Renal Colic Advice

Renal colic (or ureteric colic) is the term given to the classic pain associated with kidney stones. Not all patients have the classic symptoms.

What are the symptoms?

Classical symptoms of renal colic are sudden-onset severe abdominal pain. This typically starts round the side in the loin/ flank and then can radiate into the groin and even genitalia. It is often associated with nausea and vomiting and is episodic. It can be normal to have no pain, and then suddenly pain can come back again. If the stone is near the bladder, it can cause you to go to the toilet frequently.

Why does this happen?

This happens when a stone moves from the kidney into the ureter (pipe connecting the kidney and bladder) causing blockage. The stone may have been in the kidney for quite some time causing no symptoms at all. It is often only when it migrates to the ureter and causes obstruction that the symptoms come on.

Will the stone pass on its own?

There is no simple answer to this, and this can be discussed this in clinic. The chance of spontaneous passage depends on the stone size, stone location and how big the ureter pipe is. Some people can pass quite large stones (7-10mm), whilst others find it difficult to pass much smaller stones (3-4mm). The severity of the pain has nothing to do with the size of the stone, and even tiny stones of 2mm can cause the most severe pain. Overall 80% of stones do pass on their own, but the chances get much less for stones >5mm. Below is embedded an online calculator (from an external site). This calcultor was created by the BURST collaborative (a large trainee-led research group in the UK) and can be used to calculate chance of stone passage. 

[disclaimer: this embedded calculator is an external site for which I can take no responsibility or credit for its use]

How long does a stone take to pass?

This is very variable and will depend on the same factors as listed above (size, location, ureter size). Most stones pass in 2-3 weeks. If a stone has not passed within 4 weeks, then there should be a plan for treating it. If a stone does not pass and continues to cause obstruction, it can cause functional loss of the kidney that is irreversible. Based on old experiments, this is not felt to happen in less than 6 weeks.

 What pain killers should I use?

If you are able to take them, then non-steroidal anti-inflammatory (NSAID) medication is often the best. This class of drug includes ibuprofen, naproxen and diclofenac. Some people can’t take these if they have had stomach ulcers before, have bad asthma or if their kidney function is deranged. You should have been advised about this. It is always a good idea to take NSAID medication with food to protect the stomach lining. As well as this, you can take paracetamol. It is important you stick to the dosages as advised on the prescription or packaging. If in doubt ask! Some people may have been given codeine containing medication. This is a weak opiate, and will often cause constipation, so try and avoid using this unless absolutely necessary.

Is there anything else I can take to help the stone pass?

Generally being active and drinking plenty of water (see below) will help. Some people are given a medication called tamsulosin (an alpha blocker) to help stone passage. This has been commonly used in the past, but some big trials suggested it may not be as effective as we thought. Different urologists will have different policies about whether they use this. If it does work, it is likely to be for the larger stone (5-10mm) in the lower ureter only.

Will I feel the stone pass and if I have no pain does that mean the stone has gone?

After the initial episode, often patients have no symptoms for some time, or may get recurring pain. Stones can remain silent for several weeks, so being pain-free does not mean the stone has passed. Thus it is important to get checked out to ensure a stone has gone to prevent long-term damage. Often patients do experience some further pain and this may be the stone trying to pass. Some patients may feel something pass in the urethra (pipe from the bladder), or hear or see something in the toilet. It is a good idea to check the urine and some people sieve their urine to check. If you do pass the stone and can retrieve it, then this can be sent for stone analysis to check what type of stone it is.

How much fluid should I drink?

Some people think that by drinking loads of fluid it will flush the stone out. Whilst it is important to maintain good hydration, you should not overdo it either. 2-3 litres per day is about the right amount for most people.

What should I look out for / when to seek help?

If you are feeling unwell or have a fever then you may have an infection. Having infection in the presence of a blocked kidney can be dangerous, so if you have a fever >38 degrees, or uncontrolled shivering (rigors) you should seek immediate medical advice. This may mean (re)attending the Emergency Department. The other reason for seeking help is if the pain cannot be controlled.

Do I need treatment for the stone?

If the stone has a low chance of passing, then early primary treatment should be considered – this means treating with either shockwave lithotripsy (ESWL) or ureteroscopy (see below).

The emergency treatment for a stone, particularly if there is severe pain or infection (fever >38) is to place a ureteric stent. This unblocks the kidney and allows drainage again. Occasionally if a patient is very unwell, then a tube (nephrostomy) is passed directly into the kidney from the skin to drain the kidney.

What are the treatments?

1) Ureteric stent. This is a hollow tube/ straw that runs from the kidney to the bladder, allowing urine to pass. If it placed under general anaesthetic via the bladder. The stent can often be felt inside and can cause pain, bleeding and urinary frequency and urgency.

 2) Shockwave lithotripsy (ESWL). This is a procedure when ultrasound shockwaves are targeted on the stone from outside to break the stone. You are fully awake for this and go home afterwards. Not all stones can be targeted with this, and so you may need an x-ray to check if suitable.

 3) Ureteroscopy. This is also under general anaesthetic, and a thin metal telescope is passed through the bladder and up the ureter pipe to get to the stone and usually break it up with a laser. Often a stent is left in afterwards for a short period of time.

Are there any restrictions to me while I have a stone?

Generally, patients can go about their normal day-to-day life, but may need some pain killers. All patients (with an untreated stone in the ureter) are advised not to fly, and should inform their airlines, who would almost certainly not allow you to fly without medical authorisation. You should inform your travel insurance if you are planning to travel, as you will likely find that they will not cover you in the event of an emergency abroad – as it has now become a pre-existing condition at the point that you travelled. Having a stent in will often allow travel as the kidney can no longer be obstructed.

What follow-up will I have?

This will depend on a number of factors and so is different for everyone. This will discussed with you to individualise arrangements. As mentioned above, this should be in a timely way as it is important to ensure the stone has passed, or to plan treatment for the stone.