Kidney stone pain can vary greatly from person to person. While some people may experience constant, severe pain from kidney stones, for others the pain may come and go in waves or fluctuate in severity. Understanding the nature of kidney stone pain can help those afflicted seek proper treatment and coping methods.
The Causes of Kidney Stone Pain
Kidney stones form when minerals and salts in the urine crystallize and build up. These stone deposits can range greatly in size – from a grain of sand to a golf ball. Small stones may pass through the urinary tract without causing much discomfort. However, larger stones can become lodged in the ureters (tubes that carry urine from the kidneys to the bladder), blocking the flow of urine and causing excruciating pain.
Kidney stone pain occurs when the stone moves within the urinary tract, causing inflammation and irritation. The ureters are narrow muscular tubes about the width of a pencil. Any stone larger than 2-3 mm would not be able to smoothly pass through. A lodged kidney stone stretches the ureter walls, stimulating pain receptors in the muscle lining. This causes the ureter muscles to spasm, trying to force the stone through. These muscle spasms are what causes the intense cramping pain associated with kidney stones.
The pain is typically sharp and excruciating in nature and located in the flank (lower back), radiating to the lower abdomen and groin area. The pain may change in intensity based on the stone’s location. As the stone moves down the ureter, closer to the bladder, the pain location may radiate down toward the groin. Once the stone passes into the bladder, pain levels usually decrease significantly.
Characteristics of Kidney Stone Pain
While the exact nature, duration and intensity of kidney stone pain can vary from person to person, most people describe the pain as:
- Severe, sharp, and cramping
- Starting and stopping suddenly, increasing and decreasing in intensity
- In the flank or lower back and radiating to the abdomen and groin area
- Incapacitating, making it difficult to find a comfortable position
- Similar to contractions experienced during childbirth
- Possibly accompanied by symptoms like nausea, vomiting, fever and chills, blood in the urine
The onset of pain from kidney stones is often sudden and excruciating. The pain may start as a dull ache that rapidly intensifies into severe cramping. The pain may fade or pass temporarily, only to return in full force again minutes or hours later. These intermittent waves of pain can repeat until the stone passes or is treated.
While the pain may seem to come and go randomly, certain triggers may influence a stone attack. Dehydration, physical activity, urination, and certain foods can provoke a stone’s movement and corresponding pain. Events that increase pressure in the urinary tract, like straining to pass stool, may also stimulate more pain.
Is the Pain Constant?
For many suffering from kidney stones, the pain is not constant and does fluctuate in severity. In a 2015 study, researchers surveyed patients with kidney stones about their symptoms. Approximately 60% reported intermittent pain that came and went, while 25% had persistent pain. The remaining 15% had pain that progressively worsened until passing the stone.
While the pain may not always be constant, kidney stone attacks can still be frequent, coming in intervals as short as 10-15 minutes apart. The sporadic nature of the pain can make it difficult to find relief until the stone passes or is removed.
Pain Between Attacks
The intense pain of a kidney stone attack does usually subside between episodes. However, some residual discomfort in the back or abdomen may remain. Between stone attacks patients may still experience:
- A dull, aching pain or soreness where the stone is located
- Increased urinary urgency and frequency
- A burning sensation during urination
- Visible blood in the urine
While not as severe as an active stone attack, this discomfort between episodes serves as a reminder that the stone still needs to be treated. Even after passing the stone, some individuals may continue to have residual discomfort and urinary symptoms for a few days up to a week.
What Factors Influence the Pain?
The exact nature and intensity of kidney stone pain can be influenced by multiple factors, including:
Stone Size and Location
Larger stones cause more severe blockages and irritation, provoking more intense pain. Stones located near the top of the ureter, close to the kidney, also tend to cause worse symptoms. As the stone descends, pain levels may gradually reduce.
Ureter Diameter
Some people may have ureters that are more narrow than average, making stone passage more difficult. Obstructions in narrow ureters can increase the force of the muscular contractions trying to move the stone, worsening pain.
Stone Composition
Rough, jagged stones usually cause more pain than smooth stones. And certain stone types, like calcium oxalate, tend to form with sharp angles that irritate the ureters more. Uric acid and struvite stones are often less painful.
Stone Speed
Very slow-moving stones that gradually inch down the ureter may cause more prolonged, constant pain compared to stones that pass more quickly.
Number of Stones
If multiple stones are present, including bilateral stones (in both kidneys), then bouts of pain may occur more frequently.
Pain Tolerance
Each individual’s tolerance for painful stimuli is different based on multiple factors. Personality type, genetics, and hormone levels all influence sensitivity. Those with lower pain tolerances may rate kidney stone attacks as more severe.
How Long Does Kidney Stone Pain Last?
The duration of a kidney stone attack varies depending on the factors discussed above. Small stones may only cause brief 15-30 minute episodes of pain as they pass quickly. However, larger stones can get stuck for days to weeks, bringing about frequent intermittent attacks.
On average, most kidney stone assaults last about 1-2 hours, with the pain usually peaking within the first 30 minutes. But any given attack could be shorter or longer depending on the specific stone. If debilitating pain lasts more than 6 hours it is advisable to seek prompt medical attention for pain control and evaluation.
Total Duration
Although individual attacks may be brief, the total duration of symptoms related to an underlying kidney stone can last:
- Hours to days for small stones that pass quickly
- Weeks for larger stones requiring more time to pass
- Months in cases where stones fail to pass naturally and need surgical intervention
So while the pain itself may come and go, the overall condition should be treated as soon as possible for the fastest resolution.
When to Seek Emergency Treatment
Severe kidney stone pain can be excruciating. While many choose to try passing a stone at home, prompt medical treatment is recommended for faster relief and to avoid complications. Emergency care should be sought if:
- Pain is unbearable, uncontrolled with medication
- Persistent nausea and vomiting prevents keeping down fluids
- Signs of infection like fever over 102°F (38.9°C)
- Visible blood in the urine
- No urine production for more than 12 hours, which may indicate a blocked ureter
- Uncontrolled shaking and chills
- Pain or burning with urination
Severe kidney stone cases may require hospitalization not only for pain management but also for supportive treatment of dehydration and infection. Powerful prescription pain medications, placement of a ureteral stent, or surgical stone removal are all options for acute cases.
Coping with Kidney Stone Pain
Living with the intense pain of kidney stones while waiting for them to pass can be physically and emotionally taxing. Until the stone passes or is treated, a few self-care measures may help temporarily ease the discomfort:
- Hydration – Drinking plenty of water dilutes the urine and allows stones to pass more easily. At least 2-3 liters per day is recommended if able to keep fluids down.
- Pain relievers – Over-the-counter NSAIDs like ibuprofen may provide some relief during attacks. But stronger prescription narcotics are often needed for adequate control.
- Warm baths or packs – Applying heating pads or warm towels to the back can help ease the muscular component of the pain.
- Passage aids – Medications that help dilate the ureter may enable passage of stubborn stones.
- Urinary alkalinizers – Making the urine less acidic may help some stones (like uric acid) dissolve.
Of course, these conservative measures are just temporary fixes until proper medical treatment expels the stone. To help avoid recurrent episodes, dietary and lifestyle changes are often needed to keep new stones from forming.
When to Expect Relief from the Pain
The severe pain of passing a kidney stone may persist until the stone fully passes out of the urinary tract. However, there are certain points at which relief may come:
- Stone reaches the bladder – Pain levels typically decrease as the stone moves from the ureter to the bladder. The bladder has more space and stretch to accommodate a stone.
- Stone is passed – Once the stone is finally excreted during urination, pain resolves significantly within a day or so.
- Stone is removed – Surgical procedures like ureteroscopy laser lithotripsy provide immediate relief by taking out the stone.
- Stent placement – Ureteral stents bypass the obstructing stone, allowing urine flow and reducing pressure.
- Pain medication – Strong prescription narcotics may temporarily dampen pain signals even if the stone is still present.
So in summary, the most definitive relief comes when the stone is no longer obstructing urine flow, either by passing naturally or through intervention. But prescriptions drugs and stents can ease symptoms until this occurs.
Preventing Painful Kidney Stones
Once someone has experienced the excruciating pain of kidney stones, prevention becomes a top concern. Some helpful prevention tips include:
- Drinking enough fluids – At least 2-3 liters of water per day
- Eating a low-sodium, low-animal protein diet
- Avoiding excessive vitamin C supplements
- Preventing urinary tract infections, which increase stone risk
- Managing medical conditions like hyperparathyroidism or gout
- Taking prescribed medications to prevent certain stone types
Depending on the stone’s composition, dietary changes and medications can help change the urine environment to stop stones from forming. Getting enough fluids is one of the simplest ways to flush out minerals before they can crystallize.
When Kidney Stone Pain May Require Surgery
Most kidney stones less than 5 mm can successfully pass out of the body with sufficient hydration and medications. However, larger or persistent stones may require surgical interventions for removal and pain relief. Procedures like ureteroscopy and extracorporeal shock wave lithotripsy (ESWL) can break up or extract stones that won’t budge.
Surgical removal may be warranted if:
- The stone fails to pass after 4-6 weeks of waiting
- The stone is larger than 6-7 mm
- Persistent pain and nausea are uncontrolled by conservative treatment
- An infection develops from the obstructed stone
- There is one large stone or multiple smaller stones
- The stone is blocking urine drainage from the kidney
In some cases, surgery may be performed on an emergency basis, such as for a severely obstructing stone causing unbearable pain, infection, or kidney damage. Otherwise, procedures can be planned in advance once it’s clear a stone won’t pass naturally.
Surgery for Immediate Pain Relief
Several surgical options can provide immediate pain relief by removing the obstruction. This may be needed for intolerable colic resistant to other pain management approaches. Surgery essentially takes out the “stone causing the problem” to halt pain signals. Options include:
- Ureteroscopy – A thin scope is passed into the ureter to directly visualize the stone. Then special tools break up or grab the stone for extraction.
- Laser lithotripsy – Laser energy delivered through a ureteroscope breaks large stones into tiny fragments that can pass easily.
- Stent placement – A hollow tube placed in the ureter serves as an internal bypass, allowing urine flow past the obstruction.
These minimally invasive surgeries require only a small incision under anesthesia. They provide the quickest method for relieving stone pain compared to waiting for natural passage. Fragmenting or removing the obstruction immediately eases ureteral spasms and discomfort.
Conclusions
The hallmark symptom of kidney stones is intense intermittent pain as small deposits travel through the urinary tract. For many patients, the pain comes and goes in unpredictable waves rather than constant agony. However, larger or poorly positioned stones may cause longer lasting attacks. Regardless of the pattern, living with recurrent kidney stone pain can be debilitating – negatively impacting work, sleep, and overall quality of life. While home remedies can provide temporary relief between attacks, the pain ultimately resolves only once the stone completely passes out or is removed. Understanding the nature of the pain and seeking prompt medical treatment are important in coping with this common and often recurring health condition.
