Severe loin-to-groin pain. Anti-inflammatories work better than morphine, and half of people get another within a decade.
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Kidney stones form when minerals in the urine crystallise. Small stones pass unnoticed. A stone that moves into the ureter causes renal colic — a pain widely described as among the most severe there is, and which women who have experienced both often rate above childbirth.
The pain has a characteristic quality: it comes in waves, runs from the loin round to the groin, and you cannot find a position that helps. That last part is genuinely diagnostic. People with peritonitis lie completely still; people with renal colic pace, writhe and cannot settle.
Two practical points worth knowing.
Anti-inflammatories are more effective than opioids for renal colic, and are what national guidance recommends first. Being offered morphine before an NSAID is common and is not what the evidence supports.
A stone with a fever is a urological emergency. An obstructed, infected kidney can become life-threatening within hours and needs immediate drainage — not antibiotics and a wait.
High in the loin suggests the kidney or upper ureter. Radiating to the groin suggests the mid-ureter. Urinary urgency and frequency with pain at the tip suggests the stone is near the bladder — and stones that far down usually pass.
Fever, shivering, feeling systemically unwell, or confusion alongside the pain — this suggests an infected obstructed kidney and is a surgical emergency.
Also urgent: a single kidney, known kidney impairment, pregnancy, or being unable to keep fluids down.
Calcium oxalate is much the commonest. Others include calcium phosphate, uric acid (associated with gout), struvite (associated with infection) and cystine (inherited).
Knowing the type changes the prevention advice, which is why catching the stone matters.
A low-dose CT of the kidneys, ureters and bladder is the standard investigation and should be done within 24 hours of arrival. It shows the stone, its size, its position, and whether the kidney is obstructed — all of which determine what happens next.
Strain your urine and keep whatever you pass. Analysing the stone identifies its type, and the type determines the prevention strategy. It is easily done, costs nothing, and is very often forgotten.
A leaking abdominal aortic aneurysm presents as loin pain in an older adult and is the most important thing not to miss. Also: appendicitis, ectopic pregnancy, ovarian torsion, testicular torsion, diverticulitis, and a kidney infection without a stone.
Acute renal colic needs to be assessed in person, and usually needs a scan the same day. If you are in severe pain now, go to A&E or call 111 — not because we are being cautious, but because you need imaging and injectable pain relief that no video call provides.
The gap in stone care is not the acute episode. It is everything afterwards, and it is a real gap.
Prescribe opioids remotely, under any circumstances. Severe pain needs assessment, not a prescription issued at a distance.
Call 999 or go to A&E immediately if you have loin pain with:
Seek same-day assessment for:
Aim for 2.5 to 3 litres a day, spread out, enough to produce around 2 to 2.5 litres of urine. The target you can actually check is the colour: pale straw, all day.
Drink through the evening too, since urine concentrates overnight and that is when many stones form.
Do not cut down on dietary calcium. This is the commonest mistake people make, and it makes things worse. Calcium in food binds oxalate in the gut so it is excreted in stool rather than urine. A low-calcium diet increases stone risk.
Calcium supplements are different and should be discussed rather than assumed safe.
If you are in acute renal colic, go to A&E. We will say that plainly rather than book you in.
The gap is prevention, and it is a wide one.
This page follows NICE NG118 on renal and ureteric stones.
Recurrence is common, with a substantial proportion of people forming a further stone within five to ten years. This is the basis for the guidance on prevention advice and follow-up, which is the part of stone care most frequently omitted.
Reviewed against NICE NG118 current at the date shown above.
Severe. It is routinely described as among the worst pains people experience, and it comes in waves.
The distinguishing feature is restlessness — you cannot lie still or find any position that helps, which is the opposite of most abdominal emergencies.
Not first. NICE recommends an anti-inflammatory as first-line, because it works better for this specific pain.
Opioids are second-line, for where NSAIDs cannot be used or are not enough.
Stone pain with a fever or shivering. That means a possible obstructed, infected kidney, which can become life-threatening within hours.
It needs urgent drainage, not antibiotics and a wait. Go to A&E.
Most stones under 5mm do, usually within a few weeks. Between 5 and 10mm it is less certain, and an alpha blocker may help.
Larger stones, or an obstructed kidney, usually need a procedure.
No — and this is the commonest and most counterproductive mistake. Dietary calcium binds oxalate in the gut so it leaves in the stool rather than the urine.
Cutting calcium increases your stone risk. Keep a normal intake.
Two and a half to three litres a day, spread through the day and into the evening.
Judge it by urine colour: pale straw all day. That is a more useful target than counting glasses.
Yes, and it is not folklore. Citrate inhibits stone formation, and fresh lemon juice in water is specifically recommended in the guidance.
Around half of people do within five to ten years. That is precisely why prevention matters.
Most people are never given a plan, which is the most fixable part of stone care.
Because the type determines the prevention advice, and the advice differs substantially between oxalate, urate and infection stones.
Strain your urine and keep whatever you pass — it costs nothing and it is very commonly forgotten.
August 30, 2026
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