Kidney Stone Symptoms: When to Go to the ER

Many people describe it as the worst pain they have ever felt. It starts suddenly in the side of the back, then builds until you find yourself pacing the room, sitting, standing, bending over, and nothing helps. It may ease for a while, then come back in a stronger wave. If that is what is happening to you right now, the most likely explanation is renal colic: a kidney stone on the move. The good news is that most small stones pass by themselves. But a few specific signs turn this from a miserable night into a genuine emergency, and those are what you need to know tonight.

What does kidney stone pain feel like?

A kidney stone is a small, hard lump formed from salts and minerals in the urine. It can sit in the kidney for years without causing any trouble. Pain usually starts when it moves into the ureter, the narrow tube between the kidney and the bladder, and partly or fully blocks it. The typical pattern:

• Sudden, sharp pain in the side or back below the ribs, usually on one side.
• Pain that spreads to the lower abdomen and groin, and in men sometimes the testicle, as the stone travels down.
• Pain that comes in waves, building and easing, rather than staying constant.
• No comfortable position: many people keep moving, unlike the kind of abdominal pain that makes you lie very still.
• Nausea or vomiting, driven by the intensity of the pain itself.

Back pain that gets worse with particular movements and eases with rest, with no urinary symptoms at all, is more typical of a muscle strain. Our guide to lower back pain: physiotherapy or the ER can help you tell the difference.

Other kidney stone symptoms: blood in urine and needing to pee

• Pink, red or brown urine from blood, or blood that only shows on a urine test.
• Needing to pee often or urgently, or pain and burning when peeing, especially as the stone nears the bladder.
• Passing only small amounts of urine each time.
• Cloudy or foul-smelling urine, which can point to an infection alongside the stone.

Blood in the urine is common with stones and doesn't by itself mean something serious, but it should always be checked, because it has causes other than stones.

When to go to the ER for a kidney stone

Fever with stone pain: don't wait

This is the single most important rule in this article. If you have stone-type pain with a fever, chills or shivering, urine may be trapped behind the stone and become infected. An infected, blocked kidney can't drain the infection away, and it can spread into the bloodstream quickly. That is an emergency that needs immediate assessment, not a painkiller and a wait until morning.

Also go to the ER for

• Severe pain that isn't eased by the pain relief you can take at home.
• Repeated vomiting that stops you keeping fluids or medicine down.
• Passing very little urine, or none, which can mean a complete blockage.
• Having only one kidney, a kidney transplant, or known kidney disease: a blockage is far more serious.
• Pregnancy: any severe side or abdominal pain in pregnancy needs prompt assessment.
• Heavy blood in the urine, or passing clots.

Call 911 for

• Fainting, confusion, extreme drowsiness, or cold, pale skin with a fast pulse (signs of shock).
• A high fever with feeling extremely unwell or breathing difficulty.
• Sudden, severe back or abdominal pain in someone over 60 who has never had a stone, especially with dizziness.

Jordan's emergency number is 911. For more on when to call and when to drive yourself, see our guide to emergency numbers in Jordan.

Kidney stone or something else?

Pain in the side and back has many causes, and some are more serious than a stone. This table is a rough guide, not a substitute for an examination:

Pain low on the right can be a stone, or it can be the appendix. See our guide to appendicitis symptoms in adults and children. In women of childbearing age, severe lower abdominal pain with any chance of pregnancy needs the ER to rule out an ectopic pregnancy. In men, sudden severe testicular pain is an emergency in its own right.

What to do at home if the pain is manageable

If you have been diagnosed with stones before, the pain is familiar and manageable, and none of the warning signs above apply, these are reasonable steps:

• Drink steadily enough to keep your urine pale yellow, without forcing large amounts if you are vomiting.
• Paracetamol is a safe option for most people. Anti-inflammatory painkillers such as ibuprofen are often used for stone pain but aren't suitable for everyone, including people with kidney disease, stomach ulcers, or in pregnancy. Check with a pharmacist or doctor first.
• If your doctor asks, strain your urine to catch the stone; testing it helps prevent the next one.
• Keep an eye on your temperature. Any fever or chills means going to the ER.
• If you aren't improving within a day or two, or episodes keep coming back, see a doctor.

If this is the first time you have felt pain like this, don't assume it is a stone. A first episode needs an examination to be sure.

Why heat and low fluid intake raise your risk

When you lose fluid through sweat and don't replace it, your kidneys make less urine, and it is more concentrated. In concentrated urine, salts and minerals meet more easily and form crystals, and stones grow from those crystals. That is why health bodies such as Mayo Clinic list hot, dry climates and low fluid intake as risk factors, alongside family history, a high-salt diet, obesity, and some medical conditions and medicines.

In Jordan, that means paying attention through the long, hot summer months, especially if you work outdoors, spend hours in the car and drink less to avoid stopping, or fast on hot days. If you have a history of stones and plan to fast, talk to your doctor beforehand about how to make up fluids between iftar and suhoor. The simplest guide: pale yellow urine usually means you are drinking enough; dark urine means you are behind.

Dehydration in the heat can cause bigger problems than stones. Know the heatstroke warning signs in Amman.

Urgent care or the ER? What happens when you arrive

If the pain is manageable and there is no fever or other warning sign, urgent care sees walk-ins around the clock. With fever or chills, severe pain, ongoing vomiting, little urine, pregnancy or a single kidney, go straight to the emergency department. If you're unsure, our guide to ER vs urgent care explains the difference.

The doctor starts with questions and an examination. A urine test looks for blood and signs of infection, and blood tests help assess kidney function and look for infection. An ultrasound can help show whether the kidney is swollen from a blockage, and may show the stone itself, although it doesn't pick up every stone. Based on the results, the doctor decides whether this can be managed at home or needs further assessment.

Sources

• NHS — Kidney Stones
• Mayo Clinic — Kidney Stones: Symptoms and Causes
• NICE — Renal and Ureteric Stones: Assessment and Management (NG118)
• MedlinePlus — Kidney Stones