Renal colic:
how to recognize it and what to do before the doctor arrives

Renal colic is an attack of acute pain that occurs when the flow of urine from the kidney is suddenly blocked. Most often, it is caused by a stone lodged in the ureter. This is not a condition to be endured at home: if you have renal colic, you should seek medical attention, and if certain symptoms occur, call an ambulance immediately. Below, we’ll explain how to distinguish colic from other types of pain and what to do in the first few minutes.

How to understand that it is renal colic

An attack usually begins suddenly, without warning — a person may wake up from the pain at night or feel it in the middle of a normal day. Characteristic signs:

• Sharp pain in the lower back or side, usually on one side;
• the pain radiates downwards - to the lower abdomen, groin, genitals, inner thigh;
• the pain is wave-like : it increases almost to the point of being unbearable, then subsides for a short time;
• a person cannot find a comfortable position - he gets up, walks, changes position, but it does not get any easier;
• nausea, sometimes vomiting, bloating;
• frequent and painful urge to urinate, burning sensation;
• Urine may become pink or reddish due to the presence of blood.

Behavior during an attack is an important clue. With renal colic, a person tosses and turns and cannot lie still. With abdominal inflammation, on the contrary, they try to remain still, because any movement intensifies the pain. Doctors pay attention to this first.

What can it be confused with?

Lower back and flank pain aren’t limited to kidney pain. Similar symptoms can include appendicitis, ectopic pregnancy, ovarian torsion, and other gynecological conditions, worsening spinal problems, and, in older adults, abdominal aortic aneurysm. Some of these conditions are life-threatening and require surgery within a few hours.

Hence the simple rule: you can’t self-diagnose based on your symptoms. Even if you’ve had an attack before and the sensations seem familiar, the cause this time may be different.

When to call an ambulance immediately

There are situations where waiting and waiting is not an option. Call an ambulance if you experience pain along with any of these symptoms:

• fever and chills - this may mean that an infection has joined the blockage;
• vomiting that does not stop and does not even allow drinking;
• there is no urine at all or it has decreased sharply;
• you have one kidney or a transplanted kidney;
• you are pregnant;
• fainting, confusion, severe weakness, cold sweat;
• the pain does not go away completely and does not change in intensity.

What can you do before the doctor arrives?

The goal at this stage is not to cure yourself, but to wait for help without harming yourself and to convey as much information as possible to the doctor.

1. Ensure rest. Lie down or sit in a position that is less painful, and remove tight clothing.
2. Don’t be alone. Ask someone to stay with you or at least keep in touch by phone.
3. Write down the details of the attack: when the pain started, where exactly it hurts and where it radiates, take your temperature, note whether there was vomiting, and whether your urine changed color. After an hour or two, all of this will be forgotten, but it will be useful to your doctor.
4. Prepare documents: results of previous ultrasound and CT scans, medical records, a list of medications you take regularly.
5. If your doctor has previously prescribed you a painkiller specifically for an attack , take it exactly as prescribed and be sure to tell the medical team this when they arrive.

What not to do

• Warm your lower back and take a hot bath until you see a doctor. Advice from the internet about using a heating pad is dangerous : if the pain is caused by inflammation or not colic at all, heat will intensify the process and worsen the condition. Heat is definitely contraindicated for those with a fever.
• Taking antibiotics or diuretics on your own. An antibiotic "just in case" will blur the picture, while a diuretic will increase pressure in the kidney if there’s a blockage.
• Try to "pass the stone" with herbal teas and liters of water. If the ureter is blocked, the excess fluid simply has nowhere to go.
• Endure for days. Even if the pain subsides, urine flow may not have recovered — and prolonged blockage can cause irreversible damage to the kidney.
• Trying to numb the pain with everything. Using several different medications in a row won’t help as much as it will hinder the doctor’s ability to assess the situation.

What happens next?

In the hospital, they typically perform urine and blood tests, a kidney ultrasound, and, if necessary, a CT scan — this most accurately reveals the stone’s location and size. Further treatment depends on these two parameters. Small stones often pass on their own under the doctor’s supervision and with prescribed therapy. If the stone is large, immobile, or completely obstructs the ureter, it is removed — for example, using an endoscopic procedure called contact ureterolithotripsy , which crushes the stone directly in the ureter through the natural urinary tract, without incisions.

And one more thing that’s often forgotten: just because the pain subsides doesn’t mean the stone has passed. After an attack, a urologist examination is essential to ensure urine flow has been restored and to understand why stones are forming in the first place.