What causes kidney stone pain?

Diagram of locations where stones become lodged

Three locations where stones become lodged

Stones usually first develop in the kidneys. (For more information on the process of stone development, see: How do kidney stones form?) A kidney stone usually first causes symptoms when it tries to move down the ureter and out of the urinary system. As it makes its way down the ureter, it can cause blockage, which leads to the development of increased pressure in the kidney above. This pressure leads to the pain associated with passing a stone.

As a stone moves  down the ureter, it tends to become lodged in three locations of natural narrowing: the ureteropelvic junction, the crossing of the ureter over the iliac vessels, and at the entrance of the ureter into the bladder. Depending on where a stone is located along this path, the pain associated with it can vary. Stone pain usually starts high up near the kidney then migrates towards the abdomen and eventually down towards the groin as the stone moves further down the ureter. As a stone is almost ready to come out, patients may feel the urge to urinate.

What about kidney stones that aren’t passing?

Most doctors feel that kidney stones only cause pain if they are blocking the ureter and trying to pass down towards the bladder. Stones that are not obstructing, such as those located in the kidney’s calyxes, are generally thought to be non-painful. This explains why some patients can have extremely large stones filling up their entire kidney with no or minimal pain.

However, it does appear that some non-obstructing kidney stones can cause pain because of either blockage of small tubular structures in the kidney itself (the collecting tubules) or for other unclear reasons. Supporting this view is a recent medical journal article suggesting that the treatment of small non-obstructing “papillary” stones may provide pain relief. (Gdor et al, Multi-institutional assessment of ureteroscopic laser papillotomy for chronic pain associated with papillary calcifications, J Urol 2011) Additionally, testimonials from many kidney stone patients (including a urologist with a personal history of kidney stones) suggest that some  non-obstructing stones can cause pain.


141 Responses to What causes kidney stone pain?

  1. nickg says:

    I have been having kidney stones for the last 5 years, approximately 4 per year. The first time I was terrified by the pain, nothing has ever hurt so much. I honestly thought I was dying. The pain is like someone stabbed you with a knife in the back, is slowly moves down and hurts like hell, especially in the testicles.

    Dilaudid helps a bit but most people don’t realize you vomit so much with the stones it’s hard to keep medicine in. The pills also cause constipation which doesn’t help matters. In moments of extreme pain the ER has given me a shot of morphine and that at leaks gives me a couple hours of relief.

    I now pass them with a lot less pain, I believe my insides are so scared from the stones I lost a lot of feeling.

    The doctors tell me I’m just unlucky, and I’m at the common age for kidney stones, 32 now. I stopped drinking soda, no help, I stopped taking Tylenol and advil for my headaches, no help I drink about 2L of water a day, not helping. I avoid fast food as much as possible but I travel often for work and that makes it hard to do. I consume much dairy, that hasn’t helped either.

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