When Passing a Kidney Stone: What to Expect—and When to See a Doctor

At Big Apple Medical Care, we believe that knowing what to expect during a kidney stone event empowers patients to manage pain, make safe decisions, and seek timely care. Passing a kidney stone can be one of the most agonizing experiences—but much of it is predictable. In this authoritative guide, we’ll walk through the symptoms, stages, self-care strategies, warning signs, and medical interventions associated with kidney stone passage.

Understanding Kidney Stones: A Quick Primer

A kidney stone (renal calculus) is a hard deposit formed from minerals and salts—commonly calcium oxalate, uric acid, cystine, or struvite—within the kidneys or urinary tract.

Many stones remain asymptomatic while in the kidney. The trouble begins when a stone dislodges and moves into the ureter (the tube connecting kidney to bladder), causing obstruction, pressure, spasm, and pain.

The likelihood of a stone passing naturally depends on stone size, location, and anatomy:

• Stones ≤ 5 mm often pass spontaneously, with success rates nearing 80–98 % in favorable conditions.

• Stones 5–7 mm have more variability in passage, often requiring medical assistance.

• Larger stones (> 7 mm) are less likely to pass without intervention.

• Stones closer to the bladder (distal ureter) are more likely to pass than those stuck higher.

What to Expect: Symptoms & The Passage Process

The journey of a kidney stone usually unfolds in stages, with symptoms that vary in intensity:

Silent Phase / Formation

When a stone forms or remains lodged in the kidney, symptoms may be absent or minimal. Because there’s no movement, pain often does not start until the stone shifts.

Onset & Renal Colic

Once the stone begins to migrate into the ureter, renal colic typically occurs. Key features include:

• Sudden, severe pain (flank or side pain), often described as sharp, cramping, or wave-like. The pain may radiate toward the groin, lower abdomen, or genital region.

• Pain fluctuations: episodes of intense pain interspersed with shorter lulls, often due to ureteral spasm.

• Nausea and vomiting are common side symptoms triggered by the pain reflex.

• Hematuria (blood in urine): The urine may become pink, red, or brown as the stone scrapes the lining of the urinary tract.

• Urinary urgency, frequency, burning: As the stone nears the bladder or irritates the lining, you may feel the need to urinate more often or pain while doing so.

• Discomfort in lower abdomen or groin: once the stone advances.

This painful phase may last hours or days, depending on how quickly the stone moves.

Passage into Bladder / Urethra

Once the stone reaches the bladder, many patients experience a reduction in flank pain. However:

• There may still be burning or stinging pain during urination as the stone moves through the urethra.

• Small fragments may pass gradually over hours or a few days.

• Mild discomfort or spasm may linger.

• You may see stone fragments in the urine (if you strain your urine).

Beyond the Passage

After successful passage, symptoms usually subside. However:

• Some residual irritation or soreness may last a few days.

• Urine may remain discolored briefly.

• There’s a chance of new stones forming—stone recurrence is common.

Self-Care While Passing a Stone: Tips & Measures

If your healthcare provider determines the stone is likely to pass on its own, here are evidence-based self-care strategies:

Hydration to Promote Passage

• Drink plenty of fluids to flush the urinary system. Aim for 2 to 3 liters of water daily, unless contraindicated.

• Proper hydration helps maintain urine flow, reduce concentration of stone-forming minerals, and encourage movement.

Pain Management

• Over-the-counter NSAIDs (e.g. ibuprofen, naproxen) or acetaminophen can help manage pain and inflammation.

• In severe pain, a doctor may prescribe stronger analgesics or opioids temporarily.

• Heat therapy (heating pad on flank or lower back) may offer temporary relief.

Medical Aids to Assist Passage

• Some clinicians may prescribe alpha-blockers (e.g. tamsulosin) to relax ureteral smooth muscle, easing stone passage.

• Anti-spasm medications may help reduce ureteral spasms and pain.

• Occasionally medical expulsive therapy is considered for stones of moderate size.

Strain Your Urine

Using a fine mesh urine strainer, try to collect passed stones or fragments. Analyzing the stone’s composition helps guide preventive strategies.

Rest and Activity Modification

• Avoid heavy lifting or strenuous exercise during intense pain.

• Gentle ambulation may help move the stone downward.

• Avoid putting pressure on your flank or changing posture abruptly during pain episodes.

When It’s Time to See a Doctor (Do Not Delay)

Although many kidney stones pass without intervention, there are specific warning signs and scenarios when urgent medical care is needed:

Red Flag Symptoms / “Emergency” Signs

• Fever or chills: May indicate infection (urinary tract infection or pyelonephritis).

• Persistent, severe pain unresponsive to analgesics.

• Inability to urinate or urinary retention.

• Significant bleeding in urine (clotting or large amounts).

• Signs of kidney impairment: reduced urine output, swelling, fatigue, nausea.

• Underlying conditions: a solitary functioning kidney, chronic kidney disease, or structural urinary abnormalities.

When these occur, prompt evaluation, imaging, and likely intervention are required.

When Stones Likely Won’t Pass

• Stones larger than 7–10 mm typically don’t pass on their own and may require removal.

• Anatomic obstructions or strictures may block progress.

• Bilateral stones or obstructing stones may compromise kidney function.

• Stones accompanied by infection demand urgent removal rather than waiting.

Diagnostic Workup & Medical Interventions

If medical evaluation is needed, the typical workflow includes:

Imaging & Labs

• Noncontrast CT scan (CT KUB): gold standard to identify stone size, location, and obstruction.

• Ultrasound (especially in pregnant patients or to reduce radiation).

• Urinalysis: microscopic blood, crystals, pH, signs of infection.

• Blood tests: kidney function (creatinine, BUN), blood count, electrolytes.

• Stone analysis (if passed stone is collected).

Treatment Options If Stone Does Not Pass

• Medical Expulsive Therapy (MET)

  • Use of drugs (like tamsulosin) to enhance spontaneous passage of moderate stones.

• Shock Wave Lithotripsy (SWL)

  • Noninvasive sound waves break stones into fragments that can pass.

• Ureteroscopy (URS)

  • A small endoscope is passed through ureter to locate, break (laser), or extract stones.

• Percutaneous Nephrolithotomy (PCNL)

  • Used for large or complex stones: surgical access via a skin puncture into the kidney.

• Open or Laparoscopic Surgery

  • Rare, reserved for complex or anatomically challenging stones.

• Stent Placement / Nephrostomy

  • Temporary drainage when obstruction or infection is present.

The choice depends on stone size, location, obstruction severity, patient health status, and presence of infection.

What Patients Should Ask Their Doctor

When facing a kidney stone, these questions help ensure proactive care:

• What is the size, type, and location of the stone?

• What is its likelihood of passing naturally?

• What medications or therapies can facilitate passage?

• What is your plan B if the stone fails to pass?

• How to manage pain and hydration safely?

• Should I collect stone fragments for analysis?

• What lifestyle, diet, or medical changes reduce recurrence risk?

Preventing Recurrence: Lifelong Strategies

Passing a stone is only part of the journey. Recurrence rates are high, so effective prevention is crucial:

• Stay well hydrated: produce at least 2 to 2.5 L of urine daily

• Limit sodium and dietary salt

• Optimize dietary calcium (not too low) to bind oxalate

• Reduce high-oxalate foods (spinach, beets, chocolate, nuts) when risk is high

• Moderate animal protein (especially red meat)

• Maintain healthy weight and control hypertension, diabetes

• Use medications (e.g. potassium citrate, thiazide diuretics) when indicated

• Regular follow-up with labs and imaging to monitor for stone formation

What to Expect in Recovery & Monitoring

• Once a stone passes (or is removed), pain should diminish rapidly.

• Hydration and continuing preventive measures remain essential.

• Your physician may schedule periodic imaging (ultrasound, CT) and urine tests to detect new stones early.

• Stone analysis, if available, will guide tailored dietary or medical therapy.

• In patients with metabolic disorders, urologist or nephrologist oversight may be necessary for long-term prevention.

Conclusion: Be Prepared, Act Wisely

Passing a kidney stone is painful, but many stones—especially small ones—do pass with conservative management. Understanding symptoms, what to expect, how to care for yourself, and when to seek medical help makes the process safer and less frightening.

At Big Apple Medical Care, we encourage patients not to suffer in silence. If you experience persistent or severe pain, fever, urinary blockage, or other red-flag symptoms, do not delay seeking medical evaluation. Early intervention preserves kidney function, avoids complications, and ensures peace of mind.

Let knowledge guide you—prepare for discomfort, practice hydration and safe pain relief, track your symptoms, and partner with medical professionals when needed.