A ureteral stent is a small, soft, tube-like device that is placed in the ureter to help urine drain from the kidneys to the bladder. Ureteral stents are commonly used after kidney stone surgery or other procedures on the ureters or kidneys. While stents play an important role in helping urinary drainage and healing, they frequently cause pain and discomfort that can significantly impact quality of life. Fortunately, there are several effective ways to help relieve ureteral stent pain.
What causes pain from ureteral stents?
Ureteral stents cause pain due to several factors:
- Irritation of the bladder – The end of the stent sits in the bladder and can cause bladder spasms, urgency and frequency.
- Irritation of the kidney – The upper coil of the stent sits in the kidney and can cause flank pain.
- Irritation of the ureter – The stent rubs along the wall of the ureter, causing discomfort.
- Urinary reflux – Urine can reflux up the stent into the kidney, causing pain and infection risk.
- Positioning – If the stent is placed too far into the kidney or bladder, it can cause more irritation.
In general, the foreign body sensation of having a stent in the urinary system leads to pain, cramping and urinary symptoms. However, some people experience worse stent pain than others depending on individual anatomy and sensitivity.
Medications for ureteral stent pain relief
Several types of medications can help provide relief from ureteral stent discomfort:
Alpha blockers
Alpha blockers like tamsulosin (Flomax) help relax the muscles around the ureter to allow better drainage and decrease spasms. This can relieve bladder pain, urinary frequency and urgency caused by the stent.
Pain relievers
Over-the-counter pain medicines like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce ureteral stent pain. For severe pain, prescription medications like oxybutynin (Ditropan) or tramadol (Ultram) may be used short-term under medical supervision.
Anti-cholinergics
These medications like oxybutynin (Ditropan) and tolterodine (Detrol) block nerve signals to the bladder to help control bladder spasms and overactivity caused by the stent. This relieves urgency and frequency.
Phenazopyridine
This medication can be used for several days after stent placement to help control bladder pain and urinary urgency/frequency. It acts directly on the urinary tract.
Antibiotics
If a stent becomes infected, antibiotics may be used short-term to treat irritation and urinary symptoms until the stent can be removed.
Proper medication can provide significant relief in many patients with ureteral stent discomfort. A urologist can help determine the best medical therapy based on an individual’s specific symptoms.
Home remedies and lifestyle measures
Several at-home remedies and lifestyle adjustments can also help minimize ureteral stent pain:
Hydration
Drinking plenty of fluids, especially water, dilutes the urine and helps reduce bladder irritation from the stent.
Heat therapy
Applying a heating pad to the flank, abdomen or pelvic area can help relax the muscles and reduce spasms and discomfort. Use a warm (not hot) heating pad or water bottle for 15-20 minutes as needed for pain relief.
Urinary alkalization
Making the urine less acidic can help reduce irritation from the stent. Taking baking soda, potassium citrate or other alkalizing agents can raise the pH of urine. Discuss with your doctor before starting.
Urinary analgesics
Some over-the-counter urinary pain relievers like phenazopyridine or Uristat can provide topical anesthetic relief when passing urine with a stent.
Activity modification
Strenuous activity can make stent pain worse. Making adjustments like avoiding heavy lifting, intense exercise or prolonged standing may help reduce discomfort.
Comfortable undergarments
Wearing loose, comfortable underwear and avoiding constrictive clothing around the abdomen and pelvis can prevent extra pressure on the stent.
Stool softeners
Constipation and straining can increase stent pain. Keeping stools soft with docusate, fiber, fluids and other laxatives helps avoid this problem.
Urinary urgency aids
For people struggling with intense urinary urgency from the stent, urinary pessaries or impulse control devices can help control leaking between bathroom trips.
Special procedures for stent pain relief
Some additional procedures that may help alleviate stent discomfort include:
Stent exchange
If a stent is causing intolerable pain, it may need to be replaced or repositioned to provide relief. This can be done under light sedation in some cases.
Stent removal or shortening
Taking the stent out or trimming the ends can provide relief if it was placed too far into the bladder or kidney. This may require anesthesia for removal/replacement.
Ureteral dilation
Stretching a narrowed ureter with a special balloon catheter can allow better drainage and less reflux up the stent. This may reduce pain and infection risk.
Bladder Botox injections
Botox injections into the bladder muscle temporarily limit bladder contractions and overactivity from the stent. This reduces urinary frequency and urgency.
Temporary ureteral catheter
In rare cases, switching from a stent to a ureteral catheter for short-term drainage may provide better comfort. The catheter can be easily removed once drainage is no longer needed.
Minimizing time with a ureteral stent is key to reducing pain and complications. However, when a stent must remain for a period of time, a combination of medications, lifestyle approaches and selective procedures can provide significant relief until stent removal.
When to seek medical help for stent pain
Contact a doctor right away if you experience:
- Fever, chills or flu-like symptoms – may indicate stent infection
- Inability to urinate or severe pain with urination – could signify blockage
- Heavy or bloody urine – suggests bleeding complication
- Unmanageable pain despite medication use
- Side effects from medications like oxybutynin or phenazopyridine
Rare complications like stent migration, fragmentation, occlusion or severe infection may require prompt evaluation and treatment. Follow up closely with your urologist while you have a ureteral stent in place. Call if your symptoms suddenly worsen or change despite standard pain management approaches.
When can you expect stent pain relief?
You should notice some improvement in ureteral stent pain and urinary symptoms within:
- 30-60 minutes after taking phenazopyridine or urinary analgesics
- 2-4 hours after taking ibuprofen, oxybutynin or prescription pain medications
- 12-24 hours after starting alpha blockers medications
- 1-3 days after having stent exchange/repositioning procedures
- 3-7 days after starting Botox injections for bladder spasms
However, complete resolution of stent discomfort usually requires removal of the stent. This is typically 1-2 weeks after ureteroscopy or other urinary stone procedures, unless complications occur requiring prolonged stenting.
Conclusion
Ureteral stents cause pain and urinary symptoms that can impact quality of life after kidney stone surgery. To relieve discomfort until stent removal, a combination of medications, at-home remedies and selective procedures is most effective. Start with conservative measures like alpha blockers and urinary analgesics, then progress to stronger pain medicines or interventions if needed. Avoiding strenuous activity and staying well hydrated also helps with stent pain management. Promptly report any concerns or worsening symptoms to your urologist while stented. With the right treatment approach, ureteral stent pain can be minimized for the duration required until the stent is removed and relief is finally achieved.