Agonizing, 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
The 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.
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.
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 unilat
eral 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 CT
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).
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.
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Two or three weeks ago, I had severe pain in my right flank, but it went away after a couple of days. The pain came back the beginning of this week and has not gone away, and is actually worse. Having never had any type of stones, I assumed I had strained a muscle, but now I am not sure.
I am wondering if it’s possible to have a kidney stone without any symptoms other than pain? The pain is almost non existent when I lay down. I am physically unable to reach around to the right to wipe my rear end. (having done this for the past 45+ years, I find it funny that I can’t figure out how to do this left handed.)
If it is a kidney stone, is it possible to allow it to pass naturally, and how long does that on average? I have a high tolerance for pain and usually manage to deal with any pain using ibuprofen and/or naproxen. Would either of these have a negative impact on my kidneys while passing a stone?
Thank you
Hi Cindy, This pain seems dependent on position and body movements. As such it is not likely due to a kidney stone so much as the muscles and skeletal system. If there are any other signs of a stone – urine bleeding, white blood cells as examples your physicians might want to do an appropriate imaging. But my bet is not a stone. Regards, Fred Coe
Thank you for your reply.
I’m a healthy male in my mid 40’s. About 1 month ago I was woken up at 1 am with blinding pain in my right flank. Wife drove me to the ER for what I assumed was a kidney stone. I have no history of kidney stones, but all the signs were there… Intense flank pain and massive amounts of blood in my urine. Looked like red wine. Had a CT scan with and without contrast. Showed no sign of stones. Spent 3 days in the hospital. Dilaudid and large amounts of I.V. saline made the pain subside. Urologist did a cysto, placed a stent in the right kidney, and told me that he saw small tumors which could be malignant. Followed up with a kidney specialist who scheduled another cysto a few weeks later and was planning on doing a biopsy of the tumors. When he went in, there was nothing to biopsy. He was in there for an hour and did not see anything unusual. Did a stent swap and wants to do another cysto in 3 months to see if there is anything unusual in the kidney. A week later and I am still passing clots and have blood in my urine. Everything else is normal. Good kidney function, no sign of infection, etc… So the cause of all of this drama and pain is really a mystery right now. Any input or ideas as to why this may be happening or what my prognosis may be?
Hi Dom, The acute pain could well have been blood clots that acted like stones can in producing transient obstruction. Right now, the emphasis is on finding the reason for the bleeding. I agree with your surgeons that a second look is right. Whatever they can do to find the cause is worthwhile. Regards, Fred Coe
Thank you sir.
I had a PCNL 2 months ago for a >2cm stone. My back has been hurting like it did before the PCNL but I do not have stones on that side. Follow up x-rays show a piece of the guidewire from the procedure is in my kidney. Is it possible for the wire to be causing pain similar to kidney stones?
Hi Marie, Residual guidewire could cause pain, but that is a surgical detail. I would ask the surgeon for his opinion about the symptoms and also about whether the guidewire residue can be removed. Possibly you might want to ask for a second opinion, unless that guidewire was left there for a purpose and is to be removed shortly. Regards, Fred Coe
Thank you for your reply.
I had a second opinion and it is believed to be a piece of the guide wire that broke during the original procedure. Both of the urologists that I met with thought the wire was in the collection area of my kidney but I had a ureteroscopy last week and it couldn’t be found. The urologist said he grabbed something that dissolved and I have a ‘bump’ in the kidney tissue that may be the wire. I will be having a CT Scan to see if it is still there.
The urologists that I have do not think this can cause the pain that I am having. It feels like the kidney stone pain in my back so I’m lost as to what is going on.
If a wire is in the actual kidney, would that cause pain and should it be removed?
Hi Marie, I would be bold and misguided to essay an answer from so far away. All I can say is that a foreign body, if indeed inside of the kidney or urinary system naturally arouses suspicion it could cause pain. So the CT is a very good idea. If part of a wire lies somewhere inside the urinary system, removal would be desirable if possible. Regards, Fred Coe
Can you please tell me if a non obstructing stone can cause pain? The pain is horrendous and nothing else has been found except stone. I have blood in urine, leucocytes in urine and most recently protein. The pain is now severe and constant, very sharp knives in my back and my kidneys hurt. I have flank pain, sides and abdominal. I cannot lay on my back anymore. I am constantly told non obstructing stones dont cause pain but feel like Im dying every day!
Hi Jane, indeed more and more of us believe they do indeed cause pain. The issue is when surgery might benefit or not. When stones are there and symptoms severe some surgeons contemplate surgical removal. Of course surgery is itself a serious matter. One approach I always favor is intense efforts to reduce crystallization and more stones. In other words prevention of more stones is prevention of more crystals that may indeed be causing some of your pain. Here is a good plan. Regards, Fred Coe
Thank you for reply.
Cant they break up stones with lithotripsy instead of surgery?
Hi Jane, ureteroscopy tends to be more exacting. Regards, Fred Coe
I have an 8mm stone which my GP said was “partially blocking”, whatever that means. This was found via CT scan with contrast, ordered because I was having dull pain in rear flank and blood in urine. Three weeks went by with zero symptoms. Now, I am having nearly daily excruciating pain usually in the evening – but no blood as far as I can see.
I can’t see the urologist for another two weeks due to his schedule. I can handle the pain – but I don’t want to “ruin” my kidney. Will waiting a couple of weeks then likely another week until removal surgery cause my kidney to become compromised?
Hi Chuck, Given you had an obstructing stone you may have pain because it is moving or obstructing more. I would think your physician might want to get a more immediate ultrasound of CT. Probably he/she is not aware of your new symptoms. You might want to speak with the nurse practitioner there and bring up the question of possible loss of kidney function. Obviously, having no real knowledge of the details, my remarks are general, and perhaps not directly germane to your actual situation. Even so, I would call. Regards, Fred Coe
Hi
Very informative website. I have a question. I was told I have a stone stuck inside the meat of the kidney.. whatever that means.. but told my back pain is not caused by that. I find it odd because I have had an MRI of my back and there is nothing wrong with my back. All is there is the stone which is about 5mm. How can I get this out? I have pain in my sides too and for some reason my other kidney hurts too. Wish someone knew whats going on.
Hi Johnny, I gather you have calcium deposits in the kidney tissue and also have pain. From here – far away – I cannot make much of a comment. Perhaps your urologist might want to remove the stone via ureteroscopy but that may not cure the pain and does not seem indicated because of obstruction, infection, or bleeding. That you pain is on both sides makes me wonder if it is muscular and would yield to physical therapy. Regards, Fred Coe
I’ve already been doing physical therapy and its not helping at all. I know back pain from kidney pain as its inside that hurts not my back. Again I have had all other tests done and I continue to have kidney pain and stabbing pains. I have blood, protein and white blood cells in urine. Plus back pain doesnt radiate to the front under ribcage. So something isnt right.
Hi Johnny, The blood and white cells in your urine sound like possible infection either of the urinary tract, or possibly the kidney /and or the stone. I imagine your physicians are trying to sort out the sources of this. Protein is not rare with blood and might be simply because of bleeding as opposed to kidney disease per se. This, too, is something your physicians will have to solve. From this far away, I am afraid I cannot be very helpful. Regards, Fred Coe
Thanks for replies. One last thing I noted is kidney pain after eating as well. And no one can tell me why. I drink no alcohol or smoke. Do stones or infection cause that?
Hi Johnny, In general that symptom does not point to any specific abnormality. The key is proper radiographic visualization of your kidneys and decisions about whether stones might possible cause enough pain to warrant surgery. Only your personal physicians and you can decide about that. Regards, Fred Coe
Thanks for a great article. I believe I’m exactly like the specific example you cited in your non-obstructive conundrum. I think I’m suffering right flank pain due to a 5mm stone in the lower chamber of the kidney on that side.
I have a psychiatry textbook, published in 1972, which asserts that there is no reason for a woman to complain of severe menstrual cramps and, if she persists, she is most likely rejecting her femininity and needs psychiatric care. What BS. Thankfully, somebody finally discovered the existence and function of prostaglandins as it relates to menstrual cramps. The arrogant tendency of physicians to assume that, if they don’t understand it, then it doesn’t exist, has always annoyed me. Back in the 1970s I was eyed suspiciously, and refused more than once, when requesting pain medication for that awful pain. I saved the meds that were readily prescribed by my dentist that I DIDN’T need, and used them for that purpose. It would not surprise me if someone were to eventually discover that the presence of renal calculi stimulates production of a similar, possibly yet unknown, substance that causes strong contractions of the kidney as the body’s mechanism for beginning expulsion of the stones, something that will never be detected by all the fancy, expensive imaging technology in the world.
Hi Margie, Lots of people agree with you, like me. But, what to do? Surgery may not be needed, yet what else but balance pain against surgery? NSAIDS are a possibility – you mentioned prostaglandins. Trials – none. Data, none. Frustration – a real lot! Fred
Also frustrating is the lack of data about what causes diverticulitis. I’m fairly certain it has nothing to do with nuts, seeds, or popcorn. I’ve surmised that the avoidance of any possible causes of intestinal inflammation, or inflammation in general, might help and can’t hurt, and so have tried to eliminate all of those things. Sugar, gluten, high omega 6 fats, among other things. NSAIDS are one possible cause of intestinal inflammation, so I avoid them. Haven’t taken one in 8+ years. One or more of the many (mostly dietary) changes I’ve made may have helped the diverticular problem. I went from 3 infections in less than a year to one every 3 or 4 years. Or maybe it’s a coincidence. Hard to know without those non-existent studies. Funny how so many doctors don’t hesitate to make certain assertions (e.g., renal calculi in situ can’t possibly cause pain; nuts & seeds cause diverticulitis flare-ups) that are mere theories backed by no evidence whatsoever, but scoff at so many other theories (like my self-prescribed dietary regimen) because of the lack of scientific evidence. Often seems to be no rhyme or reason. Frustrating indeed. Thanks for the sympathetic attitude and the place to vent
Hello
Can kidney stones kill you? I have a 7mm stone and feel much back pain and much weakness. Am awaiting visit to doctor.
Hi Harrinder, Not usually. Obstruction can damage kidneys, infection can be dangerous. Have your physician see you soon to be sure of your exact condition. Prevention is the important thing. Regards, Fred Coe
Thank you for reply. Can back pain from stone be a constant pain or on and off? Never had before so pain is very intense and worrisome.
Yes. The pain can come and go. It needs monitoring by a physician at all times to assure kidneys are not obstructed and at risk of serious injury. Fred Coe
I have had calcium oxalate stones in the past. A recent KUB shows a 1.2cm stone in my left kidney. I have so much pain and discomfort with stents. Do I have any non stent options?
Hi Vicki, some surgeons do without stents. The decision is highly specific to the surgeon, the planned surgery, the anatomy. Ask your surgeon who will no doubt have thought about all this. If you truly cringe at stents ask for a second opinion of one who might do without. But remember, stents may be needed at the end depending on what happened during the surgery. Regards, Fred Coe
I waited a few months with known stones. I had frequent bleeding, but my pain never reached the levels that people describe. CT showed partial obstruction and I had a rapid rise in creatinine to 1.6, which did come down. I passed lots of tiny stones. Finally I passed an 11 × 5 mm stone along with a 5 mm rounder stone. There was no pain! How could this be? Also, I an now showing proteinuria. Could waiting with the stones have caused kidney damage? If so, can it heal?
Hi Gina, that you had partial obstruction – on one side? and an increased serum creatinine means your other kidney must also have some damage. ALternatively you were obstructed on both sides. But why did you wait in the presence of obstruction. I imagine your physicians wanted to remove the stones. Do not do this again. If stones obstruct a few days perhaps but not months. The protein may be from kidney injury or from bleeding. Your physician can sort that out for you. Be careful in the future. Stones can injure kidneys when they obstruct and some stone formers develop chronic kidney disease. Regards, Fred Coe
Thank you for your reply. You are very kind to take the time to answer our questions. My creatinine levels came down to high normal levels shortly after the CT and 2 ultrasounds did not show signs of obstruction. But, I continued to have intermittent bleeding and vague discomfort. The Nephrologist said it was a “soft call” in terms of intervention. So, I waited. After testing I was started on allopurinol and Uricit K. I thought that maybe the stones would dissolve.
Hi Gina, I gather the stones were uric acid. Allopurinol has little benefit for uric acid stones, although potassium citrate is ideal. Allopurinol has been used for calcium oxalate stones – I was the person who first proposed such a use. Even though things were fine, I would advise you not let obstruction simmer along. A rise in creatinine means both kidneys functioned abnormally. Regards, Fred Coe
My mom has had non obstructing stone and partially obstructing stones. She said she feels very weak and dizzy spells and alot pain in upper back. Is this all related? Thanks
Dear Sandra, partially obstructing stones and weakness and dizziness could be infection, maybe sepsis. She needs care from her physicians to understand what is wrong. The obstruction cannot be let go very long because kidneys are injured. Speak to her physicians. Regards, Fred Coe
Thanks for reply. If it was sepsis wouldn’t they have seen on blood tests by now? Not sure what tests need to be done. Shes dizzy alot and has been for over a month. Im worried.
I guess by a month it would be obvious, but infection that is more chronic can cause weakness and dizziness. I would ask her physicians to try to figure out what is wrong sooner than later. Regards, Fred Coe
My urologist has shown me my kidney stones after a CT scan, the pain is very bad not all the time it comes and goes. My problem is I don’t have a bladder for the stones to pass into is this the reason for the pain if they are getting stuck I the uretha. Hope you can put my mind at rest as the pain is very severe.
Hi Brenda, That sounds as though you have a very complex anatomy – no bladder. With such a problem, care becomes so particular only your personal physicians have any chance of understanding its origins. Regards, Fred Coe
Hello. It was discovered I have a 1.5cm cyst inside kidney. I am having terrible flank pain and some blood in urine. They said nothing to worry about but my pain is constant. Not sure where to go from here.
Hi Eduardo, Cysts can bleed and cause pain. This is outside the scope of the site. Your personal physicians need to insure that the cyst has been completely evaluated to be sure it is benign. If painful and or bleeding over time it can be surgically corrected. Regards, Fred Coe
Thanks. I was just informed that its a simple cyst but I continue to have flank and side pain. Is that a fairly large size cyst given its inside the kidney?
Hi Eduardo, A simple cyst can be treated surgically if it is causing enough pain to warrant it. That would be your decision and your surgeon would consider its size and other issues. Regards, Fred Coe
Dr. Coe-
Very happy I came across your article! I have similar pain that comes and goes for the past 8 years. I have passed obstructing stones a few times, so I know what the pain feels like. However, I sometimes go through periods of time where I have a dull ache (much less severe than renal colic, but same type of pain) in one of my kidneys and also symptoms of urinary frequency and urgency with no signs of infection. I’ve had CTs for this issue and the only thing that comes up is non-obstructing stones in my kidney. My doctor always tells me these shouldn’t be causing pain. It can be frustrating at times! Eventually, the pain usually subsides overs a few weeks/months for me until another episode happens shortly after.
Brooke
Hi Brooke, The frequency and urgency suggest that crystals are passing. Small stone pain localizes to the flanks. If it is from crystals the pain should respond to better reduction of supersaturation. Consider this with your physicians. Let me know. Regards, Fred Coe
Brook, I had similar issue with non-obstructive 5mm-stone in one of my kidneys. I went through a surgery, removed the stone and I haven’t had pain since last spring. Knocking on wood…
Hi Rado, But be sure about preventing the next one! Fred Coe
Hi sir…
It is necessary to have two shock wave procesure just in one month?
Hi Ronald, Ideally it should not be needed. SWL is ideal for single stones less than 2 cm. Perhaps your urologist might consider ureteroscopy if multiple stones or fragments are present. Regards, Fred Coe
Thanks a lot sir..
I have a question. How do we know if one of our kidneys has failed if we can live normally with just one? What tests would they perfom? Wouldnt tests appear normal?
Hi Lisa, This is a terrific question, and thank you. You do not know. Routine blood tests can appear normal. That is why stone formers need to be alert and have any symptom of stone passage evaluated. Usually ultrasound can detect obstruction. CT is definitive. To tell if a kidney has failed the radioactive renogram is ideal – despite the name radiation exposure is small and the test is remarkably accurate. If you have reasons to worry about a kidney have your physician help figure it out. Regards, Fred Coe
Thanks for reply! My dad has had stones and now a cyst too, but his are non obstructing therefore he was told they wont do anything about it. Hes been alot of pain for over 6 months ..with weight loss and he said the pain is worse than anything hes experienced. I hope pain isnt an indication that hes had one kidney fail since this has been going on for so long. Not sure where to go from here as he doesnt have health insurance either.
Hi Lisa, It is hard for me to help here. Cysts can become infected and cause pain. This is something only his personal physicians can sort out with a combination of CT scanning and ultrasound. I gather he is too young for Medicare and has no health insurance. He needs to get the latter – that should be possible at least via medicaid. Regards, Fred Coe
I visited a Urologist today and was told I have not one, but two stones. One stone is roosting where the ureter on my right side connects to my bladder. The other stone is located within the right kidney. Both are about 4 – 5 cm. My doctor would like to schedule me for a ureteroscopy with the intent of removing both stones. I am really nervous about this procedure because of the literature I’ve read about the use of sheaths and stents during and after the procedure. Can you offer some guidance on this issue? Many thanks!
Hi Sherri, I much favor URS. The new instruments are terrific. The approach is elegant – remove the lower stone, go up, remove the kidney stone. Sheaths permit repeated insertion and removal of the scope to ensure a stone free kidney. With only one kidney stone I doubt your surgeon will want to use one. But sheaths protect the ureter and which ever – sheath or not – the procedure is the right one. As for stents, ask if you can get away without it. SOmetimes it seems prudent – a surgical decision. Regards, Fred Coe
How can I find a urologist who will take pain from nonobstructive stones seriously? My partner has been in moderate to severe pain for four years. She has had numerous stones in the past and this pain is the same. Her urologist in Milwaukee sent her to pain management. We also visited the Mayo Clinic and received the same recommendation. She also has Primary Progressive Aphasia, a type of dementia which is robbing her of her ability to communicate. The narcotics don’t help with her PPA, but it’s the only option she’s been given. I hope you can help recommend someone. We’ll go to Chicago if need be.
Hi Chris, Pain from small stones is a national issue. The most thoughtful and brilliant urologist who thinks about this problem is Dr James Lingeman at Indiana University. I would contact him – feel free to mention I recommended it from this site. Email, JLingeman@IUHealth.org. Regards, Fred Coe
Thank you, Dr. Cor!
Hi. Why do stones cause persistant flannk pain? And is it possible that they may cause weight loss, weakness and chest pain if you have been dealing with them for a while?
Hi Trent, So many possible reasons! Infection, obstruction within the kidney, as examples. As for weight loss and weakness, I always worry about infection. CHest pain is not so obvious a kidney stone issue. I am sure your physician has considered infection and obstruction, but a mention might not be out of line. Regards, Fred Coe
Thanks for your quick reply. The pain is out of this world though!! Sharp, piercing, stabbing mid back pain. I think if I got hit by a train it would hurt less!!
Hi Trent, I wish it were not. Prevent, prevent. Fred
I have a few stones. I also just did a 24 hour creatinine clearance test and the creatinine renal clearance is High. Is this bad?
Hi Sandy, High creatinine clearance means nothing by itself. It could reflect poor collection timing or high protein intake – no significance. But such a measurement will not lead to effective stone prevention. In case you and your physicians may want it, here is a good approach article for evaluation.
Thank you.
I have some pretty kidney severe pain, lowered WBC, low ferritin and my blood pressure spikes. Last one was 178 over 143. Not sure whats going on.
Hi Sandy, Are you sure your kidney function was high or is it that your serum creatinine is high? Your blood pressure numbers are extremely high and I am sure your physicians are searching for a reason. At this distance I cannot be helpful except that kidney pain from stone passage can raise blood pressure transiently. Rare endocrine diseases like pheochromocytoma are also a cause. Here is where your personal physicians are your only possible guide. Regards, Fred Coe
I first formed a stone in approx 2000, which was identified by my Urologist in a CT scan and X-rays. Though it was large, it passed a couple months later on its own with minimal pain. It was analysed and determined to be a Cacium Oxalate stone. I never went back to the Urologist as there was no need.
In the last 7 years, however, I have had three stones, all of which passed without pain, though with some very minimum discomfort (blood in my urine, etc.) Several months ago, I noticed blood in my urine for a day but it went away quickly. During a check-up at my Internist, no blood was found in my urine and I didn’t give the episode any more thought.
A month ago, I had an incident of blood in my urine and within a day, I passed a small stone. The next day I passed another small stone, and the day after that, a third small stone.
Am I correct in assuming that it was a single stone that had broken apart? Moreover, why am I experiencing no pain during the formation –and passing — of these stones? (Believe me, I’m not complaining about that, but I am curious!)
Thank you
Hi Michael, I would not so assume. To me this sounds like active new stone forming. I would pursue a full evaluation and find out the cause so treatment can be directed in the right way. As for no pain, this occurs in diabetes. Otherwise, I would have no immediate reason. But lack of pain can be dangerous: a stone can obstruct and even destroy a kidney and you might not know. I would advise a new CT to figure out how many stones you have and to exclude obstruction. Ask your physicians if my comments seem reasonable to them. Regards, Fred Coe
No doubt about it. I have an obstructing stone on my left side. While in the doctor’s office today I asked about the lesser, lingering, annoying pain on my right and was informed there was a 6mm lower pole stone there as well. Fortunately they will be addressing both at my upcoming surgery.
Hi Marc, Sorry for all that. Be sure and pursue prevention efforts, but wait a few weeks after the stone passes before doing your evaluation.
Can a stone be stuck inside a kidney cyst? I have had stones in the past but now only have a cyst but still the same excruciating pain. But im told cysts dont cause pain. Im confused …..
Hi Beatrice, yes they can. Cysts can cause lots of pain, a stone in a cyst could obstruct the cyst opening or foster infection. Ask your physician about this. But if he/she is certain that your pain is not from the cyst or stone, there may be good reasons why. Regards, Fred Coe
Thanks so much for your reply! Is it possible that they cannot see the stone inside cyst on imaging and only see the cyst?
Hi Beatrice, with a CT you will see stones. In your situation, given pain, a cyst, and maybe a stone, we have to rely on the judgment of your physicians. If they cannot figure out a treatment, perhaps they can identify additional expertise for you. Regards, Fred Coe
Very informative website. I have a question. I have non obstructing stones and terrible flank pain. I also do not have insurance at the moment. I cannot work due to pain and was wondering if there was a teaching hospital that I may go to that would review my case and help me at no cost. Hoping someone can help.
Hi Kayla, usually there are such facilities in every city. Perhaps you are eligible for Medicaid? But you need direct care, not a review. I think you might qualify for special benefits given pain and disability for work. But I am not an expert on health care financials. Regards, Fred Coe
Went to the ER with excruciating flank and back pain. Was diagnosed with a 5mm kidney stone in the ureter not too far from my bladder early Friday AM. Today (Saturday) I have been having on and off very mild flank pain but now I am having severe pressure and shooting pain in my labia area and rectum along with constant feeling of needing to urinate even though I don’t. I am on Flomax and an Keflex. I have been straining my urine and have not seen the stone pass. Is this expected? How long will this last? It is almost as unbearable as the severe pain was.
Hi Angela, stones at the bladder – ureter junction cause these exact symptoms. When it passes they will go away. When is hard to guess at. If your kidney is not obstructed one can wait, but if the pain is too much your physician can remove the stone simply. Be sure and find out what it was made of and get fully evaluated and treated to prevent more. Regards, Fred Coe
My son had a ct this morning, finally. All this kidney stone stuff started on October 1st. Today we found out that the stone is .5mm and obstructing. He refuses to cancel our trip (3 days from now). Will he be ok to get it taken care of when we get back?
Thanks
Hi Johanna, I am not enthusiastic about letting an obstructed kidney alone – function can be lost. I would discuss this with his surgeon who probably wants to fix things now. Put another way, even tiny risk of lost function from obstruction – it really does happen, often silently, and over rather short intervals, sometimes – overweighs the pleasure of a trip – even to paradise. So, to me it is not OK. Best, Fred Coe
I had a 4mm stone, was told it would pass on its own and it is not passing at all, and the pain continues. I think I should look into having it removed. My father was a “stone maker” as he calls himself. Kept having stones constantly. Ia this because once you get one they will always come back or a specific diet wasn’t followed?
Hi Rebecca, The main issue is obstruction. If present, removal should be prompt. If absent, removal concerns your pain. Of course your surgeon has to make the decision, but given obstruction I would imagine removal is a high priority. Of course, pursue prevention! Regards, Fred Coe
Hello. I have a question about the pain of kidney stones – back pain – versus back pain from other diseases. Does a kidney stone (or cyst) typically cause mid back, lower back and pelvic pain and it does it cause horrendous stabbing pain?
My aunt had colon cancer and also had back pain, so was wondering if that stabbing pain can be related to something else too…?
Hi Maria, Stone pain differs from routine back pain because the latter varies with position or motion, stone pain does not. But stone pain is indeed severe, usually in episodes. You need to have your physician evaluate the problem, as I am too far away to be certain. Regards, Fred Coe
I just came across this article. I have constant kidney pain, pinching pain, and stabbing not only in my kidneys but my lower back (on both sides and the middle). It is non stop relentless… with movement and just laying on my back as well hurts. I am now going for further tests. Could it be stones? Infection? Its just terrible.
Hi Donna, pain does not mean stones. If your physicians think your pain is from stones the most accurate test is a CT scan – no contrast. Stones show up with almost 100% certainty. Regards, Fred Coe
I have a kidney cyst, not stones, and I have all the same pain that the woman in this article was complaining about. Its about 2.5cm in size and my kidney and back hurt so badly I can’t put it into words. I had been dismissed by several urologists and am now going to see another who may be able to help. Not sure what procedures are available to get rid of this.
Hi Paula, benign renal cysts can cause pain – I am not an expert on cysts, so this is simply my impression. If your cyst is doing that skilled surgery can get rid of it. I am not a surgeon, either, so everything is up to those who can actually help you. Typically laparoscopic surgery is used for renal cysts. Regards, Fred Coe
i have a large stone in the lower left kidney which is scheduled to be removed with Percutaneous Nephrolithotomy (PCNL) next week. Can the pain I’m experiencing be from this stone moving around or from the passage of parts of it? My urologist said that pain is not actually from the stone but from the blockage of urine.
Hi Lorna, Certainly a large stone can cause pain, and very often it is from obstruction. So removal is good, and PCNL is the right way. Be sure to follow a good stone prevention program after you recover so more do not form. Likewise be sure to analyse this stone. Regards, Fred Coe
I currently have a 7x6x4 mm stone stuck in the UVJ. My doctor wants to go in and take it out and put in a stent, but I live in the middle of very rural Guatemala and have little confidence in this doctor for several reasons. Unfortunately, he is the only one here “qualified” to do this procedure. I have had no pain at all for the past week until this morning, but I’m assuming the discomfort I have now means this thing is moving and that’d be a good thing. My doctor says that if it moves into the bladder, I will likely be able to pass it on my own. Is that true? If this current discomfort goes away and I am able to go about my normal activities, is it safe for me to continue to try to pass it on my own? I will be going to the states for Christmas and could potentially have something done there about it. I am pretty desperate for some advice I can trust. I appreciate it!
I should mention that I have no infection or fever, and that the CT scan showed that the contrast dye made it around the stone into my bladder, so it isn’t completely obstructed.
Hi Lynn, No. The dye can flow into the bladder and the kidney be obstructed. Obstruction does not need to be complete; it can be partial, raise pressures in the kidney and damage it. If you do not trusts your physician to put up a stent, come home, now. Do not fool around. Regards, Fred Coe
Hi Lynn, The risk is that the stone is obstructing the kidney. If you do not have faith in the available physician, I would come home now and have things taken care of. If the stone is obstructing your kidney the kidney can be damaged or destroyed. Your physician there could usually tell about obstruction. Perhaps he/she knows it is present and wants to put up a stent for that reason. But if you cannot use or trust your one available physician, come home right now, no delay. Do not just wait because pain comes and goes. A painless obstruction can destroy a kidney. Lost kidneys do not come back. Regards, Fred Coe
Can a kidney stone cause stomach cramps?
My urologist diagnosed me with Uric kidney stones. I also have frequent stomach (muscle) cramping and stomach pain after defecating. Can it come from the stone or does it have other gastro sources?
Hi Health, uric acid stones should not cause your symptom. But intestinal disorders can cause uric acid stones. Have your physicians be sure that is not the case. Regards, Fred Coe
I had a ureteroscopy done. Stone is out and I immediately had energy and felt better and pain was gone. Now a month later and Im having kidney pain again. Can a stone form again that quickly??
Hi Kendra, Possibly. Calcium phosphate, cystine, and struvite stones can reform rapidly. Be sure you know what your stones are and why they form. Here is a reasonable starting place. Regards, Fred Coe
Okay. Thank you.
I haven’t found out yet what they are, but will find out. Does this mean though that I will have to do surgery/ ureteroscopy on a frequent basis!?
Hi Kendra, No. You need to get proper prevention and stop making stones. The article I picked out for you is very important for orientation. Take a look and see where you stand. Regards, Fred Coe
Hello. I am 23 weeks pregnant and was diagnosed with a stone after two episodes of severe right flank pain sent me to the ER this past weekend. Since then the pain has been minimal and dull, only on my right side. I have been chugging water and have followed up with my OB and have an appt with a eurologist on Mon but I’m wondering if the lack of pain could mean the stone has passed or is it more likely it’s just settled into a spot in there? I’m obviously terrified to feel that pain again, and my OB said that the tx during pregnancy if I can’t pass it is often insertion of a tube to filter urine off the kidney until baby comes and they can remove the stone. I guess I’m just hopeful it could have passed on it’s own but I haven’t felt any of the bladder/urine passage pain described by others. Thanks for any thoughts!
Hi Katie, The big worry is about obstruction. ULtrasound suffices in most cases. A stent is the tube in question, and the proper approach until the stone is gone. Be sure and find out what it is, and why you form them, but wait until after delivery and also after you no longer breast feed. Both obscure causes of stones. Regards, Fred Coe
I have been advised to have lithotripsy for a non-obstructive 8.5 mm (narrower in width from what I saw on ultrasound screen) in lower pole. I do get pain under left rib after exercising and have a history of sporadic hematuria. Yet the urologist believes the rib pain is not from the stone. So why would I go through this if it won’t help my pain? If I lay on my side, it hurts as well. I am a little worried about lithotripsy because every time I have surgery, it takes a long time to get back to normal. Would taking it out via scope work better? Can the stone cause pain?
Hi Jenny, I gather the stone removal is elective and for prevention of future obstruction. It is not thought to be causing you pain. So removal or not is your choice. Given the size it is not likely to pass. Given a single stone SWL or URS both should give you a stone free kidney from one treatment. Personally as a general rule I choose URS for my patients but the urological surgeon has the last word. Of course in your case, I have no real knowledge so your urologist has the first and last word. Regards, Fred Coe
Thanks. I must make a decision this month because I have alreading met my deductible and I do not want to burden my family with a 7k copay next year if something should happen. I do have PVCs, so I am a little worried, even with the option for gating. Why do you think some drs prefer lithotripsy over scope? It seems less likely to cause problems to the surrounding tissue.
Hi Jenny, Modern digital optic flex scopes give great results. I am not a surgeon but work with many and the results with scopes usually make me very happy – stone free kidneys. SWL is OK for one stone in the renal pelvis, not too big. But even there, why bother? Often you need a stent anyway. But surgeons decide what surgery they will do, and I am not someone to argue with any one surgeon in any one case. My remarks are general. Regards, Fred Coe
Hi,
i had blood in my urine in the month of september. Later i had my ultrasound which revealed 4mm stone in calyx and with the urine test it was found out to be calacium oxalate and i was prescribed with medicine. After that i didnt have any sort of pain till november 4th , then i had a pain killer and injection to stop vomitting and loose motion. This time i was prescribe with flomax and portrait m syrup. I didnt have pain till now but i have a discomfortable feel everytime i urinate and i have the urge to urinate. The recent ct scan on nov 10 revealed 5mm stone in vuj but the xray which i took yesterday that is nov 16 revealed there are no stone in kub region.
mi found some sand like particle everytime i urinate. I am curious to know if i have passed my stone
Hi Praveen, Have the sand analysed. It is not evidence that the stone is gone, but suggests you really need prevention as it is probably crystals. Regards, Fred Coe
Hi Praveen, The stone may be invisible on a routine xray. Your physician will assure the kidney is not obstructed – ultrasound is commonplace. It is his/her responsibility to take care of the stone and the kidney. Prevention is very important; be sure you are getting it. Regards, Fred Coe
Hi. Can a kidney stone, or any kidney pain and kidney issues cause referred pain to other parts of the body, like shoulder/ arms or abdomen?
Hi Mike, shoulder pain could come from stones, arms not likely, abdomen not unlikely. Other causes might be more relevant. I would have my physician evaluate the pain because there are many causes and the details of the pain and what brings it on or improves it can matter a lot. Given shoulders, arms, and abdomen as sites, I would recommend your physician know and make an evaluation. Regards, Fred Coe
Thanks for reply. Its strange because every time I have stones I also have chest pain and abdominal pain. When the stones are gone the chest and abdomen pain goes away too.
Hi Mike, The vagus nerve runs a long way through the viscera and perhaps can create the pain syndrome you describe. So long as your physicians understand the pain really is from kidney stones, let’s just call it your special pattern. Regards, Fred Coe
Hi and thanks for your time. I have Uric acid stones and have passed nearly 25 of them over the last 30 years. Most are about 3-7mm in size. The first 20 or so were all extremely painful. Went to emergency most times and got pain medication and they eventually passed, some taking a half day and the longest over a week. However the last 3 stones I have passed all within the last 6 months produced no pain at all, just some dilute coke colored blood in my urine same as most previous stones. Those last 3 were each approx 5mm in size and the last was particularly sharp pointy edged. If it weren’t for the blood in my urine and then the sight of the passed stone in the toilet I would not even have known I was passing a stone.. quite a major change from previous excruciating stone passings. Is this normal? Is it possible that my ureter has stretched from the previous stones? Any ideas? My doctor last year suggested I start taking Allopurinol but I hesitated since I don’t particularly like taking cocktails of drugs (I also take thyroxine, a statin and HBP meds) but now despite watching my diet and taking potassium citrate tabs I’m getting more stones/year even though the last few didn’t hurt I’m reconsidering that decision. Any suggestions would be appreciated.
Also, neglected to mention above that I get stones in both kidneys and the last 3 painless ones were 2 from the left and 1 from the right according to Usounds that I had in the summer. Those were the only ones that were seen and corresponded to the estimated stone sizes. I also drink ~2 litres of water/day as instructed by my physician. I have a stable 1.3×1.0x1.2 cm AML in my right kidney and it has been monitored for the last 5 years which is the main reason I get a yearly Usound although it’s also handy to know what stones are present.
Hi Harvey, Same story here as below. Stop them. Regards, Fred Coe
Hi Harvey, If your stones are really still uric acid, and they are newly forming, and you take potassium citrate then you are not taking enough potassium citrate to raise your 24 hour average urine pH above 6. Uric acid stones need never recur. Get retested – 24 hour urines – get the pH above 6, and uric acid is done. Allopurinol does little good for such stones. Regards, Fred Coe
Hello. I read some of the posts on your website and I can totally relate to some of what others have experienced. I get chest pain and shoulder pain too when I have kidney stones, I have had stones 5mm and up in size. When I am clear of kidney stones all the pain resolves. The chest pain can be quite alarming but feel great when the stones are gone.
Hi Cassie, Thanks. I guess chest radiation from stones needs to go into the books. Regards, Fred Coe
Hi Dr. Coe,
I’m a 39 year old female. I just got the results of my 24hr urine test and it showed oxalate fine at 32, but uric acid over the norm, at 715. My PH was 6.8 and citrate is 671. I had an 8mm calcium oxalate stone that was removed in January. The paper said ‘Patient has Hyperuricosuria. Suspected cause: Hyperuricosuric Nephrolithiasis.’ I thought PH over 6 decreased the uric acid in urine? What do I do now?
Hi Deana, I started this 40 years ago when I described high urine uric acid in calcium oxalate stone formers and showed their stone rate fell with allopurinol – a drug that lowers urine uric acid. A formal trial confirmed my work but I never figured out the mechanism. What I would do is just lower my protein intake a bit – uric acid comes from beef and poultry – cell nuclei degrade to it. Regards, Fred Coe
I had stones and was always told the pain was back pain as stones inside a kidney dont cause pain. Well I ended up visiting a urologist in another country. I had them removed and the pain stopped. I had back pain, pains on my sides, my abdominal pain and sharp lower back pain as well. Some nights I felt like I was dying, and it seemed never ending. Movement made it worse at times and other times better. Mine were 4 to 6mm in size. Something should be done about this, because its not right dismissing patients and telling them its back pain when it isnt. Kidney stone pain is worse than anything I experienced, the stabbing intensity of the pain.. I dont with this pain upon my worse enemy. And NONE of my stones were obstructing anything.
Hi Gary, You are part of a vanguard of people with a similar story. Small non obstructing stones seem to cause pain, and we need to get a trial of surgery organized. Thanks for sharing. Regards, Fred Coe
Thanks for quick reply. Yes, that would be great. A lot of folks suffering out there and taking heavy pain meds for something that can be easily resolved.
I have no stones but a cyst that is a bit over 2cm. I have terrible pain on the side of the cyst, side pain, abdominal, and back pain. I am told it shouldnt cause pain, well IT IS.. as there is nothing else wrong with me! Someone told me they had it aspirated and it help relieve their pain, but they are in Europe. I am looking for someone that can aspirate this cyst anywhere in America! I honestly do not understand why patients are left suffering with stones or cysts when the procedures are simple and effective for removing both! It is mind boggling to me!!
Hi Sandra, I am not an expert concerning surgery of cysts, but I agree it is generally straightforward. I am not sure if it is aspirated, or treated via laparoscopic procedure, but in the US are many surgeons who can help. If you tell me where you live, I can make some suggestions. If you wish, the cyst can be treated here at University of Chicago if it is convenient for you. Regards, Fred Coe
Thank you for quick reply. In Buffalo NY, but am willing to go anywhere I can get proper care. I am told it is a fairly simple procedure too.
The university hospital in ROchester has a good kidney stone program, and skilled surgeons. I would suggest calling them. Regards, Fred Coe
I am very worried. I have constant stabbing kidney pain, and pelvic pain. I also have very sharp lower back pain. I have never experienced anything so terribly painful. I am told stones inside kidney should not cause this pain. Told to go to a pain specialist. Stone is 5mm. Could all this pain be caused by a stone ? Im a single mother and my daughter needs me. I can barely function. What do I do?
Hi Barb, We are finding that small stones can indeed cause pain. Given your story I would speak with your urological surgeon about the possibility of ureteroscopic removal of the one stone in case that will cure you. Regards, Fred Coe
Good Day, Dr. Coe. I have been experiencing shoulder pain (both sides, equally) for nearly 2 months. My doctor ran bloodwork for arthritis, Lyme disease, etc. several weeks ago – all which came back negative. I was prescribed Naproxen – which seemed to alleviate the pain until my neurosurgeon told me I can not take it due to a cervical fusion in mid-August of this year (there is apparently a 6 month wait after fusion surgery before taking NSAID’s due to inhibiting bone growth). Yesterday, at 5:00pm, I began to experience continual urinary issues (where I felt like my bladder was full but could only manage a few dribbles of urine at a time). At the same time, I began experiencing what felt like constipation pain – though I had a bowel movement just hours earlier. Several hours later, I began experiencing rolling (contraction type) sharp pain in my lower, right abdomen – and subsequently in my lower, right back. The 3rd episode brought me to my knees in writhing pain – at which time I went to the ER. Via CT Scan, it was confirmed that I had a 3mm kidney stone and was given morphine intravenously for the pain. Via bloodwork, it was determined that I also had low potassium (everything else checked out okay) – so I was given 2 potassium pills in the ER also. Due to the stone size, I was informed that it would pass on its own, given prescriptions for Norco (pain), Zofran (nausea) and Flomax to help open passage for the stone and sent home. At this point, I have not had discoloration of my urine (blood/pink/brown). My question is two-fold: 1) My shoulder pain seems to have subsided for the first time in months (even before getting the Morphine and taking the Norco). Is it possible that the stone was the culprit of my shoulder pain this whole time but is now diminished due to the stone moving downward? 2) Once the ER Morphine wore off, the abdominal/back pain returned (even after taking my first Norco). It lasted for another couple hours and then dissipated. I was able to urinate freely this morning and have been using a strainer to check for stone discharge (nothing as of yet). With no pain and urinating freely now, can I assume that the stone is now in my bladder awaiting it’s decent down my urethra as some point? And if that’s the case, how long should I wait before becoming concerned if I do not see stone discharge via strainer examination?
And I forgot to mention that the CT Scan showed the stone closer to the bladder than to the kidney – so it had obviously been travelling downward for 3 to 4 hours (from pain onset to CT imaging).
Hi Scott, from your description I had no doubt it had done exactly as you say. Regards, Fred Coe
Hi Scott, I put nothing past stones – they can cause all kinds of pain. You cannot assume the stone is gone, however, as obstruction can be silent and injure kidneys. Have your urologist evaluate matters for you. By the way, prevention matters. Here is a decent place to start. Regards, Fred Coe
Does a kidney infection hurt just as much as kidney stone? I dont have stone aa I passed it on my own so nothing is there but was told I have infection. Same stabbing pain as well aa lower back pain. Can an infection cause this and why do kidney infections hurt so much? Thanks
Hi Kristy, infections can hurt because of inflammation. But be sure about that stone. Have your surgeon be sure none are obstructing a kidney. They can tell but only if you bring your symptom to them. Regards, Fred Coe
Is it possible that a CT scan can miss stones? I also had a nuclear renal scan done. Strange because I passed the one stone but my other kidney feela like I might have another yet its not showing up anywhere on imaging and have that similar stabbing pain and it literally feels like I have a “something” inside my kidney.
Hi Kristy, CT scans are very sensitive. If negative, probably no stones remains in the kidneys or urinary tract. But the latter is a big place, and sometimes a stone can be missed at the junction of the bladder and ureter. I am sure your urologist has looked as carefully as she/he can. Regards, Fred Coe
Hi Dr. Coe,
Sorry to bother you. I found your article after much searching for some of the symptoms I’ve been experiencing. I’ve been fighting with kidney stones for the first time in my life for the last 7 weeks. I had a 5mm obstructing (which passed), a 4mm obstructing (which also passed), and a 3 mm non obstructing that I have every reason to believe passed yet have not had a CT scan or Xray to confirm (as my urologist keeps asking me to have the Xray to verify the presence of stones.) I have been feeling great since last Sunday, exactly one week ago, where I was sure I had passed the latter mentioned stone. Today I was going grocery shopping and at the end of my journey, suddenly my lower back all along my sacroiliac area began to hurt so incredibly badly that I couldn’t walk or stand. I am having left lower flank and left groinal pain, similar to when I had the other stones but not as bad, but the pain in my lower back is so severe I can’t stay in one position for more than 15 minutes, I can’t toilet myself, I keep crying…I hate to go back to the ER again but my urologist keeps basically saying he can’t do anything to help me. I am at my wit’s end and only have motrin and tylenol to help with the pain. Any suggestions? Thank you for your time, sir.
Darcie Hall
I should also mention that the ER physician mentioned in my last CT with intravenous and ingested contrast that there seems to be more stones in my kidney, I think. It’s hard to remember exactly what he said because I was in so much pain it was hard to think straight. I just have no idea what could be causing this as I have lost almost 100 lbs and am eating healthier now, drinking only water with 1 cup of coffee a week, and moving more than I have in years. I have Fibromyalgia but it has NEVER affected me to this degree, although I am aware that it may be contributing to the intensity of my pain. I’m checking out your link I saw posted below entitled “Putting It All Together”.
Hi Darcie, You have found a most useful useful link. It links to other more detailed articles, as well. Losing 100 pounds sounds like a possible reason things started up. You need management of what I suspect is a current stone, and evaluation so you can prevent more. Regards, Fred Coe
Hi Darcie, I would imagine another stone, and a new CT or ultrasound is in order. I would be sure and get the new imaging. But prevention is crucial. Here is a good place to start when your pain is better. Of major import, collect stones and get them analysed! Regards, Fred Coe
I am a 69 years old female, recently diagnosed with mild gout. This was a wakeup call to live a more healthy lifestyle. I have stopped eating sugar, have always watched my fat and protein intake, rather eat vegetables and whole wheat breads. Eliminating sugar (sugary drinks, pastries, hidden sugars in foods, etc.) has had a positive effect, I have lost 37 lbs, lowered uric acid levels, triglycerides are normal, normal blood glucose levels,etc. This is all great, but now I seem to be developing a kidney stone. I will be having a catscan this week to be sure, but I am confused. I have pain on right side of lower back, along the side, circling around to the front, but it is fairly mild to medium pain that comes and goes during the day. I also feel a lot of pressure at the site. My doctor did a urine test that showed a mild amount of blood in my urine, hence the catscan. Everything I’ve heard from family/friends and what I’ve read is that stones cause very strong pain…so my question is, why is my pain so low, is low pain common, and is my stone just at it’s beginnings as to pain?
Oops, meant pain is on my left side. Sometimes I get a little dyslexic.
Hi Penny, The CT scan is a very good idea. If there is a stone, uric acid would be a good bet given gout. The radiologist can help assess if that is the case. Whatever the case, you should want to prevent more. Try this article. Regards, Fred Coe
Thank you Dr. Coe, I read those articles and found them informative and helpful. I am curious though, on how overeating sugar impacts stone formation. I read the book “The case Against Sugar” by Gary Taubes and boy was it an eye opener. That book and a few others have discussed the link between sugar and high uric acid levels, metabolic syndrome, and pre-diabetes. Of course that might be related to taking in so many empty calories, but very interesting. Just wondered about your thoughts on this. Thank you for your info again and thank you for your kindness to all of us kidney stone sufferers. You are a great advocate and resource.
Hi Penny, Sugar causes metabolic syndrome etc because it is 1/2 fructose and 1/2 glucose; the former directly causes insulin resistance and lipid abnormalities. For stones, sugar raises urine calcium. So, leave it be. Regards, Fred Coe
I have been having right flank pain since September 8, two ER trips. CT shows stones in both kidneys. The right has a 4 mm and another cluster. My urologist an his PA says it can’t be the stones because they are not obstructing ( he even canceled a follow up on me because he couldn’t help me). I am at a pain clinic now and one of these doctors believes it is the stones, he had me try napraxon which did not help. I just had a trigger point injections in the back with cortisone yesterday. The doctor was up front that if it is the kidney it wouldn’t help. I know I have to give the cortisone a chance. To complicate things I’m on Coumadin due to DVT history. How do I find a urologist that believes this article?
Hi Tim, Small stone pain is a big topic right now and no one really knows lacking trials if surgery will help. Given considerable pain, many urologists are not opting for stone removal. But whether it helps remains unknown. I would discuss this possibility with your urologist. Regards, Fred Coe
Thanks for putting great efforts writing this incredible article. These are some major signs for kidney pain:
1. High Blood Pressure
2. Changes in the amount and number of times urine is passed.
3. Blood in your urine.
4. Tiredness
5. Difficulty sleeping
6. Headaches
7. Shortness of breath
8. Nausea and Vomiting
Reference: https://www.healthmagaz.com/kidneys/kidney-pain/11-signs-may-kidney-pain/
Hi Anna, Thank you. For other readers, I want to clarify what you have written. All forms of severe pain can raise blood pressure. Blood in the urine arises from stones with or without pain. Nausea and vomiting are prominent with stone passage, and severe pain. The frequency of urination often rises when a stone is at the junction of the ureter and bladder. But more or less people with stones do indeed report all you have written. Thanks, Fred Coe