Renal Colic: Symptoms, Causes, Diagnosis & Treatment

Renal colic is a type of intense, sharp pain usually felt in the lower back or side. This discomfort can also spread to the lower abdomen, often making it difficult to perform daily activities.

In many cases, this condition is accompanied by a burning sensation during urination or the presence of blood in the urine. These symptoms typically occur when a kidney stone blocks the flow of urine within the urinary tract.

While kidney stones are the most common cause, renal colic can also result from a kidney infection or certain types of cysts. It is essential to identify the underlying cause to receive the proper medical treatment.

Main symptoms

The hallmark symptom of renal colic is severe pain in the lower back and flank area. The intensity of this pain can fluctuate throughout the day, often becoming so debilitating that it limits physical movement.

Depending on the cause, the pain may radiate toward the groin, the abdominal region, or the genital area. Because the severity and location can vary, it is important to monitor how the symptoms progress.

If you experience these symptoms, you should consult a nephrologist or urologist. These specialists can determine the exact cause of the pain and recommend the most effective treatment plan.

Main causes

The primary causes of renal colic include:

• The presence of kidney stones (nephrolithiasis).

• Kidney infection, also known as pyelonephritis.

• The presence of kidney cysts.

• Kidney swelling, a condition called hydronephrosis.

• Renal tumors.

To diagnose the cause of renal colic, a doctor may order imaging tests to visualize the kidneys. Common diagnostic tools include Magnetic Resonance Imaging (MRI), Computed Tomography (CT scans), or an abdominal ultrasound.

Which doctor to consult

The most qualified specialist to diagnose and treat a renal colic crisis is a nephrologist, as they specialize in kidney health. However, a urologist can also provide immediate symptom relief and may refer you to a nephrologist if long-term kidney management is required.

What to do for relief

If you are experiencing renal colic, seeking medical advice is vital for pain management and to prevent future episodes. Treatment focuses on identifying the source of the blockage and alleviating discomfort.

1. Medication treatments

To manage the intense pain of a renal crisis, doctors often prescribe oral medications or intravenous (IV) treatments for faster relief:

• Anti-inflammatories, such as Naproxen, Ketoprofen, or Ibuprofen: These are typically the first line of defense because they reduce the inflammation and swelling that worsen the crisis.

• Analgesics, such as Acetaminophen: These are standard options used to help manage general pain levels.

• Opioid analgesics, such as Codeine, Tramadol, or Morphine: These powerful medications are reserved for severe pain that does not respond to standard over the counter options.

• Alpha-blockers, such as Tamsulosin: These help relax the muscles in the ureter, making it easier for a stone to pass and reducing the painful spasms caused by obstructed urine flow.

• Antiemetics, such as Ondansetron, Metoclopramide, or Dimenhydrinate: These are used to treat the nausea and vomiting that often accompany severe renal pain.

After the acute crisis has passed, a doctor may continue prescribing medications like tamsulosin to help the body pass any remaining stones and prevent future blockages.

2. Increase water intake

Patients with renal colic are encouraged to drink between 2 and 3 liters of water daily, consumed in small amounts throughout the day. Proper hydration is critical during and after a crisis, as it stimulates urine production, supports kidney function, and helps flush out stones.

3. Limit high-oxalate foods

Since kidney stones are the leading cause of renal colic, dietary adjustments are essential. Consuming foods high in oxalate can increase the risk of stone formation. It is recommended to limit or avoid spinach, cocoa, chocolate, beets, peanuts, walnuts, shellfish, sodas, coffee, and certain teas such as black, mate, or green tea. Read more about the kidney stone diet and see a sample 3-day meal plan.

Additionally, it is wise to avoid excessive Vitamin C supplements and high protein intake, limiting protein to 100g per day. Reducing salt intake is also a key strategy in preventing stone recurrence.

4. Home remedies

Home remedies should only be used as a supplement to medical treatment and under a doctor's supervision. Drinking lemon water is often recommended, as the citrate can help prevent crystals from sticking together to form larger stones.

During a pain crisis, applying a warm compress or heating pad to the affected area may provide comfort. The heat can help relax the urinary tract, potentially easing the passage of the stone and reducing discomfort.

5. Surgery

Surgical intervention is generally reserved for cases where the pain is persistent and does not respond to medication. Surgery may also be necessary if the stone is larger than 0.8 cm, if it is causing a significant obstruction that threatens kidney function, or if there is a suspected infection.