length.  On the right, the inflow is much higher than the outflow and water (urine) shoots out from along the hose at exceedingly high pressure.

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Three Phases of Pain in more Detail

The Physiology

No discussion regarding ureteral obstruction would be complete without the work of E. Darracott Vaughan, who characterized the physiology of urinary obstruction in the 1970’s.

Assuming two functional kidneys, the physiologic effects of acute unilatScreen Shot 2015-05-21 at 11.04.09 PMeral ureteral obstruction can be marked by three distinct phases.

In phase one, the effects of the inflammatory cascade described above cause a progressive rise in renal blood flow and renal pelvis and ureteral pressure. This phase lasts for approximately one to one and a half hours. This is the portion where the afferent arteriole – the faucet – is maximally opened.

Phase two is marked by efferent arteriolar vasoconstriction which causes a decrease in overall renal blood flow but an increase in ureteral pressure for up to five hours. The faucet is opened and the end clamp is tightened.

Phase three is marked by a further decrease in renal blood flow to the affected kidney and ultimately decreased ureteral pressure. The end clamp is progressively tightened so blood flow to the kidney is reduced enough that filtration and urine production begin to fall, and pressure with it.

Measurements of ureteral pressure (red) and renal blood flow (blue) after onset of acute unilateral ureteral obstruction. (Courtesy Campbell-Walsh Urology, Tenth Edition, Elsevier Inc.)

The fall in blood flow is not injurious during an acute attack, but over time it can be. This means that relief of an obstructing stone is an important matter. Commonly stones pass of themselves. But stone attacks need medical attention because if the stone continues to obstruct it must be removed.

The Symptoms

It is easy to conjecture how these three distinct phases correlate clinically to the symptoms experienced during an acute episode of colic.

The onset of pain classically correlates to phase one and the inciting obstructive event. It is at this point that the patient commonly seeks care in the emergency room or physician’s office.

The pain classically persists at a severe level for several hours (phase two) but ultimately subsides, at least partially (phase three).

In many instances pain comes in waves, potentially a sign of intermittent obstruction activating the above pathway each time urinary flow is obstructed. This occurs through a combination of the stone moving and the tensions of the ureter with increases or decreases of muscle spasm.

THE CONUNDRUM – Pain Without Obstruction

Opinions of Urologists in General

Though the physiologic basis of pain in the setting of obstruction is clear, it does not provide an explanation for one of the most commonly encountered conundrums in stone disease – the symptomatic non-obstructing stone. These can be actual free stones that have not passed, stones attached to plaque, or actual plugs in the kidney tubules that are massed together enough to show up on a CT scan as ‘stones’ though actually tissue calcifications.

There is perhaps as much variation in clinical opinion in such instances as any other clinical scenario in the field.

If one were to ask a group of urologists whether they believed that small nonobstructing stones could cause renal colic, opinions would range from absolute certainty to complete dismissal of the concept altogether.

What Happens to Patients

As a result, there is no standard of care regarding how to optimally manage such patients. In all cases it is first imperative to rule out other potential sources of pain; however, such workups often end with the same result – a patient with bothersome flank pain and evidence of one or more nonobstructing stones on imaging.

Lacking a physiologic explanation to explain their symptoms, patients with pain and non obstructing stones are often sent for detailed workups, secondary and tertiary consultations and referral to pain specialists and even psychiatrists. However, in an age where flexible ureteroscopy can be performed quite safely and on an outpatient basis one must wonder whether such patients are being treated appropriately.

A Specific Example

As an example, I recently met a patient who had been referred from several hours away seeking a fourth opinion regarding her chronic flank pain. For months she had suffered from a severe ache in her left flank that had limited her ability to work and live her normal life.

She had attributed the pain to a 7 mm lower pole nonobstructing renal stone on that side which was discovered on a CTScreen Shot 2015-05-21 at 2.32.24 PM scan during her initial presentation to an outside emergency room (Figure 3). However, none of the physicians she had seen agreed with her self diagnosis.

Figure 3 – CT image of left lower pole nonobstructing stone (red arrow).  There is no evidence of obstruction or inflammation around the kidney.

In the ER she was given narcotic pain medication and sent home to follow-up with a urologist.

The first urologist she saw told her that while the stone was visible, its location within the kidney meant that it could not possibly be causing her pain. He refilled her prescription for pain medication and sent her to see a pain specialist.

The pain specialist tried physical therapy for what he thought may be a musculoskeletal source but ultimately this did not prove effective and she was given more pain medication.

She later sought care from a second urologist who also told her that the stone could not possibly be causing her pain in the absence of obstruction. This time however she was accused of having an agenda and seeking care specifically to get pain medication. Similar visits to a variety of emergency rooms elicited more CT scans as well as accusations of seeking pain medications. Each CT result was the same though, all demonstrating a 7 mm non obstructing left lower pole stone.

On one instance a treating practitioner even admonished her, saying that nonobstructing stones don’t cause pain and he should know since he too had been diagnosed with such stones incidentally on a CT scan.

Ultimately she made her way to the clinic for consultation at which point she was offered a ureteroscopy and stone removal. The procedure went well and she was discharged with a stent for one week. She was last seen back 5 weeks after the procedure and reported complete resolution of her pain. She was no longer taking any pain medication whatsoever and there was no evidence of any stone or hydronephrosis on follow-up imaging.

What is Known to Date

Such patients are frequently encountered. Despite a lack of physiologic explanation as to why these non-obstructing stones may cause pain, there is emerging evidence that they do and therefore that removal can cure it.

In 2006 Taub et al. described outcomes of twenty such patients who had chronic flank pain as well as radiographically evident calcifications within their papillae without obvious collecting system stones. Ureteroscopy with laser papillotomy to unroof and remove all evident stone was performed on twenty seven kidneys. Pain improvement was seen in 85% of cases with a durable improvement for greater than one year in nearly 60% of cases.

This study was then repeated on a multi-institutional level with 65 patients undergoing similar procedures over a ten year period. Overall there were 176 procedures performed in this cohort with patients reporting less pain after the procedure 85% of the time. The mean duration of response was 26 months with 60% of patients having sustainable improvements in their pain levels for over one year.

Finally, this clinical scenario is seen commonly enough that it garnered its own nickname at Massachusetts General Hospital where it has been described as “small stone syndrome”In a retrospective review of patients treated there with ureteroscopic removal of small nonobstructing stones (<4mm) for reasons related to chronic pain, 11/13 patients reported being pain free after the procedure with the other two noting a partial response.

What I think

We still do not completely understand the physiologic explanation for pain in these patients. However, much like Hippocrates over two thousand years ago, clinical observation often precedes scientific understanding. In this regard it is unfair to dismiss the notion that small non obstructing stones can elicit legitimate renal colic.

Physiologic breakthroughs in the understanding of pain signaling and inflammation are currently happening at a rapid rate and it is likely that in time we may be able to better decipher which non-obstructing stones are truly responsible for symptoms. However, until then, such scenarios will continue to be a commonly encountered clinical complexity for urologists.

For the time being I would still advocate consideration of alternative causes of pain in such situations including urinary infection, obstruction and malignancy. A careful history is critical to rule out non-urologic sources such as pathology within the musculoskeletal, pulmonary, gynecologic and gastrointestinal systems. Another important element of the history is whether the patient has previously passed a stone and if the current symptoms are similar to that experience.

Once other explanations have been ruled out, offering stone removal is entirely reasonable. This not only has the potential to improve pain but may also decrease the risk of future stone growth or spontaneous passage at a later date. In such instances, I prefer flexible ureteroscopy with stone removal to shock wave lithotripsy. First, ureteroscopy maximizes the likelihood that all stones can be identified and removed which is especially important in the event that pain persists after the procedure. Second, with ureteroscopy one can inspect the inside of the kidney in high definition which has the potential to offer information not readily available on x-rays and CT scans such as embedded stones, tissue calcifications, and other pathology (Figure 4).

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Figure 4 – High definition images obtained during renal endoscopy demonstrating tubular plugging (stones embedded in the kidney) (Courtesy: AE Evan, IMCD and BD plugs: Do they have a role in stone formation). 

Finally, it is critical to establish realistic expectations before surgery in regards to pain control. Our understanding of this concept is in evolution and the published literature suggesting a treatment response is limited to relatively few patients. However, as science and history have shown us, just because we don’t fully understand the connection doesn’t mean it doesn’t exist.

More You Might Like

What Kidney Stones Are

Types of Kidney Stones

Do We Need to Analyse All Those Stones?

How Kidney Stones Form

When Crystals Plug The Kidneys

Medullary Sponge Kidneys

 

 

 

 

401 Responses to “Why Do Kidney Stones Cause Pain?”

  1. Andrea

    I apologize in advance if this question has already been asked and answered. I’ve been diagnosed with kidney stones in the past. Two days ago, I went to see my doctor about having flank pain on the right side. A urinalysis showed blood in the urine (+2 moderate), but not visible to the naked eye. An x-ray showed a small stone in my right kidney, but nothing in the ureters. Would/Could a stone that is still in the kidney cause microscopic blood to be in the urine? Or, is blood in the urine only possible when the stone(s) begins to move down the tube? I thank you for any feedback you can provide.

    Reply
    • Fredric Coe, MD

      Hi Andrea, The blood and right sided pain go with a stone that is in the kidney and intermittently blocking the junction of the ureter and renal pelvis. ALternatively you may be passing crystals in large enough amounts to cause pain. Be sure you have been properly evaluated. And treated – to prevent more stones. Regards, Fred Coe

      Reply
  2. Jenny B

    I have had non-obstructive stones for the last 15 years which do not move (except for one 1 mm that exited), and have even been told during an abdominal ultrasound that the kidney was hydronephrotic. A later scan showed no hydronephrosis or resolution. Consequently, after being referred to a urologist for evaluation, she noticed that I had hematuria on a regular basis, and any pathology was ruled out with a cytoscope.
    A strange thing has happened. Last week I twisted my body as I rolled over in bed and experienced severe pain with immobility in left upper and lower quadrant. It was diagnosed as a psoas strain. That same week I have my semi-annual US for the non-obstructive kidney stones and get a call back that they are now 8 and 5mm, but in the same spot and no hydronephrosis. Interestingly, I had IBS attack while the US tech was scanning my bladder, as the mild pressure caused pain – actually any pressure normally causes pain, but not that easily.
    So now I have constant mid abdominal pain wrapping around to my back with bloating, burping, pinching, pressure, difficulty taking a deep breath, and mild nausea. The urologist on call says it has absolutely nothing to do with the unobstructed stones. I am leaving for a 3 week European vacation in very soon (once in a lifetime trip). What do I do? My plan is to call primary care office or my regular urologist next week if things don’t subside. My family will be extremely angry if they lose out. Previously, the only pain I had was IBS intermittently, pain when pressing lower left rib in flank and pain with wire bras or snug waistbands. I think I should have one more US before I leave to ensure no movement or swelling. Is the on-call urologist correct (this has nothing to do with stones)? Am I wrong? If I fly and the 8mm causes hydronephrosis, how long do I have to get to ER before my kidney goes bad?
    Thanks.

    Reply
    • Fredric Coe, MD

      Hi Jenny, Because so much of the problem reflects only in the images I am afraid my opinion will be of little value. Your symptoms do not sound like stone passage. If you feel another ultrasound will reassure you, it is worth the time and money for just that purpose. Finally, Europe is first world medically and if needed care readily at hand. Good Luck, Fred Coe

      Reply
      • Jenny B

        Thanks so much for your quick reply. I appreciate your opinion. One thing is for sure, I am going to do the procedure she suggests so I won’t have to worry about my next vacation!

        Reply
  3. christina n

    Friday morning right after work I went to the ER I know my pain levels and can usually guess the size of my stones and be right, this pain is the pain I have felt one other time about a year ago another 9mm but this time in the right kidney, last year I passed the 9mm by myself, the pain was so unbearable I felt like I was having an out of body experience, last time the 9mm took weeks to finally drop I pray this isn’t the case!

    Reply
  4. Bryan

    Hello Doctor,
    Suffered from stones, once before I knew it, only three times. Just a question about blood flow. Does the blood flow equally? Or does it flow in series to the kidneys? I understand the flow is regulated by constriction of the vessels in and out, per your article. But does blood flow by first one kidney then another? Meaning is one more prone to stone formation. My left kidney has been assaulted thrice now and right only once. Luckily passed them all naturally. I really appreciate the article. I hate taking pills for pain. Too often it is just the easy way out with no solution offered.

    Reply
  5. Malek

    Thanks a lot for such an inspiring page. i am 48 and i have been suffering from kidney stone pain for 8 years now. on my first CT laser test i found a 1.5 cm stone to which i applied lithotripsy in 2010. thinking that i had gotten rid of kidney stone pain once and for all, i had not diagnosed until 2014 when i discovered a stone as big as an egg -4 cm. they had to put a hole in my back to reach it, destroy it and extract its particles. since then i have been good until the last 4 months when i noticed a 9 ml stone again (very probably having remained from my last surgery). it is nonobtructing and it aches only whenever i do not drink enough water. hence my question: does drinking enough water have any influence on kidney stone pain? Thanks again!

    Reply
    • Fredric Coe, MD

      Hi Malek, Water will not cure or treat kidney stone pain. But preventing stones and crystals will. What are these huge stones made of? Given the rate of new ones I suspect uric acid, but it matters a lot. Whatever they are you need effective prevention right away. Regards, Fred Coe

      Reply
      • Malek

        Malek. thanks Dr. Coe for your eye-opening directions. i really appreciate your noble dedication! I analyzed the composition of my kidneys and the results were a combination of calcium oxalate and calcium phosphates and uric acid. my doctor recommended mainly cutting dow on animal proteins and drinking plenty of water, especially ‘effervescent’-like water. After my last laser test i was sure i’m not a stone former. because the 9mm stone i found had been there since july 2014. the problem with it is that it aches every time i’m late to drink water. By the way, i haven’t drunk tap water since my last surgery. i always drink mineral water so as to minimize the chance of forming more stone as tap water in the place where i live (Meknes, Morocco) contains a lot of limestone/calcaire. i thought that the source of the pain was the hypothesis that with less water, the kidney shrinks or contracts, causing the stone -that must be sharp and edgy- to touch/scratch the interior of the kidney, and cause pain as a result. I wonder Dr. if my hypothesis is right. Thanks again for your concern!

        Reply
        • Fredric Coe, MD

          Hi Malek, the combination of calcium oxalate, and calcium phosphate and uric acid in one person usually means extreme low urine volumes. I say this because the uric acid requires an acid urine the calcium phosphate an alkaline urine and urine cannot be both at once. Very low volumes, however, can get this to happen. Animal protein is a problem only for the uric acid stones, water is a very good idea. I do not think your pain is because the kidney shrinks, but it may be crystals form when urine volume falls. You really should be fully evaluated to figure out the cause of the stones. Here is a good plan. Regards, Fred Coe

          Reply
  6. Kathy Urquhart

    What causes a kidney stone to move out of the kidney?

    Reply
  7. Bridge

    3 weeks ago I woke in the middle of the night with severe pain in my right flank, unbearable and knowing here we go again! A little over three years ago woke up in pain finding out shortly after I had 8 stones scattered in both kidneys. Anyway, I saw my urologist and had a KUB, the pain stopped a few days later. The next day sever horrific pain on the left, went back, Ct scan done, ended up in ER, unimaginable pain. Left side is experiencing all the pain and right is not hurting which is where the stone is, 5mm, second Ct next day which shows it’s in the urerter on the right. I’ve never experienced pain in opposite side from the stone. It’s confusing to me. Urologist and others said it can happen, but what I don’t understand is why this one hurts like the death of me when I’ve passed bigger with less pain. It just sounds like no rhyme or reason to it. I still have one 9mm in one kidney and a 8mm in the other, both are stated to be stable but I have intermittent pain which is consistent with the pain and symptoms I feel with problem ones. The last scans show small cysts ( about 1/2″) one on each kidney, I’m told those are stable. Is the kidney stones causing cysts or is that unrelated?

    Reply
  8. TULSHI RAM UPADHYAY

    I have 7mm stone in right kidney at mid Pole but it is not so painful but my left kidney is paining… I did CT scan but thr is a stone in right side of kidney.. I m feeling confused why my left kidney is paining..
    Plz advice me

    Reply
    • Fredric Coe, MD

      Hi Tulshi, I cannot be sure from this distance. With a negative CT on the left, the left pain may be something other than a kidney stone. This is one your personal physicians have to figure out. Sorry. Regards, Fred Coe

      Reply
    • Fredric Coe, MD

      Hi Tulshi, I cannot be sure from this distance. With a negative CT on the left, the left pain may be something other than a kidney stone. This is one your personal physicians have to figure out. Sorry. Regards, Fred Coe

      Reply
  9. linda martin

    Hi there., I wonder f you can help.

    I was admitted to hospital last week with s.eduevere pain in left flank. I had a CT scan which revealed a partial obstruction by a 6mm kidney stone in my ureter. I am now at home but still have intermittent pain in left flank every day and I have been advised not to drive long distances . I am taking Diclofenac for pain and Tamsulosin (pilot medication, usually prescribed to men) What are the chances of a 6mm stone in ureter being passed naturally, without the need for surgery and is there anything i can do to minimise the risk of needing to have surgery. Thank you. Linda

    Reply
    • Fredric Coe, MD

      Hi Linda, A stone this size may well pass, so let it be. Your urologist needs to be sure it does not obstruct your kidney too long – something you need to trust him/her about. The Tamsulosin helps relax the urinary tract smooth muscles by acting on the sympathetic autonomic nervous system. Your main purpose is prevention of more stones, and that requires a plan. Here is a reasonable one. Regards, Fred Coe

      Reply
  10. DL

    Thank you for the article and the effort in answering all the questions. I’m 48 and without warning passed my first ever stone last week, 2 mm. CT scan reveals a 1 mm parked in the same kidney. No pain from the remaining one and I do NOT want to repeat the trip to the ER, so I’m drinking all the water I can. Will read your prevention article ASAP. Thanks again.

    Reply
  11. Amy

    Thank you for this powerful and insightful article. I have a family history of kidney stones both maternal and paternal. I was first diagnosed in February of this year had a month of relief and then and passed a 5mm stone at the beginning of march. I started an acute episode today with pain around the bladder area and just slight flank pain. My questions are 1. Why is the pain always only on the left if we have two kidneys? 2. I drink water like it’s going out of style is it possible that despite the genetic factor could my water filtration system be contributing? 3. How besides drinking water can I prevent future episodes? I’m assuming don’t eat a lot of calcium enriched food but is there anything else?
    Again thank you for this amazing and insightful article and thank you in advance for your response

    Reply
    • Fredric Coe, MD

      Hi Amy, I would presume your pain is left sided because that is the side stones form on – presently. For stone prevention water is not enough. You need a full evaluation and focused measures. Low calcium diet has no place in such prevention. Regards, Fred Coe

      Reply
    • Matthew

      I just passed another kidney stone a week and half ago. My first one was 11 years ago. I also drink a lot more water than I used to albeit more recently (within the last 2-3 years). From what I understand and what the doctor told me at the ER is citric acid has been proven to significantly lower your chances of forming more stones because it changes the PH of your urine and causes it to become more alkaline. The doctor mentioned that I should squeeze lemon juice in water regularly and that should help. So as a result, I have decided to do that and drink lemonade regularly. I’m hoping this works because I’d do anything to avoid another one even if it is every 11 years.

      Reply
      • Fredric Coe, MD

        Hi Matthew, The idea is good but there is more. Some people need and benefit from potassium citrate, others have no need of it. Before doing something everyone needs to be sure about why stones are forming because you want treatment to focus on what is wrong. Here is a reasonable plan. If indeed your stones are calcium oxalate – not calcium phosphate or something else, and also if you have no systemic causes of stones, and if your urine citrate excretion is low enough to pose risk of stones – <400 mg/d, lemon juice could work, Crystal light, or potassium citrate pills. Citric acid will not help as it is metabolized without creating alkali; it is the citrate ion that is metabolized as citric acid, takes up a proton and produces alkali. THe higher urine pH is not what helps stones it is the higher urine citrate. Here are the trials. Regards, Fred Coe

        Reply
  12. Radо Keнаyov

    Dr. Coe.
    Thanks very much for the useful information. I read almost all of the posts on here. I too seem to fall in within the group with Calyceal non-obstructive kidney stones resulting in constant moderate flank pain. I had CT scan a week ago after insisting on it and the radiologist confirmed the presence of a 5mm stone in my right Kidney. Given the location, it was assumed that this perhaps the same 2.5mm stone that was recognized through a CT scan back in 2014 when I had minor neck injury. It must have grown gradually since then to a size that may have caused some pressure (who knows). My urologist insisted that this is not the cause of my pain, but I know my body and I recognize this pain from my previous, rather seldom, kidney stone dramas. I plan on scheduling an appointment with a surgeon to remove the stone, preferably with laser ureteroscopy if possible. Knowing the concepts of growing crystals (studied mineralogy/ontogeny of minerals for awhile) I would prefer not to have any tiny leftovers after the procedure, but I understand that is not always possible. Frankly, I don’t care if they think this is not the cause of my pain, but I will need the stone removed since it has the potential to grow even bigger. There should be more research on the is matter as it seems a lot of people have symptoms under similar circumstances. Do you think I’m doing the right thing? I appreciate your opinion and thanks for all your help provided to all of us poor-soul “stoners” :).

    Reply
    • Fredric Coe, MD

      Hi Rado, Given the pain resembles stone pain surgery is not irrational. I hope it works. We do need a trial of surgery vs. no surgery and I hope for one. Be sure you prevent more stones – I know you have read through the site; remember this one. Regards, Fred Coe

      Reply
      • Radо Keнаyov

        I went through a URETEROSCOPIC STONE REMOVAL. Luckily there was not need to break up the stone with the laser.After the surgery I had some nasty pain associated with the stent in my ureter but once removed everything was back to normal i.o no moderate flank pain. The bottom line, at least from my experience, is that kidney stones hurt even if they are not in the ureter. Again, I had calyceal non-obstructive 5mm stone. Thanks and good luck to everyone reading this forum.

        Reply
  13. Tim

    Third year medical student here. Thank you for the great article on this common condition. To help passage of stones is it recommended to drink lots of water, or will this cause hydronephrosis and worsen the pain and nausea due to blockage?

    Reply
    • Fredric Coe, MD

      Hi Tim, Yes, fluids are recommended – not a lot of data. Whether hydronephrosis worsens, along with pain and all depends on how much the stone obstructs at the time. You can see that pressures rise then fall again. Regards, Fred Coe

      Reply
  14. Sergs

    Dear Doc,
    I was diagnosed just 1 day ago having a 9mm uretheral stone. I DON’T have pain at all. My only symptom is when I void I feel something is still left.
    I was given a medicine (Harnal OCAS) to relieve the symptom and was ask to undergo shock-wave treatment.

    I am afraid of the suggested treatment due to its probable long-term effect on other organs.

    It is possible to pass this 9mm stone in the urether on its own? I am currently drinking lemon juice + olive oil + apple cider vinegar as per my friends’ advise since they too experience stones episodes in the past (but not this BIG).

    Among the available operational treatment for stones, is it advisable to pick ‘laser’ treatment?

    Thank YOU!

    Reply
    • Fredric Coe, MD

      Hi Sergs, a 9 mm stone is not likely to pass. Perhaps given your concerns your urologist might want to do ureteroscopy but if it is only one single stone of that size in the renal pelvis or upper ureter SWL is indeed a reasonable treatment. Be sure to seek prevention against more of these. Regards, Fred Coe

      Reply
      • Sergs

        Thank you Doc for a prompt response.
        Just a follow up questions:
        Why 9mm ureteral stone doesn’t cause me pain at all?
        What is the possibility if I waited til Dec 2017 to have my stone remove since I prefer to have it done by a specialized doctor back home (I’m currently out-of-the country).
        How safe is the shock-wave treatment as far as other organs near the stone is concerned (I’ve read some blogs saying it might cause diabetes in the future as it affects the nearby organs).
        Thank you and more power!

        Reply
        • Fredric Coe, MD

          Hi Sergs, Not all stones cause pain; it depends on how much obstruction and how sudden it was. As for waiting, only the physician caring for you can tell. If there is any kidney obstruction you can lose the function of that organ, so be certain your physician is willing to wait. As for diabetes etc, SWL does not cause it. Be careful!! Regards, Fred Coe

          Reply
  15. Heather

    Beautiful article! Finally, something extensive to take to my urologist to explain why my inch long (plus) chains of stones, in addition to plaques and free floating stones, may be causing my flank pain. I was formally diagnosed with MSK and nephrocalcinosis through lithotripsy and uteroscopy by the most wonderful Urologist…but once she moved, it has been difficult to explain the severity of my constant flank pain. Thank you!

    Reply
    • Fredric Coe, MD

      Hi Heather, I am glad it is useful to you. Pain from small stones is a world wide observation. Treatment is not as yet very well established. Regards, Fred Coe

      Reply
      • Noel

        I’m so happy to have read this! I thought I was going crazy! I’m in so much pain for over a week now and I knew it was a stone from past experiences. The ER doctor was trying to convince me the stone wasn’t causing pain due to its location. He was giving me an attitude almost, like I was there trying to get pain meds. Needless to say, he sent me home without anything and told me to drink water and see my urologist. My urology appointment isn’t until the end of next week and then by the time they set up without trip see it’ll be at least another week. Meanwhile I’m supposed to live like this? I finally got my doctor to call me in something today, which I can’t wait until it gets to the pharmacy. This is worse pain than childbirth!

        Reply
        • Fredric Coe, MD

          Hi Noel, If it feels like a stone it probably is something – either a small stone moving or perhaps one in the ureter missed, or even crystals. I would ask my physicians to help in looking for a source. Regards, Fred Coe

          Reply
        • Teresa Walker

          Same for me. Twice now. Doctors keep telling me that I don’t feel it it’s back pain it’s not my kidney I told him it’s my kidney they do a CT they see a kidney stone how did I know it was there if it doesn’t hurt it makes me very angry

          Reply
      • Donald Daugherty

        Dr. Coe. My daughter has had pain and nausea and vomiting for over a year. She’s spent 2 months in the hospital after a couple of surgical procedures, first a partial gastrectomy with removal of an ulcer, then a roux n y procedure to try and stop the nausea and vomiting. She has had a total hyst, a cholecystectomy, appendectomy.
        They say now that she has non obstructing stones on ct but don’t believe that is the cause of the pain which she describes as stabbing pain and like someone is burning her, along the upper abdomen just under the ribs. No pain in the lower abdomen at all. She does have difficulty urinating quite often and sometime is unable. I am waiting for a call from one of her surgeons to discuss this with him. Is there any advice that you can give me to get them to at least consider the stones as a possible source of the pain? When she had her gall bladder removed there were no stones, just a fine “sand” as the doc said but she still had tremendous pain. thanks.

        Reply
        • Fredric Coe, MD

          Hi Donald, This is a very worrisome situation: partial gastrectomy then a diversion procedure and three more surgeries beside. Two months in a hospital itself worries one. I urge outside consultation. Her physicians have done what they can do and she is still in a hospital and ill. If she is not in a university hospital consider transfer to one. It is not that private hospitals are inferior to those of universities, it is that when things become so odd and serious as you describe one may need that extra element that university centers can provide. From here I could not even guess at the possible causes and treatments for her. Regards, Fred Coe

          Reply
          • Donald Daugherty

            Thanks. She is in University Hospital in San Antonio and the Chief of Surgery is the one that has done her surgeries. The pain has remained unchanged despite the multiple surgeries and scopes. They did find an ulcer which I think we knew was present the last time they opened her up. It was on a Friday when they did the Roux n Y and then had to take her back on Sunday for emergency surgery because the pouch filled with blood and she aspirated some of it. Then they had to take her from the OR to Angio with her belly still open to try and locate the source of the bleeding, sealed off 2 places and left one that was leaking slightly. The kidney stones have been present on multiple CT’s with contrast and even though they are not obstructive I am concerned that with their presence and the unchanged nature of her pain that they might be related.

            Reply
            • Fredric Coe, MD

              Hi, She is in a fine hospital, and having a lot of trouble. The stones are not likely to be a key issue at this point but as I am far away and she is very ill I can only recommend the physicians there who do a lot of kidney stone work might want to come by and help decide. She is an example of medical complexity far beyond the reach of an outsider. I hope for the best for her, and send my prayers. Fred

              Reply
  16. RR

    Hey Doc, thanks for the article. i have had extreme pain in my left side two days ago it was unbearable i visted ER. they diagnosed me with ( Mild Hydronephrosis and upper hydroureter, by 5mm vesico ureteric stone). they told me to go home drink lots of water and do jump up and down. also prescribed me voltalin and flomax. the pain is still unbearable even with the voltalin. what i am worried about is if the stone passes the ureter and gets stuck in urethra. should i use the laser or ultrasound cure?
    Best regards.
    i am a 22 year old, 5.9 ft , 171 lb male

    Reply
  17. A

    Is it possible to pass stones without pain? I sometimes have black flakes and specks in my urine. Recently my bladder was bothering me a little. I assumed uti but I found what looks like a tiny kidney stone when I took a bath right after I used the toilet one night. How it got there, I don’t know lol. I saved it in case I decide to call my doctor. I know that’s the only way to get answers. But the fact there was no agonizing pain and only mild bladder discomfort is odd and goes against everything the internet says happens with stones. It stops me from calling my doctor because I don’t want to be told I’m crazy.

    Reply
    • Fredric Coe, MD

      Hi A, The best course is to have the material analysed. It may not be stone at all, in other words it may contain no crystals. If it is a stone, you should seek prevention, and not let matters progress. Regards, Fred Coe

      Reply
    • Mike Chambers

      “Is it possible to pass stones without pain?” Short answer, Yes. But I can usually retrieve them and pass em on to MD to ck. I’m a white 60 yr old male whose has passed a lot of stones over the last 20 yrs. Many passed. Several lithotripcies, 1 awful lithotomy, finally found an urologist familiar with Litholink, and got a med that almost completely stopped my previous 8 yrs of continual stone production. Due to low blood pressure the MD reduces the med and I started passing an occasional stone, with only a brief mild flash of pain as I passed it out b4 the clink of it hitting the ceramic toilet. I rinse em of and give them to the MD but they are the same old calcium stones I always pass. I was recenty taken off the hydrochlorothiazide completely due to complications (low blood pressure) taken with Carvedilol. In just 2 months the stones got bigger, from 1 to 2 mm up to 3 mm with no pain. But one, maybe bigger, is hurtin bad now.

      Reply
      • Fredric Coe, MD

        Hi Mike, Thanks for the useful note. Of course they can be without pain and your comment is a valuable point. As for the drug, it is probably acting by lowering urine calcium. If you cannot use the drug you can substitute very low sodium diet which will accomplish the same thing and perhaps with less symptoms. Regards, Fred Coe

        Reply
    • Gail

      Thank you for this question. I searched and found this article after my husband passed one this morning without pain. Everything I had ever heard was about how excruciatingly painful they are to pass, so I thought passing one without pain might be abnormal. Glad to read that others have had it happen without pain, too.

      Reply
  18. Niki

    Hi doc..its my uncle’s problem..he had severe flank pain about 9 months back n was diagnosed with ureteral stone 14 mm..he was given med n in a week it descended to lower ureter n after a few weeks of more meds n fluid..pain vanished and follow up xray had no visible stones..he was advised to follow up after 3months bt he completely forgot..after that he had been asymptomatic bt recently he developed mild pain over flank that reduced after fluid intake..is it possible the previous stone persisted and it might have done kidney damage??

    Reply
    • Fredric Coe, MD

      Hi Niki, It is possible and he should not have forgotten what his physician asked for. He needs to be reevaluated and hope the kidney is still alright. Regards, Fred Coe

      Reply
  19. vinay narayan

    My name is Vinay I have start kidney stones for 9 months I have really pain right & left side in scanning report the doctor say 3mm to 5 mm I am very sad my working is going to bad in my company please help me sir my number 9066300492

    Reply
    • Fredric Coe, MD

      Hi Vinay, I am sorry you are having such problems. Of course your personal physicians are the ones who have to provide your care. I will try to call you, however. Regards, Fred Coe

      Reply
  20. karthikeyanarjunan

    I am 25 years of age, being on June 2016 i have diagnosed with 5mm stone in my left kidney, i have been taking medicines and proper intake of food etc., and later in the mid of October 2016, i had a pain in my left lower abdomen and again consulted doctor and got scanned, but the result was positive as no stones are in my kidney.But for the past one month , i am having a pain in my lower left abdomen and once in week i get trouble in digestive issues and looking for the solution.

    Reply
    • Fredric Coe, MD

      Hi, Possibly the left sided stone is causing pain, or caused it; in June there was a stone, in October you say there was no stone so perhaps that stone passed. Do your physicians know where it went? Is it perhaps still in the ureter? I am afraid the information you offer is too vague for more right now. Regards, Fred Coe

      Reply
  21. Kim Teehan

    I have been dealing with severe, non-stabbing pain in the upper right flank area for almost two weeks. Did the CT scan a few days ago and it showed several free-floating, non-obstructive stones the largest of which is 3mm. I have been told by doctor, as others have, that these stones should not be causing the pain I am having, but of course they are – and the pain is real and debilitating!! Have increased fluid intake, but generally drink a lot of fluids anyway. Pain has made it difficult to work. The pain moves from upper right flank to waist from time to time, but no pain below the waist. I am 60 and doctor says that he thinks this is shingles, although I have no rash. His suspicion is based on the fact that examination showed that I was flinching when he pressed on painful area. Of course I flinched – the whole flank area hurts!!! I know he is just trying to do what he thinks is best, but I have had shingles before and this is not the same kind of pain at all. I have no idea what type of stones these are, but from reading this site, I’m not sure what the next step should be? I can’t stay on these pain pills and they aren’t helping the pain much anyway. Should I be asking for a referral to a urologist? Thank you for this informative site!

    Reply
    • Fredric Coe, MD

      Hi Kim, As you have read there is real controversy about the small stone pain issue but in all probability your pain is not herpes but related to the stones. One good question is whether the pain is related to motion – twisting, bending, lying, walking. Stone pain is indifferent to such, whereas muscle and skeletal pain is not. In the event it is likely to be from the stones the main choice is always your own: Is it enough to warrant the certain pain and effort of ureteroscopic removal? Regards, Fred Coe

      Reply
      • Kim Teehan

        Dr. Coe,
        Thank you – and the pain is not affected at all by the muscular/skeletal movements, and I have no issues with range of motion or movement – which I showed my doctor during my latest visit yesterday. Yet, he is insisting on an MRI of my spine because he does not believe this pain is associated with these free-moving stones. To have to incur additional costs associated with a test that I believe to be unnecessary is very upsetting. Is it possible for the stone/stones to eventually pass on their own with increased fluid intake? Or if they become “lodged or attached” to something in the kidney, does that mean that the only choice is ureteroscopic removal? Besides the obvious pain I have, would some other procedure, such as the CT scan I had, be able to determine that stones are “lodged or attached” to something, warranting the ureterscopic removal?

        Reply
        • Fredric Coe, MD

          Hi Kim, The stones may be causing pain. Whether to have them removed is a personal choice; surgery is itself intrusive and unpleasant so you have to weight out how much trouble the pain is vs. the undertaking of surgery. CT or other tests will not at this stage help in deciding if surgery will reduce pain. Regards, Fred Coe

          Reply
  22. Erin Chism

    I am a 35 yo f and have been getting chronic stones ( I have had several hundred ) over the past 16yrs. I have been seen by numerous urologists and nephrologists over the course of this time and none thusfar have been able to determine a specific cause or offer any sort of long term treatment plan. Various doctors have put me on medication that is supposed to slow the stone formation, but none have succeeded. In April of 2011 I had a right whole nephrectomy due to severe chronic kidney and uti infections and the almost complete blockage of my right ureter from scar tissue buildup. Before the nephrectomy I had never had a stone in my left kidney, always the right. Two months after the surgery I developed the first stone in my remaining kidney. Since then I have had close to 80 stones, so far as I can recall, and my kidney has almost completely shut down on me twice. Living with this and the not knowing has been difficult to put it mildly, but the way that I have been treated by physicians over the years has been almost worse in a way. I have been portrayed as a drug seeker countless times, been laughed at, and in a few cases doctors have outright refused to continue to see me. Going through what I have, and still am, has been difficult enough. Combine that with the ill treatment I have received and it has made the situation almost unbearable. I am now afraid to seek care when I need it for fear of ridicule, and I put off being seen until it almost always requires hospitalization. I hope that in years to come doctors will gain a more complete understanding of non obstructive stone pain and find ways to better treat patients who suffer from it. This report is one of the only ones I’ve read that lends merit to people who live with this and I thank you for it.

    Reply
    • Fredric Coe, MD

      Dear Erin, Your problem of accelerated stones is familiar to me as I have published several papers about such patients. But with all of the stones you did not say what they were made of. If they are simple calcium oxalate stones in the absence of systemic disease prevention is not difficult. If there is a more complex source, what is it. Prevention is crucial for you and must be pursued. Regards, Fred Coe

      Reply
      • Erin Chism

        They are Struvite

        Reply
        • Fredric Coe, MD

          Dear Erin, If they are all struvite they are arising from infection with bacteria that can hydrolyse urea to ammonia. This kind of disease requires special treatment that my site has not as yet discussed. Has your physician discussed specific treatment for these infection stones? If it is not possible for him/her to pursue prevention perhaps a referral can be made to someone convenient to you who can help. It is important that these be stopped. Regards, Fred Coe

          Reply
          • Erin Chism

            at the onset they were not all struvite, they started out as calcium but the past 9 years or so all the stones that have been analyzed have been struvite. my current urologist has offered no options for treatment so far. i guess then that my next step would be to ask for a referral. its just discouraging, going from doctor to doctor, when none seem to have the slightest clue how to treat me.. and if their is a treatment for this, like you mentioned, why have none of my previous doctors thought to try it? is their a specialty, like a nephrologist, that i should be seeing? currently i am seeing just a urologist.

            Reply
            • Fredric Coe, MD

              Dear Erin, if you once had calcium stones and now struvite, you have become secondarily infected. If the organisms producing struvite can be cultured – proteus, klebsiella, pseudomonas, enterococcus are usual – and are susceptible to antibiotics a course of properly chosen agents might clear things unless stones in the kidneys are infected. If cultures are negative you may be infected with a fastidious urea splitting organism and this needs to be searched out and treated. Acetohydroxamic acid is a nasty but effective aid that inhibits urea splitting and can be used while hunting and during definitive treatment efforts. Whatever, the stones are of bacterial origin and need to be treated as such. Regards, Fred Coe

              Reply
              • Erin Chism

                I did a bit of reading up on the various things you last mentioned and from what I saw I would have to lean towards the fastidious urea splitting organism you mentioned. I have had many stents placed over the years and many would become very calcified within the month of placement. I have also had two nephrostomy tubes, one of which became so calcified on the interior of the site that, because I was pregnant at the time, they could not remove it without opening the site up. The calcification regarding that took only a week to build up. They ended up leaving part of the tube in and placed another next to it until I gave birth and they were able to operate safely.
                While it may not turn out to be that, it’s the closest thing I have read as a possible link. Thank you very very much for shedding some light on this!

              • Fredric Coe, MD

                Hi Erin, I imagine they would have analysed the crusting on the stents and made cultures – check. If struvite is the culprit there is something living in you producing it. Obviously from your answer cultures are turning out unhelpful. Let me know, Regards, Fred Coe

  23. Joe DiCioccio

    Thank you for all of the in depth and helpful information Dr. Coe and thank you confirming that my pain is from a non-obstructing kidney stone.

    My urologist explained that since the stones were not near the left ureter that they are not causing the constant pain and discomfort of the last three weeks. And since I am also experiencing numbness and discomfort mid-front left thigh then the cause is lower back and sciatic nerve.

    Can non-obstructing stones cause the symptoms in my left thigh as well?

    Reply
    • Fredric Coe, MD

      Hi Joe, numbness is a sure sign of nerve origin of pain. WHereas non obstructing stones do appear to cause pain it is not in the thigh but usually in the flank region. Regards, Fred Coe

      Reply
  24. Kielan

    Hi I am 20 years and at 19 i discovered that i had kidney stones I had 9 in total in my left kidney which I had removed. the doctors have done most test, and a year down the line I have another 4. They are not sure why I keep getting them is there any way to prevent them. I have been drinking more and have changed my diet. The stones have varied in size the smallest 2mm to the biggest being 13mm

    Reply
  25. Jason

    I am in my mid forties and had my first bout with kidney stones in my early thirties. I have passed numerous stones in that time, with two being removed from ureter (on different occasions) after being struck for days. I can feel stones moving in kidneys sometimes. I have numerous 5 mm stones in left kidney currently. I was recently referred to my current urologist due to significant stabbing right kidney pain. Lithotripsy has been done twice breaking stones to 1mm and powder as of second round. The pain continues only on the right. It is daily and ramps up much most days throughout the day. It is debilitating kidney pain and is on the level of kidney stone pain within kidney when passing stones even though I am only passing kidney stone fragments. My Urologist says the same thing – no doubt I am in pain, but nothing is blocked. This is heading into fourth month and I am struggling to stay the course and stay out of ER. We’ve done blood work and urinalysis and CT and nothing sticks out except stones. Any recommendations for my discussion with my Urologist on “small stone disease”? The pain is real and I cannot tolerate much longer. Thank you so much for the article! It makes total sense to me.

    Reply
    • Fredric Coe, MD

      Hi Jason, Of course I am not personally a urological surgeon and far away from the reality of your situation, but perhaps your surgeon might consider going up with a ureteroscope and removing all residual fragments. The procedure is more definitive than shock wave lithotripsy, and modern digital scopes provide a very clear view. By the way I did not see 24 hour testing in your list. It will not show normal results, and I do not see the stone analyses. Take a look here, you may benefit from more detailed testing and prevention. Regards, Fred Coe

      Reply
      • Jason

        Thank you for your reply Dr. Coe. No 24 hour testing has been done and stone fragments were analyzed and are calcium oxylate. I will discuss the removal procedure with my Urologist.

        Reply
  26. Aarushi sharma

    Hi..i am aarushi. I was diagnosed with kidney stones last year and now i am feeling frequent pain due to stones. I have started to note the cause for it and one thing i found was whenever i consume alcohol the next day my stones start to pain. Please help me and suggest me what to do cause i think the pain is due to the stone movement(it passes out).

    Reply
  27. Vincent B

    Here’s my story. I’m 34 years old.

    Some months ago, I began to have on and off blood in my urine. i had no pain. After a CT scan, they found a 8mm kidney stone.

    On December 13, I had an ureteroscopy and they use a laser to burst it and installed a double j stent. The first days I had on and off pain and blood in my urine. They told me to remove the stent on Saturday which I did. After that, I had MAJOR pain, so much that I went to ER on Sunday and they gave me morphine. During the night I peed huge blood cloths (several centimetres) and since then the pain is still there (on and off) but it can be control by tylenol so it’s ok.

    After removing the stent, I began to saw small stones fragments in my urine (maybe 10 to this day). As if, with the stent installed, nothing passed except urine and now those huge blood cloths and small stones begin to pass after removing it. Notice that these huge blood cloths happened one time. Since I peed them, I had only very small “normal” cloths.

    When I was at ER, they did a x-ray and ultrasound and told me that I had still a 4mm fragment in my kidney and some smaller ones in my ureter. Since I’m back home, I peed another one that was 3mm without any pain to my surprise.

    1- Sometimes the pain is in the upper section of my belly and sometimes lower section. I suppose it’s because they are moving ? When they aren’t moving, there is no pain ? (if they don’t block ureter I mean).

    2- Now I saw this pattern. When I have no pain for several hours, my urine has less blood. If I begin to have pain, the blood comes back. How much time does it take for these fragments to pass ? I drink a lot of water. They told me the 4mm still in my kidney could pass next day or in 6 months… The smaller ones in ureter should pass by themselves.

    3- With all this blood I see in urine, is it dangerous ? I know that just a little of blood can impressive but nonetheless…

    4- And even if they go down the ureter, they can stay in the bladder for a while before getting out ? Am I right ?

    5- How can small stones (like grains of sand) can do so much pain ? They cannot block the ureter, they are too small… How can they stay in ureter for days ? I though the ureter was smooth. How can they stick to it ?

    Right now I have pain in my lower belly, near my bladder. I suppose one will come out eventually.

    thank you very much !

    Reply
    • Fredric Coe, MD

      Hi Vincent, Yes, tiny crystal fragments can cause terrible pain. You need medication for it until they have all passed. The bleeding is usually not quantitatively important however alarming. Crystals can adhere to ureteral and bladder surfaces. Most important, collect as many of the fragments as possible and see that they are all analysed to find out the crystals they contain. That is a key step in stone prevention. Be sure you are fully evaluated so you can prevent more of this. Here is a good starting place. Regards, Fred Coe

      Reply
      • Vincent B

        Thank you for your answer !

        I keep fragments with me but my urologist doesn’t want to analyse them. He said that one stone in 34 years is probably just “bad luck”… He said if I have more stones in the future, then we will analyse them…

        Reply
        • Fredric Coe, MD

          Hi Vincent – Analyse them; ignorance is not bliss. Analyses are not expensive. I do not believe in luck where disease is concerned. The world is filled with surprises. Regards, Fred Coe

          Reply
          • Vincent B

            I’ll keep them with me and I’ll analyse them as you recommend.

            Otherwise, it’s getting better everyday. I don’t have huge pain anymore. It’s more like discomfort from the kidney to the bladder. Probably because of the ureteroscopy, the stent and all the fragments from the last days/week. I suppose there is some irritation here. If I don’t think about it I don’t feel it so…

            There is less blood in my urine. In fact, I would say that half of the time there is no blood at all (at least to the naked eye). When there is, it’s a light right or kind of brownish (very little).

            I did not pee fragment for 2 or 3 days and the blood started decreasing at the same time. I don’t know if some are still there.

            Is this little blood I have from time to time can be caused by some fragments still there or after all this I can still see little blood before my body heals completely ?

            Thank you and merry Christmas !

            Reply
            • Vincent B

              oh and last question, I took flomax for 10 days. I had side effets like retrograde ejaculation. Now it’s been 4 days since I stopped taking it and the quantity of sperm getting out of my penis (instead of going to my bladder) increases but it’s still not perfect and I have some perineum pain when ejaculating.

              How much time does flomax stays in body or how much time before being like before ?

              Note that before I had absolutely no pain et ejaculation problem.
              Thank you

              Reply
              • Fredric Coe, MD

                Hi Vincent, Being an alpha blocker the drug can cause your symptom. The drug has an 18 hour half life although symptom persistence is noted for some weeks. It should go away. Regards, Fred Coe

              • Vincent B

                thank you again.

                My pharmacist told me that retrograde ejaculation is normal with Flomax but pain near the anus while ejaculating is not (seems to be the muscle that suppose to “expel” semen that hurts) …

                This pain appeared after 6-7 days of flomax but not sure if it’s because of it or the ureteroscopy or the stent

                Maybe I should consult again

              • Fredric Coe, MD

                Hi Vincent, Of course consulting with your physician is always worthwhile. Regards, Fred Coe

            • Fredric Coe, MD

              Hi Vincent, Surely the blood can come from all those fragments and outlast their passage by days or more. Regards, Fred Coe

              Reply
  28. William

    THE CONUNDRUM – Pain Without Obstruction
    “Stuck Stones do not Hurt!” Not!
    Short version- I have been going through this for quite a while, and that story is almost a mirror image of mine.
    Over the last year I have been beyond miserable, I have complained of back pain and urinary tract pain. I was diagnosed with hyperparathyriodism in my early 30’s, but due to my sub-par insurance nothing has been done. I have had stones in the past and have insisted in my own kinda passive way that this pain is related to a stone. (a 10mm 5mm and 4mm) but they have been stuck and stuck stones don’t hurt. I have passed several small stones during the same time period. I have been given pain medicine for a ruptured disk in my back, but I have known they were 2 different animals. 2 weeks ago I ended up in the ER again in more pain than I have ever been in in my life (thinking I would just be sent home after feeling belittled) but the 10/5mm had passed and were both stuck in my left ureter. I had the laser lithotripsy done and a stent put in, and spent a couple of days in the hospital. I have been on Flomax and had the stent removed last Friday, it has been real up and down, but something is different. I am still dealing with a 4mm stone, but Sunday I felt really quite good. Almost no pain on minimal meds.
    Is it possible? The only thing that has made me even slightly functional for quite a while has been pain meds. I am almost 6’3″ and got down to 140lbs because I could hardly eat for a while. Crushing depression with total lack of motivation. If I mowed the yard the pain in my left flank became out of control. I am 48 and am healthy, most people think I am in my 30’s, except for the fact that I have crashed and burned over what seems like half a lifetime. so drained and lost in what I have felt was most certainly the path to the end.
    Could it be true? Just #$%$#% stones?
    Wow…..
    William in Texas…..

    Reply
    • Fredric Coe, MD

      Hi William, lyes, stones cause pain, stuck or not, so there is no mystery about it. The worrisome thing for you is that you may indeed have primary hyperparathyroidism and if you do it must be cured because it is a systemic disease that can cause much harm apart from just stones. It is not an option to leave it, and no insurance company can deny surgery – it is immoral. That you can distinguish back pain from stone pain means you have an excellent sense, as they are indeed different. Prevention for you may well be parathyroid surgery – it is very safe, and almost always curative. Do not let anything stand in the way of that cure. Regards, Fred Coe

      Reply
    • MoPy

      I can relate. Stuck stones in the kidney can hurt and allow you to go on with your life with transient pain. Since everyone feels pain differently these may need to be taken care of through surgery too. Stuck stones in the ureter hurt like hell and have to be taken care of ASAP. I could not stand a 3 millimeter stone in my ureter back in March. Had a blasted it out with a stent put in. Now I just got a call today that I have a 7 millimeter stone stuck in the lower part of my kidney. I am in a lot of pain from the left side of my kidney to the left side of my belly button. I am a post thyroidectomy with one parathyroid removed and 3 kept in the last part of October 2016. At the same time I was diagnosed with hyperparathyroidism I was diagnosed with thyroid cancer. Parathyroidism needs to be taken care of ASAP. Keep in mind that a hyperparathyroid is handled by an endocrinologist not a urologist. Ask to be referred to an endocrinologist if you have not done so already. Thyroid cancer can grow a bit slower, be asymptomatic but can spread. Revisit the parathyroidism because that is the cause of the kidney stones. Ask for an appeal if get denied on receiving treatment. Do it please! Let us know how you’re doing!

      Reply
  29. Ppotse

    I have had one bout of severe colic 6 mo ago attributed to 5mm stone. recently after some chronic discomfort for a month identified a 1cm stone plus a bunch of other smaller ones right kidney only, I had flex laser lithoscopy, the doctor said he removed 6 stones by opening incision on lip of the chamber dividers and found no stones where he typically finds them in the chambers. Post op CT shows he missed 4 or more 5mm stones, he believes looking with radiologist that these are hidden in meat of kidney but were clearly a bit stumped and recommends only conservative wait and see. I don’t have a sense yet if my discomfort level is better than before but likely not worse. I could wait months like that but probably not lifetime. Any thoughts on how to proceed?

    Reply
    • Fredric Coe, MD

      Hi, I gather that CT scan showed multiple stones but on URS your surgeon could not see them. After the URS there were calcifications. This is indeed calcifications in the kidney itself, and probably large tubule plugs. Usually this occurs in calcium phosphate stone formers. The other possibility is Medullary Sponge Kidney wherein the calcifications are in cysts and are hard to see by URS. Stones are often calcium oxalate. In any event it is important to pursue prevention – here is a good guide. If a movie was made during the URS or perhaps from memory your surgeon might consider if the papillae has the blunt sail shape of MSK and whether yellow plaque was seen – see plugging article. Regards, Fred Coe

      Reply
    • Natasha Reed

      I am a 37 year old female that has been diagnosed with kidney disease. I have had nine surgeries on my right kidney to include lithotripsy, cystostomy, and a stent put in for a month. The total of nine surgeries resolved my pain momentarily (2 years) but I have been experiencing the same type of pain that I had prior to my surgeries. I went to see my urologist and he confirmed that I have a kidney stone in the same kidney that I have experienced all the issues with, but it was not obstructed and therefore should not be causing pain, but I am in a terrible amount of pain. After the visit with the uroligist I went to see my primary care physician as recommended, who said I had blood in my urine sample. I also told the primary care physician that I am in a terrible amount of pain/pressure when I go to the bathroom urinate and bowel movement. Any advice?

      Reply
      • Fredric Coe, MD

        Hi Natasha, I discarded the copy of your note leaving just one to post. You say you have kidney disease, but I think you mean stones with a lot of procedures but otherwise normal kidney function. With nine surgeries on the right kidney and present pain and a stone, I would be concerned the stone is causing pain perhaps by producing obstruction on and off. This is challenging to interpret from far away, as I am, but perhaps given so many procedures and new pain, and uncertainties about what to do you might want to ask for and obtain a second urological opinion. I am sure your physicians will be happy to help arrange for this. Regards, Fred Coe

        Reply
        • Natasha Reed

          Dr. Coe thank you for your help and support. The PCP prescribed me flomax in efforts to assist me with passing the stone as well as pain medication. I am a little hesitant to take the flomax because in the past when I have passed a stone it has be extremely painful and I got very ill, not to mention the PCP didn’t consult with the uroligist about this medication. I do know that I have numerous calcium deposits. Is that from not enough water consumption? I am definitely interested in prevention at this point. Thank you again for you time and dedication to these issues. God bless

          Reply
  30. Ashley

    Hi Fred,
    I am three months postpartum, and have had two kidney infections within a month and a half of delivering my baby. The first time I had pain in the right kidney and was treated with oral antibiotics. The second time I was hospitalized and given antibiotics intravenously. After being released from the hospital I saw a urologist who ordered a CT scan and placed me on a low dose of antibiotics that I am to take every night. The nurse sent me a message saying that I have two stones and a cyst. I haven’t been able to speak with the doctor or the nurse and am not expected to see the doctor until the middle of January. At that time, the urologist wants to do a scope of my bladder (something the urologist decided to do prior to ordering the CT scan). I am wondering what the purpose of the bladder scope would be and if it is really necessary. My thinking would be that the kidney stones are causing the infections, so there would be no need to do a scope of the bladder (I am prone to UTIs, and am not comfortable having the scope done because I am concerned about it causing more trouble). What are your thoughts on the bladder scope?
    I am also wondering if all types of kidney stones cause kidney infections or if only a certain type of stone would cause an infection.
    Also, I drink a hot cup of lemon water each morning (8oz of water, juice of half a lemon, T of honey, and 1/2 tsp of turmeric powder) could the lemon juice have caused the stones? I am also drinking apple cider vinegar because I read that it could possibly help with kidney stones (about 2T or so twice a day). Would drinking apple cider vinegar be harmful or possibly cause more stones?
    Since having my baby, I have been eating smoothies that contain almond milk and spinach….could this be the cause of the kidney stones in a matter of months? I am willing to change my diet any way I need to in order to prevent stones in the future, but I wasn’t sure if I should stop with the lemon water and the apple cider vinegar. I won’t be consuming spinach or almond milk from now on as per the list on this website.
    I am experiencing some discomfort in my left kidney…it’s certainly not painful, but not comfortable either. Does this mean the stone is just staying in one place and not moving? Would this indicate that the stone is too large to pass? How long could it take to pass a stone? I drink approximately 104 oz of water everyday because I am nursing and have done so even before my baby was born. I am confused that I would develop any kind of kidney problem when I drink plenty of water.
    Thank you for this website and all of the information…I’m completely in the dark on this matter because my doctor didn’t even call to talk to me about the results of the CT scan. I only got the brief online message from the nurse. Thank you so much for any advice you could offer.

    Sincerely,
    Ashley

    Reply
  31. Britney

    I’m 27 years old . I have cystinuria. I produce cystine stones. I just had 2 ureterscopys and 1 lithotripsy back in april 2016 and may2016 3cm stone in my right kidney causing obstruction for at least 2 years. Kept getting misdiagnosed. Anyway finally found out I have cystine stones back in may. After the 3rd surgery one the one stone I was finally a lot better. Now 6 months later I have another cystine stone but in the left kidney 1cm in size but they said it’s in my lower pole kidney and it’s not obstructing . I’m nauseated a lot of days and I have pain in my side/back where my rib cage is but I was told I couldn’t be in any pain nor could I be nauseous from the non obstructing new stone. Urologist said I’m not going to go clean you out right away for your body just to do the same thing again. He also said I can guarantee you that the stone isn’t gonna go Anywhere but I had a 3cm stone move and make me really really sick in the past please help any advice appreciated

    Reply
    • Fredric Coe, MD

      Hi Britney, Cystine stones can grow rapidly and get large. They can be prevented and dissolved but are a special part of stone disease. Prevention needs to be started now, and pursued life long. Ask your physician what his/her plans are for this and begin as soon as possible. Very high urine volumes, increase of urine pH with alkali, reduced diet sodium intake and reduced diet protein are first line; medications can be added but are complex and have side effects. See your physician about prevention right away so new stones do not grow back. The pain could be from infection, from the trauma of the procedure, or from the stones – they can cause pain sans obstruction. Regards, Fred Coe

      Reply
  32. Tom

    I was diagnosed with a Kidney stone two week ago 11/15 in ER and had a CT one week ago 11/22 which indicated a backup of fluid in my kidney and a small stone about 1/3 down the ureter and I’m scheduled to have stone removed next Tues 12/6 (ureteroscopy). My concerns is that I have not been very good about using strainer during urination and for past three day I have had no pain at all and I feel 100% so I guess that it is possible that I passed the stone unknowingly, but my questions is would it be reasonable to have a stone in the ureter and have no pain at all for this long?

    Reply
    • Fredric Coe, MD

      Hi Tom, It is possible to have a silent obstruction, also possible that the stone moved. Before any surgery your physician will confirm that the stone is there or not. Do not under any circumstances assume it is gone and fail to have physician followup as chronic obstruction neglected can destroy the kidney. Regards Fred Coe

      Reply
      • Tom

        Hi Dr. Coe, Thank you for the quick response. One other question – you indicated that before the surgery the doctor will confirm that the stone is still there – is that accomplished via a conventional Xray or Cat Scan? Much appreciated…

        Reply
  33. Mo

    Hello, I have a 1.2cm stone (yikes!) that is partially lodged at the beginning of my ureter but certainly not going any further. My surgery is not for a few weeks. I visited my urologist after a lot of on and off again blood in my urine. She was shocked that I had not been in pain. I, of course, was relieved. However, I have now started to have bouts of severe/ crippling pain. There is no infection (I had bloodworm to check) but a lot of pain and a lot of blood. Is there anything besides drugs and drinking lots of water that I can do to help relieve the pain. Does excessive water even help considering there is no way that this stone can pass naturally? Thank you!!!!

    Reply
    • Fredric Coe, MD

      Hi Mo, A stone this big needs surgery. Given all your pain, I would think the surgery needs to be sooner. I see no reason why it is not apart from OR schedules but this much pain should be a major factor in getting the work done. Water and such are not reliable in that the pain is coming from obstruction by the stone. I would also be worried about the obstruction and perhaps a new ultrasound might be something your physician would want to do. regards, Fred Coe

      Reply
  34. Herbert Baker

    I have pain in kidney on right side. No obstruction with urine, at first I had heavy dizziness when standing up. Any advice, please, and thankyou.

    Reply
    • Fredric Coe, MD

      Hi Herbert, pain on one side need not be from the kidney, and dizziness likewise. You need to have your physician figure out what is wrong. Regards, Fred Coe

      Reply
  35. Yvonne Ortega

    Hello Dr. Coe
    I am a 64 year old female. I spoke with my OB/GYN about recurring pain in the right flank area for the past six months. She ordered an Abdominal Ultrasound, which revealed a kidney stone. What concerns me is that, at it’s worse, it is extremely painful, however I fall into the Pain Without Obstruction category. Upon urination, my urine is brown in color and somewhat cloudy. I’m scheduled to see a Urologist in the next few weeks and would like to know what I might say to him to help rid me of my pain without pain pills. Another question is that is it possible that my RA medication could be causing these stones? I take an IV infusion every six weeks of 800 mg of Remicade. After reading all the testimonials, I’m not very optimistic and not looking forward to my appointment. I thank you and I am anxious to hear your thoughts.
    God bless, Yvonne

    Reply
    • Fredric Coe, MD

      Hi Yvonne, I am sorry to hear about this stone. Ultrasound is not as sensitive to stones and the anatomical issues associated with them as are CT scans, and I suspect your urologist will want a CT scan prior to any surgical intervention. There is bleeding, pain, and perhaps infection – I would have the latter checked. I presume the stone is in the right kidney but it may be in the renal pelvis, and intermittently block outflow which can produce severe pain. Such stones are amenable to possibly shock wave lithotripsy and certainly to ureteroscopic fragmentation and removal. A PubMed search for remicade AND kidney stones gives no publications so it is very unlikely the drug is playing a role. Regards, Fred Coe

      Reply
  36. Augustine. AA

    I was diagnose 3 stones in my kidney , 1 at the right side and 2 at the left side. The doctor advice me to keep on drinking excess fluid like water cos it will help pass the stone through urine. I want to know what always Precipitate the pain. I drink a lot of alcohol, I have Sex almost everyday cos am living with my girl friend. The last time i nearly died of the pain, i was taking a bottle of beer, before they pain came. In-fact it was an emergency for me that day. I was rushed to the hospital. The doctor was confused, he was thinking that i have been poisoned , later he administered buscopan injection with some strong pain reliever before the pain subsided. My question is i need an advice, What causes the pain. ? is it alcohol, or sex? or any kind of strenuous activity? No 2, what other kind of medication can help to dissolve the stone? Help me doctor with dew respect, or anybody in this room. Thanks. stay blessed.

    Reply
    • Fredric Coe, MD

      Hi Augustine, If the stones are causing pain, a likely idea, it is that they obstruct the kidney. Intercourse and alcohol are not able to affect whether stones obstruct or not and are not the reason for the pain. If the stones cannot pass your physician can remove them. As for dissolving stones, it is not necessarily possible. The real issue is to prevent more. Regards, Fred Coe

      Reply
      • Augustine. AA

        Thank you so much MD Fredric Coe, Am very very grateful for your candid medical advice. Stay blessed.

        Reply
    • Fredric Coe, MD

      Hi Augustine, If the stones are causing pain, a likely idea, it is that they obstruct the kidney. Intercourse and alcohol are not able to affect whether stones obstruct or not and are not the reason for the pain. If the stones cannot pass your physician can remove them. As for dissolving stones, it is not necessarily possible. The real issue is to prevent more. Regards, Fred Coe

      Reply
  37. Anita Watkins

    I have a 9mm stone, first identified as a 7mm in 2012. They tried EWSL back then but couldnt find it on ultrasound or xray on the day of the procedure. Today, Nov 7, I tried to have a utersocopy done to remove the stone as I have had multiple UTI’s with blood in the urine and bilateral hydronephrosis. The dr said he could not find the stone, that it must be in the “meaty” part of the kidney. He did say the hydronephrosis that was on two CT scans is better, but I have been in pain for months and really want the stone gone! Should I consider the surgery through the back? Or do you think that will fail too? Should I try another urologist? Should I just live with the stone and in pain?
    Your website has been very informative and helpful! Thank you very much for your hard work!

    Reply
    • Fredric Coe, MD

      Hi Anita, Quite possibly the calcification on CT is indeed a tissue calcium deposit that cannot be reached via ureteroscopy. That is not rare. Such a deposit would not cause hydronephrosis. It is not necessarily important to remove such a deposit, but I do not know what kind it is from your description. I would not simply suffer. I imagine your urologist, who has worked hard trying to be of help, would appreciate a second opinion, and would help you locate an appropriate person for that purpose. Regards, Fred Coe

      Reply
      • Anita Watkins

        Hi again, I did end up getting a second opinion. It turns out I had a calyceal diverticulum. And, the “big” 7-9mm stone turned out to be lots of little stones. So far, I have passed over 40 stones, ranging in size from 1-3mm. The dr was able to retrieve some larger ones, but not much larger than that. I asked him when he removed the stent why there were many small stones instead of a larger one and he said he had no idea. He is referring me to a nephrologist. He also did not have the analysis back yet for the stones. I was really hoping this last surgery would help the pain, but at 2 weeks post-op, it has not. I still feel the same “kidney stone” type pain (in my back, side, and groin) that I had before. I would appreciate any thoughts you might have. Thank you in advance!!

        Reply
  38. christy

    I went to the urologist for an 8mm kidney stone he was subpost to do surgery on the 2nd of November but my blood work was off anyway he had gave me 40 7.5 norcos for my pain at that time and now he is saying I shouldn’t be in pain because my stone isn’t obstructed and now that the surgery has been moved till the end of the month he won’t help what can I do it really does hurt and it makes me very angery that he doesn’t believe that

    Reply
    • Fredric Coe, MD

      Dear Christy, You are in a large group of people with chronic pain from non obstructing stones, and physicians are unsure what to do. Even those who are very involved with the matter cannot in the absence of a trial know if surgery will in general improve matters when there is no obvious obstruction. It sounds like your surgeon plans to remove the stone. I hope it helps and I am sorry that the surgery is being delayed. In your case, given the size, is it possible that indeed the stone is obstructing the urinary track on and off? If so, it would be better to remove it sooner. Regards, Fred Coe

      Reply
  39. Bruce Berin

    I am a 58 y/o white male, recently admitted to hospital for kidney stone. After having blood in my urine I originally went to my PCP whom did not think it was a kidney stone. He checked sample and found that I had heightened white blood cells. PCP was to send sample to lab (Thur) and get back to me on Sat (Never heard from PCP) on Sunday night of course around 8:00 PM EST I just wasn’t able to get comfortable and pain began to increase. By 9:00 PM I was unable to get comfortable and took 2 oxycodone with no relief. Due to previous medical condition (Last March 2015 suffered from Aortic aneurism which then went to a dissection of the aorta) I went to the hospital that had treated me which was further away than local hospital. In ER B/P was 210/90 staff asked if I suffered from HBP? Only in pain. Dr prescribed Tramadol and Morphine which did nothing for pain. Ct Scan 2x first one without contrast and 2nd with. No evidence of Kidney stone, referenced previous ct scan and could not find stone. Evidence lead to stone Inflammation to Kidney and urethra. Blood cleared and 2 days later discharged. That was 2 months ago. Still have slight pain to right testicle area as though you sat wrong. And suffering from pain to the lower back nearly continuous. Had PSA level checked and found that PSA was at a 5 or 6.. Cardiologist did not want to take me off Blood thinner for biopsy.. DTE was done and did not feel any irregularity and felt biopsy could wait. My concern is lower right side back pain that wakes me up and the pain to the testicle. At hospital urologist offered to have a camera inserted and put through penis to look. This does not sound assuring.. Any suggestions?

    Reply
    • Fredric Coe, MD

      Hi Bruce, Although I am far away and have no first hand knowledge of your situation pain radiating to the testicle and of the character you describe sounds lot like a possible stone. I agree with your physician that if you have continued trouble digital ureteroscopy is a reasonable idea. Of course, I assume that ultrasound has assured everyone that the kidney is not obstructed. To look or not is a complex surgical decision and of course your decision as well. Regards, Fred Coe

      Reply
  40. Michelle

    I just saw a urologist about a half hour ago about a stone that the CT scan September 27 showed to be about 3mm. I had kidney stones in the past. I have pain in my left flank, the dr told me that she is baffled because I shouldn’t be having any pain due to the stone being in the kidney. Which is still visible on the x-ray. This is frustrating I do not take pain medication I try to tough it out. It is affecting my daily life. I feel as though even though I showed her a picture of a stone i passed prior to the CT scan
    she still didn’t believe me.

    Reply
    • Fredric Coe, MD

      Hi Michelle, You are part of the emerging and exasperating problem of small stone pain. Most surgeons are beginning to think small stones can and so cause pain, but then there is the big decision: It surgery really appropriate being always some risk and a lot of trouble to patients, vs the problems and miseries of chronic pain. We need a trial that will take a while and be hard to do. In the meantime all we have is the ancient nostrum: IF the pain becomes severe enough you feel the problems and risks of surgery are the lesser evil – including the real risk that surgery may not help – your surgeon can help you decide. In passing I want to emphasize the best way of all is prevention. Be sure you have been properly evaluated and treated for that purpose. Regards, Fred Coe

      Reply
    • Michelle

      If you are doing a study/research I would be willing to assist.

      Reply
  41. Cassandra Boriboune

    Hi, I am 33 years and have been suffering with Kidney stones since I was about 20. I have seen a few urologists and have had blood work and 24 hours urine test done which all come back normal. I have also lithotripsy done ones. None of the urologists that I have seen can give me a reason for my stone. I just get told that my kidneys make very small stones. My last CT showed about 20 small stone in both of my kidneys. I have pain that comes and goes for the last 13 years, most of the time I just deal with pain until it goes away or I pass a small stone. I have found that when the pain gets bad heat and pressure on my Kidneys seems to help or chugging 2-3 bottles of water. I have had to stop using Ibuprofen because it seems to make the pain worse vs better. I have been dealing with this for so long and hope this not something that I will be dealing with for the rest of my life. I am hoping you can shed some light on this for me and maybe give me some suggestions or help.

    Reply
  42. Lisa

    I have had a long history over 7 years of occasional pain when I wake up on my left side. The pain is immediately relieved when I lie on back on my right side and doesn’t cause any other symptoms in the daytime.. I had a ultrasound done back then which was read as “possible vascular calcifications”. Then a couple years later I had an Xray for other reasons, and the radiologist said they were possible stones.. My ?’s are 1) should I get it further worked up/do they need to be treated? 2) is there anything besides increasing fluids and avoiding stone forming foods that I can naturally do to encourage the stones to dissolve? Is there any truth or logic to the olive oil/lemon/apple cider vinegar method?(I did see the other thread). Thank you!

    Reply
    • Fredric Coe, MD

      Hi Lisa, I would suggest a CT scan – stone protocol – which has great sensitivity in detecting stones. If there are stones, it is best to follow an organized path to prevention. Here is one I like (because I wrote it). The world abounds in remedies that will prevent stones via magic, but they are unnecessary because fairly simple measures work and are in fact the diet portions of such measures are keys to good health in general. Let me know, Regards, Fred Coe

      Reply
      • Lisa

        Hi Dr. Coe, Thanks for the response. Sorry for the delay here. I looked into this. Do you think the low radiation stone protocol is OK? Is that widely used now? I’m afraid of the radiation effects, then again, I do want an accurate diagnosis since the implications of renal artery calcifications do not sound good either. Thanks-I happen to be a physician (who probably doesn’t drink enough water 🙂

        Reply
        • Fredric Coe, MD

          Hi Lisa, Low radiation machines are good, and the view can be kidney limited with shielding elsewhere, so I think it is a good bet. About the water, just be sure you do get a proper evaluation, physician or not! Regards, Fred

          Reply
  43. Nafisur

    I have stone in kidney for last 3 years and I am using regular medicines sometimes not , because I hate medicines.But it is very painful, need to get ralief can I get relief from stone? Please give me some idea to get relief.i will be very thankful to you.

    Reply
  44. Charles Dee

    Hx of oxalate stones in early-mid 20’s. Mixed benefit from lithotripsy. Passed 5mm stone. Had one remaining 3mm asymptomatic lingering stone. Didn’t think much of it. 12 years later (now) have had 3 month Hx of intermittent left and right testicle pain. Nrml labs and ultrasound. Recent CT rvealed stone is now 3x6mm in middle pole.
    1. This the possible cause of pain?
    2. Given the dimensions, this more likely to pass than 6mm round?
    3. Can you comment on lithotripsy vs ureteroscopy for size, location, and composition?
    Thank you for your time.

    Reply
    • Fredric Coe, MD

      Hi CHarles, testicular pain is not rare from stones. A stone can always cause pain, often intermittent. From here it is hard – impossible – to make a serious recommendation about surgery, but in general modern ureteroscopy is proving superior to shock wave lithotripsy. You seem to have only one stone, of modest size, however, so the choice is difficult. Probably either modality will work. Whether surgery will cure the pain is impossible for me to assess as an outsider. Regards, Fred Coe

      Reply
  45. john

    what about 7.8 mm stone .is there any quick pain reliever for kidney stone of size 7.8 mm .

    Reply
  46. Raj

    Hello,
    what about a 4mm stone in the lower pole of a kidney with mild fullness in the other kidney and hematouria as well? Sometimes there is a burning sensation while urinating. The doc prescribed norfloxacin and nothing else. Pain is normally in the groin region. But ultrasound (KUB) showed no obstruction. Please suggest. Thanks

    Reply
    • Fredric Coe, MD

      Hi Raj, This is complicated. The lower pole stone is not likely to cause urinary symptoms or groin pain. Perhaps you are infected, perhaps crystals are forming in the urine. Here is a place where the only good advice will come from your personal physician who has your CT scan, and can look at your urine under a microscope. Regards, Fred Coe

      Reply
  47. Don Ballje

    I have been suffering from kidney stones for over 30 years. Had lithotripsy through UofC in the 80’s when only NW had a device, that was with water. Had ultrasonic lithotripsy about 8 years ago for a stone the size of a small marble when I was in Philadelphia. I moved back to Chicago in 2010 and my regular doctor prescribes pain killers since I pass one every other month or so. I recently decided to see a Urologist because this current pain has been lasting for a couple of months now. KUB, CT-scan all confirm kidney stones, the largest being 5mm. But my current Urologist does not believe I have pain since there is no blockage so I fall into this conundrum. The pain I have is the same pain I have had for all these years and goes away when I ultimately pass the stone. But since there is no blockage, no pain killers from this Dr. which is the only thing that helps. Should I change Urologist’s? I’m not a fan of taking pain killers because of the gastro issues that I suffer but it is the only thing that helps. What do you suggest?

    Reply
    • Fredric Coe, MD

      Hi Don, You are indeed in the midst of a controversy. Physicians are loathe to use chronic narcotic, for reasons medical and reasons arising from the unfortunate criminalization of narcotic drugs by the ‘War’. But in fact, it sounds like you have accumulated many stones and have pain, and the pain may indeed be arising from the stones. I would think you would want both serious prevention efforts to halt further buildup and perhaps ureteroscopic removal of the stones. Perhaps your personal physicians might be helpful in this regard. Regards, Fred Coe

      Reply
      • Don Ballje

        Dr. Coe,
        Thank you very much for your reply, I think I’ll print this and give it to my Urologist but I’m sure he still won’t agree. And yes, my personal physician of 30 years understands and provides the pain relief. Believe me, I am very aware of the dangers and misuse of opiates. Since I DO only use them when needed, it causes havoc on my system but I have not choice. My only other hope/wish at this time is that this condition gets put on the list for medical marijuana because that helps me with low grade pain more than anything and then I don’t have to use the opiates with their associated side affects. My Urologist at the University of Pennsylvania was great because he is a stone sufferer as well – I think that should be a prerequisite for those that treat kidney stones but I don’t wish this on anyone. I have used Potassium on and off for many years as it is supposed to prevent stones from forming but it hasn’t seemed to work for me. Thank you again, at least I know there are some out there that understand – wish I lived closer to U0fC!

        Reply
        • Don Ballje

          And I just read your article on prevention. Great information – Thank You again. I do have my stones analyzed as my personal physician recommends and every time I am able to retrieve one (and i try even if it means grabbing them from a public toilet) they have all come back as calcium oxalate. Your information is fantastic and I appreciate the posts. Best regards, Don Ballje.

          Reply
  48. Gene Price

    I was just diagnosed by CT with 2 stones in left kidney, 7mm and 8mm one in tube and one still in kidney. Went to doc because pain was bad. That was 4 days ago. No pain. Is that normal? It started with dark urine. No problems with stream. Now urine is clear. What is going on? Do I really need the stones removed or have they dissolved? Thanks for your response.

    Reply
    • Fredric Coe, MD

      Hi Gene, The one in the ureter needs to be managed by your physicians. The one in the kidney depends on where it is and if it is obstruction within the kidney, or causing pain, bleeding or infection. There are complex decisions but this is what your physicians need to determine. If the stone in the kidney is doing none of the aforesaid it can be led ft in place. Regards, Fred Coe

      Reply
  49. juby

    I had been diagonised with a 7.2mm stone 12yrs back and it was removed with endoscopy. Now I’m diagnosed with a 6mm stone in left ureter(mid), 2 months back. The doc believes that it should move out with medicines and fluid intake. I had a follow up a month ago and it has moved to bottom without any pain. But today, I have an excruciating pain and frequent urination and even constant bowel movements. What does it indicate? Can u help me to know it doc?

    Reply
  50. Connie Eiden

    Re: small stone syndrome
    I think only flank pain was discussed. Is it possible for a stone in the kidney to cause chronic lower back pain? I have a 4mm stone in my left kidney that was seen on CT 2 yrs ago when a stone in my rt kidney had to be removed. I do have Lumbar spine issues that were diagnosed by MRI but you can never tell what if anything is actually causing the pain. My urologist wanted to do Litho at the time but I declined. If I knew that the stone is responsible for this misery I would do it, or rather, ask for Ureteroscopy.

    Reply
    • Fredric Coe, MD

      Hi Connie, This is tricky. Stone pain can radiate but low back pain is more likely than not to be from the back itself. Your physicians can examine you and make a judgment. Likewise a physical medicine physician. Regards, Fred Coe

      Reply
  51. Ashley Sexton KY

    I am 31 years old and I have suffered with kidney stones since I was 16. I almost cried when I read this article. I have been told I was crazy, just looking for pain meds, and everything you can think of. I have gotten so used to the pain I don’t even know when I have an infection anymore until I am running a high fever or my urine smells so bad. I have been told more times than I can remember that yes, there are several stones in the kidney but they don’t seem to be moving so, I shouldn’t be in pain.I have been to more urologist than I can remember. It has gotten to the point to where I don’t trust them. Why do doctors not think that a foreign body located in your kidney can cause you pain? A gallstone can cause you pain. I believe that I am printing this article out and going to find a new doctor.

    Reply
    • Fredric Coe, MD

      Hi Ashley, It is very important to discuss your own personal situation with your physicians. Infections can involve stones and in some cases removal of stones can reduce infections. But you do need physicians to help you make this kind of important decision because surgery is a major undertaking. But, yes, stones can cause pain and infection, bleeding and obstruction, as you say. Regards, Fred Coe

      Reply
  52. shubh

    I have non obstructing kidney stones in both of my kidneys for 2 weeks.(size-5,7mm). My doctor advise is to drink plenty of fluids with some prescribed medications. But how do I know whether i have passed those stones or not. Will there be burning sensation during urine (I feel burning sensations during urination). How long will it remain. Even after urination it also feels like burning for few minutes. Is it normal or some kind of infection?

    Reply
    • Fredric Coe, MD

      Hi Shubh, I gather you just found out about the stones – they would have formed in a prior period of time. Passage or not is usually obvious – lots of pain, not subtle. Ultrasound monitoring is always a good way as well. The burning may be from crystals meaning you have excessive urine supersaturations. Here is a good way to go about prevention – stones and crystals, too. Regards, Fred Coe

      Reply
  53. Art

    Is it normal for pain to be very intermittent? I was diagnosed about 48 hours ago now with a 2mm stone through a CT scan. Apparently it had already moved halfway down my ureter. I will be pain free for hours at a time, then have an hour or hours of very bad pain in my flank. The ER PA wasn’t clear on whether I should drink a lot of fluids to help it pass, but I feel like I should. Thoughts?

    Reply
  54. Rob

    I have kidney stone problem that when I go to the CT scan and x-ray they cannot find any kidney stone even they do the urs cannot find any kidney stone but the kidney stone is visible in ultrasound from 0.7 eswl til 0.3 mm but after a lot of session of eswl the kidney stone still in that exact position on the top of kidney near ribs still 0.3 won’t broken down. I have flank pain in the left kidney and nause when pressed the kidney. It’s been 6 months. What’s the recommendation? Thx

    Reply
    • Fredric Coe, MD

      Hi Rob, If one cannot find a stone on ureteroscopy or CT there is no stone. I do not know what the ultrasound is showing but it is not likely to be of importance stone wise. I would not have more SWL sessions for an ultrasound finding unconfirmed by CT and also by URS. The nausea from pressing on the kidney is not a sign of stones. I would stop. Regards Fred Coe

      Reply
  55. Lance

    I have a ~2mm stone (for 2 months) in the ureter how can I know if its obstrucing or non-obstructing. If its non-obstructing is it really necessary to have it removed?
    Regards

    Reply
    • Fredric Coe, MD

      Hi Lance, Ultrasound testing is usually fine for that purpose. The question of what to do with a lodged stone after 2 months is very individual and something your surgeon will have to answer. Your only work is to be sure and stay on his/her radar. Regards, Fred Coe

      Reply
      • Lance

        UPDATE: Maybe this could be helpful for others, maybe not. Originally, after serious pain (ER) I was diagnosed with 1mm and 2mm stone in the ureter. After a month, they had not moved and the Dr wanted to use a scope to remove them. They were not causing any pain but the concern was that they could still cause kidney damage. I put the operation off and yesterday (Sep 5) 3 months following the 2nd consultation, there were no stones. I was super happy about that, especially since I didn’t have any pain. They either passed or just dissolved (no idea), but it took time. I opted for a more wait, drink lots of water, exercise, and pray to Jesus that the stones would go, however the Dr was more into more invasive procedures. In my case, either approach was probably correct. Point being that you have to do you best to find the way ahead for you. For larger stones I am reasonably sure a procedure would have been required, but that was not my case. Had they still been in the ureta, I am still not sure what I would have opted for but I didn’t need to make that decision. Hope that helps some one.

        Reply
  56. belete

    my doctor told me there is tiny kidney stone in my kidney and can remove by water easily .but is it remedy and what is other alternative quickly remove?

    Reply
    • Fredric Coe, MD

      Hi belete, Water is wonderful for prevention of new stones but is unlikely to dissolve a stone. Nothing I know of will actually remove a stone. But if is not causing obstruction, pain, bleeding or infection there is no reason to do anything about it. Perhaps you might check with your physician to be sure it is not doing any of those four things, and if not perhaps simply leave it alone. But if you have formed a stone, high fluid intake will tend to prevent more, and I think that is what your physician was saying. Regards, Fred Coe

      Reply
  57. Anumika

    Yesterday when I was in my office, there was a sudden onset of a horrible pain on the left side of my waist, a pain that I has never ever encountered. I even slightly fainted suddenly and lost control of my legs and felt down. Later I was given IV and 3 more injections and the pain subsided after 4 hours. I underwent an ultrasound and was diagnosed with a kidney stone of 3.7 mm wch had shifted down and now at any moment can enter the bladder. There was swelling in the kidneys which had caused that excruciating pain. It was hell. I have been given medicines and have been asked to drink lots of water so as to make it pass through urine. I want to know, how many days will it take to pass and when it will enter the bladder, is it going to hurt? Christ, I don’t want that pain again..

    Reply
  58. Gill Whittaker

    My sister, who is 68, has been diagnosed with a kidney stone that is ’embedded’ in her kidney. She has had, almost constant, urinary infections for three or more years. She had been told that she must live with both the stone, the pain and the resulting infections and drink more cranberry juice. I have suggested that she seeks a second opinion. I would value your thoughts on this.
    Regards

    Reply
    • Fredric Coe, MD

      Hi Gill, I think she should indeed discuss with her physician the relationship between the stone and her infections. Stones do become infected, and can perpetuate infection episodes. A second opinion is also a normal practice and I am sure her physician would be pleased to help obtain one. If a university is nearby, sometimes in this kind of complex situation it is an excellent source. Regards, Fred Coe

      Reply
  59. Tashrock

    Hi Dr Coe,
    I had an incident of hematuria in MARCH of this year. I had plenty of water and the problem seemed to pass away.
    A month later in April, I’d a very strenuous day. Returned home and peed blood that day and the days after.
    I went to the urologist this time. Did Xrays, usg, creatinine and other tests done. The urologist saw that the reports were all normal and asked me to observe for a month.
    I did a lot of online research and dreaded this was bladder cancer. Took another urinalysis a week later. This said ‘RBC Numerous’. Came to the urologist. He wanted me to observe further. I did not feel much pain except for occassional throbbing pain near my penis.
    Over the next few urinalysis tests, my RBC came down to nil. I was happy that the problems had passed.
    Around June, I began feeling a pain near my left abdomen. It was like a muscle cramp. Also, I had white discharge every one to two days while taking a hard dump in the mornings.
    I saw another GP around end of July. He told me this was nothing.
    Then the pain vanished for a few days. Then came the burning sensation after peeing.
    Finally two days back, while peeing a 1.5mm stone came out. I managed to collect it as it fell on the dry end of the commode. Am now at the urologist’s again.
    My question is, I still occassionally feel a slight discomfot on the left side. Not the same intensity. And the location of pain seems to have travelled a bit upwards toward my left belly.
    Does this mean there may be more stones or this is just a residual pain?
    FYI I no longer have the burning sensation while peeing. However the white discharge happened during this morning again.
    Your feedback will be appreciated.
    Thanks in advance

    Reply
    • Fredric Coe, MD

      Hi Tashrock, Be sure the stone is analysed. The way to find out about other stones is a CT which is advisable. The blood is most likely to have come from the stone, but most urologists advise checking for other causes which I am sure your physician will want to do. Prevention of more stones is reasonable. Here is an approach you might find useful. Best wishes, Fred Coe

      Reply
  60. Kelly Stanley

    I went to the doctor for flank pain was given cipro for possible infection. A week later still had the same symptoms and was referred to a urologist who ordered a CT scan. the findings were Nonobstructing calcifications are seen in each kidney. There is no hydronephrosis or hydroureter. No stones are seen along the course of either ureter. So my urologist said that since the stones were not obstructing it could not cause pain. My question is should I get a second opinion? Or continue to live with this pain?

    Reply
    • Fredric Coe, MD

      Hi Kelly, So much is unclear here, it is hard to answer. Were you really infected – I mean a proven positive urine culture? What was the organism? I gather the pain was of recent onset and the stones are not obstructing, so it is not clear what changed. Stones without obstruction can cause pain, many patients attest to this, but why now? I would review the cultures – perhaps you are still infected. Was there a follow up culture after the antibiotic? Regards, Fred Coe

      Reply
      • Kelly Stanley

        Dr Coe,
        My PCP decided to give the antibiotics as a precaution. She sent the urine to be cultured and it never was infected. I only found this out after I went back for a follow up because I didn’t feel better after a week. The only things that changed recently for me is I lost 30 pounds since March 1 (on purpose through diet and exercise)and now am at a good BMI. Also, unfortunately I have been chronically dehydrated through most of the summer I live in Virginia and work in a hot environment. Could this be why I have pain now maybe? I read your articles on supersaturation and crystals and know better now. I have been urinating a lot more! Thanks for the great information. Kelly

        Reply
  61. Sainabou Njie

    I have been diagnosed with kidney stone on my left side and the pain is too much now. The urologist fix a tube for me since February this year, I don’t know what to do

    Reply
    • Fredric Coe, MD

      Hi Sainabou, I cannot be sure what is meant by ‘fix a tube’ but it sounds like something was wrong with a ureter and that led to a surgery. As you are having pain and perhaps have some urological problem it is very important that your surgeon help with the problem. From so far away I cannot do anything but urge you to see that doctor and get help. If that is impossible see another urologist. Pain could be from obstruction and that can injure the kidney. Regards, Fred Coe

      Reply
  62. Aamir Ali

    I have a 4mm stone in the lower pole, i’m feeling pain when drinking water. What should i do about treatment?

    Thanks!

    Regards,
    Aamir Ali

    Reply
    • Fredric Coe, MD

      Hi Aamir, It all depends. The stone is probably causing the pain, but your physician can help decide if this probability is high or not. If the pain is bothersome enough to warrant surgery and your physician is reasonably sure the stone is causing the pain then the stone can be removed. But surgery is not trivial, so it pays to be as sure as possible it will be of help. Regards, Fred Coe

      Reply
  63. Anna

    This article was a lifesaver for me. I had a burning pain on my right hand side, constant urination, fever and chills. The doctors told me I had a kidney infection but it took multiple courses of antibiotics to even touch the symptoms. Once the infection symptoms such as fever, shakes etc. finally went away the pain remained. I knew something was wrong so insisted on a scan. Turns out I had a 3mm non-obstructive kidney stone on my right hand side. I saw multiple urologists and all insisted the stone wasn’t the course of my pain OR my infection. Seemed mighty coincidental that my pain was in the exact spot the kidney stone was in and the infection was only on the right hand side. Anyway I continued to live an average quality of life until I finally saw a urologist who agreed to surgically remove the stupid thing. He still didn’t believe that it was causing me pain but I literally begged him until he just gave in. Best thing I ever did. The stent was the most physically painful thing I’ve ever experienced in my life and I had quite a lot of post-surgery pain due to a narrow ureter with a kink in it, but those symptoms eventually subsided. I’m now back to my old self and have my quality of life back. I no longer spend weekends lying in bed with a heatpack and taking painkillers!! To anyone reading this, there is hope! Find a doctor who will listen and even if they don’t really believe you just beg them to take it out. Eventually someone will give in. I even had to go to the same urologist twice!! To the writers of the article – thank you. This article was one of the reasons I finally felt understood and not like I was going crazy. If you’ve helped me I”m sure you’ve helped many others around the world feel understood. Open-minded doctors who think outside the box are a rarity and worth their weight in gold (particularly urologists). The world needs more people like you – thanks for changing my life 🙂

    Reply
    • Michael Borofsky M.D.

      Thank you Anna, that is a very kind note and we are so happy you are doing well.

      Mike Borofsky

      Reply
  64. stephanie

    Are you serious that there is NO PAIN with a lower pole stone?!?!?!?!!! I currently have one 6mm. Yes it does hurt.. Its a dull achy pain.. Two months worth and its getting worse. To whoever reads this, yes you can have pain and its real. It doesn’t have to be in the ureter to cause pain. Its only when its there that the pain is unbearable. SMH

    Reply
    • Fredric Coe, MD

      Hi Stephanie, I do not think Mike Borofsky intended that lower pole stones do not cause pain; such pain as you describe is rather commonly encountered. What you describe, pain from non obstructing stones in the kidney is coming under considerable scrutiny by urological surgeons – disclaimer, I am not a surgeon – who increasingly believe such pain does occur and may benefit from surgery. The problem is that surgery is so large an intervention research is needed to test its benefits. The question is this: Will surgical removal really benefit the pain or just make matters worse. That decision is for each person to make with their physician, and hope the outcome is a good one. Regards, Fred Coe

      Reply
    • Michael Borofsky M.D.

      Dear Stephanie,

      Certainly I believe that you can experience pain from a lower pole stone. As discussed in the article much of our understanding regarding how stones cause pain is based upon a model of urinary obstruction when stones become dislodged in the ureter. The precise mechanism by which a stone can cause pain when still in the kidney (such as the lower pole stone you describe) is much less well understood. I have seen many patients like you who have non obstructing stones in the kidney that cause pain. Interestingly, many patients with non obstructing kidney stones have no symptoms at all. When symptoms do occur though (such as you describe) stone removal should be considered. I hope this is helpful, please feel free to ask further questions if you have any.

      Sincerely,
      Mike Borofsky

      Reply
      • CeCe

        Dr. Borofsky,
        I have a non obstructing 5mm lower pole calculus in my right kidney. I also have mild right lower pole cortical scarring. I had a CT w/ contrast and all other findings were normal. I have mod to severe lower back pain (depending on the day) and pain in my pelvis/abdomen, but more pain on left side than right. I donated my left kidney 16 years ago. What is the thought about removing the stone vs. letting it pass on it’s own for a patient with one kidney? Do the stones always pass or is it possible for them to remain non obstructing?

        Sincerely,
        CeCe

        Reply
  65. Gurmukh Sahi

    I had pain mild to moderate in my rt flank since 9 months .no obstruction in ureters .1 ct done .3ultrasounds .no decrease in pain .pain goes away immidiately on lying down.occasional pain in lower part of penis. Taken lot of physical therapy.got some relief but pain comes back again.evenings are usually better.occasional hematuria in urine from last 5 months.repeat CT appointment on 15 sep 2016 .earlier CT showed 6mm stone in rt an 5.5 mm stone on left kidney with multiple small calculi in right kidney.please helpe further. …..

    Reply
    • Fredric Coe, MD

      Hi Gurmukh, Although the ureters are not obstructed perhaps stones in the kidneys are causing obstruction in the kidneys themselves. The problem in your case is to be sure there is pain from the stones because surgery is always an issue. That it ceases on lying down makes me unsure if the back pain is from the kidneys – they produce pain that is very unrelated to posture, position or activity. Here is where your physicians really need to make a decision for you, because if the pain is not from the kidney stones a surgical procedure to remove them will not help and could cause problems. The penile pain, on the other hand, can be from small masses of crystals, which your physicians can look for. Regards, Fred Coe

      Reply
  66. Gurmukh Singh Sahi

    I had pain mild to moderate in my rt flank since 9 months .no obstruction in ureters .1 ct done .3ultrasounds .no decrease in pain .pain goes away immidiately on lying down.occasional pain in lower part of penis. Taken lot of physical therapy.got some relief but pain comes back again.evenings are usually better.occasional hematuria in urine from last 5 months.repeat CT appointment on 15 sep 2016 .earlier CT showed 6mm stone in rt an 5.5 mm stone on left kidney with multiple small calculi in right kidney.please helpe further. …..

    Reply
    • Fredric Coe, MD

      Hi This seems like a duplicate of your other post. I have left it here in case I am wrong but I think I answered to your question. Fred Coe

      Reply
  67. Mona

    I think I passed a stone Tuesday. I’m still in pain but the pain is now coming and going on my left side where the pain was only on my right side and down the middle. The urologist thinks I’m passing more stones. If so would my pain move to the other side???

    Reply
    • Fredric Coe, MD

      Hi Mona, You may well be passing another. Be sure your physician knows and the passage of the stone properly monitored. If the side has changed it is likely the stone is passing from the side with pain. Regards, Fred Coe

      Reply
  68. Hope Richard

    I have has several stones in the last 3 years. I also don’t have any obstructing but am in excruciating pai.. 15-20 ER visits, same in PCP visits, 2 different urologists, No help or preventive car. My quality of life sucks, where do I turn to for help? Sick of living with right flank and lower abdominal pain!?

    Reply
    • Fredric Coe, MD

      Hi Hope, A lot depends on the character of the pain. If it is constant I would suspect that kidney stones have led to pain from another cause like back muscle spasms – and you need physical therapy. One way to tell is that muscle/fascial pain is affected by posture, bending, turning, whereas kidney stone pain is unaffected. If pain is coming in spells, I would suspect small stones or even crystal attacks. Try to figure out which fits your situation. Regards, Fred Coe

      Reply
      • Michael

        Hi Dr. Coe, I want to apologize for the things I said to you. Otherwise , the remainder of what I said I feel strongly about. As I stated I’ve had urologic problems and procedures since I was 9 years old. I’m 56 and even though I’ve spent the majority of my life as a medical professional working with doctors, my life has often been a roller coaster ride especially with urologist. I’m jaded when it comes to this subject or doctors in general. However, I didn’t know you were part of this great article and after reading some of the comments followed by your very competent advice, I must truly apologize. Please remove my earlier replies. Thanks.

        Reply
  69. Rita shotton

    How will I know if I passed my kidney stone can any harm come buy having kidney stone for 2years

    Reply
    • Fredric Coe, MD

      Hi Rita, If there is any uncertainty your physician will want to look – usually a CT scan or perhaps ultrasound. It is very important to not leave a stone without knowing what happened because a kidney can be obstructed and thereby damaged. Be sure your physician is aware of the stone and that it may still be there. Regards, Fred Coe

      Reply
  70. Richard Johnson

    Since December 2104, 12 er visits, 7 laser lithotripsy procedures, two admission for pain control. Only change in lifestyle/diet was that I quit drinking coffee. The best treatment for pain in the ER for me has been an injection of toradol, works within ten minutes, pain level goes from to 10+ to zero.

    Reply
    • Fredric Coe, MD

      Hi Richard, I am glad you found a proper remedy for pain. Be sure and get on track for prevention so these stones stop. Regards, Fred Coe

      Reply
      • Rita shotton

        I have kidney stones but the other day I was on toilet and screamed on the toilet for about 25 mine the pain was giving birth i even was like wanting to push them after I got the runs do you think i passed my kidney stone

        Reply
        • Fredric Coe, MD

          Hi Rita, If the stone did not pass so you could be sure of it, your physician will want to know and get a followup ultrasound or even a CT. Stones can obstruct a kidney so you want to be sure where it is or where it went. Regards, Fred Coe

          Reply
  71. Sanjeet

    I have a 8*6 mm(+1248HU) stone located in the interpolar calyx. Do I need surgery?

    Reply
    • Fredric Coe, MD

      Hi Sanjeet, In general stones are removed if they cause pain, serious bleeding, obstruction, or are a site of infection. Barring that, they can be left alone. Regards, Fred Coe

      Reply
  72. Steph

    I’ve been developing stones for the last two years. They do not pass. I’ve had two procedures. With the first procedure, the urologist couldn’t get to the kidney as my ureters were too narrow. I wore a stent for three months and the next procedure.was successful. Three months later, I developed a 5mm nonobstructing stone in the same place, the lower pole of my left kidney. That’s when the new symptom started which I described below.

    After starting to urinate, sometimes right before, I get a lot of pressure in my left flank The pain will sometimes continue for about ten minutes afterwards. It’s worse with the first urine void in the morning. However when I I have a bowel movement, this does not happen. I’ve experimented to see if there is a difference and there is. I get the same type of pain throughout the day and it’s the pain I had is the same as before. The difference is that urinating can actually start the pain At this point in time, it has not been removed.

    The pain is like a vise tightening in my side. I sometimes get the pain throughout the day. The intensity as well as the occurrence varies. It’s worse when I am lying in bed. Sometimes I get nauseous. All my blood/urine tests are normal so the urologist simply shrugs and repeats this.

    I don’t have gas or bloating when this happens. Nothing has been seen in the CScans. I know I am not imagining this.

    What might cause this?

    Thanks.

    Reply
    • Fredric Coe, MD

      Hi Steph, I gather that by negative there is no stone in the left kidney? The pain seems very related to voiding and there was a left stent so I wonder if there is reflux on the left because of the long standing stent. This would not be common, but perhaps a voiding study might be of value. Ask your urologist if that seems reasonable. Regards, Fred Coe

      Reply
  73. Karen milligan

    For two weeks on and off I’ve had severe pain in my left side. I have noticed it’s a pattern of the days I work. I have early shifts working in s supermarket. Within ten minutes of starting work were I’m standing my pain starts and after several hours calms down. My doctor has already got me a scan and waiting on urology appointment. I just wondered if standing and lifting can set the pain off as when I’m not working I’m not having spasms

    Reply
    • Fredric Coe, MD

      Dear Karen, although I have not seen you, I am suspicious that your pain is not from stones but simply from sore muscles due to work posture. Ask your physicians if that might not be the case. Regards, Fred Coe

      Reply
  74. Chelsea Sloanes

    Hi. I have been having increasing left flank pain, although it is intermittent. CT showed a 9 mm stone in the renal pelvis without obstruction (I’m 34). My PCP said that since there is no obstruction it cannot be causing the pain. I am unsure how to approach my Dr now but also fearful not to do anything because the pain is getting worse. I’ve had a thorough workup and there is no other source for the pain. I have nausea during the intense pain and microscopic hematuria. Is it possibly that the stone is intermittently causing obstruction acting like a plug? Or can the tissue of the renal pelvis be sensitive to a stone moving around? The pain is interfering now with work and home life. Thank you.

    Reply
    • Fredric Coe, MD

      Dear Chelsea, It is very likely that is indeed happening, and I am sure your physician will agree when you describe the nature of your attacks. Intermittent obstruction is very common with pelvic stones. Regards, Fred Coe

      Reply
  75. Germ

    Hi, I woke up early ( around 5:39am) with the need to urinate however I was feeling really sleepy so I decided to pee really hard mid way through my urination so that I could go back to sleep sooner but I was greeted with a stabbing pain in my penis shaft as if something moved forward because of the immense strain I was putting on my penis to urinate quicker. As soon as that happened the flow of my urine drastically slowed down and it feels like a glass shard is in my penis, there is also NO Blood in my urine.
    This has been going on from the morning and it only hurts when I pee or move in a certain position. I also have a stabbing pain in my rectum after this whole incident occurred.
    I have had Kidney stones before and although this feels very similar, the fact that I had no pain before all this seems strange. I had no back pain or anything.
    Is it possible that I sprained something or damaged something down there by peeing too hard?
    Pls advise. Thanks!

    Reply
    • Fredric Coe, MD

      Hi Germ, Perhaps you passed a small stone which is lodged in the urethra. If so, that will become reasonably clear on its own. Otherwise, it is probably as you say. Regards, Fred Coe

      Reply
  76. alkoos

    Reading this while in pain ? my pain started 2.5 weeks ago went to the ER like vomiting from pain after 2 injections of (i don’t know what) the pain came down a bit not completely, after x-ray and ultrasound they referred me to a urologist he told me that I might have had a stone and have passed it with no more stons to worry about, I was happy that I am done with that but 2 days before, came from work the pain started again in the same area right flank after 30 mins trying to cope with no result I went to the ER again and the whole thins starts again two injections go home next day the same my back was filled with injection marks, after speaking the the doctor he said I must have a CT and IVP scan, now just waiting for that,

    Reply
  77. Stacey

    I have multiple small stones both kidneys 5 per ultrasound and ct this time no obstruction doctor after doctor 3 urologist so far and all say the pain isn’t from the stones I have stones several times a year almost monthly it seems this pain is so intense it’s to the point of unbearable I have lupus sle and diabetes among other issues now renal colic has been added but no one will help me any advise

    Reply
    • Fredric Coe, MD

      Hi Stacy, would guess you are passing tiny stones that cause these attacks. Try and strain your urine when one begins so catch any crystals. Because you are diabetic you could form uric acid stones so look out for any red or orange crystals in your urine. During an attack have your physician take a look at your urine for blood and crystals. Regards, Fred Coe

      Reply
      • Stacey

        Thank you for the info I have been straining no blood or colored stones granules are being caught still puzzled at the pain as i am being told they shouldn’t hurt at this size

        Reply
    • Sourav

      I tried it for one month and passed out the stones naturally without any pain. VINIDIA, GC and ACIDIM are probably the best natural products that I have ever used for curing my kidney stones. My CT scan now shows that I don’t have any kidney stones.

      Reply
      • Fredric Coe, MD

        Hi Sourav, I have a policy of putting up what patients say, but I do have to mention that the experience of one person is not a basis for the care of others and I know of no studies that support these materials as a valid stone treatment. Regards, Fred Coe

        Reply
  78. Luccy

    I was in 6 months of pregnancy first time pain started in my left kidney side.now is total 9 months finished bt now my left kidney below the ribs it’s paining. Pain its comes n goes in day 3to 4 times. .plz advise me

    Reply
    • Fredric Coe, MD

      Hi Luccy, Is your pain from stones? If so, are they obstructing your kidneys? You meed to have a urological surgeon taking care of things, and soon. Regards, Fred Coe

      Reply
  79. Natalie

    Hello,
    I have a right kidney stone 3-4mm. I have been having UTI’s positive urine cultures every four weeks for the past year. I have seen multiple urologist with no resolution or solutions. I experience right flank pain daily which is the side the stone is located, urinary urgency and frequency. Can the stone be causing these symptoms and how could I convince a urologist to take me seriously… Thank you kindly, Nat

    Reply
    • Fredric Coe, MD

      Dear Natalie, Te one stone should not be perpetuating so much infection, but could be even so. The bacteria found monthly is important. What are they? Is the stone growing, a suggestion that it is from infection or itself infected. If you have pain and infection, perhaps it is time to remove the stone. Shock wave lithotripsy is not unreasonable with one small stone, or perhaps ureteroscopy. Regards, Fred Coe

      Reply
  80. Natalie

    Hello,
    I have a right non-obstructing kidney stone approx 4mm in size.. I have had it for some time now. Over the past year I have seen many specialist as I have consistent right flank pain with episodes of severe pain in the same area that come and go. I have also had positive bacteria cultures every 4 weeks for the past year all with the enterococcus species . I have seen many specialist and ruled out may other anatomical issues and all finding have thankfully been negative. However, every specialist I see seems to denied any connection of my pain to this kidney stone or even the possibly kidney stone and bacteria connection. How could I go about finding the right urologist to explore this opinion. My case sound so similar to the case listed above. I am so desperate for my life back. Thank you kindly,

    Reply
    • Fredric Coe, MD

      Hi Natalie, I believe I have answered your query, at least as best I could. But now that I see enterococcus, I am rather concerned that the stone is infected or could become so, and enlarge. Enterococcus is one of the bacteria that possess urease, an enzyme that degrades urea in urine to ammonia and produces struvite stones. Of course this may not have happened as yet in you: The enterococcus may be only in the lower urinary tract and the stone sterile, but I would ask your physicians if it is not time to be concerned about an infected stone and consider ureteroscopic removal – as an alternative. The handling of a potentially infected stone is complex, as they will surely know. That the enterococcus persists makes me concerned that the stone is indeed infected. Regards, Fred Coe

      Reply
  81. Eleanor Yu

    My mother, 83 years old was diagnosed with kidney stones yesterday. If at any point, the doctor tells us she has to undergo surgery to remove the stones, is that still acceptable co doddering her age? Thank you.

    Reply
    • Fredric Coe, MD

      Hi Eleanor, Stones need to be removed when they cause pain, obstruction, infection, or serious bleeding. If this is the case, surgery is very important. Perhaps you should discuss the reasons with her physician, as I am sure one of these is the reason. It is indeed odd for stones to begin so late in life. Often they are uric acid or from infection. Regards, Fred Coe

      Reply
  82. Angela

    I was diagnosed with kidney stones in 2008 after being admitted to the hospital with a kidney infection while pregnant with my first child. I dealt with them through 3 more pregnancies. They seemed to cause me the most pain then, or that I only had them when I was pregnant so not much could be done. I’ve been having pain almost exclusively in the left flank. The pain doesn’t move, and I haven’t passed any stones recently that I can tell. I had an appointment with my urologist a few months ago and had a CT scan. Both kidneys are full of small stones (too small for lithotripsy). I have yet to call and get a copy of the image/results. I have a follow-up with the urologist in a couple weeks to discuss options (remove them all, or do nothing). Just yesterday I had horrible pain in the same spot. After reading this, I am wondering if maybe I have pain from non-obstructive stones. Also, any time I have a urinalysis at a regular appointment, they put me on an antibiotic. Can stones cause a false uti test result?

    Reply
    • Fredric Coe, MD

      Dear Angela, With a lot of stones pain is not surprising. Urinalysis is not an ideal basis for antibiotics – urine culture is needed, and stones can cause an abnormal urinalysis by themselves. If your pain is so substantial as to warrant something so invasive as possible surgery then that option should be considered. Flexible digital ureteroscopy would be ideal, in general. Perhaps you should discuss this with your personal physicians. If pain is coming in attacks, it may be that one of your stones is intermittently obstructing the kidney, and that certainly can be remedied. Regards, Fred Coe

      Reply
      • Angela

        Update: my followup appointments with my urologist, he was unavailable. The first followup. The PA totally dismissed the idea that nonobstructive stones cause pain and put me on chlorthalidone. I didn’t like the side effects so I discontinued that. The 2nd followup appt, urologist wasn’t available so I cancelled the appt and asked for a referral to a nephrologist. This may be unrelated, but on Monday this week, I started having pain in the front of my right shoulder. It would get worse as the day progressed. Everyone I took a breath, the pain would increase, and bending over or laying down with my kids before bed was almost unbearable. Pain was so much worse Tuesday night that I was in tears. Wednesday night I could feel the pain starting again, so I went to the ER. They did a CT of my chest, xray of shoulder, checked my heart, and ultrasound to check liver, gallbladder, ect. Everything was fine, except that the ultrasound tech was finding >7mm stones in my right kidney. The CT scan didn’t show my kidneys. ER Dr didn’t think anything of stones, gave me a sling for my arm (even though he knew there wasn’t anything actually wrong with my shoulder), and a prescription for hydrocodone. They suspected my gallbladder, but could kidney pain be referred to my shoulder?
        I saw the nephrologist yesterday. He just looked over my records and ordered another 24 hr collection, bloodwork, change my diet, drink more water, and prescribed potassium citrate, allopurinol, and hydrochlorathiazide. He also said without missing a beat that nonobstructive stones do not cause pain and there is no way to dissolve the stones I have and that surgery would be intrusive. Here are my concerns: if I am put on all these treatments to prevent stones, how will they know any of them work if the older stones are still there? And I’m not to thrilled about having all of the stones sitting in my kidneys. Couldn’t they damage my kidneys? I don’t see any Dr when I have the flank pain, mostly because I feel like I should just deal with it, or that nobody will believe me and dismiss me as just trying to get pain pills. Maybe I should start going in every time so there is an actual record of it? Maybe someone would take it seriously?

        Reply
        • Fredric Coe, MD

          Hi Angela, the pain in your shoulder does not have the characteristics of kidney stone pain, which may be bothersome or severe but is not influenced by position, movement, or any of the factors you describe. Pain from gall stones likewise. So I think – I am very far away – it was muscle or tendon pain. Stones in the kidneys so cause pain – I think we are as a community coming to that conclusion – but it is not as you describe: a sudden shoulder pain made worse by moving and bending. One knows if a treatment is effective because over time the numbers of stones in the kidneys does not increase, and stone passage is accompanied by loss of prior stones. Usually stones in a kidney to not cause damage unless they care causing obstruction – that is a urological decision. You mention flank pain, which would be different from the shoulder pain, and that may well be from the stones. The issue is whether such pain is bad enough to be worth having a surgery – that is a decision you have to make with your physicians. If the flank pain is from tiny stone passage there may be blood or crystals in the urine so it is worth having this checked as it will clarify the cause of pain. Prevention is important – it needs to be orderly. Here is a reasonable guide. Be sure all of the steps have been covered. Regards, Fred Coe

          Reply
  83. Nabil

    Hi,

    It is for the first time that I have become a victim of kidney stones, last week I had a sudden attack of pain around my left kidney area and it was unbearable. After scan, I came to know that there is a 5.2mm stone in the left ureter causing pain, and two more stones of 4.7mm & 3.8mm in right kidney causing no pain till now.

    My parents had the same problem years ago and the first drink every morning they used to have was bitter gourd juice. And amazingly it worked for them, stones got removed within the period of 7-10 days. I too, started taking this and have good relief from the pain, 4 days completed another few days and lets see what it results in the next scan.

    Reply
  84. Saurav

    I was diagnosed with 2 stones day before yesterday only. One in the right ureter of 5 mm and other in right kidney of 2.6 mm. It pained a lot. I’m drinking lot of water but there’s no pressure created in the ureter I suppose. I have to travel to Australia from India in 5 days. Please suggest me some measure so that if it pains just in case when I’m in the flight what should I do?
    Thanks

    Reply
    • Fredric Coe, MD

      Hi Saurav, You need a urologist. These stones could act up on the long flight and there is little that could be done for you. Possibly they can obstruct the kidneys. I would think your urologist needs to determine if you are fit to fly right now. Regards, Fred Coe

      Reply
  85. Param

    Having two stones. One is about 5.6mm and other is about 4mm. 5.6mm calculus is coming to urinary tube and it’s not coming out so my kidney gets swollen what should I do?

    Reply
  86. Saman

    I have recently diagnosed kidney stones in my both kidneys. CT scan pyelogram findings show that 3-4 small calculi largest in left kidney lower pole measures 0.9 cm. I have mild pain and it increases when I move my body and do physical work. Pain also increase on less intake of water. Please suggest me its treatment.

    Reply
  87. Kelly

    Hello Candace! I also suffer from kidney stones and have gotten them often. I had three lithotripsies last year and the most recent one broke up about a 9mm stone. I have been having chronic pain for almost a year now due to the stones reforming and once causing an obstuction. My most recent scan showed the 9mm stone had not moved, yet I am still so often in pain. And just as you, I cannot take NSAIDs or aspirin due to a platelet disorder, but sometimes I cannot help it. If you find any information out on how to manage the pain/ why a non moving stone is causing so much pain please share! I am often nauseas and so exhausted I find myself unable to do much and enjoy it.

    Reply
  88. CANDACE

    recently on April 24th after having 3 days of pain that got worse and continued with vomiting I went to the er as I have a history of kidney stones I had left flank pain along with pain shooting down towards pelvic area and was extremely nauseated I received an ultrasound where it showed I have 3 6mm non obstructive stones and my urinalysis came back with few bacteria 100 protein and 3-5 rbc. they gave me Zofran and iv pain meds in the hospital and sent me home with some pain meds. I have a bleeding disorder so I can not take any nsaid due to the affects it can have on my platelet’s. the er doctor told me one stone was in the lower pole of my kidney and that I might have passed one upon arrival. the last few days the pain has gotten worse leaving me to tears and same shooting pain from flank to groin I have an urge to urinate constantly but not much comes out and I have severe pain in the lower area when I do urinate bringing me to the point of not wanting to urinate due to the pain. I currently do not have medical coverage and the urologist that will see me is booked for over two months. why am I having this pain if it is in the lower pole? what can I do to help ease the pain? I do not want to go back to the er due to the fact I don’t want them thinking I just want drugs so I have been taking Tylenol and ibprofen(not suppose to but pain is horrible).is there anything I can do it is becoming hard to even play with my soon to be 2 year old as at times it hurts no matter if I sit stand lay down. do you have any suggestions on what I could/should do.

    Reply
    • Fredric Coe, MD

      Hi Candace, I suspect you have a stone lodged at the junction of the ureter and bladder. Such a stone can cause your symptoms. Your urologist should want to see you promptly in as it could be removed. Alternatively the ER physicians can probably see it on a radiograph and prescribe proper pain medications. Of course I am far away and just hazarding an opinion, and they are there. Ask about it. Regards, Fred Coe

      Reply
  89. Anna

    I wrote on this site last year in regards to a small non-obstructive kidney stone that I thought was causing my pain. Finally I got a urologist to listen to me and has agreed to remove the 3mm kidney stone on my right kidney! Thanks to your article I managed to convince him. Anyway, when the doctor went in there to take out my stone he discovered a narrow kinky ureter so he has had to insert a stent for 2 weeks before they attempt to take it out again. He will then take the stone out in another two weeks and I will likely have another stent for a week or so. Whilst I’m glad things are finally moving forward, I was wondering how normal it is to have some pain and discomfort with the stent? Yesterday (2 days after surgery), I was in excruciating pain, today my body seems to have adjusted and I can move around and do things more but still have a constant ache in my side and am experiencing a lot of discomfort. Heat packs and pain medication have helped ease the pain. I was just wondering whether pain and discomfort from the stent is normal? Will this go on the entire 2-4 weeks i have the stent in me or will it get more tolerable? Will the pain and discomfort ease as soon as the stent is removed or will it take a few days after it’s removed to return back to ‘normal’? After everything I’ve been through I just want to go back to a normal pain-free life! Any help would be appreciated 🙂

    Reply
    • Fredric Coe, MD

      Hi Anna, Stents are known for their discomfort and I am sorry you have to have one. I do hope that when your ureter is dilated and the stone removed it will all have been worthwhile. Please write again so we can find out. I for one send along all hopes and best wishes for you. Fred Coe

      Reply
  90. Wendy

    My 16 yo old daughter was diagnosed with multiple small nonobstucting kidney stones about a year ago after a UTI. Was told by two urologists they were not causing her the mostly right sided, back occasional groin pain she has had for the full year. She has seen gyn, gi and had endo and colonoscopy scans. Was scheduled for a lap with appendix removal till she passed he first stone (we believe, anyway) last week and has had blood in her urine which caused the surgeon to cancel/postpone the lap :((( Kid has had every test and work up and appt possible and we are soooo frustated. Her pain is pretty constant on the right, sometimes more of a discomfort than intense pain but has highly restricted her from doing what she loves – basketball and horse back riding. The pain intensifies with physical activity always but can be present at rest as well, usually just not as intense. No one has ever considered the small 2-3mm stones in both kidneys as possibly contibuting to her pain issues??? Any suggestions or thoughts to disprove that theory??? Am planning on rescheduling the lap but am not too hopeful it will reveal anything diagnostic or specific. Needless to say, we are at out wits end. Have had other urologists recommended to us but am told they will not see a patient under 18 yeas of age. OMG!!! Any input would be greatly appreciated….

    Reply
    • Fredric Coe, MD

      Hi Wendy, As the article by MIke Borofsky makes clear the issue is still unresolved. But Many patients and physicians have encountered this kind of pain from what appear to be non obstructing small multiple stones. I would be suspicious that these are part of her problem. Her appendix as a cause seems a rather long reach, but of course I am at a great distance and cannot hazard an opinion about the pending surgery. That she has passed a stone is reasonable given they are in the kidneys. Of high importance is prevention of more stones and crystals; the latter may well cause pain, and that can be tested by lowering supersaturations in the urine so none will form. Sometimes pain improves. Prevention is crucial altogether as more stones could make everything worse. That her pain worsens with exercise has two implications. Possibly dehydration with exercise is causing crystals and pain. Possibly her pain is musculo-skeletal, and being worsened by exercise and being ascribed to her kidneys or other internal source. Physical medicine physicians can be helpful. Infection in some of her small stones is not unlikely but that will not be visible in the urine and antibiotics would be inappropriate. So, I have to very general ideas for you. The first is a very strong effort at changing urine chemistries to reduce crystallization – link above; the second is possibly another surgical consultation at a center that has interested itself in this matter. Mike references several in his article. I might put off the appendix surgery for a while to see if the pain can be moderated as I have mentioned and likewise what another surgical group might offer. Regards, Fred Coe

      Reply
      • Michael Borofsky M.D.

        Dear Wendy,

        I agree with Dr. Coe entirely. Whether or not the stones are causing the pain, the fact that she has stones at this relatively young age suggests that something should be done to try and determine why they are forming and what can be done to prevent them. As evidenced by the large response that this post has generated, there are many patients who do seem to have pain attributable to small non obstructing stones, though I caution that with stones being a common finding it does not mean that other medical issues can’t be contributing to pain as well. In situations such as the one you have described I highly recommend having a team based approach by members of several specialties who are willing to work together. For instance, a urologist to address the stones as well as a general surgeon and gynecologist to address other possible abdominal causes. Laparoscopy in particular deserves coordinated consideration with both general surgeon and gynecologist as this procedure can also be helpful in the workup, diagnosis and treatment of endometriosis, another disease that can be challenging to diagnose but frequently causes nonspecific pain. Abdominal surgery here should be a last resort, though it sounds like you have seen a number of specialists already. Additionally, if her pain seems to have gotten better since the stone has passed this may also point to the stones being the source. Wish her the best.

        Mike Borofsky

        Reply
  91. darlene a madden

    I am so confused. I have been in severe pain for about two weeks now. Went to Urologist back a few months ago and he told me i had stones inside the kidney and they were too big to pass so he scheduled a lipo and I had to cancel due to another emergency surgery. Now after 6 months the pain has come back and I have suffered for two weeks. Went to ER they said stones were not obstructing anything so I called and made apt with urologist. The first apt available was 6 months away they finally gave me apt in two days after constantly calling the office. no one can live with this pain. They act like they don.t believe me. I have had three kidney stone surgeries in the past but this time I could not get a urologist to meet me at the hospital or get me in to see the doctor any sooner I am taking pain meds which do not hep at all. I do not sleep or hardly eat the pain is so bad. I have two more days to go and then dont know what they will do. Any advise???

    Reply
    • Fredric Coe, MD

      Dear Darlene, I am sure the physicians do not realize how much pain you are having. Possibly one of the stones is obstructing or you are infected. If you cannot get care with your current physicians consider asking for referral. If there is a university hospital near enough to use, consider going there. With so much pain, long wait times do not seem ideal. Of course, I am distant so my remarks are general and not specific to your case. Regards, Fred Coe

      Reply
  92. Katy

    Dear Dr. Coe,
    I experienced what I first thought was atrophic vaginitis for several days beginning Mar. 18th, but after a few days of increasing intensity I realized it was a bladder infection. Increasing pain and blood in my urine, so I got a UA on 3/22 which reported blood and some leukocytes. Flank pain was extremely intense, it feels like there is a swollen thing underneath my ribs. Sent for an ultrasound, which was negative. Given pyridium. Had to fly across the country for a trip I’d planned long ago. Upon arrival in Boston another doctor looked at my labs and prescribed Bactrim DS x 7 days. Lots of improvement for about 4 days, but then woke up with increased flank pain again, but had to fly back across the country again, went to my doctor on 3/29 with super-intense back pain. I am in recovery from addiction and have not asked for any pain medication at these visits, as that only clouds the issue, but I have to tell you this really hurts! 3/29 UA showed traces of blood but no bacteria, but was sent for culture. Was given 1 gm of Rocefin IM, and cefuroxime 500mg BID x 7days, which I started yesterday. Today the culture came back negative. CT is tomorrow.
    Does this sound like a stone that began as an infection? The Bactrim really helped, and my urine smelled nasty until I’d taken several days of it.

    Because I am a recovering addict, they do not seem to believe the blood in the urine was mine, or that it actually came from my ureters and not my vagina, even though I have not had a period for at least a year, as I am on hormones and do not do the monthly week off to have a period (I take the hormones continuously).

    I have a history of kidney stones and multiple UTIs.

    I’d just appreciate any input you have 🙂 and thanks.
    – Katy TW

    Reply
    • Fredric Coe, MD

      Hi Katy, The CT scan is crucial. It will show stones, obstruction and all related problems. If it is negative, the pain is arising from elsewhere than the kidneys. The urine odor suggests infection with a urea splitting organism, as they impart an ammonia like smell. Let me know. Best, Fred Coe

      Reply
  93. Deb

    Dear Dr Coe,
    I was diagnosed with 7 or more small kidney stones (3mm) in my left kidney in May 2015 after having an attack where i was on the floor profusely sweating, doubled over, began dry heaving and the worse pain ever….worse than child birth and I have four children. I was told the kidney stones did not cause this or the pain that has been non-stop in my left kidney since May of 2015. I also have a 1.4 cm simple cyst in my left kidney. Since May 2015 I have seen three urologists (all who say the stones are not causing my pain) had an upper GI, colonoscopy, DNC, saw an endometriosis specialist and all of the doctors cannot find anything. Everyone is saying the kidney stones could not be causing the pain. I have also been to the emergency room three times now with three more of the attacks that I described above. I have refused any pain meds as I have felt that some doctors think I am a drug seeker which I absolutely am not. All three emergency room visits came with the same result that i have several small non-obstructing stones that would not cause the pain. Do you have any suggestions for resources or doctors that actually believe small stones can cause pain. I am miserable! The pain is constant in my left flank area but does vary in degree of pain from day to day. I have noticed when i wake in the morning feeling dehydrated the flank pain is more severe. Any guidance or suggestions you can provide would be greatly appreciated. Thank you ~Deb

    Reply
    • Fredric Coe, MD

      Hi Deb, I think from the intensity of the attacks you are passing crystals or very small stones. Stones in the kidneys do cause real pain but usually not so horrid as what you describe. Of course the correct approach is to reduce crystallization via a fall in supersaturation. Read through the link and its associated articles and get this for yourself. I believe these terrible attacks may mitigate. Regards, Fred Coe

      Reply
      • Deb Stump

        Hi Dr. Coe, Thank you for your response. Just to clarify, the daily pain I experience is more like a heavy feeling in the kidney. It even hurts to lay on my left side to sleep at night. I have been told I have a lot of kidney stones in that kidney but none are obstructing. The renal colic horrible feeling has only happened four times with four trips to the ER but no evidence that I actually passed a stone. I am wondering is the constant flank pain likely from the many stones I have in the kidney? What is the best approach to attacking this? I have had this constant pain for 10 months now. Some days it is not as noticeable as others. I have had every other test run on me all to come out negative. Any suggestions on how to handle the daily pain would be greatly appreciated. I have to believe they are from the stones. Please advise and thank you. Oh, I was also recently told that I have Medullary nephrocalcinosis. I am not even sure what that is or if it causes pain and needs to be treated. Again, any help you can provide would be greatly appreciated. Deb

        Reply
        • Fredric Coe, MD

          Hi Deb, Quite a number of patients with numerous stones in the kidneys experience chronic pain even though there is no acute obstruction. The only possible treatment so far is surgical removal of stones – usually flexible ureteroscopy, but that has not been tested rigorously. If the pain becomes a serious impediment to living, it could be considered as a treatment. Regards, Fred Coe

          Reply
  94. Stella owen

    I too have some non obstructing cystine stones that are causing pain and discomfit. We are trying to dissolve them with mist potcit for three months, but I wonder if it’s worth trying or just have the stones removed

    Reply
    • Fredric Coe, MD

      To dissolve cystine stones you need to have a large volume of urine because you need to lower cystine supersaturation below about 0.5. Only one commercial vendor – Litholink Corp – produces a cystine supersaturation product. If your physician can get that test and your insurance will pay it can aid in the process. It is always better to avoid surgery if that is possible.

      To be clear, my mention of Litholink could be viewed as a conflict of interest as I consult for them, and I want to make that potential conflict perfectly clear. If there is indeed another company that produces a cystine supersaturation test, I have no reason to favor Litholink over that company- I do not know of such another company or I would give the name here. Fred Coe

      Reply
  95. Cait

    Your discussion of pain associated with non-obstructing stones focuses on small stones; so I am wondering your thoughts on larger, non-obstructing stones? My husband was diagnosed with a 1 cm (10mm) nonobstructing stone in the midpole. He was treated with ESWL which failed to have any affect on the stone and he continues to experience pain that comes and goes (seems to intensify when he is more active). His treating urologists are discussing how to treat the stone after the ESWL didn’t work but seem to be skeptical that my husband is really experiencing any pain. My husband is young, active, and otherwise healthy. He had a ureterscopy 2 years ago for a ureteral stone (the pain experienced then was definitely more acute).

    Reply
    • Fredric Coe, MD

      Hi Cait, A 1 cm stone is too large to pass – more or less so disrupting it will ultimately be essential. ESWL did not work and I am sure your husband’s urologist is planning flexible ureteroscopy, which is very likely to result in a stone free kidney. As the stone pain story unfolds I am having less and less trouble believing that stones do indeed cause pain when they are not actively obstructing. By the way, when stone free, be sure he sets out on a proper plan for prevention. Stones can come back, and often do. Regards, Fred Coe

      Reply
  96. Steve Ashley

    Really interesting, i have had pain around flank, groin and back for months, i have been off work 1 month and have stopped playing golf as too painful. I have been treated by hip surgeon as a slightly arthritic hip has shown up in MRI. Had cortisone injections for hip but pain much to the surgeons surprise did not clear up. All urine test continially show up with blood in. I had CT scan last week and 11mm stone found. Seeing urology chap tomorrow. So pain from kidney stone can occur whilst stone still in Kidney, maybe the end of pain is in sight as long as urologist agrees that pain can occur without having to pass.

    Reply
    • Fredric Coe, MD

      Hi Steve, Yes, a stone that is not in the ureter and causing obstruction can cause pain. Firstly it can on and off obstruct the junction where the ureter joins the renal pelvis, which I guess is the case with you. Second, it would seem that large numbers of people with small stones up in the renal calyces have lots of pain, often. Regards, Fred Coe

      Reply
    • Jen

      I have been passing kidney stones since I was 16 I am now 32 I have had several Dr.. tell me stones do not hurt while in the kidney. until reading this I was beginning to wonder if it was just in my head. on top of having a stone in my kidney that has been in the same place for over six months I also pass stones at least once a month. at least now I know that I’m not the only one that feels pain when the stones are in the kidney. plus knowing that it can be removed brings hope to being pain free.

      Reply
  97. Andrea

    this article just mad me cry. I am on year 10 of multiple stones from passing a 17 mm to having a 2 mm stuck. I thought I found a great urologist but again im being pushed off. I would have what you call small stone syndrome, but a lot of them. Last proceed 72 to be exact. I have brushrite stones with fast recurring had 10 back 3 weeks after procedure. now been 4 months 12 er visits 7 uti 1 severe kidney infection. And once again the head doctor at ohio state said go upstairs and see the physiatrist. Now I am being pushed to see an infectious dieses doctor.

    Reply
    • Fredric Coe, MD

      Dear Andrea, I am sorry you are having so much trouble. Brushite stones are indeed a problem – high recurrence is not rare, and they are hard and not so easy to fragment. Mineral deposits in kidney tissue are sparse but large. Prevention measures have not been formally tried but in fact most patients have idiopathic hypercalciuria which can be treated with low sodium diet, and thiazide diuretic agents – together – along with high fluids. I would advise this approach strongly because recurrence simply maintains the pain and urological difficulties. You should pursue 24 your urine and blood testing to establish the cause of stones, and if it is idiopathic hypercalciuria have it treated. If it is another cause, it can be treated as well. Perhaps you, like many people with chronic illness, might benefit from mental health professional counselling, but you will surely benefit from well organized stone prevention care as well. Regards, Fred Coe

      Reply
      • Andrea

        I have had 24 and 48 hr urines done the all show high calcium and no uric acid. I follow low sodium and take diuretics. My blood calcium stays at 9 to 10.4. Parathyroid level at the last high part of normal. I drink a liter of fresh lemonade a day along with water with more water. My potassium stays low I feel awful. I am a active mom with 9 kids. I coach jr high softball and play womens league. I cant do it anymore and am lost. It has took over my daily living. guess just looking for something or someone that can help somewhere. I do agree counseling does help a lot, but when a doctor knows you go they push you off as crazy.
        Thank you

        Reply
        • Fredric Coe, MD

          Dear Andrea, You have hypercalciuria and the common treatments are not working, so they are not being used enough to lower your urine supersaturation. I suspect your urine sodium is too high – can you put up the number? That would lower your potassium. I also suspect your urine volume needs to be higher. These are just suggestions. But the main point is that your problem is technical: You just need to get the volume high enough the sodium low enough so the calcium is low enough, and the supersaturation will fall and the stones will stop forming. Given the borderline calcium and PTH have your doctor be sure about primary hyperparathyroidism. Regards, Fred Coe

          Reply
          • Andrea

            i see the doctor Friday I will get my numbers. I haven’t heard anything about sodium levels in my urine. it is sally low in my blood work.

            Reply
  98. Deon

    U.A.E. Hi! Dr. i just want to ask if dizziness is symptoms of kidney stone. I suffer from dizziness almost 1 week i cannot concentrate and feel lightheaded with little head pain. My doc check my blood for anemia and creatinine but the result is normal. Last Dec 28, 2015 i make CT scan and find 6mm stone on my right lower ureter and 3mm on my right kidney. After 1 month and half i make ultrasound and they cannot find any stone at all. I was still suffering from mild lower back pain and my urine become dark (yellow) and bubbly when i was not regularly drinking water ( every hour). I didn’t also feel any severe pain which is associated when passing a stone. Now i stop taking my medicine omnic ocas, rowatinex, and urocit-k because of my severe dizziness but still i feel the same dizzy. Im taking only cystone 2 tablets twice a day and drink 3-4 lt of water. What should i do?, is dizziness is also associated with the stone? What is the best thing to do?

    Reply
    • Fredric Coe, MD

      Hi Deon; No, kidney stones are not a cause of dizziness. I think the dizziness should be evaluated and treated as a completely separate problem. As for the stones, being multiple, they can be prevented in a conventional manner. Regards, Fred Coe

      Reply
      • jenny

        I get dizzy from the unfocused pain. It’s like being punched in the gut, and I feel faint. I’ve known I’ve had unobstructed stones for years, but this Friday, one small one became lose and I was told there are much larger ones in the kidney. I get more pain from these than the one that got loose. Tomorrow I see a urologist for the first time; I have no idea what to expect. Figures I have a prepaid cruise coming up in less than 2 weeks.

        Reply
        • Fredric Coe, MD

          Dear Jenny, I wish the problem of pain from non obstructing stones were better attended to. There are a lot of people like yourself. Fortunately a number of surgeons consider the matter very important and I am hopeful of progress. The stones that are free in the kidney and do or could obstruct should certainly be removed. Regards, Fred Coe

          Reply
  99. Lacey

    Hi Dr. Arizona, USA here. As I read this is felt I was reading my own story. I was diagnosed with my first 9mm stone in my ureter near my kidney at the ER and admitted for laser ureteroscopy with a stint amd revealed it being a calcium oxalate stone. 2 days later while home I had profuse vomiting and pain that I went back to the ER, admitted and had surgery again to have the stint removed. 4 days later at home I had vomiting again but less pain, but still renal colic pain and day my urogist. He ordered a 3d ct scan and there are two 3mm stones in the pocket (lower pole) of my kidney which are stones left over from the 9mm stone he lasered. I begged hik to do a repeat suegery and remove the stones and he said no they will pass. They never have. I was upset and he said this is not the cause of my pain which I did not believe. The ct ruled out any swelling in my ureter or kidney but my frustrations of being in pain were still there. I went to another urologist who was adamant in the stones not causing my pain and sent me home. After researching on my own I found forums where other people had pain from stones in their kidneys like myself. I feel so lost and helpless and I shouldn’t be in pain everyday and I miss working out daily. What does someone in my situation do?

    Reply
    • Fredric Coe, MD

      Hi Lacey, A reasonable approach would be flexible ureteroscopy to remove those stones. It sounds technically feasible if you are having enough pain to make it a worthwhile effort. That judgment is between you and your surgeons, of course, as the pain must be enough to take on the risks of anaesthesia and another procedure. Regards, Fred Coe

      Reply
  100. Victoria White

    Hello, I am currently 12 weeks pregnant. 2 weeks ago I was awaken at 2am with severe lower left back pain. I’ve never had a kidney stone before. The pain came in spasms and I honestly thought I was having a miscarriage. We went to the ER, and I was told I have a UTI. Being pregnant, they couldn’t do a CT, so they did an ultrasound. They couldn’t see a stone and said there wasn’t any hydronephrosis. I was told to take antibiotics and pain meds. Being pregnant, I can’tell take anti-inflammatory drugs. The pain is horrible. My obgyn wants me to go to my psychiatrist. (I do have schizoaffective disorder, but it is thankfully under control) he finally agreed to send me to a urologist but I have to see a high risk pregnancy doctor first. No appointments have been made. I can’t make him stop dragging his feet and take me seriously. I don’t know what to do. I am exhausted and so sick of the pain.

    Reply
    • Fredric Coe, MD

      Hi Victoria, I think your physicians are doing the right things but perhaps the pace is not ideal. The high risk pregnancy physician is key here and I would try to get seen as soon as possible. This kind of pain sounds like something that should be taken care of one way or another. Obviously from this distance I would have no idea what it might be. Regards, Fred Coe

      Reply
  101. Pat hayes

    I am 75 and I have now passed 6 kidney stones in the past few months. I have never had one before this year. I have read all I can about what causes them, etc. I have tried to do all I can to not have them but they keep coming. What can I do to prevent them because they are no fun. I must pass them by drinking lots of water because they go away after about two days. I have never been to a doctor about them. What can Doctor do that I haven’t done already, other than tell me I have kidney stones? Thank you.

    Reply
    • Fredric Coe, MD

      Hi Pat, The composition of the stones is crucial. A common reason for late age stones is a fall in urine pH with uric acid stones as a consequence. What are your stone made of? If you have never had them analyzed what do they look like – especially what color? There is no reason to have so many and not know why they form and get treatment to stop them from forming. Regards, Fred Coe

      Reply
  102. Joni

    Hello. I went to the ER for sharp pains in my lower right back and mild pain in my stomach. Got a CT done and they found a 2mm stone in my left kidney. Shouldn’t I be having back pain on my left side where the stone is instead of my right side?
    Any help would be appreciated!
    Can you email me your response?
    Thank you kindly!
    Joni

    Reply
    • Fredric Coe, MD

      Hi Joni, I guess we take what we get. The stone on the left is your primary issue. Sometimes CT scans can get mislabeled right to left, although given the anatomy this should be easily recognized. SOmetimes there are two stones, and only one is seen. This means your physicians will no doubt we wary. Regards, Fred Coe

      Reply
  103. Prateek

    hello sir,
    i have stone in my left kidney..approx 2 mm. i am on a treatment…but few days before i suffered pain in my left testicle..cn u tell me is this pain normal??should i do something to cure this??

    Reply
    • Fredric Coe, MD

      Hi Prateek, the left testicular pain is from the stone and is simply referred there because of shared nerves between the ureter bladder and testicle. It has nothing to do with the testicle and will vanish when the stone passes. Regards, Fred Coe

      Reply
  104. Tamara Dossett

    I am one of the patients that have been told there is no reason for me to be having pain. I am on my 5th stone issue right now. The first 2 were not diagnosed as stones at all. One of which I was pregnant and had urgency and stabbing pain in my urethra. It lasted for 2 months approximately. I had blood in my urine but nothing showed up in my cultures. My 3rd stone I had the same symptoms. I had a CAT scan done and was told repeatedly that while they could see the stone, it was not in a location that would cause pain. By the time I made it to the urologist visit, I was actually passing the stone on the way to the office. I felt like I was having a baby, having the urge to push. Then all of a sudden out of nowhere, I was fine. A week later I collected the stone from my urine. It was calcium oxclate. In 2012, the exact same thing occurred again. I informed my general doctor that it WAS a stone, gave her the info from the previous experience. Again, I was told there were stones, but NONE would be causing me pain. Blood in urine and stabbing in my urethra and urgency. After 2 months of going to the ER repeatedly she finally referred me to a urologist. By the time I made it to that appointment, I had the stone in hand. Size of the stone was 36mg. Again calcium oxalate. I asked her why they all keep saying there is not a stone when there is. She said I do not present typically. She even wrote on a prescription pad information to give to future doctors. ( It states that I do no have hydronephrosis, no pheboliths in my pelvis.) Not one time have I been prescribed any medication to help me with the pain, I am instructed to take Ibprohine. Now here I am again in 2015 November and am having severe stabbing pain in my urethra, my bladder aches, and blood in my urine. Now they say I have lots of little stones, but none should be causing me pain. I am at a complete loss. My abdomen is sore, I have stints of flank pain, but the urgency and stabbing is killing me. I have an appointment with a urologist in Feb 9th. I just want to cry. No pain meds and go to the ER if it gets too bad. *Also as soon as the stone passed previously there is NO pain what so ever. And I have NO history of drug use what so ever.

    Reply
    • Fredric Coe, MD

      Dear Tamara, I am sure that the pain you are having is from stones as there is no pain between them and you pass stones eventually. I wish that the contemporary craze over pain medications would abate. Your note speaks about 11/15 so the episode is no doubt resolved. Did you pass another stones? I might ask why you keep having stones. Can you get prevention? See the article and get what you most need – an end to new stones.

      Reply
  105. Richard Wilsdon

    A very interesting article and I thank you for it. I live in the UK and began experiencing severe left flank pain in February 2015. I had MRI to check my muscular skeletal issues that came back clear except for fair wear and tear. A partial colonoscopy and a CT scan.
    I then came off Statins (Simvastin). My pain greatly reduced but I still have occasional severe pain. I have now been informed that I have a Staghorn Calculi in my right kidney but the right side has never been an issue. Plus 2 small stones (3 and 5mm) in my left kidney. I believe these must be giving me non obstructive pain, I have never passed a stone I my 63 years,
    Is this a typical presentation?

    Reply
    • Fredric Coe, MD

      Hi Richard, No this is not very typical but it is in a way also reasonably straightforward. The left staghorn needs to be removed by a PERC. While under anaesthesia perhaps the left stones could be removed via URS. The analysis of the stones is critical; the staghorn could be from infection and a host of other causes. The small ones likewise need to be analyzed. Given all this you should have 24 hour urine and serum testing to find out what is causing all the stones. Regards Fred Coe

      Reply
      • Michael Borofsky M.D.

        Hi Richard, yes I completely agree with Dr. Coe. Staghorn calculi can be quite serious stones with high likelihoods of longterm kidney damage, infection, and other medical problems. Despite the fact that the right side is not bothering you I would consider it the side of greater concern at this point in time. I recommend trying to meet with a urologist, ideally someone who routinely performs percutaneous nephrolitotomy (PCNL or PERC), for consideration of stone removal. In some cases the side with smaller stones can be treated simultaneously, in other cases they can be treated at a separate setting. Regardless, your situation certainly merits consultation with a surgeon.

        Regards,
        Mike Borofsky

        Reply
        • Richard Wilsdon

          Thank you Fredric and Mike for your replies. The unfortunate thing in the UK is that although our National Health scheme is free, it is slow. I have an appointment with a consultant but not until 10th March. I will keep you posted. Just to throw something else into the mix, the pain last February began after an allergic reaction (sickness, Diarrhea, sweats etc) to Shellfish through cross contamination in a restaurant. I am now white fish intolerant as well but thankfully this is not immediate (2 – 3 hours)
          Many Thanks Richard
          Thanks again

          Reply
  106. Cyndee Hurst

    I have medullary sponge kidney disease, and both of my kidneys are full of stones, calcifications, and cysts. I was diagnosed when I was 11 years old and am now 61 years old. I have had many urologists and nephrologists since my diagnosis, and I have never had one acknowledge that non-obstructing kidney stones can cause flank pain. I have always suffered with chronic flank pain, and as I’ve gotten older, it had worsened. I pass kidney stones several times during a year, and also pass crystals in my urine on a daily basis. Thank you so much for writing this article! I really wish that I could find a urologist who would recognize that my pain is real and not from my spine, back, muscles, etc.

    Reply
    • Fredric Coe, MD

      I have little doubt that these calcifications can cause pain; the problem is that proper surgical approaches have not as yet become established. Of special importance is the crystals passing; they are absolute proof that urine supersaturation is too high and needs to be lower. Lowering it and therefore abolishing the crystal passage may not end your pain but might possibly lessen it considerably. I strongly suggest your take steps with your physicians to lower urine supersaturation with respect to calcium phosphate- -the crystals surely are calcium phosphate – in hopes of lessening symptoms. Regards, Fred Coe

      Reply
      • Cyndee Hurst

        Thanks so much for your reply! I will definitely talk with my urologist about urine supersaturation during my next appointment. I drink only bottled water, and try to drink at least 2 liters per day (more during the summer when I sweat a lot). I’m taking 25 mg of hydrochlorothiazide per day. I have been prescribed potassium citrate through the years, but it causes me to have severe stomach pain. My last 24 hour urine collection was two years ago. How often do you think this needs to be done? Whenever I wake up in the morning, my kidneys ache, cramp, and feel very heavy. It takes several hours for them to calm down. What do you think could cause this? Also, why do I always have blood in my urine? Almost every urine specimen that I’ve ever had taken has shown trace amounts of blood. (Of course, when I’m passing a stone, I pass larger amounts of visible blood.) My doctors have never been concerned about it, so I’m assuming that it must be associated with my medullary sponge kidney disease. I appreciate your time in answering my questions!

        Reply
        • Fredric Coe, MD

          You should have your past studies reviewed with respect to calcium phosphate and calcium oxalate supersaturations, if these crystals are calcium crystals, as I assume. If they were uric acid they would generally have an orange red tint which you did not mention. Surely the crystals have been analysed as you are always passing them, and the key supersaturation is the one that corresponds to your crystals. Blind treatments do not work- they must be directed at the relevant supersaturation. Regards, Fred Coe

          Reply
  107. Tejas

    My wife has 3 stone of 10 mm in ureter. She has not feel pain since 2 week. Blood and urine report suggest no clinical complications. Please suggest is it necessary to go through surgery

    Reply
    • Fredric Coe, MD

      Hi Tejas, surgery is needed if stones obstruct the ureters whether pain is present or not. I presume if her physicians want to operate it is because the stone is lodged in the ureter and is or may well begin obstructing the ureter. That would be a serious risk for loss of function in that kidney. If the stone was merely in the kidney and not obstructing, then surgery or not is a much more nuanced decision. Regards, Fred Coe

      Reply
  108. Rittu

    Hello sir
    2 weeks ago I have a severe pain then the physician adviced me to go through ultra sonography, there its found to be one 4mm stone in left kidney and a 6.5mm in ureters. I was asked to go through medicines, then for 5 days I don’t have pain now. Now today I again have gone for sonography, now it detects a stone in right kidney of 5.8 mm. Was it already there or what??? Please can anyone explain.

    Reply
    • Fredric Coe, MD

      Hi Rittu, One possibility is that the stone in the ureter on the right has moved back up into the kidney – I gather it is no longer in the ureter and you have without pain. The size difference of 6.5 to 5.8 is well within the error from measurement using ultrasound. Regards, Fred Coe

      Reply
  109. Tamara

    My daughter (6 years old) was diagnosed with 5-6mm kidney stone last week. She had a couple of days of severe pain, but the pain seems to have gone away completely. I have collected and strained all of her urine and she has not passed a stone. Is this normal?

    Reply
    • Fredric Coe, MD

      Hi Tamara, I would be sure and speak with her physician. The stone may have passed or perhaps is obstructing her ureter. It is important for her physician to be sure. As for stones at 6, this is a serious matter and the cause of the stones must be ascertained so that prevention can be accomplished. Childhood stones are often due to common genetic hypercalciuria but can also be from a serious systemic disease, so be sure the cause is determined. Regards, Fred Coe

      Reply
  110. Johanna escobar

    I am reading this and I need help! This is one of the first articles and doctor that I have found that actually might understand what im going through. Like the lady in the article, I have too been told I am med seeking and that I shouldnt be in this much pain. Please, if anyone knows how to contact this urologist or has any advice, PLEASE respond. This is my 10th or 11th stone within eight months. I cant work because of the pain. Ive had this current stone for five days. Lots of pain, vomiting anf chills. I need to help fifuring out how to avoid making these in the first place. They keep dropping into my uritur. Some only one or two days apart. Thank you.

    Reply
    • Fredric Coe, MD

      Dear Johanna, I am very sorry to hear about so much trouble. Firstly, having 8 – 9 stones in 8 months means that prevention is very urgent. Before embarking on a search for other physicians, be sure and speak with those who already care for you and bring up the importance of prevention. Prevention of stones is very practical and usually effective. If your present physicians cannot stone these stones perhaps they can arrange a referral for you to a center where it can be accomplished. The physician who wrote the article works at the Methodist Stone Center at Indiana University, Indianapolis, and would, I am sure, be pleased to speak with you or email. Let me know, Regards, Fred Coe

      Reply
  111. Wayne

    Can anyone offer some advice my wife has been diagnosed with a large kidney stone and is awaiting surjury to have it removed however the pain she is going through is unbearable I have had her to the er twice before we found out about it watching her go through this is driving me crazy knowing there is nothing I can do any suggestions on how we can lessen the pain

    Reply
    • Fredric Coe, MD

      Hi Wayne, I take it the stone is obstructing the urinary system and that is the cause of her acute pain. When severe enough narcotics are not unreasonable presuming NSAIDS have been ineffective. This is a complex surgical issue, and no one at a distance can make any useful advice apart from this: Acute pain from a stone can be very severe, short term narcotics are entirely justified to control pain until the stone can be managed surgically, and one is justified in speaking the the personal physicians involved to assure short term pain management until the episode has been resolved. Regards, Fred Coe

      Reply
  112. Jamie

    I’m 28 weeks pregnant and was diagnosed with Kidney stones. However, the pain is in my left flank where 2 CT scan did not pic anything up. A stone was found on my right. Due to being pregnant, I was finally sent home after 3ER visits with pain med (Dilaudid). Tonight the pain is worsened even over the meds. I’m confused what to do! My options for pain relief is limited due to pregnancy. The Er/OB basically told me to let it run its course…a course that cannot be found and I’m in pain! What are my options? It’s been 5 long days and no results. I’m so scared

    Reply
    • Fredric Coe, MD

      Dear Jamie, Your’s is an odd situation. I gather the right stone is not obstructing your ureter, and there is nothing at all on the left side. The CT scans are normal apart from the stone on the right. Firstly, it is not acceptable to have narcotic level pain during an otherwise normal pregnancy and it is also not reasonable to ascribe pain of such magnitude to stones on a side that shows no stones. So there must be another reason for the left sided pain. I would think your personal OB physician needs to figure this out. What if the pain on the left is not from stones? Is it possible there was a small left stone – missed on CT – which is now obstructing; if so an ultrasound- no radiation- can be helpful. By all means to not let this simply do what it is doing without your personal OB physician closely monitoring things and figuring out the nature of the problem and a medically proper solution. Fred Coe

      Reply
  113. Stephanie S

    I have two herniated discs in my lower spine. It has caused sciatica pain in my left leg, I have been having back pain for about a month now which I dismissed as pain associated with my back issues. I then started my monthly cycle and dismissed the cramps in my stomach as menstrual pains. The pain increased so much that I went to the ER. They did a CT scan and said I have a 2 mm stone, sent me home with pain meds and something for being nauseous. Now the pain is so bad I can’t get up out of bed. I need to know if this is normal and if I should seek further treatment. How long should this last? I drink about a gallon of water a day, I have tried fresh lemon juice and olive oil, cranberry juice and water with lemons. The pain never fully leaves but it does increase to unbearable levels then back down to being tolerable. When I walk it hurts, I can’t bend over and I can’t sit up on my own. My left leg has pain at times then the pain completely goes away. Please let me know what you think.

    Reply
    • Fredric Coe, MD

      Hi Stephanie, I guess the question is whether it is the stone causing your pain or your disc disease. Is the 2 mm stone obstructing the ureter? If it is, that can cause terrible pain which should go away when the stone has passed. The new pain, in your stomach, may well have been from the stone as stones rarely cause sciatic pain. So there are two pains of perhaps differing origins. From the stone, the pain will not improve or worsen with motion, position, bending or any other physical means. So what you describe at the end of your note is presumably from your back and may require physical medicine care. Nausea and abdominal pain is usually not from a disc and could be from the stone. The fluids are a good idea, the lemons of dubious value, and the cranberry juice likewise. I would wait for the stone to pass and seek care for the disc problem. When things get better, be sure and have your physicians figure out why you formed the stone so you can take steps to avoid more of them. Regards, Fred Coe

      Reply
  114. Guna

    Hello sir,
    Three days ago, I had pain in my lower left stomach and when I went to the hospital, I was diagonised with with 7 mm kidney stone. The doctor said the stone is on the way to the bladder and gave me pain medications and Flomax. But so far I am not feeling any pain for the past two days. I am concerned as to what is going on. Please any advise would be much appreciated.
    Thanks

    Reply
    • Fredric Coe, MD

      Hi Guna, Usually physicians want to know if pain changes, as yours has done, so it is important to let your physician know. Perhaps the stone has passed, or perhaps it is lodged in the ureter. Either way, your physician needs to know and make a new evaluation. Regards, Fred Coe

      Reply
  115. Zoya

    Hello sir
    I have posted earlier regarding my 5.6 mm stone in my left kidney. I have been prescribed uralyt u granules, but the taste is bitter causing nausea. Because of nausea i m skipping this drug. Is there any tablet of potassium sodium hydrogen citrate. Can you please elaborate on medical expulsive therapy for renal calculus. I took Tamuolosin for 10 days but nothing happened, the stone is still there. I have appointment with Dr after 2 weeks
    Please reply
    Thanks

    Reply
    • Fredric Coe, MD

      Hi Zoya, potassium citrate has nothing to do with stones that are already formed. Those are surgical problems, unless they pass on their own. Potassium citrate and all other prevention measurements are to prevent more stones. At this point your urologist needs to deal with the stone. Thereafter you need to have proper prevention so there are no more to cause trouble later on. Fred Coe

      Reply
  116. Raj K B

    Very nice Article, For the first time, I Suddenly had pain in groin which I thought might be pain in testes due to sleeping injury or might be urinary infection. So, I tried antibiotics and tablets for pain killers without any relief . Pain was constant for around 4 hours with increasing urge to pass the urine but I was unable to do that. Then pain started increasing with spasm in abdominal area, urge for urinating was causing hell lot of discomfort. Slowly, pain increases more and my jaws, face muscles got spasm, also both hand and feet muscles were undergoing contraction. Condition was much like Tetanus. For once I thought It might be Paralysis attack because upper part of body was loosing the sensation. Pain was so high I was afraid of pass out. After lots of medication on time, I got some relief and kidney stone moved out. So, my observation is, “extreme pain” may cause symptoms like “tetanus” and “loss of sensation” in body parts. Thanks!!

    Reply
    • Fredric Coe, MD

      Hi Raj, Thanks for the comment. I suspect you were hyperventilating and lowered your blood calcium ion concentration which caused the spasms. Good luck in preventing more stones! Fred Coe

      Reply
  117. Deb fowler

    Facinating article, I have had kidney stones(oxalate) since age 23, had lithotripsy then and again 17 yrs later and again 5 yrs later due to medullary sponge kidney. The stones are always rattling around and this year for the first time they have decided to move on their own and hurt. My urologist says the stones are too small for the lithotripter at 6mm but they hurt moving or just staying. Thanks for your article.

    Reply
    • Fredric Coe, MD

      Hi Deb, You are part of the small stone dilemma. Certainly shock wave lithotripsy is not likely to do much good. Whether people with pain and small stones benefit from ureteroscopic treatment to remove the stones and tubule plugs is a matter of controversy. A lot depends upon how much pain and therefore whether it is worth your undertaking surgical treatment not as yet tested in any trials. Fred Coe

      Reply
  118. VISHAL SINGH

    Hello sir
    Recently my doctor diagnosed a fibre size kidney stone in my right kidney I am taking medicine since four days but I am feeling a mild pain continuously on right side abdomen
    I am drinking 3 litres of water daily but pain is hurting when I touched or exercises

    Reply
    • Fredric Coe, MD

      Hi Vishal, If you are passing a stone, your personal physician needs to keep track of its progress and be sure it leaves your urinary tract. Be sure and follow up with him. Otherwise the fluids sound like a good idea. If your physician gave you medication take it as directed. Regards, Fred Coe

      Reply
  119. Zoya

    Hello sir
    Yesterday i got pain and got an ultrasound done
    It says 5.6 mm calculus in left kidney in lower pole
    And in the right kidney mild prominence of pelvicalyceal system and right ureter not visualised. What is your opinion. I am having nausea too. My urine is acidic Ph 6
    I am taking uralyt u granules
    Please reply

    Reply
    • Fredric Coe, MD

      Hi Zoya, Your medication, URALYT-U® is a preparation of sodium and potassium citrate about equivalent to two US potassium citrate tablets in citrate content but having half sodium and half potassium as the cation. It is for uric acid stones. For calcium stones, the sodium component would be less ideal as sodium will raise urine calcium. Your present attack is unclear as your pain is not specified as to which side. The left kidney has a stone in it that could have transiently blocked urine flow and caused pain. The right side does not seem abnormal. What to do here is a matter of surgical judgment for your personal physicians. Regards, Fred Coe

      Reply
      • Zoya

        Hello sir
        Pain was localized to right lower abdomen radiatng from back and coming in waves
        Can a 5.6 mm stone pass via urine. I am prescribed good hydration
        Dietary changes
        Tamuolosin aplha blocker to dilate ureters for ten days

        Reply
        • Fredric Coe, MD

          Dear Zoya, the right sided pain could be a stone. But the stone you mentioned was on the left. I presume there are two stones or else you have the stone and pain mixed as to the side. In any event management of stones seems right – from your description of your meds – and a 5.6 mm stone can pass. You doctors seem to be doing all the right things. After the stone has passed and you are well you should have the stone analysed so you know what it is, and have blood and urine testing to determine the causes of the stones. Regards, Fred Coe

          Reply
          • Zoya

            Hello sir
            I have been prescribed tablet uricare two tablets three times after meals by doctor for 1 month. Its an ayurvedic medicine. Will it affect my kidneys in a bad way? . I have a 5.6 mm stone in my left kidney. Please reply
            Thanks

            Reply
            • Zoya

              Uricare tablet is also known as cystone. Waiting for your opinion

              Reply
            • Fredric Coe, MD

              Hi Zoya, I found one study of this drug which was resoundingly negative. It did not lower urine supersaturations. The total burden of stones in the kidneys did not decrease over one year, and in fact increased. It seems worthless based on this trial. Of course it was a short trial and perhaps a longer one might be positive, and might not be. If you have significant stones, why not pursue more established prevention: 24 hour testing to find out what is wrong; stone analysis to find out what crystals we are trying to prevent; diet changes and meds if needed to reverse supersaturations for the crystals in your stones. Regards, Fred Coe

              Reply
  120. Chris

    Hi,

    My father has been hospitalized for 1 month now with flank pain and ‘too small to cause this pain’ kidney stones. They have run all sorts of tests, CT, ultrasound, echo-cardiogram, bonescan, etc, not finding anything. I have asked and asked for a urologist to do a ureteroscope but they insist it’s not indicated. What can I do? Thanks so much!

    Reply
    • Fredric Coe, MD

      Hi Chris, It seems unusual to be hospitalized for a month for flank pain. I doubt that small stone pain would lead to a month of inpatient care however so much it can be burdensome. If it really a whole month then I would suspect more than stones. Possibly you mean he has had hospital associated pain episodes; perhaps you might clarify this so I could be more helpful. Regards, Fred Coe

      Reply
  121. Karen Laurie

    Dear Dr. Coe,

    Thanks for your thoughtful explanation about non-obstructive kidney stones, their ability to cause pain and the significant disagreement within the field. After reporting mild right side pain where I have a small stone (3mm) in the lower pole and questioning if it could be causing pain and hematuria (the latter symptom I’ve had x 6 months) I was told categorically that the stone could not be causing this pain and that the pain was probably from the UPJ obstruction pyeloplasty sequelae. I pointed out that the pyeloplasty was performed on my left side and my pain was on the right. Also, I was informed that urology had performed every test to determine the cause of the hematuria and the results were negative. I was very clear that I was not claiming that the stone was passing, that the pain was dull and intermittent and tolerable. Obviously Dr. Coe, I have omitted many of the details in order to focus on the current bothersome symptoms. The pain I can live with unless the stone is not only causing the pain, but more importantly the stone is somehow causing the daily gross hematuria (I have read that non-obstructive stones cause cause hematuria but I am not clear as to how).

    Thanks for any feedback and for your appreciation that as medical knowledge evolves patients can have a rough go of it depending on the practitioner’s beliefs and whether the patients can be relentless in getting answers.

    Thank you for your time and thoughts,

    Karen

    Reply
    • Fredric Coe, MD

      Dear Karen, You are certainly in a large group of people which this kind of symptom, and not a few people in the field are concerned about what is causing the problem and how best to treat it. As for hematuria, so long as important other causes have been eliminated by your urologists it is presumed from the stones and is itself not of especial concern per se nor an indication for s surgical procedure. Regards, Fred Coe

      Reply
  122. Venus B

    Hi thank you so much for this article!
    I was in the ER last night after a sharp horrible pain in my right mid flank for kidney stones but the doctor said there were no stones present in the CT scan as it probably had past. They found samples in my urine and that for them was the evidence that I indeed had stones. I was treated horribly by the doctor I felt like he saw me as a patient just looking for pain medication but I really was in the most horrible pain in my life. I got to a UC school far from home full time so I cannot see my primary doc and am also an athlete and I am now very scared the stones will come back as the doctor said they are in my kidneys. I don’t want to have to go to the ER again and have the doctor give me the dirty “your a druggie” look. Any advice is much appreciated.

    Reply
    • Fredric Coe, MD

      Hi Venus, It sounds like you passed some crystals; they can cause pain and bleeding but are not seen on CT scans. Being an athlete means potential for dehydration, and I wonder if this attack followed a particularly strenuous event. I gather there are stones in your kidneys and that you are young. You need a full evaluation for causes of stones and a proper prevention program. This would require referral to a skilled physician. Do this, as especially women – I am guessing – who form stones early in life are prone to form many and also have distinctive abnormalities that can be effectively treated. Regards, Fred Coe

      Reply
  123. Janette

    After reading this article I feel hope for the first time in years. I have been seeing my family doctor for some time now regarding the exact same thing you are talking about which is pain in what seems to be my right kidney. He sent me to a urologist and they found nothing. They did a CT scan and found 2 stones in my right kidney but they all said that they are not the cause of the pain. I’ve had my gallbladder removed after having that tested and was told that it was performing below the “normal” levels and that didn’t solve anything. They sent me to a pain specialist where he did a procedure where the myelin sheath is severed believing that it was nerve pain in my lower back and once again nothing. They sent me for a colonoscopy and then an endoscopy and yet again was given what seemed to me as bad news as there was nothing detected as to what was causing the pain. I just scheduled an appointment with my doctor to talk to him about this article and I’m really worried about what his response will be. Any suggestions before I go as to what I should say to him to make him possibly believe me?

    Reply
    • Fredric Coe, MD

      Hi Janette, I am afraid that the only thing we have to offer is the article itself. Small stones do seem associated with chronic pain, but surgical procedures for such pain are presently in the province of surgical research centers as there are no prospective randomized trials. If pain is so severe as you describe, and there are stones present, it would not be remarkable to remove them, especially via ureteroscopy so that the papillae can be visualized. The unsolved problem is crystal deposits within the kidney tissues. Your physician can distinguish these from stones at the time of the procedure. Regards, Fred Coe

      Reply
  124. shubham mishra

    hi sir i am shubham mishra i have 7 stones size 5,6,7 mm and both are kidneys its very painfull what can i do please suggest me

    Reply
    • Fredric Coe, MD

      Hi Shubham, Seven stones is a lot, and given the pain I would guess one of more of them is obstructing the kidney. There is nothing you can do about this; you need a skilled urologist who can take care of this matter. I would suggest you get the proper physician and let him or her resolve things for you. Regards, Fred Coe

      Reply
  125. Priya Singh

    Hi..
    since I hv 3 kidney stones frm last 5 months so during starting 3 tyms I suffered frm severe pain so mah urologist suggested fr operations so I request you to ans meh dat nw a days I feel totally fyn n there is no pain but stones r still present so is it ok? If
    I take sos wen needed..n is it ok if I do aerobics every evening?

    Reply
    • Fredric Coe, MD

      Hi Priya, I take it that you have three stones in your kidneys, you have had severe pain presumably from one of the stones but are not free of pain. It is OK to do nothing if – a very important if – your urologist is sure there is no obstruction being produced by any of your stones. Stones that are not causing obstruction, infection, bleeding or pain can be left in place. You would know about severe bleeding and pain and could guess about infection but obstruction can be silent – so be sure of this. As for aerobics, not a problem. Stay well hydrated so as not to form more stones! Fred Coe

      Reply
    • jay

      if it is smaller than 5mm you should drink 3-4 ltr water in a day it can pass from urin and if it is bigger than 5 mm concern with doctor bkz lasour operation cannot successful stone dissolve for few time after that u have problem again

      Reply
  126. Travis

    This article was very informative, my only wish is that this information be made more widely available to E.R. and family doctors. To many times I see doctors get stuck in the rut of believing only what a text book says, or be handicapped by what an insurance company will pay for. The part that gets me is do E.R. doctors really believe we as kidney stone patients are that stupid ??? For us that have had to deal with real kidney pain, we know the drill you go the E.R. first thing they do is order the gold standard, C.T.. If they don’t see any obstructing stones they say it shouldn’t hurt, next if their nice they will give you tordol which does help, but doesn’t relieve the majority of the pain. Do doctors really think we want to subject ourselves to C.T. after C.T. only to be told we shouldn’t be having pain? I work as a Diesel Mechanic, and have seen trucks come in the shop that have been to 5 other shops and bills as high $3,000 for stupid things that should have be caught. After fixing the problem, the customers always ask the same thing why was it that I took it to all the other places and they couldn’t figure out the problem but you did, or someone else in my shop did. My response is usually always the same, because the answer the problem wasn’t is in a book, or technical service bulletin. We had to but 2 and 2 together and realize the manual was wrong, or the diagram was printed wrong. Here is a good example, customer says check engine light comes on mostly when going around corner. Other shops said sorry you don’t have any codes, customer gets mad the light comes on again, he takes it to another shop and the same thing repeats itself, customer comes to our shop and he tells us everything he has been through at the previous shops. So we start off with the customer is correct and not lying, after a few diagnostic steps we find that yes there is no codes and yes there is a rubbed through wire that is grounding out the check engine light. Errors in programming are found everyday, and we are used to it. Heck the idiom we are only human, confirms it. Ok I’m done with my rant now, please keep up the good work and continue to think outside the box, not many people believed Einsteins ideas but the atomic bomb left a literal explanation point that he was right.

    Reply
    • Fredric Coe, MD

      Hi Travis, I love the analogy. To me physicians are all diesel mechanics, but we do not get a users manuals for our engines (bodies), circuit diagrams, or code – we need to work them out ourselves – called biomedical research – and somehow distribute the results to the folks fixing the engines (physicians) – called medical education. I am convinced that pain without obstruction must be common and I know it is not an accepted phenomenon. This is a real research problem as nothing else can fix the ER problem, and make life better for people with this pain. Great note, thanks, Fred Coe

      Reply
    • Anna

      Just saw this comment, Travis, and it is 100% spot on. Doctors are spouting off what they read in a medical textbook but not actually opening their minds and seeing what happens in the real-world and using real-life examples to changes their views. Due to doctors’ closed-mindedness I’ve suffered for a long time with my non-obstructive stone. Funnily enough, I recently went to Indonesia for a work trip where I happened to attend a training session at a hospital with a group of doctors. In Indonesia (a developing country) all the doctors were taught that non-obstructive kidney stones CAN cause pain and this seemed to be general knowledge amongst all the doctors I met. i got a prescription for Flomax over there which although hasn’t eradicated my pain has REALLY helped and I have a lot more energy now. Not sure what exactly it’s done but seems to be doing something right. If nothing happens after a few weeks on Flomax I’ll investigate into finding a doctor to perform surgery for me (I still haven’t found one here yet). Why the thinking that was common knowledge with the doctors I met in a developing country is NOT common knowledge in first world countries, I’ll never know. Good luck and I hope you and I BOTH stop suffering soon 🙂

      Reply
    • Grace Battisti

      Lovely interesting letter Travis!!
      Grace

      Reply
  127. Celia Mac Donald

    Mike Bornofsky you say “The pain classically persists at a severe level for several hours (phase two) but ultimately subsides, at least partially (phase three)”. Some of our MSK group members when passing stones experience these same symptoms of extreme renal colic, not for hours, but for days, weeks and even months on end! Trying their best to avoid ER for the millionth time this year for obvious reasons (same attitude, same treatment, same dirty looks, same insinuations, accusations for seeking unjustified pain relief!) Many of our members are living their lives in dialy chronic pain due to MSK, when renal colic hits from passing yet another stone, their pain is multiplied, never ending relentless pain, till they finally pass that darned stone (days, weeks or months later!) Once this episode has passed, they’re blessed with … what? a week? a month? 2 months of colic free symptoms until … the next stone, and all this pain hits again, for days, weeks, or months at a time!

    Reply
  128. Susie Joz-Williams (Facebook Account Name)

    I passed my first 7 kidney stones on my husband’s 40th birthday, (he’s 10 yrs. & 6 wks. older than me), 6 hrs. prior to the surprise party to begin. I had been planning this for 4 mths., and I had been having severe pain the prior 9-10 days with nausea, vomiting, horrible diarrhea, sweats, fever, bloody urine and often felt very light headed. I honestly thought it was my Crohn’s Disease flaring up and I was just miserable. I was diagnosed at age 22 that I inherented from my Nanny, (Mom’s Mom & 2 female cousins.)
    After being admitted to the hospital from the ER on 8/29/2000, it took a week to diagnose at ‘U of M’ in Ann Arbor, MI. I was tested with all the following: Blood, Urine, 24 & 48-hr collections, along with X-rays, CT Scans and an IVP. I was told that I have Medullay Sponge Kidneys and the most stones in both my kidneys! Since 8/27/00, I have passed over 19,685+ stones! In just over 15 years, I’ve had only 1 – day, each year that I didn’t pass any stones, which is when I had to have them removed surgically!
    In an average 24 hr day, I pass between 50-100, (best day=7•worst day=157.) I was just about to be scheduled for ESWL Surgery, but then we moved to Las Vegays, NV. I have had a heck of a time trying to convince BOTH my Urologist and Nephrologist to preform the ESWL! They feel and have told me, “it could cause damage to my other organs, because of the sheer amount of stones they would need to ‘blast’!”
    Since diagnosed, I see a Nutritionist that has me on a very specific and healthy Diet, for BOTH my MSK & Crohn’s Disease, which is a very delicate balancing act! I drink 2 gallonsof bottledwater daily & a 1/2 gallon of Lemon and /or Lime water, a low protein diet and see my Internist every 3 mths and both my kidney MD’S every month, along with my pain doctor.
    At this point, I am passing ALL forms of kidney stones and over the last 18-20 mths, the are fusing (bonding) together, which of course makes this even more painful!
    I lead a very healthy lifestyle: don’t smoke don’t drink alcohol, caffeine (of any kind), no nuts, chocolate, lots of organic healthy foods and for do water arobics 3-4x/wk, and light forms of yoga.
    I would like to know your opinion and any suggestions that you may have, after everything I’ve described to me over the past 15+ years.
    Thank you in advance for your input!
    Respectfully, Suzy Williams
    ☆ Dr. Fredric Coe, you can see my Facebook info. under the legal name I provided to you.

    Reply
    • Fredric Coe, MD

      Hi Susie, It sounds like you have stone disease complicated by bowel disease, which is indeed a difficult treatment situation. We have observed and published series of accelerated stone disease like yours and found that they are not so difficult to prevent. I agree with your surgeons that shock wave lithotripsy is potentially harmful and should not be used very often, and mention that medical prevention is the proper approach. Youe physicians at Ann Arbor are likely to be outstanding specialists, and have, I am sure, thought carefully about treatment options for preventing recurrence. From your description I do not detect what I might have expected by way of treatments, and there may be good reasons why not. I do not know why a low protein diet would be helpful. If you are really drinking 2 gallons of water daily and do not have diarrhea which would otherwise dissipate that water then your urine volume would approach 2 gallons per day; at that level of flow I cannot imagine any supersaturation would be present to drive crystal and therefore stone formation. For this reason, I would be concerned that the urine chemistries are abnormal in unusual ways which I do not know about. Perhaps your physicians are indeed already working to correct matters. Whatever, prevention of such numbers of stones should certainly be possible at a major university center and no doubt will be achieved. Fred Coe

      Reply
      • Lynn

        Wow Suzie! And I thought I was having issues when I passed 27 stones last Sunday after 14 agonizing hours of pulsing wave pain. Hot baths really helped. Never hurts expelling them..only the path down the ureter. Left side for me. I hope someone figures out why diluting urine with large quantities of water isn’t helping you. Because I haven’t had a stone since age 23 (I’m now 63), I wonder why all of a sudden I passed a mass of these suckers! Since Sunday, I’ve begun a daily regimen of 500 mg of magnesium, 75 mg of B6 (in a balanced-B vitamin), and trying to take in 1200 mg of calcium. I’ve never been big on calcium & I now read that studies show that people who produce calcium oxalate stones are usually low on calcium and magnesium. I have no clue what these latest stones are made of, but I’ve saved them. I don’t go to doctors anymore & try to self-treat via research. The stones are smooth & round & various sizes but small enough to pass at this point. For what it’s worth, I’m a chocolate addict (very high in oxalate) & I began to eat unsalted nuts by the handful a few times/day. Bad combo apparently when not taking in calcium & magnesium. I hope some of this might strike a chord with you as sounds like we have something here in common, but I’m on the minor edge while you’re off the charts! Good luck! -Lynn

        Reply
        • Lynn

          I should add that I drink more than 1 quart of water daily & have just begun to add the juice of one lemon to that. I’d sure like to hear what Dr. Coe thinks about all that I’m doing. I know I must drink more water! (and that first stone at age 22 had to be removed surgically as it was 1975) I guess I should try to find a way to have the 27 stones analyzed but hate to have to pay a doctor just to hand them over! Is there another way to have them tested? tks!

          Reply
          • Fredric Coe, MD

            Hi Lynn, a quart of water is not much in this league – 3 would be good protection. The lemon thing is mostly nonsense, if you need potassium citrate – which is what lemons are presumed to supply – you need a lot of lemons and are better off with medication. See what I wrote below. As for paying, stone analyses are not expensive. Regards Fred Coe

            Reply
        • Fredric Coe, MD

          Hi Lynn, I gather you had stones in your youth and none since age 23, then – all of a sudden?? – passed 27. Firstly you should have the stones analysed. It really matters. Given so many, you should get a CT scan and see what is in your kidneys. As for diet calcium, many stone formers have genetic hypercalciuria and will lose bone mineral in their urine if they do not eat enough calcium with their meals. The calcium needs to be with food. If necessary one can take a calcium supplement but with the meal. The lower the diet sodium, the lower the urine calcium, so low sodium diet is a big help. The magnesium and B vitamins have no proven role in stone prevention. Regards, Fred Coe

          Reply
  129. Rachel

    Thank you so much for replying Dr. Coe!! You gave me valuable information. 🙂 I was going to see what openings Dr Monga had that week as the date/time of Dr Noble’s appointment may not work for me. I take the chlothaladone at night, so I definitely have a higher urine volume overnight..I often have to wake up in the middle of the night at least once. I have already increased liquids and am watching sodium, but will be more mindful now that I know. I’ll find out the results of my 24 hour urine this week and I’m hopeful the calcium has gone down and citrate up. My father had a severe form of kidney stone disease. I remember him going through several procedures and mentioning calcium build up or something in his ureters. Thank you again!! I realize how kind it is to take your time to reply. You have been very helpful!!

    Reply
  130. Rachel

    Thank you so much for this much needed article! I am a 38 year old female. I found out that I had over a dozen non-obstructing stones in each kidney in May, 2015. Since then, I have passed 33 stones (that I have collected – there may have been more) and had one procedure to remove an obstructing stone in my upper ureter. I have been to the ER on multiple occasions, often told “you have multiple calculi in both kidneys and a few in your bladder, but none are obstructing and you shouldn’t be having pain”. As of the last CT done a few weeks ago, I had 16 stones in my left kidney and 15 in my right. The stones in my left haven’t done a thing and aren’t growing, but my right kidney is making them faster than I’m passing them and they are all growing. I had a 24 hour urine done in the beginning of July, showing high levels of calcium and low citrate, so I was placed on potassium citrate and chlorthaladone to help reduce the stone making process. So far, no results. I went to the Cleveland Clinic last week to figure out why this is happening and don’t have any answers – I go back in November to see a urologist who specializes in stone disease. During the past year, I have also fractured multiple bones in my feet and teeth (15 all together) most of which were spontaneous. The one that wasn’t a spontaneous fracture in my foot was precipitated by hopping. The endocrinologist I saw at Cleveland said it’s not osteoporosis as they are small bones, plus I had a normal bone density. I feel like something metabolic is going on with my system. I have another endocrinologist appointment next month and am hoping they will run the right tests. Oh, my parathyroid and serum calcium are both normal, along with my D3. Have you ever heard of anyone presenting with bone disease along with kidney stones? Also, when will the treatment of potassium citrate and chlorthaladone start working? Do you agree that there has to be some sort of condition that’s causing this many stones? I can’t imagine this continuing for years, as it has been a nightmare! The urologist I saw at Cleveland Clinic, who didn’t specialize in stone disease, said there were a few surgical options if this continues with no solution. I could replace my ureters with intestines (so the stones wouldn’t get stuck) or move my right kidney next to my bladder, as that is my problem kidney. My life as I have known it has changed due to this and I feel like I’m suffering.. a lot! I’m still working full time, but have had to call off intermittently due to this. Thanks again and thanks in advance for my questions!

    Reply
    • Fredric Coe, MD

      Dear Rachel, You seem to have high urine calcium loss and presumably idiopathic hypercalciuria. It is an hereditary condition in which bone disease is very well described, sometimes rather severe and not at all necessarily like routine osteoporosis. Your physicians presumably know this already, and are taking steps to prevent more fractures. The chlorthalidone is certainly a reasonable drug and I prefer it for my own practice. The potassium citrate depends. If the stones are calcium phosphate, there are no trials to be sure it is beneficial; if the stones are calcium oxalate, it has been shown to be beneficial. So analysis of all those stones is important. I suspect they are calcium phosphate. The drugs are not enough or you would stop forming stones. I would think a very high urine volume would be important. This site has a lot about fluids. Likewise about kinds of fluids. The chlorthalidone works best with a reduced sodium diet – be sure your urine sodium is on the low wide. I have never found it necessary to resort to extreme surgical measures such as replacing ureters with intestinal segments. I am sure your physicians are doing all they can for you, and hope these few additions will make the needed difference and result in stoppage of stones. Incidentally the main stone urologist at Cleveland Clinic is excellent, and someone I know personally. All the best, Fred Coe

      Reply
      • Rachel

        Thank you so much for responding!! That’s incredibly kind of you. Very good information regarding the association of kidney stones and fractures. The make up of a stone I had analyzed was 65% calcium oxalate dihydrate and 35% Carbonate apatite. Does that change anything? I’m doing another 24 hour urine this weekend to see if the medication has had an effect. If you don’t mind me asking, who is the Dr at Cleveland Clinic you know? I’m scheduled with Dr Noble, but have heard good things about Dr Monga as well.

        Reply
        • Fredric Coe, MD

          I know Dr. Monga, but that is not to say Dr. Noble is not of the same quality. The dihydrate composition of the stone is compatible with high urine calcium driving crystal formation, and the carbonate apatite means your urine pH is higher than in the usual calcium oxalate stone former. The higher phosphate concentration would mean to me a great emphasis on prevention, so your medications should be bolstered by as low a diet sodium as possible and as high a urine volume – especially overnight. Your goal is eradication of new stones, which is certainly a reasonable goal. The bone disease may well be related to idiopathic hypercalciuria, a matter I have not as yet taken up on this site but is very well known. It is familial, by the way, both IH and its bone disease. Best wishes for a successful visit to Cleveland Clinic, and my regards to Dr. Monga should you encounter him. Fred Coe

          Reply
          • Jane

            I have sponge kidneys and have passed hundreds of stones over the past 25+ years. Dr. Monga was my Dr for 25 years and I was heartbroken when he moved from the U of M to Cleveland. You will be in good hands………….Jane

            Reply
  131. Eileen

    Thank you for this website!! I’ve been a “chronic” sufferer of kidney stones and infections for the past 20 years. It started with recurring kidney infections, treatment with antibiotics, and then kidney stones. I had a large stone surgically removed 7 years ago, and last June when I had a scan done (Viascan) the doctor found a stone “as big as his head”. Clearly it’s too large to pass, which is a blessing because I’ve been through that pain! But I now have chronic flank pain. What is the prognosis for something like this? Does it just continue to get bigger until I decide to have it removed? The pain isn’t unbearable, I’ve gotten used to it for the most part. But I worry that it’s getting bigger every day!

    Reply
    • Michael Borofsky M.D.

      Dear Eileen,

      If you do in fact have a large stone in your kidney at the moment that would be a very likely explanation for the reason you are having pain. It sounds like something that should be removed. Obviously the remainder of your medical history is critical to this sort of decision but the stone is likely to continue to grow over time and I would not expect the pain to improve without the it being treated. Additionally since this is now the second large stone you have developed in your kidney over the past several years you should consider undergoing formal blood and urine testing to try and figure out why you are forming these recurrent stones and what if anything can be done to prevent them in the future. We wish you well.

      Sincerely,
      Mike Borofsky

      Reply
  132. Brittney

    I’m a 28 y/o, female. I had my first kidney stone in Aug 2011. It was 10mm, obstructing, wbc 26, in renal failure. Immediate surgery for stint placement, contacted a super-bug in my lungs and 36 hours later was back in the hospital with a o2-38%- spent over a week in ICU and then on the floor for about a week. A month later, I had lithotripsy. Since then, I’ve had at least 17 surgeries for kidney stones and had one urologist go in and empty out all of the stones in 2013. I have kidney stones in both kidneys. My kidneys hurt all of the time. I went from being a full-time student and employee to no life whatsoever. I haven’t worked since Aug 2011 and there’s no way I could be relied upon to even run an errand. I’m not sure I’ve been without an infection since this first began. I’ve been on antibiotics on and off the entire time. In fact, they rarely even have an effect big enough to knock out the infections completely. I’ve seen 6 specialist and the one who retired is the only one who gave me any sense of hope. He was the one who emptied out my kidneys and believed that it truly does cause pain. *note: he retired.
    Back to square one.
    I’m entirely too young to be laid up on the couch or in the bed or even in any kind of discomfort that would keep me from living like a 28 y/o should. Then, to have anyone tell you that there’s no way you could hurt- because, the stones are inside of the kidney. Have mercy on them, Lord; because, I surly do not.
    I would rather pass kidney stones all day long as to have them in my kidneys. It’s a pain that doesn’t ever truly go away. It’s always there. When I bend, turn, lift…sometimes, with every step that I take. It is awful.
    I understand, the pandemic with narcotics. I do. It’s hard for me to feel ashamed of needing the only thing that knocks the pain out enough for me to even sometimes make it just walking through my house. It is sad that any human with a heart and conscious would refuse to write a prescription for someone to have some sort of quality of life…and instead…be the reason someone, like myself, has to suffer from day to say and see no light at the end of the tunnel. It takes a huge toll on you. Believe me. The way I see it, if you aren’t willing to help find a solution; rather- you run test, can’t find any answers and throw your hands up, refuse pain medication- because, you’ve been told for years and years that there’s no pain to accompany stones that are of passing size… Well, you have been lied to. Not everyone is looking for pain medication to get a “buzz”. Some of us are just trying to get by with the only fix to our kidney pain.
    I apologize for the rant. It’s been going on for years, now, and I’m at my wits end. I just need someone who will help me. Because, it hasn’t happened in Arkansas. Please, if there is anyone who I could be referred to, who is willing to help me figure out how to overcome this pain and these kidney stones- I would gladly accept it. My email is brittneydollins@gmail.com

    Reply
  133. Jenny

    I was curious as to the best way to contact Dr. Borofsky regarding this article?

    Reply
    • Fredric Coe, MD

      Hi Jenny, I am a bit hesitant to put email addresses of others on the site, but Mike is at Indiana University Indianapolis (IUPUI) and easily located on the web. Likewise we have a facebook site kidneystone docs with him on it. I suppose I am being squeamish, so forgive me. Best, Fred Coe

      Reply
  134. Anna

    Thanks for this information; so interesting to read the article and the comments especially about small, non-obstructive stones. I’m a 31 year old female who has always been very healthy. In the past 2 months I’ve been getting pain, predominantly on my right-hand side. It is mostly flank pain with some referred pain down to my lower back/groin area. I’ve also had a low fever, shakes, sweats and just generally feeling run-down. I ended up in emergency twice. They tested me for EVERYTHING and all they can find is a 2-3mm non-obstructive stone in my right kidney plus a small one (I think 1-2mm) in my left kidney. I’ve been referred to a urologist and a nephrologist. The urologist said I have a virus and the nephrologist diagnosed me with pylonephritis and put me on an antibiotic. I think I did have a bit of nephritis as the antibiotics have helped with a lot of the referred symptoms (shakes, sweats, nausea etc.) but I have still got the pain after all this time! I have a feeling the pain is from the stone as they can’t find anything else….but the problem is convincing a doctor that this is the case! Not ONE doctor I’ve spoken to whether specialist or otherwise has believed that the stone would be the cause of my problems. Any ideas about where to go next or what to do? How do I find a doctor who will actually listen?!

    Reply
    • Fredric Coe, MD

      Hi Anna, Of course, at this distance I cannot tell you what is wrong, but the fever and shaking are compatible with infected stones or infection behind a stone that is partly obstructing within the kidney. The stone pain from small stones that Mike described in his article did not include fever or what appears to be chills. Surgeons differ about the pain of non obstructing stones, and I am not a surgeon, so my advice is this: If the pain goes on too long, write directly to Mike Borofsky who wrote the article and ask him about surgeons who share his opinion and might be reasonable consultants for you. If the fever and chills come back, that is another matter and your personal physicians will no doubt treat you for infection and need to track it down to its source, wherever that may be. Fred Coe

      Reply
      • Anna

        Thanks so much for your prompt reply! You’re right in that i definitely had an infection on top of the stones; it’s just a matter of which came first. Now the infection has cleared up but I’m left with the flank pain. What would be the best way for me to get in touch with Mike Borovsky?

        Reply
        • Michael Borofsky M.D.

          Dear Anna,

          Thanks for sharing your story. As Dr. Coe stated it is always somewhat of a challenge to give medical advice in such a forum as the remainder of your history, lab work, physical exam and medical imaging are essential to guiding the most appropriate treatment. That being said we see many patients like you so I am happy to share my thoughts on a general level. In my opinion, if other potential sources of flank pain have been considered and ruled out including musculoskeletal and gynecologic sources and all that you are left with is evidence of a stone then it is reasonable to consider a ureteroscopy to remove it. This procedure also allows your surgeon to take a detailed look around your kidney which can be quite diagnostic in its own right as detailed elsewhere on this site. Another reason to consider removing the stone is your history of infection. Stones are foreign bodies and in the presence of infection often become seeded with bacteria which is hard to clear with antibiotic therapy alone. This is especially true if you are suffering from recurring infections, particularly with the same bacteria which would indicate that the stone may in fact be the source. Of course, ureteroscopy is an invasive procedure and is carries with it its own risks, but that will have to be discussed and considered further with your treating urologist. I hope you find this information useful and wish you the best.

          Sincerely,
          Michael Borofsky

          Reply
          • Anna

            Thanks so much for you thoughtful comment, Dr. Borofsky. I will print this article and our conversation and will try to find a urologist that shares your opinions. To answer your question, yes, I’ve had an ovarian/uterine ultrasound which shows everything in that area is working perfectly and muscoskeletal sources were also ruled out whilst in one of my emergency room stays. On top of that I have a history of childhood nephritis which I’ve told multiple doctors who still claim the stone could not possibly be causing my constant infections. Hopefully I’ll find the right urologist to share your sentiments.

            Reply
          • Anna

            Thanks so much for your thoughtful reply. I will print this article as well as our conversation trail and hopefully try to find a urologist who will share your sentiments! To answer your query, yes, I have visited a gynecologist who gave me a uterine/ovarian scan which showed everything is functioning perfectly in that area. Musculoskeletal factors were also ruled out whilst in one of my hospital stays. On top of this I have a history of childhood nephritis which I’ve told doctors to no avail (I thought maybe this would mean I’m more at risk of infections from a stone). Hopefully I’ll have some better luck with finding someone to help me. Thanks again!

            Reply
      • Anna

        This may be a long shot but you don’t know the names of any good urologists in the Asia/Pacific region, do you? If not I’ll just do my own investigation. I’m in Australia (a long way away)!

        Reply
        • Fredric Coe, MD

          Hi Anna, I do not. But, Mike Borofsky probably does in that urologists travel a lot and tend to know one another. He has been on the site a lot and is easy to find. Regards, Fred Coe

          Reply
  135. Brandon

    I am a 24 year old who has been to the doctor and emergency department for a small stone….. i dont know if it’s obstructive or not but let me tell you, the pain has been ridiculous. They had me on a morphine drip for the fact I couldn’t handle the pain and something for nausea due to the fact of throwing up everything I put in my system….. they then refused to tell me which junction the stone was at but just said it was at a junction and that’s why I was so miserable. The stone is 2 mm and I’ve honestly been hurting so bad I almost asked my room mate to cut my kidney out that’s how painful this is. I’m shaking tired and frustrated at the fact it’s been over 3 months and I haven’t passed it and just been in pain dealing with night sweats, sleepless nights, vomiting, nausea, and severe dehydration because I can’t keep fluids down.

    Reply
    • Fredric Coe, MD

      Dear Brandon, It would seem that this has gone on too long and it is time to do a urological procedure to remove the stone even if it is not obstructing the ureter. I would insist on it, if I were you. Three months of pain is too much. Fred Coe

      Reply
    • Anna

      Brandon; my stone is also 2mm and causing me similar amounts of pain plus the sleepless nights, sweats, nausea etc. Anti-biotics have helped a little with the referred infection but today I feel bloated and was in so much pain at work I had to lie down. Let’s hope we both get our situations sorted out so we can lead happier lives!

      Reply
  136. Holly

    I think I might have a “small stone”story. I am a 55 yo in good health on no meds and recently passed my first kidney stone. I still have a 6 mm non-obstructing stone on CT scan. I have had moderately severe intermittant right back /flankpain for the past year and occasional bouts of nausea. I thought the back pain was MSK in origin as it got better with hot packs and motrin. It also seemed to get worse when I was doing a shift in the ED (no breaks, usually dehydrated, main source of nutrition Bare Naked juice which incidentally gave me 20-40x RDA of vitamin C). Pain bad enough that I’ve needed to take motrin 1.8 grams daily on and off for past year. The nausea I figured was due to peri-menopause.

    Since passing the stone, I have no back pain if I hydrate but get nagging flank pain if I don’t drink adequete fluid. I haven’t had any more nausea, I also have lost 4 pounds in a week without trying- by far the most I have ever lost. I am wondering if the constant inflammation increased my insulin resistance or impacted my weight in some other way.

    Reply
    • Fredric Coe, MD

      Hi Holly, Thank you for the story which is very instructive. All of us wonder about ‘non obstructive’ stones, whether there is inflammation, papillary surface injury, or other, and about the role of pre-emptive surgery. Frankly I think a surgical trial is reasonable and likely to be organized. Until then the matter is a bit moot; will surgeons and patients want to take the chance of doing a procedure without some strong reason to believe the benefit is likely and substantial? If I may add a small point, now that the stone has passed, please avoid dehydration and maintain a high fluid intake. New ones can form. Best wishes, Fred Coe

      Reply
  137. Cathy Orlando

    Anything new on cystine kidney stones.

    Reply
  138. Derek Louey

    Is there also a theory for the phenomena of ‘silent’ ureteric stones found on routine imaging with variable degrees of obstruction.

    Reply
    • Fredric Coe, MD

      Hi Derek, certainly we have all seen ‘silent’ stones in the ureter, often not obstructing and sometimes having lodged in the ureter wall. Partially obstructing stones are also sometimes without symptoms, and most ominously a kidney can be obstructed with loss of the organ and symptoms did not lead to early discovery. The main message is watchfulness. New pain, new bleeding, or any other suspicion surely warrants a call to one’s personal physician. Ultrasound is without radiation risk and often will identify a stone or obstruction. Fred Coe

      Reply
  139. Laura Bousada

    Thank you for the article and the efforts to understand pain with non-obstructing stones . If a patient has msk, nephrocalcinosis, incomplete distal renal tubular acidosis, nephrolithiasis, chronic uti’s and chronic flank/back pain, along with having had multiple lithotripsy and multiple ureteroscopies. In your opinion, since non-obstructing stones can cause pain could you say where the chronic pain might be coming from? Trauma from many surgeries? Could it be the nephrocalcinosis since that is non-obstructing and always present? Also, as far as the health of the kidneys go do you believe that more surgeries would be beneficial or detrimental, to try to remove more calcifications embedded? It would be awesome to have msk included in future studies as many suffer from it and are in daily pain with non-obstructing stones. Also, to link msk with nephrocalcinosis instead of it being said that msk is considered harmless, I think it is so important to have all urologists and nephrologists start to understand in the way that Dr. D. Goldfarb and Professor Giovanni Gambaro do that Msk can have many symptoms and be a very painful and debilitating disease. Thank you for your time and best regards. Most of the various kidney foundations have outdated information regarding Msk. This should be changed. Laura

    Reply
    • Michael Borofsky M.D.

      Dear Laura,

      Your concerns are well noted, have faith that there are many people within the kidney stone community who share such interests and are currently trying to better understand this challenging situation. I am hopeful to touch on some of the issues you raise in an upcoming post on specifically on MSK. I believe the term is MSK is often used to describe a variety of challenging clinical findings among stone formers including ductal plugging, nephrocalcinosis, and high stone burdens, when in fact these all may be separate entities that require tailored treatment strategies. In regards to whether or not more surgeries would be beneficial, this is something that must be addressed between you and your urologist on the basis of pain relief, evidence of stones on imaging, and other clinical issues.

      Sincerely,
      Mike Borofsky

      Reply
  140. laura bousada

    Thank you for your work and articles on the physiology of pain. I have MSK, nephrocalcinosis, incomplete RTA, and chronic uti’s & chronic pain. Although this article speaks of pain
    with unobstructed stones, it also indicates this pain is resolved with
    removal. The pain I have is daily. I
    have had 9 lithotripsy, and about six
    ureteroscopies. The last two were
    to remove embedded calcifications in the calyx. Which do
    you think is the most likely cause of pain that is daily and for years. The
    surgeries?, possibly traumatizing the
    kidneys? Or nephrocalcinosis?
    If nephrolithiasis can cause pain would
    it stand to reason nephrocalcinosis
    could be the cause of the chronic pain. All this being said because the medical books claim MSK does not
    cause pain. Then where is it coming from? I make calcium phosphate (apatite & brushite) stones. Could it be that there are two types of MSK? One that is simply MSK and one with added complications? Also, is it possible to misdiagnose MSK when it is plugged tubules? We have about 800 people in our MSK support group and half if not more have pain, fatigue, and complications. Thank you again in advance for any light you can shed on this complicated and misunderstood disease. Best regards, Laura

    Reply
    • Michael Borofsky M.D.

      Dear Laura,

      Thank you for sharing your history, your situation sounds quite distressing and I hope that ultimately you are able to find relief. Your questions are excellent and honestly I am not certain we as a field are able to provide the answers you seek at this moment in time. The entire concept of pain from non obstructing stones is very controversial; though clearly given the number of people who share stories similar to your own there must be something to the matter that we do not yet understand.

      One thing you mention that caught my attention was the fact that you make brushite stones. This in its own right can be a clinical challenge as these stones tend to be more difficult to treat, faster to recur, and have associations with metabolic abnormalities. There also seems to be an association between these stones and abnormal appearing kidneys on endoscopy, though not necessarily MSK. Your point about differentiating tubular plugging from MSK is important and I would encourage you make sure that you are being followed by a provider specializing in the metabolic aspect of kidney stones to make sure your risk of forming more stones is minimized.

      Sincerely,
      Mike Borofsky

      Reply
  141. Jaime Schmidt

    I appreciate your article and I too have MSK. Its a disease that gets played down as just kidney stones. I have had 24 kidney surgeries with various types of stone removal. Hopefully you will find an accurate publication about MSK. It’s a disease that isnt given the credit it deserves. Debilitating, well thats just the start of the MSK nightmare. I would love to see a study about the possibility that MSK is more autoimmune than exclusively kidney. The symptoms shared by other MSKers are so great its hard to not pay attention to it. There may not be very many with MSK, but I can promise you there is a screaming need for more research. Thank you for your research so far. I hope you will hear enough pleas from the msk community and decide to dive in deeper into the lonely msk world. Thank you

    Reply
    • Fredric Coe, MD

      Dear Jaime, Our group published a recent paper on MSK which details its rather specific anatomy and points out how it is via modern digital ureteroscopy that MSK can be distinguished from other diseases which resemble it on radiographs but are in fact different in their character. A link to the paper is in my response to Celia MacDonald just below. We are planning an article for one week from this coming tuesday on the MSK anatomy and surgical appearance and how it differs from other diseases with many stones and tissue crystals. Regards, Fred Coe

      Reply
  142. Celia Mac Donald

    Thank you very much for getting back to me Fredrick Coe and thanks for the useful information! I belong to one of the fb MSK support groups, altogether in the various groups, there are over a thousand MSK patients most of whom suffer from daily chronic pain and fatigue not to mention many other common symptoms.

    Reply
    • Fredric Coe, MD

      Dear Celia, I had not until now known about the large numbers of patients with chronic pain from stones that are not obstructing the urinary tract. It is indeed a very important matter, and I will do everything I can to make this issue clear to the stone research community in hopes of furthering better treatment. Regards, Fred Coe

      Reply
  143. Kathy Day RN

    “Another important element of the history is whether the patient has previously passed a stone and if the current symptoms are similar to that experience.”This is the most important part of your article…ask your patient. Let them describe their pain and history. Observe them for signs of fatigue or paleness, clammy skin, etc. And remember that they may have their pain under control while they are in front of you. I had some relief with bucket loads of Advil.

    I am currently waiting for laser lithotripsy for a 1.5CM stone. I had horrid pain and nausea starting on May 15. My previous 2 stones caused me several hours of pain and then the stone moved and I passed them without incident. This one..the pain was unrelenting and causing nausea. I went to the ER day 2. All they did was a urinalysis. I had to jump through hoops all week long to finally land in a urologists office who recognized how ill I was and who did an urgent stent placement. My pain absolutely was not the same as my other stones…it was worse and it wouldn’t stop. It was because this large stone wasn’t moving and my kidney was working hard to pass urine and to move the stone. No wonder! I got lousy care at the ER, and had to go through my PCP for the necessary testing, wait 2 days for results…all this time I was very sick. Here is my blog about my experience. I can’t wait to have this behind me. http://mcclearymrsaprevention.com/?p=1594

    Reply
    • Fredric Coe, MD

      Hi Kathy, You are correct, in my opinion, that one should ask anyone who has had a stone if the new attack is like the other ones. I think patients always know stone pain, and are an ideal source of insight. As for your unfortunate experience, I am very sympathetic and sorry you had such an ordeal. You are very kind to share your blog with others. Fred Coe

      Reply
  144. Celia Mac Donald

    May I ask why you do not mention Medullary Sponge Kidney in your article on chronic pain,? although you do talk about calcifications, embedded stones, in the link to “For Scientists” there’s an article entitled “Tubule Plugging” which talks about plaque, but nowhere do I see mention of MSK? As far as I know, these are all characteristics of MSK!

    Reply
    • Fredric Coe, MD

      Hi Celia, Medullary sponge kidney is a developmental anomaly of the most distal – last parts – of the nephrons, and a special kind of disease. It is true there are calcifications seen on radiographs but in fact the correct diagnosis is not made not that way but during ureteroscopic examination of the kidney during stone removal. The calcifications are mostly dilated cystic collecting ducts filled with innumerable tiny microscopic round ‘stones’ each perhaps a millimeter or so in diameter. If the surgeon unroofs such a duct with a laser they come rolling out like tiny marbles on a table top. They are not embedded in the tissue. The tubule plugging Andy Evan describes is something very different. Patients who form calcium phosphate stones acquire this kind of plugging, which is not a developmental abnormality of how the kidney is formed but a damaging collection of crystals inside the kidney tubules. I am sorry we do not have an article on MSK on the site as yet. This site is in evolution, being built in public one might say, and I nor any of my colleagues has as yet written such an article. Here is a link to our recent publication on MSK. As you can see from the abstract is is quite new so we are just ourselves becoming clear about the disease. Thank you for the very thoughtful question, Fred Coe

      Reply
  145. Ivelisse

    This is a great article! Thank you 🙂 I have MSK and pain without obstruction has been a huge part of my life

    Reply
    • Fredric Coe, MD

      Hi Ivelisse, I am glad the article is valuable. See the comment to Celia, which is above. You may have MSK or tubule plugging. It is hard to tell except at stone surgery. Good luck with your treatment, and I hope your pain condition is under good control. Fred coe

      Reply
  146. Hollie Navarre

    Thankful for this article! I have chronic pain associated with small stones. I have medullary sponge kidney and hope to see research for people like myself struggling to making it through each day with the pain I experience with this disorder. I can’t even tell you how much it means to me that you have validated pain with non obstructing stones. It’s real and doctors need to understand this.

    Reply
  147. Ashley Hawkes

    Over the past 4 years as well as during all 3 of my pregnancies, I have been on a very painful and often frustrating journey very similar to the story recounted of the woman with nonobstructing stone and pain. I’ve researched this topic quite a bit in an effort to better understand my pain, and had to become my own health advocate. Having finally been diagnosed with Medullary Sponge Kidney this past year, my urologist performed a papillotomy on my affected kidney. The pain relief was very notable, but only lasted about 1 month before my symptoms cropped up again. My urologist, while very understanding, tends to be of the camp who believe that nonobstructing stones cannot cause pain. It has only been since I started a regimen of lemon juice in my diet that the pain has mostly disappeared and I’ve been able to get my life back.

    Reply
  148. Mary Tilton

    Thank you. 24 hour urine test coming up soon.

    Reply

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