Kidney Stones: Symptoms, Severe Pain and When to Seek Care

But according to Arash Akhavein, MD, director of Urology Clinical Outreach at Cedars-Sinai, a true kidney stone is actually painless unless it’s blocking urine from exiting the kidney.

“The blockage usually happens once the stone leaves the kidney and enters the ureter, which is the thin tube that takes urine to the bladder,” said Akhavein. “The pain caused by a kidney stone blockage is one of the worst a patient can encounter. A majority of women who have experienced it say it’s worse than childbirth.”

The pain caused by a kidney stone is one of the worst a patient can encounter.

The pain is sharp and usually comes in waves, starting in the back or side, below the ribs. If you suspect your pain is due to a kidney stone blockage, go to the emergency room right away if:

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• The pain is uncontrollable

• The pain is accompanied by a fever, chills or persistent vomiting

• You can’t urinate

• You have a single kidney or other serious medical condition

Otherwise, make an appointment to get evaluated by your primary care doctor or a urologist as soon as possible.

What Are Kidney Stones?

Kidney stones are made of minerals in urine that crystalize in the kidneys to form hard deposits. When they are very small, like grains of sand, they can be passed out of the body when you urinate. But when they grow larger, they can block the urinary tract. This causes the pain associated with the condition, which is also known as renal colic.

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“Most kidney stones are calcium-based. Others can be made from uric acid,” said Akhavein. “They often form when someone is dehydrated and their urine becomes too concentrated, or when someone has too much salt in the diet.”

But don’t take dairy and calcium out of your diet, he said. Normal recommended amounts of dietary calcium may actually help prevent kidney stones.

What Do Kidney Stones Feel Like?

Kidney-stone pain is often sudden and severe, described as a stabbing pain that comes in waves. It usually starts in the back on one side and can move to the abdomen and groin as the stone moves.

“The pain is deep. It’s not at the surface,” Akhavein said. “It can cause nausea and vomiting as well as an urgent need to urinate. And there may be some blood in the urine.”

Can You Pass a Kidney Stone Naturally?

Most smaller kidney stones can be passed naturally.

“If a stone is up to 5 or 6 millimeters (less than a quarter of an inch), then there is a reasonable chance the patient can pass it without intervention,” Akhavein said. “Larger than that, passing it becomes less likely.”  

Patients who try to pass their kidney stone should attempt to capture it at home for analysis, said Akhavein.  

“You can use a small plastic strainer or even a goldfish net from the pet store,” he said. “We want to know what the stone is made of so we can make recommendations to prevent the next one.”  

What Happens If a Kidney Stone Does Not Pass?

It’s important to confirm the kidney stone has passed.  

“If the stone isn’t captured, we have to go back and do more imaging to make sure it’s truly gone,” explained Akhavein. “Because even if the pain goes away, the stone may still be there causing a blockage and damaging the kidney.”  

A kidney stone that does not pass and is not removed can lead to loss of kidney function, infection and even sepsis, which is life-threatening.  

How Are Kidney Stones Diagnosed and Treated?

A CT scan is the best way to diagnose a kidney stone.  

“If imaging confirms a kidney stone, we look at several factors when deciding on treatment,” said Akhavein. “How big is the stone? Is there infection? Is kidney function good overall? Is the pain controlled?”

If the stone won’t pass naturally, there are three minimally invasive treatment options:

• Ureteroscopy: This is the most common treatment. A scope is passed through the urethra and bladder into the ureter to find the stone. If it’s small, it’s captured and pulled out. Larger stones are broken up with a laser before removal.

• Extracorporeal shock wave lithotripsy: Sound waves are focused on the stone from outside the body to break it into pieces that can be passed naturally.

• Percutaneous nephrolithotomy: A small puncture is made in the patient’s back, and a surgeon uses a scope to remove stones directly from the kidney. This approach is generally used for larger or more complex stones.  

What Causes Kidney Stones and How Can You Prevent Them?

Dehydration is a common cause of kidney stones, so drinking lots of water can help prevent them.  

“We recommend at least three quarts a day, more if you’re in hot weather or doing exercise and sweating a lot,” said Akhavein. “And do it steadily throughout the day, not all at once.”

Adding citrates—found in lemons, limes and oranges—to your diet can also help prevent kidney stones by changing the acidity in your urine.

“And go easy on the salt and any kinds of meat or animal protein,” Akhavein said. “The DASH (Dietary Approaches to Stop Hypertension) diet, which is designed to lower blood pressure, usually works well.”