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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Does anyone know.. after a stone is passed, will the Frequent feeling of urination accompanied with very little urine coming out completely STOP, or is this now a permanent feeling in my bladder even after stone is gone?
Also, is it Extremely painful when the stone makes it’s way out the pee hole?
Hi Brian, your symptoms could be from a retained fragment of stone at the junction of the ureter and bladder. Passing a stone indeed can hurt as well. Your urologist is in a position to give you an exact answer because s/he has seen your images. Regards, Fred Coe
Hello. I am 9 months pregnant with 2 stones shadowing each other measuring 11mm each. They are non obstructing and in South Pole region. OB said go to ER if id like Nubain as I cried to her begging for help not narcs as my history with kidney stones prove they don’t help anyway and urology said nothing can be done until after deliver and OB can handle pain control. I’ve not wasted time with Tylenol and can’t take Motrin during pregnancy and won’t waste time taking a narcotic especially while pregnant. I am in agony non stop and for months now. I don’t know what else to say or do as I have literally begged for my Doctors to help me.
Hi Kacee, Non obstructing stones during pregnancy are a big problem. Stents would be worthless. I am a bit surprised because the urinary tract is dilated with pregnancy. Perhaps the stones are not the cause of the pain. I am sorry for the late answer – I missed this before. Of course, one cannot do any elective procedures during a pregnancy for fear of injuring the child. Regards, Fred Coe
Hey Brian, I had a calcium oxalate stone about 5mm long. Had the usually excruciating pain while it exited the kidney and traveled down the ureter. But when it got past that and entered the bladder, all the pain stopped. I was told by my dr. to pee through a wire strainer (like one in a kitchen) to catch the stone so it’s type could be identified.
Didn’t feel any pain at all as it left the pee hole while urinating. One morning I just looked at the strainer after peeing and there it was.
Hi. I had a kidney stone for 7 mos. not knowing what was even causing all of the excruciating pain and symptoms for about half of that time. I finally went to the er and had a scan revealing a 5mm stone. I was told as a rule of thumb a 5mm stone has a 50% chance of passing. I am stubborn and did not want to go see a urologist so I suffered through it and did 3 rounds of Flomax. I could tell when the stone had moved down closer to the bladder. The pain was awful and would come in waves that would make me double over but there was a constant stabbing kind of pain in the entire groin region and I would be in and out of the bathroom all day and night with the urge to urinate but then barely any urine came out. I wondered how a stone could cause so much pain and agony and so many other strange symptoms and started wondering if there was actually something else wrong and when the stone passed if I would still be miserable. Jumping ahead…on my 3rd prescription of Flomax (which I obtained by begging and pleading with a doctor at Med Express who thought I needed to go to the urologist) I took a pill before I went to bed. Had another miserable sleepless night dealing with the pain and constant discomfort. I woke in the morning to use the bathroom dreading the burning and pain and to my surprise there was kind of like an almost pop sound/feeling and there was the stone that had made my life sheer hell for 7 mos. No pain at all. Just that little pop or pressure and very little blood when I wiped. All of the radiated pain, stabbing, burning, and frequent urination was gone as soon as it left my body. It was crazy. I think I had forgotten what normal felt like. My husband kept asking me every few hours how I was feeling. I told him all of that stuff that accompanied that stone is completely gone. I felt great. It turned out that when they measured the stone it was actually 8mm
No wonder I fought with it for so long. Next time I will just go to the urologist lol
Hi Molly, Yes, next time do that. And, before the next stone, get evaluated for cause and begin prevention of more stones. Try this article as an introduction. Regards, Fred Coe
I believe I had an big stone attack (right side flank area) in 2015 (thought I was going to die basically) though the pain subsided within a half-hour or so. I did not have insurance at the time so I let it go. I’ve been under some obvious stresses & anxieties since then, like job loss, car lease payments, moving out on my own, new car, more mentally stressing employment (ride-sharing) etc. Anyway, come June or July this year and I started having testis pain mostly on the right side though at times momentary stab like pains in the left too. I’m pretty sure this has all been kidney stones but clinic urologists ordered x-rays and ultrasound which found nothing. I’ve been reading that those are not so helpful in diagnosing ureteral stones. I can never see any stones passed in my urine, but lately I have been taken the herb called stonebreaker or chance piedra and the pain has gone for the most pain. Do you have any recommendations or perhaps any good urologists you might be able to refer me to in my area? I honestly can’t live like this for another month. Thank you so much in advance for any help you can give me!
Hi Jonathan, I seems as if your physicians cannot find stones. Your pain could be from stones or even crystals but both usually cause some urinary bleeding. If by ride sharing you mean driving for UBER etc, dehydration is a big risk and could cause crystal attacks with pain. I would be sure and stay well hydrated and do nothing more. The herbs are worthless, but I have not been energetic enough to write about them – no real data, no real trial. If you want a second opinion let me know where you live and I can try to find a name. Regards, Fred Coe
11 years ago I had a 4MM obstructing stone that was backing urine up into my kidney I have never hurt like that before. In the ER the doc said “what you like for your pain, does any meidcine work better for you?” I said ” I don’t care You can give me dirty toilet water if it will make this pain stop.” Well I passed it 3 days but now 11 years later a CT scan while checking for a hernia I was diagnosed with a 3MM non obstructing stone in the lower pole of my left kidney. They told me to stay hydrated and come in if it drops. I am terrified of going thru what I went thru before is there anything that can be done proactively besides waiting for the other shoe to drop? Thank you.
Hi Mike, So, you have formed 2 stones, the old one that passed and now a new one. About the new one, a surgery is something not so pleasant so if it is not causing obstruction, infection, pain, or bleeding I would leave it be. But, I would get evaluated for why stones are forming, and take steps to prevent more. Here is one of my better articles on that subject. Regards, Fred Coe
Last month, I had a serious pain between kidney n ureter caused of kidney stone as doctor’s said that I had 10mm stone in ureter but after few days pain was completely gone and day before yesterday my bladder was pain in short time and gone.. Now I don’t feel any pain.so please tell me what does it mean that ..
Hi Kunchok, I think it means the stone caused pain when in the ureter, then moved down into the junction of the ureter and bladder, then passed. But it may not have passed and could be obstructing, so your physician needs to take another look. You should strain your urine to try to collect it so it can be analysed. Likewise, you should get checked for cause and pursue prevention of more. Regards, Fred Coe
My daughter just turned 18 she has had stone removal before and is currently in the hospital complaining of similar pain she has 3 stones each kidney 5-6 mm. They say because they are not obstructing that’s not the reason for her pain. Any up to date urologists in tampa Fl?
Hi Holly, That you daughter has 6 stones means serious problems. No one knows if surgery will reduce pain from small stones or just add more trouble. But everyone would agree she should be evaluated for cause and treated to prevent more stones. I would do that. Often, prevention measures reduce new crystal formation and thereby reduce pain. Regards, Fred Coe
Daughter who had 2 obstructing stones started having severe pain ct as noted below had 3 stones each kidney. One side after removal 2 6mm and one 7. She described the pain as very similar to when she obstructed. Urology removed stones but dismissed these as cause of pain and labeled her drug seeking. So upsetting. Daughter had foot surgeries with hardware before did not like taking the narcotics. They lectured her one day post double stents about not using narcotics Fortunately we are home and she is feeling much better having spasm of course and feeling burning. So upsetting to be treated this way. She just turned 18
Holly
Wish we lived closer to see you!
Hi Holly, Small stone pain sans obstruction is a national issue and many urologists are concerned about it. If her stones are not obstructing but she has pain, her surgeons may want to consider the pro and con of surgical removal. It is a present surgical controversy. Regards, Fred Coe
Thank you! This site has been a great resource,
Regards
Holly
I do think it needs to be brought to the attention of the hospital that pain can occur with nonobstructing articles. I plan to share this article. Any other articles you could recommend to educate medical staff administration? I hate to think of other patients being dismissed and labeled drug seeking. Daughter was in terrible pain who would want surgery and stents to get drugs? My daughter hates any medical procedures but was desparate to feel better vomiting pain an 8 and white as a sheet stated pain almost as bad as last obstructing stone 3 months ago! Sorry just so upset about treatment
Holly
I have 2 stones which one I passed and the other I feel is in my urethra but I can’t pass is. Had Dyer urge romper every 5 mins and pee a little. Bladder and kidneys hurt… what can I do????
Hi Tina, This is a problem only your urologist can solve/ If a stone is lodged in your ureter near the bladder and causing symptoms s/he can remove it. Let your physician know. Regards, Fred Coe
I have a 9mm non obstructing stone in the lower pole of my right kidney. I have had the scope done to no avail. Said he couldn’t get it without causing damage. This was followed by ESWL which didn’t work. Now they are telling me it’s not what’s causing my pain. I have had stones before and know that particular pain. How can I find someone to help?
Hi SHaron, non obstructing stones and pain is an ongoing urological controversy, and the stone may indeed cause pain as noted in the article. If URS has been ineffective, perhaps your urologist might want to help you find a second opinion. Alternatively s/he may have found the ‘stone’ is actually a calcification within the kidney tissue itself and therefore not removable. This is complex surgical material, which is why I can only recommend another opinion as a helpful option. Regards, Fred Coe
I started out last Nov with 29 stones, passed two, four removed(12 UTI’s supposedly), now only have catheterized specimens , only one UTI since April surgery. But did shed light this blood is from my female system not urinary. Still have flank pain , groin pressure, still my urinary system does not seem right. Occasional big pain. Did get back eval- mild degenerative stuff, I use a tens unit for pain which does help I think. Negative colonoscopy. All the stones and Randall’s plaques are embedded. So do those come out or will they always stay there? On Allupurinol, had 24 hr urine and serum labs. On vitamin D, mine is normal now but on the low side with medicine., on Jills site. Eat very little meat, eliminate high oxalate stuff, and drink lemon water. I tried chiropractic for months. I just want the side pain to go away.
Hi Karen, I gather that your surgeons have found plaque and embedded stones. The latter will not come out and stones can grow over the tissue bound crystals. You need the usual evaluation for causes and then prevention oriented treatment. Here is a good place to begin reading. Allopurinol, low meat intake, all that may be altogether off the mark; find out what is wrong and treat that. Jill is an excellent resource, by the way. Regards, Fred Coe
19 stones not 29 oops
Hello I’m a 39 year old healthy female. Last week I smelled a funny odor in my urine and I brushed it off, thinking I need to drink more water. I do not like water and love coffee, I’m also a Registered Nurse. I began having discomfort, fatigue nausea and low back pain. I went to urgent care dx with a UTI and treated with Cipro. That night I experienced excruciating pain took a muscle relaxer pain killer and Ibuprofen which barely helped by this time I was sure I had a stone, I knew this because I’ve had it before. The next morning I woke up with discomfort throbbing but not excruciating I went to work and called my PCP, I immediately requested an US which was like pulling a tooth they tried to convince I must have “low back strain” from nursing. Needless to say I do not do any patient care I sit at a desk so this pain is not related. I found out there is a 10cm non obstructing stone and I’m being told that it shouldn’t be painful however I’m very uncomfortable constant throbbing! This is not my normal low back pain and at this point I’m very frustrated. It’s unfortunate that people are ignored because the science doesn’t match!
Hi Ari, The funny odor does suggest infection, perhaps of the stone; if it smelled like ammonia, it would be a good evidence for this. Infection of a stone will cause inflammation and that can cause pain. The stone is rather large, and perhaps removal is not a bad idea, especially if you are indeed infected. Regards, Fred Coe
Hi Karen Dickson,
This was a great excellent informative post you have shared on this page about the scoliosis pain relief scoloosis and hip pain because sometimes all it takes is bending over to pick up a pen from the floor for back pain to strike. Fortunately, most of the time back pain is short term and goes away on its own. But if you experience chronic back pain, you may benefit from making certain everyday adjustments.
Thanks.
Hi, I have approved this despite it contains commercial content as you are answering a patient. Having it here does not reflect my approval or disapproval of your product. Usually I would have sent a commercial post to spam. Fred Coe
I have a non obstructive kidney stone that is causing me severe lower flank pain and into my leg I have been to the ER and had ultrasound what can I do please help
Hi Shelly, Be sure it is the stone. Pain radiating into the leg may be from the spine or even sciatic nerve. Perhaps a physical medicine consult might help. If it were from the stone the only way to stop the pain is surgery and that is reasonable when one is sure. Regards, Fred Coe
Hello 37 yr old healthy female. Have been suffering for 1 year with episodes of constant urge to urinate, especially after voiding. Walking and moving around intensifies this feeling. Was recently diagnosed with 2 small stones in left kidney and awaiting to see an urologist. I think the prenatal vitamins I took for 2 years caused the stones but my question is could it be that I have urethral irritation and frequent urge to urinate due to these stones? I have been drinking a lot of lemon juice in hopes of the stones dissolving or breaking apart. thank you
Hi Gianna, The kidney stones would not do this but a tiny stone at the junction of the ureter and bladder could and might be hard to see. Likewise, crystals may form and irritate the bladder and urethra. You need 24 hour urine testing to see what is wrong, and I imagine your physicians are indeed planning just that. Regards, Fred Coe
Thank you for your reply. Would the crystals explain why I have these attacks of frequent urination that last 4-5 days and then ease off? I have noticed a lot of sediment in my urine as well as what looks like mucus which is coming from the bladder
Hi Gianna, they could. Your physician would have to look for them to be sure, but if crystals are causing trouble one can get rid of them. Regards, Fred Coe
I’ve passed 4 small 2-3mm stones successfully from both kidneys. The 5th stone, however, got stuck in my ureter and refused to budge. It was removed by urethroscopy and a stent placed. I now have another 3mm stone on the same side, still in my kidney. My urologist is not listening to me, seems to think I’m overreacting. I’m in a constant state of being uncomfortable, with flare ups of extreme pain. I’m very afraid this one will get stuck too, and this doctor is not taking me seriously.
Hi Linda, I gather you want the 3 mm stone removed via URS and your surgeon demurs. It is indeed not an easy choice – to operate for a passable stone. ON the other you are the patient. If your surgeon does not feel comfortable with preemptive surgery perhaps S/He might suggest an alternate surgeon to offer another opinion, ane perhaps meet your needs. Regards, Fred Coe
Hi, I was previously pregnant and had 3 kidney stones. Two stuck in the ureter and one in the kidney. All around the same size of 7-8mm. I found out I had kidney stones when I was 25 weeks pregnant so I had to wait to have surgery until after I had the baby. I did however have a procedure done to have a stent placed. After the baby came, and the surgery to get the stones removed, I just found out that the surgeon only blasted the two that were stuck in my ureter. I have no hope for the one in my kidney to pass successfully because of how big it is. Although I am having pains in my right side but more in my stomach than the kidney. Could this be the stone moving to the ureter? Can you feel the stone when it’s in your ureter? I’m only 18, so I just want all of this to go away.
Hi Nicole, The large stone can be removed either with shock wave lithotripsy or ureteroscopy – I much favor the latter as more likely to give a stone free kidney. You should pursue prevention to avoid more stones, as they can recur. Regards, Fred Coe
Hi, I’m a 42 year old. It’s my fault that I don’t drink water regularly and drink coffee more. I also take magnesium before bed every night. For 3 and 1/2 months I’ve had pain in my upper flank. I ignored it thinking it was a pulled muscle. Just the other day I saw my practitioner who took urine sample saying I drink plenty of water but I have bacteria and a trace of blood in urine. The Dr. said it is more than likely a stone lodged in my kidney. Dr. Said it’s probably not a kidney infection because I don’t have a fever or vomit. Dr. Gave me antibiotics to clear up a uti (which I don’t have.) The Dr. said if the antibiotics don’t work, then she’ll prescribe different antibiotics to try and clear up the bacteria. She ordered a CT scan (which I had two years ago and showed small stones and calcification in both kidneys, as well as very small cysts on both kidneys.) While I’m home waiting for the referral, which can take up to a week or more, I’m in a ton of onset sciatic pain shooting through my back and leg. I’m so freaked out because my dad died of kidney cancer and developed stones when he was my age. He died at age 62. All I keep reading is that spinach, salt, and protein is bad. I have a feeling the Drs are going to give me the run around or cheaper option of blasting the stone out (if it’s a lodged stone, which the Drs confident it is) rather than the surgery with stent and camera to see if there’s more. I think the antibiotics will only make things worse. What’s your opinion?
Hi Lynn, I am not sure if I understand the situation. You have considerable pain, there is blood in your urine, and your physician ordered a CT scan, but you did not say what the scan showed. The one two years ago showed stones in both kidneys, but the new one?? If you have an obstructing stones, your physicians will have to manage it. If not, then they will need to sort out the cause of the pain, so the CT results are crucial. Since you have multiple stones in your kidneys prevention is already timely. Take a look at how to go about it, and try to get it for yourself. Kidney cancer is not a known result of stones, so I suspect your dad had two separate diseases. Your CT scan 2 years showed no cancer, so at that time you were fine in that regard. As for management of an obstructing stone, if there is one, I do much like ureteroscopy in general, but the decision is made by your physicians. Regards, Fred Coe
Thank you for your response. I haven’t received my CT scan results yet. But the pain has shifted and eased since I’ve been taking a well known vitamin that breaks up stones, as well as drinking lots of lemon water. I’m curious about the CT scan. Thank you for the info. I’ll be sure to continue my research and hopefully I can get answers soon.
hello lynn and doctor , i am going though same thing 8 weeks ago i had so much pain in my right kidney i couldent even lay on that side . i went to er they did a cat scan and said i had non obst stones 2 4mm and 5 mm and i had mild hydros but no infection i made appointment at urologist ,but i had to wait almost a month to be seen in the mean time my pain was 24/7 2 weeks later back to er this time stones were still stable non blocking and i no longer had hydro . i just seen my urologist a few days ago he is going to do the basket or blasting the stone he said it depends if he can see the stones on a reg xray my pain is constant
Hi Samdra, I hope your stone has by now ceased to cause such trouble. I am answering rather late – lots of other work are keeping me from my own site. Be sure to get evaluated and prevention treatment so this does not happen again. Regards, Fred Coe
I have a non obstructing 7mm stone in my kidney. I have had kidney stones for 20 years and approximately 7 ureteroscopy procedures, five in the last year. The doctor will not give me pain meds because it is his opinion that I should not be in pain. I am in A LOT OF PAIN!!! I am tired of battling for pain medication.
Hi CHeryl, A single stone should not cause such pain, although many people with larger numbers of stones report pain like yours. I suspect pain is from the many procedures. Possibly you are infected, possibly you produce crystals that can give pain attacks yet no stone is found. Possibly you have some damage in a ureter and altered drainage that will show up on a dynamic renal scan, or a contrast ultra low dose CT scan. Rather than just pain meds I would hope these possibilities can be explored and get you pain free. Regards, Fred Coe
reply to: Cheryl A Britton
I passed a 5mm stone 3 days ago, and yesterday i was getting very good, until this morning, it return and like it never passed. I end in hospital this morning and the doctor told me i have more stones (but smaller) in both kidney… like my two kidney decided to do the spring cleaning. I was in pain, horrible pain for 3 days WITH MEDICATION. So. You have a freaking great strength and tolerance because you got a 7mm and you have no freaking pain killer to help you. I DON’T FREAKING UNDERSTAND. Why your doctor refuse to give you anything? Honestly, i got like anti-inflamatory pills and 2 pain killer (Strong stuff). This doc must hate you… i freaking dont understand… I hope you will get well very soon. 🙁
My ultrasound shows “possible” several kidney stones with the largest measuring 3mm. My CT however, apparently showed nothing at all. I’m having on off nausea, lower back pain, flank pain, lower abdominal pain especially in the groin that sometimes radiates down my inner theigh, feeling more tired. All the symptoms come and go randomly. The urologist is telling me that in his opinion he does not have enough evidence to prove kidney stones and says even if I had small kidney stones or sand, that I shouldn’t have symptoms. Nothing the urologist is telling me is making sense.
I forgot to mention that the CT I had was without contrast. I’m allergic to all contrast dye.
Hi Monica, The negative CT makes stones very unlikely. But crystal passage can be hard to document. Here is a good article on crystals and their problems. See if it fits your situation. Regards, Fred Coe
In my experience as a person with cystinuria (passing stones for the last 33 + years…), a CT is not as accurate as I’ve been led to believe. Whether it’s the skill of the radiologist READING the scans or just my stones, multiple CT scans have been wrong when seeing size or the actual stone at all. I had a large stone that my urologist helpfully left a large chunk behind after the first surgery (was fired as my doctor immediately), after a week long stent I was at work for 45 minutes and had to leave for the hospital. The stone measured 7 mm by CT, I was admitted for a stent placement by the on call urologist the following afternoon (against my wishes, I do NOT tolerate or require stents). By the time the doctor was available, I no longer had pain and went home. 2 weeks later, it finally passed 45 minutes before leaving home for my 3rd scheduled surgery (that stone, I’ve had over 20 ureteroscopies at this point). It measured 1/2” x 1/4” with a straight edge where the original surgery broke the stone. So the stone was at LEAST 5 mm bigger than seen, my opinion is that anything UNDER 5 mm probably won’t show up well depending on where it is. The stone was definitely inside my ureter causing an obstruction, so technically it should have been completely visible. By the way, all of my siblings have cystinuria, 4 of us with no family history of any stones or kidney disease and all of us presented differently in spite of being raised the same way. Cystinuria SUCKS rocks…it would be SO much easier if it was a consistent disease so treatment could be better. I have been labeled a “drug seeker” by more doctors than I’d care to think about, even though I have used the same hospital/urologist for over 10 years (even when I’m admitted to the hospital, pass the stone and have the nurses “visit” my stone at 2/3 am multiple times…I guess an 11x7x3 mm stone is impressive for some). I’ve had ER doctors yell at me for declining a CT scan, when I agreed the tech remembered me and I didn’t see the doctor again…I had the nurse take the stone passed in the ER to show him what “drug seeking” looks like. Sorry for the novel but this is one of my buttons and with the addiction issues (not caused by the patients with legitimate issues) treatment is getting worse not better!
Hi Ann, Thank you for sharing your experiences. I am sorry for all your troubles. For cystinuria it is essential to lower supersaturation well below 1 and to maintain high urine volume throughout the 24 hours. I am sure your physicians have tried and are using thiol agents, which would be suitable given so much surgery. Regards, Fred Coe
I have had 3 episodes of right flank pain, just pressure really, but very uncomfotable, only at night, within the last month. One lasted 2 hrs, one 30 min, and one 3 hours. All went away when I took ibuprofen. Blood results normal, CT from 3 years ago shows 4mm stone, CT yesterday shows no stones at all, just some small simple cysts. Still feeling 5% pressure in right kidney off and on (like some is poking me with a finger. We were all sure it was a stone, because blood showing in urine also. Do have a 2.3cm cyst in other kidney.
Any ideas what might be causing this slight discomfort? Only worry is that they may have missed the stone on CT…
Hi Jay, Possibly these are crystal attacks, especially if the urine has blood in it. This article (link below) on stone counting actually has my only good description of crystal attacks. Possibly the cysts are bleeding and blood clots are passing and causing pain, but you would see them. Crystal attacks arise just like stones, and one needs blood and 24 hour urine studies to figure out what is producing the crystals. Regards, Fred Coe
hi,i cant write english words correct. I have so pain in my right kidney ,and i didnt ct scan for kidney stone yet .but i did u/a and u/c and CBC and WBC and last year sonography.and my doctor said you have no problems for you kidney and bladder , i’m 32 age . And sometimes i feel a few pain in my righ .please tell me to how decrease this pain and this problem. (thanks)
Hi Saman, if there are no stones by CT, the pain may not becoming from the kidneys. Crystals can cause pain, but there usually is blood in the urine. I hope this helps. Regards, Fred Coe
I have been diagnosed with kidney stones and had pain since January 2019. The first test they did was an ultrasound and said I had small stones but I wasn’t told how many. I had 3 incidents of pain and last Friday I had a CT without dye done which showed 2 kidney on the right, a 2mm in the kidney and a 5mm that was at the bladder junction. The day after the CT I was in terrible pain and needed urgent care treatment. They prescribed flomax and pain meds. I see the urologist next Friday. My question is, could kidney stones also cause vaginal rawness and burning? They’ve checked for infection but there is none and the vaginal pain started after a week on antibiotics for a UTI because of the kidney stones.
Hi Soni, A stone at the ureter – bladder junction can indeed cause vaginal pain. It is referred from the bladder and is not arising in the vagina. Regards, Fred Coe
Hi there, I have one 9 mm kidney stone in the lower pole of my left kidney and one 4 mm in the mid pole. Both non obstructing and still inside the kidney, but I’m getting a lot of pain. I’ve had two previous uroscopies to remove stones in the past..can the procedure still be done even tho the stone hasn’t moved out of the kidney? Also, the 4 mm stone hasnt been seen on the last imagining done a month ago. The 9 mm stone has grown 7 mm since January (at which point it was only 2). My nephrologist said my diet is fine and put me on potassium citrate which I’m unable to take due to the side effects. Is there any way I can stop the stones from forming? Should I get my parathyroid checked?
Hi Lily, Be sure you have been fully evaluated and that your treatment is aimed at the causes of your stones. You are actively producing stones and one is growing, so your treatment is clearly ineffective. Get the proper 24 hour urines and blood studies, and find out what more you need. Regards, Fred Coe
Thank you for your article. I have had left flank pain for two weeks now. I go for a CT scan this week. Vicodin has helped for sleep. I’m just curious as to why sitting is so painful if it is a kidney stone. I have no blood in my urine or elevated white blood cells. Hoping to find out answers and not to be left in limbo on pain meds.
Hi Stacy, Are you sure your pain is from stones? If no stones, the cause of pain must lie elsewhere. In any event be careful about narcotics, they can habituate you to them and be hard to stop. Regards, Fred Coe
Hi
Last week i had an accute pain attack and my CT revealed a single 4 mm stone as told by the urologist.My doc suggested me to drink lots of water and gave me some pain medication and a urimax tab to increase urine flow.bt my pain is unbearable evn aftr medication and i suffer severe constipation since then.It has been 5 days now.will my stone pass as such !!any means to control the pain??
Hi Renjitha, stone passage is horrid, and I hope the stone has passed or will pass soon. Management of any individual stone passage is entirely up to your surgeon, as every event is a little different. Likewise for pain management. But when the stone has passed, do get evaluated as to cause and begin a prevention program. Regards, Fred Coe
hELLO
i AM A 75 YEAR OLD MALE
Symptoms
Painful urination
No infection
Intermittent pain thigh/groin sharp at times
One extraordinary painful event barely able to apply pressure while standing
On flow max
No back pain
What type ct or mri should be used to assess this problem /
Hi Julius, I am not sure this is stones. If you are having new onset of pain it may be reasonable to obtain a standard low dose CT without contrast to see if anything is wrong. But that is a complex medical decision and based on the exact history of the pain and other factors. So your personal physician is the only person who can really help you decide if this is a wise and valuable test. Regards, Fred Coe
Hi there, my name is Melissa. I’m a 21 year old female with a previous history of cystine type kidney stones. At age 16 I had previous bilateral renal stones removed with laser surgery, with a stent in place for 2 weeks to help pass the fragments. I have passed small stones since then on my own, resulting in a bit of pain for about 6 hours or so but then subsiding. 4 small stones in the last 3 weeks. For roughly 9 days now (including two visits to hospital) I have been dealing with incredible pain in my upper and lower back, also under my ribs. It was confirmed at the hospital with CT, x-ray and ultrasound that I have multiple stones in my right kidney, one being 8mm.
At the hospital they were very dismissive, and persisted that the pain was not related to the kidney stones in the kidney as there was no obstructions. They even tried to say it was due to constipation, from the fecal mass seen in my x-ray, probably due to the medication I have been taking to help tolerate the pain. My bloods and urine came back normal. I am now doing a 24 hr urine before seeing an out-patient urologist in just over a weeks time.
I believe they are not taking me seriously. I can recognize this pain due to the pain i experienced when I was younger, then having the renal stones removed. the pain IS the same. and I cannot bare it any longer. I cannot go to work at the moment or to university. I am so worried for my studies because I feel like I cant get this sorted.
I will be taking the information from this study to my appointment in a weeks time, to express my concerns as I absolutely believe pain can be caused from stones in the kidney, not just when they travel to the ureter. I recognize the pain, and it feels exactly the same. I am on multiple medications and muscle relaxants, as my doctor keeps giving me medication and tells me to suppress it.
After reading this information it is so wonderful to know that there are people out there like me, and that I’m not alone. It is not all in my head like they tell me, and it is excruciatingly painful physically and mentally.
Hi Melissa, cystinuria is a very serious and complex form of stone disease and is best treated in a center that has considerable experience with it. Even if your care needs be local you should be evaluated at a center and your treatment guided in part by experts. I am quite sure your stones could cause a lot of pain, and even more sure that your prevention is inadequate as you are forming more stones. I urge you to seek expert help to aid your local physicians in your care as the disease is not like ordinary stone disease. Regards, Fred Coe
Dear Mr. Coe
I am wondering if you can recommend center that have expertise in Cystenuria. I have a son who has been misdiagnosed for 6 years, and because my daughter at 23 has just been diagnosed with Cystenuria, he too did urine test with Litholink. We are having difficulty finding experts. We are in Indiana, and Charlotte NC. Any information would be greatly appreciated!! Sincerely, Debbie Henson
Hi Debbie, Here at University of Chicago we do a good job of preventing cystine stones. Litholink is an ideal testing lab for the purpose. Indiana is not that far away. Charlotte is not so easy for me, in that I do not know anyone there personally who has special interest in the problem. Can the family possibly afford to bring the Charlotte person to Chicago? At this point, you would be best off emailing me directly: flcoe@uchicago.edu. Warm Regards, Fred Coe
I understand how you feel completely. I have been dealing with kidney stones since 2010. And I 2016 I had my first obstructing 8mm stone that had to be removed. Since I have 3 more lithrotripsy to remove 7mm and up size stones. Currently I have 6mm in kidney and 3mm in other kidney and flank pain. Urology said no way pain is from stone while in kidney. It is so frustrating. Especially for people who have dealt with more than one stone, we know that pain. It is not like any other pain. She tried to say it could be muscular or gastrointestinal. It took her 10 minutes to see me and that was it. I am sure I will be back in the ER with unbearable pain in the near future. She offered to remove the 3mm because it was midpole but said she would leave the 6mm because its lower pole and isnt an issue but there are days I can literally feel the stone in my kidney. I feel like urologist doctors who havent experienced chronic stones dismiss us very quickly. Goodluck with your health and I hope things get resolved. But I feel your pain and I believe your pain.
Hi Marijane, pain with non obstructing stones is very common, and lacking trials no one knows what is the best course of action. No one has much question that the pain is real, and many of us believe it is indeed from the stones. I am hoping for some surgical trials to tell us if the risk and miseries of surgery are worth it. Regards, Fred Coe
Hi Melissa,
First , I am so sorry to hear you have Cystinuria. But I would like to know if you are aware of our foundation, The International Cystinuria Foundation? If not, check it out and if you are interested in support and advocating, we welcome you to join our Facebook Page for The International Cystinuria Foudation where we operate in a private setting of support with over 1400 members now. Our President serves as the moderator and you will definitely find a huge amount of support within the group. Hope you can join. I am a mother of 3 Cystinuria children and have known Cystinuria all my life as my mother suffers as well. Unfortunately renal failure was an end result for her but fortunately men sister was able to donate her kidney, As I sit with my eldest once again in a Childrens Hospital setting, I saw this page and felt I must respond to these comments and to invite any Cystinuria sufferers to our group. We all understand the hardship behind these constant burdensome stones that constantly pass with and without surgical intervention. My eldest has had over 30 surgeries , even auto transplanting her own kidneys to minimize pain and obstruction. The biggest issue I am finding throughout and within the medical system is the belief that YES YES! These nonpbstructing stones are painful. My children are definite proof of this and so are the hundreds within our group as well. Hopefully you will join us but if not, good luck and please take care of your self.
Can a stone in the pole cause infection ?
I keep getting them and the only thing that I seem to know is it started it when we found a stone in the right lower pole and appears to be there 4 months later and bigger in size.
Hi Tonya, I believe I already answered this. Regards, Fred Coe
I had 2 stones one in ureter 7 mm which has been removed by ureteroscopy, and one more in right kidney 3 mm which is non obstructing but it is causing pain when I work. Urologist believe I will pass this stone, I too can’t go for another surgery. Wish me luck and relief from this grave pain.
Hi Prasanna, I hope the stone passes. I also hope you pursue stone prevention to avoid more. Regards, Fred Coe
Finally, what I have been looking for! It is so frustrating to have medical professionals and literature talking about kidney stones that ONLY cause pain once they drop into the ureter or block the passage of urine. Which I fully agree with. But even after having 6 stones pass (and collected), one by surgical ureteroscopy, in the last 2 years, my current 3.5 mm lower right pole kidney stone cannot possibly be giving me pain because according to 2 ER visits with two different ultrasounds and a recent prescribed CT scan, show nothing is being obstructed. Dx : Pain not caused by kidney stone. One ER told me it is referred pain from a left sided pneumonia. What!? I have no doubt this current stone exist (by CT) and no doubt it is causing pain just like the other 6. In fact the pain started the same day number 6 passed. I did not know I would have a 7th stone try to pass on the same day! This has been going on for 3 months. I hope it just passes because I am done with pain for the last 2 years. And I’m done with most medical professionals having closed minds, even after admitting they don’t quite understand the nerve pathways of the UT system. Sounds contradictory to me.
Hi Steve, Pain from non obstructing stones is certainly possible. The problem is lack of trials. Does surgery to remove such stones reduce pain, or not? That holds physicians back, because what can they do but surgery for them. However you should do all you can to prevent more, as stones often recur. Take a look here. Regards, Fred Coe
I just recently had to go to the emergency room due to unbearable pain that I have never felt in my life and I gave natural birth to a 8 lbs child 10 years ago. I was vomiting and was so restless and the pain… oh the pain. Turned out I had a stone stuck in my ureter and multiple stones in my kidneys. I followed up with my PCP last week and she told me that I passed the stone in my ureter (after doing a STAT CTSCAN and blood work). I never felt it pass and still have extreme left sides flank pain. She even had the nerve to tell me k have no more kidney stones and I got my ctscan back and I have 4 kidney stones that are 4mm in size it said they were in my lower pole. All I know is I can literally point to my back and tell you exactly where my kidney is. It hurts. Not as bad as the on being in my ureter, that was horrid pain!!! I fear it will happen again. I’m terrified of it happening again. My kidney function was very low when it happened and I had fluid stuck in my kidneys due to it. Well I found out what that fluid was apparently when the stone broke into sediment and i had urine flow again, I urinated all puss. This is a very scary thing. I wish all of you the best in this scary journey.
Hi Ann, CT is very reliable, so if it shows stones stones are there. Whether it pays to remove these stones is not clear lacking trials. But prevention of more is essential. Regards, Fred Coe
Oh my that is horrible, passing pus instead of urine! How was it treated and how are you now ?
I have a stone in my lower right pole. It may have been there for over for months and growing. Over the past 4 months since I found out it was there. I keep getting urine samples that show blood, leukocytes and even had e Coli
during this time. I have had 2 rounds of antibiotics but the blood and leukocytes just keeping getting higher once I am off the antibiotics. Can the stone being causing the results of urine test. I have urgency as well and slight discomfort when I urinate.
Hi Tanya, Yes, a stone can become infected and lead to recurrences such as you describe. But the decision whether to remove it is complex and your physicians have to make their own evaluation. That it is growing and possibly infected may prompt them to remove it. Lower pole stones may be best reated with ureteroscopy, but that also is for your surgeon to decide. Regards, Fred Coe
Sir,
Last 8 months i suffer pain for both testis and the legs. I take ultrasound of abdomen & pelvis & scrotum. 3 mm stone find the right kidneys lower pole. I took many medicines and check another ultra sound but it was there. i consulted many urologists,surgeons but no one find the actual reason for pain.They all says this stone don’t cause pain.please replay for me.
Hi Linto, possibly the stone moves out of the lower pole from time to time and obstructs the kidney – that pain can radiate into the testicle. Possibly you form crystals copious enough to cause transient obstruction and that causes testicular pain. If possible, you should have blood and 24 hour urine testing, and analysis for crystals in the urine – microscopy of a morning sample is a good start – to figure out what is happening. Regards, Fred Coe
I am a 40 year old that has been diagnosed with kidney disease. I went to see my urologist and he confirmed that I have a kidney stone in the same kidney, 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, My doctor advised me to use OSPAREN product of Germany. I found it very effective , and I will continue to use it!”
Hi Thomson Wither, I looked in vain for a reliable article on osparen both on line – useless and in PubMed. Three articles arose from PubMed with the search OSPAREN AND Kidney stones, but I could not find this agent in any of the three. On the web I found myriads of ads, in German mostly. I think the material is an herb but that is a guess. If it helps you, I am happy, but lacking even one reliable article I am also unconvinced for the general public. Regards, Fred Coe
When one experiences flank pain from a kidney stone, how long does the pain last. I have had some symptoms of a kidney stone such as a feeling of a need to pee. Then today, I experienced a gripping pain on my left side for 2-3 seconds then complete resolution. Does that sound like Kidney stone pain or something else? My thought was that true kidney stone pain would last for minutes to hours, not 2-3 seconds.
Hi Ivan, You may be passing crystals which produce this kind of symptom. Your physician can check for them. I presume you do not have stones, but if you are getting odd symptoms an ultra low dose CT is not a bad idea. Regards, Fred Coe
Hi Ivan, You may be passing crystals which produce this kind of symptom. Your physician can check for them. I presume you do not have stones, but if you are getting odd symptoms an ultra low dose CT is not a bad idea. Regards, Fred Coe
Dr. Borofsky, would you be able to contact me by email ? I would love to have a consult with you. I have the same story regarding the patient you were referring too in non obstructing stone pain. I have been dealing with this since I’ve been 18, I am now 26. I have had 3 surgery’s and 2 lithotripsys. No dr has helped me to prevent stones. I have been to the ER The past few years and also with my follow ups with my urologist who say my non obstructing stones don’t cause my pain. I truly believe they do. I also have a history of infections. Today I left the ER with pyelonephritis and 3 kidney stones in my left kidney. They sent me home with nothing for pain. Can you help me?
Thank you,
Haley.
Hi Haley, You can reach Dr Borofsky at University of Minnesota. Regards, Fred Coe
After 1 week, a 4mm stone 1cm between ureter & bladder, this 63 yr old 181lb male, 1st timer and no history in any of his family of having this. For now, just drinking 50% of my BW and included is having 1 teaspoon of ACV w/1/2 lemon juice in 12oz glass of water daily. Told by Urologist could take up to 3-4 wks, so keep doing this for now. Any other suggestions/comments?
Hi Ken, Your surgeon is doing as most do, and it is a reasonable approach. When the stone passes or is removed be sure it is analysed. At your age a first stone may well be uric acid, specially easy to prevent. Regards, Fred Coe
Hello I have a 12mm kidney stone in the upper portion of my left kidney the doctors i’ve been to say that it shouldn’t be causing pain but i’m in severe pain 70-80% of the day i have urinated blood clots(looked like little red pieces of string) i have been urinating blood for at least 4 months that i’m aware of i have to go on the 12th of Nov. to see if they can break it up using a machine. My question is why do doctors not believe a patient when they are in pain? Why do they automatically assume that you are only there for pain pills? I do not understand. I could understand if all i did for the past 6 years was go from doctor to doctor trying to get pain meds but i haven’t i have been in pain for at least 6 years and i finally had had enough and i was treated like a drug addict looking for my next fix. I was under the assumption that doctors were there to help people not judge. My pain is at least a 6 to a 7 when it is hurting i have buckled under the pain many times so why is it that doctors do not believe someone who says they are in pain and find out they have a 12 mm kidney stone and still refuse to help? Sorry but it just doesn’t make sense to me. Thank you for your time and I hope you get back to me soon.
Hi Jared, Given such a stone, bleeding and pain, the pain is surely from the stone and the correct approach stone removal and thereafter aggressive prevention efforts. I would imagine ureteroscopy would be ideal here, if your surgeons agree. Given all the troubles you have had, I would seek at least two independent surgical opinions, one at a major stone referral center. Usually these latter are at university teaching hospitals. Extra corporeal shock wave lithotripsy may not be an ideal choice given your pain troubles, as a stone free kidney is very important here. Regards, Fred Coe
Thank you for your reply. The Dr. told me that if this didn’t work they would have to do an ureteroscopy but they were hoping this would break it up but what i’m afraid of is it won’t break up into small enough pieces and cause more pain and get stuck. I appreciate your response again thank you.
After experiencing my first kidney stone yesterday, I went to the ER and followed protocol. I have followed doctor’s orders, but there is still pain in my lower right back. If the stone has passed, should there still be pain?
Hi Jeff, a day later is not unusual for pain. If it persists, be sure your physicians investigate why. Regards, Fred Coe
4mm kidney stone in left kidney at lower pole?? Is this dangerous or not?? The Dr. Said all is well and precript some medicines but sometimes non bearable pain happen.. Kindly suggest me How to remove or Resolve the pain
Hi M. Abdullah, Some people have pain even from a lower pole stone that is not causing obstruction. If there is no other cause of the pain and the pain is severe enough to warrant surgery you should discuss surgery with your physician. Regards, Fred Coe
I am currently experiencing flank pain from a 5.6mm stone. I had a soundwave blasting done 7 years ago in which they blasted 3 3mm stones in my kidney and 5 days later I passed a 7mm stone (dont know where that came from!). The pain symptoms I have now are currently similar to what I had 7 years ago plus urinalysis showing blood in the urine. My first experience the doctors never questioned my pain and once the procedure wad done, the flank pain disappeared immediately! No more pain meds needed! I am quite upset with my current urologist because he too doesn’t belive the pain is from the stone because it is non- obstructing yet I have lots of blood in my urine and yet the stone is not passable. And CT scan shows the stone has a point. This is what I say: there is a hard solid rough object in my kidney that is NOT supposed to be there. If it wasnt for the pain to alert me (because my regular doctor during my annual checkup didn’t seem to mention my blood in the urine 3 months ago, I found it through my patient portal) the stone could have gotten larger perhaps becoming obstructive and costing me more in an ER visit. Pain is an indicator that something is not right in the body and needs treatment. And these 2 kidney stones situation is the only time I have ever had pain meds. Every body is unique and presents differently at times (though again, to me the pain is the same) and shame on doctors for not listening to the concerns of patients. Inflammation=pain= need for treatment!
Hi Jessica, stones apparently do cause pain even when not obstructing, and if your pain has no other apparent cause and is severe enough to warrant surgery you need to discuss this with your physician. Regards, Fred Coe
Hi, I am 28weeks pregnant and recently visited my hospital with unbearable pain in my left side and lower back which after an ultrasound scan was found to be undiluted kidney stones ranging from 2mm-6mm. They informed me that while I’m pregnant there is nothing that can be done Unless the stone is diluted and they can’t give me anything and to see a urinologist once I have given birth. Im in pain every day and paracetamol doesn’t even touch the pain. I also have a toddler who I am now struggling keep up with because of the excessive pain. Is there really nothing that can be done while I’m pregnant? Also I’m now having immense pressure in my bladder and pelvic area which I didn’t have before, does this mean a stone may now be stuck?
Thank you, Charlotte
Hi CHarlotte, if you have a stone obstructing your ureter some surgeons put up a stent to try to relieve the obstruction. I presume you are not obstructed and also not infected. Your problem is a complex one in surgical management and from this distance I cannot say much more. Regards, Fred Coe
Hi
I have done ESWl for 7mm in right kedny , after 2 weeks of the procedure doctor told me it passed and it dosent show on x ry, but the problem i have pain in my bladder with some blood.
Hi Ahmed, Perhaps some stone residue is in the bladder or at the end of the ureter as it enters the bladder. Your urologist needs to evaluate the cause of the bleeding and decide if anything needs to be done. Regards, Fred Coe
About 6 weeks ago I had symptoms of what I suspected was a UTI (Ive had many over the years). Symptoms included chills, extreme nausea and an ache in my left side. I made a trip to the ER where they did bloodwork and urinalysis. The bloodwork was fine but the urine did show white blood cells. The doctor prescribed an antibiotic, 10 days later my symptoms had passed except for the side ache. Made another trip to emerg and they did an abdominal xray. Nothing showed up. A week later same side ache so I went to my family doctor and we discussed the possibility of a kidney stone (even though they didnt see one in xray). Here I am 6 weeks later and in the middle of this pandemic so additional testing at our hospitals is limited right now. My current symptoms include the same side ache which is tolerable most days but feels very uncomfortable, nausea that comes and goes and an occasional sharp pain in my groin area. Not sure what more I can do right now with limited resources available to me, hoping I can get in for an ultrasound soon to see of this is infact a stone. I appreciate any advice you have to offer.
Hi Lesley, If you are not in too much pain this is not an ideal time to go into a hospital for an elective CT scan. When it becomes safer, an ultra low dose CT is the ideal to determine if a stone is present, and provides a minimum of radiation. Regards, Fred Coe
Hello
I have been feeling back pain for about 3 month plus now. I have had kidney stones in the past. My butt and leg on my right side is tingly from my nerves. I got checked and I have a 4mm stone in my kidney and some blood in my urine. My doc says well that wont cause you pain because it isnt blocking anything. I said yes it does. UGH!!! I plan to have this removed. Have you ever heard of leg nerves and pain from a stone?
Hi Joe, OF course I am far away, but if the leg main is just as you say it is the sciatic nerve and not likely to be hurting because of the kidney stone. Sometimes stones that do not obstruct cause pain, but it is hard for me to link even an obstructing stone to what seems clearly a nerve irritation. I would discuss with my physician about physical therapy for the leg pain. As for the stone, removal is always a patient choice, and I hope it helps improve the leg pain even if I appear sceptical. Regards, Fred Coe
I am just coming out of the bad pain stage of a kidney stone on my right side. Hydrated with lemon juice no meds. However, starting about an hour ago the same pain began on my left side as it begun on my right. I cant be more hydrated to be having another on the opposite side. Does that happen? Thought a pulled muscle from favoring and having the pain spasms on right side but the pain is in the exact same spot. Not sure I can do this again. Thanks so much.
Hi Angie, Stones you pass probably formed some time prior, often months or more. Your should let your urologist evaluate stone passage events as obstruction of kidneys can be silent and damage them. Likewise, I would think prevention is your main goal. Here is a very good place to start reading about it. Regards, Fred Coe
I have had kidney stones in the past and have had lithotripsy to remove the stones. For the past week I have been experiencing the same symptoms as before and actually passed one stone a few days ago. However, I am still having the same symptoms as before passing the stone. (Pain, nausea, dark colored urine, persistent urge to urinate) I have not gone to see a doctor because of my high deductible insurance. Can symptoms continue after passing a stone, or do you think there may be more stones in there?
Hi Stacy, My worry for you is that some stone material is still there and possibly obstructing a kidney. It is a pity and a shame to our country that high deductibles inhibit your care when consequences are possibly serious. Despite the cost, I would hope you could afford a visit to be sure about what has happened and whether stones are still obstructing. There is no safe way to manage stone passage alone, without a physician to help. Regards, Fred Coe
I had a CT scan recently which showed a 7.3 mm stone in the left distal ureter with mild distension of the distal third of the ureter. The doctor has recommended uretoscopic surgery to remove the stone. However, I have absolutely no pain or other symptoms of blockage. Scan shows kidneys are normal (non-oedematous, no hydronephrosis). The last time I had experienced flank pain was 6 months ago. What is the risk of leaving the stone untreated, and hoping it passes naturally, or to treat it only if I get pain symptoms again?
Hi Roger, The decision about removal vs. passing spontaneously is made by the surgeon in charge. At risk is kidney damage from prolonged obstruction. Given a 7.3 mm stone, passage probability is not as high. Pain is a poor gauge of obstruction – often it is silent if chronic and kidneys can be ruined. I would suggest you discuss waiting with your surgeon as she/he has total responsibility for the safety of your kidney. Personally, with such a stone, I would in general favor ureteroscopic removal sooner than later, but this is very general. Regards, Fred Coe