A kidney stone can feel dramatic: sharp pain in the side or back, waves of nausea, sweating, and a sudden urge to find a bathroom. In men, the pain may also travel into the lower abdomen, groin, or testicle, which can make it hard to tell whether the problem is a stone, infection, prostate issue, or testicular emergency. Blood in the urine is common with stones, but it should never be ignored, especially if it appears without pain or keeps coming back. Most small stones pass on their own with pain control, fluids, and time, but some need urgent care or a procedure. The safest next step depends on the pain pattern, fever, vomiting, urine flow, stone size, kidney function, and whether this is your first episode.
Table of Contents
- What Kidney Stone Pain Usually Feels Like
- Urinary Symptoms and Blood in Urine
- Symptoms That Need Urgent Care
- Conditions That Can Look Like Kidney Stones
- How Doctors Confirm a Kidney Stone
- What to Do During a Stone Attack
- Treatment Options and Passing Timeline
- Preventing Another Stone After Recovery
What Kidney Stone Pain Usually Feels Like
Kidney stone pain often starts suddenly on one side of the back or flank, just below the ribs. The classic pattern is not a dull muscle ache. It is sharp, deep, hard to ignore, and often comes in waves as the ureter squeezes around the stone.
The ureter is the narrow tube that carries urine from the kidney to the bladder. When a stone drops into this tube, urine may back up behind it. That pressure and spasm cause the intense pain known as renal colic.
Men often describe kidney stone pain as:
- A stabbing pain in one side of the back or flank
- Pain that moves toward the lower belly, groin, or testicle
- Waves of pain that rise, peak, ease, then return
- Restlessness, pacing, or trouble finding a comfortable position
- Nausea, sweating, or vomiting during the worst waves
Pain location can change as the stone moves. A stone high in the ureter may hurt more in the flank. A stone lower down may cause groin pain, testicular discomfort, urinary urgency, or burning when peeing.
| Stone location | Common pain pattern | Other symptoms that may appear |
|---|---|---|
| Kidney or upper ureter | Side or back pain below the ribs | Nausea, vomiting, sweating, blood in urine |
| Middle ureter | Pain moving from the flank toward the lower abdomen | Cramping waves, restlessness, trouble sitting still |
| Lower ureter near the bladder | Groin, testicle, or lower belly pain | Urgency, frequent urination, burning, small amounts of urine |
| Bladder or urethra | Pelvic or penile discomfort as the stone passes | Sudden urge to pee, stop-start stream, visible stone in urine |
A common mistake is assuming the pain must stay in one place. Kidney stone pain can travel. Another mistake is assuming severe pain means a huge stone. A small stone in the wrong spot can cause extreme pain, while a larger stone sitting quietly in the kidney may cause little or no pain.
Kidney stones can also be confused with back strain. Muscle pain usually changes when you bend, twist, press on the area, or use the muscle. Stone pain often keeps coming even when you change position. Many men with renal colic cannot lie still because no position gives reliable relief.
Pain that radiates into the testicle can be especially confusing. A kidney stone may cause referred pain to the testicle on the same side, but sudden severe testicular pain should be treated carefully because torsion can threaten the testicle. If the testicle is high-riding, swollen, very tender, or the pain starts directly in the scrotum, review the warning signs for testicular pain emergencies and seek urgent care.
Urinary Symptoms and Blood in Urine
Blood in the urine is one of the most common clues, but it may be visible or microscopic. Visible blood can look pink, red, tea-colored, cola-colored, or brown. Microscopic blood may only show up on a urine test.
Stones can scrape or irritate the lining of the urinary tract as they move. That irritation can cause bleeding, burning, and urgency. Some men notice blood first and pain later. Others have severe pain with urine that looks normal.
Kidney stone urinary symptoms may include:
- Pink, red, brown, or smoky-looking urine
- Burning or stinging when urinating
- Frequent urination
- Sudden urgency
- Feeling like only a small amount comes out
- Cloudy or foul-smelling urine
- Pain at the tip of the penis as the stone gets close to passing
- A weak, interrupted, or spraying stream if a stone reaches the urethra
Blood in urine should not be brushed off as “probably a stone,” especially in men over 40, smokers, men with chemical exposure, or anyone with painless visible blood. Stones are one possible cause, but infection, prostate problems, kidney disease, bladder tumors, and other urinary tract conditions can also cause bleeding. Persistent or unexplained bleeding deserves evaluation; see more on blood in urine in men when the symptom appears without a clear stone episode.
Urinary symptoms can become stronger when the stone nears the bladder. A man may feel like he has to pee every few minutes but only pass a few drops. This can look like a urinary tract infection, but stones and infections can also happen together.
Cloudy or bad-smelling urine is more concerning when it comes with fever, chills, worsening weakness, or confusion. A blocked urinary tract plus infection is a medical emergency because bacteria can build up behind the blockage and spread into the bloodstream.
Some men also notice pain at the end of urination or discomfort through the penis. This can happen when the stone is low in the ureter, inside the bladder, or passing through the urethra. If there is penile discharge, new sexual exposure, or burning without flank pain, sexually transmitted infections and urethritis become more likely than a kidney stone.
Symptoms That Need Urgent Care
A kidney stone is not always an emergency, but certain symptoms should not wait. The most dangerous situation is an obstructing stone with infection. Another serious problem is a blockage that stops urine from draining, especially in a man with one kidney or known kidney disease.
Seek urgent medical care now if you have:
- Fever or chills with flank pain
- Severe pain that does not improve with prescribed or over-the-counter medicine
- Repeated vomiting or inability to keep fluids down
- Fainting, confusion, severe weakness, or signs of dehydration
- Trouble urinating, inability to urinate, or only a few drops despite a full bladder feeling
- Blood clots in urine
- Known kidney disease, one kidney, kidney transplant, or recent urologic procedure
- Pain with signs of urinary infection, such as burning, cloudy urine, or foul smell
- Sudden severe testicular pain or swelling
- First-time severe flank pain, especially if the diagnosis is not clear
A blocked infected kidney can worsen quickly. Fever does not need to be extremely high to matter. Chills, shaking, fast heart rate, low blood pressure, or feeling suddenly very ill are warning signs.
Inability to urinate is another red flag. A stone can block urine flow, but in men, urinary retention may also be related to prostate enlargement, medications, nerve problems, or infection. When the bladder is full and urine will not come out, see emergency guidance on urinary retention in men rather than trying to wait it out.
Go to urgent care or the emergency department if you are unsure whether the pain is a stone. Appendicitis, abdominal aortic aneurysm, testicular torsion, bowel problems, kidney infection, and other conditions can cause overlapping pain. A first stone attack is often hard to identify at home.
When same-day care is usually enough
Same-day medical care is still wise if the pain is controlled but you have visible blood, burning, recurrent stone history, only one functioning kidney, or symptoms lasting more than a day. Same-day care may include urine testing, blood work, imaging, pain control, and a plan for follow-up.
When home monitoring may be reasonable
Home monitoring may be reasonable only when a clinician has already confirmed a small stone, your pain is controlled, you can drink fluids, you have no fever, and you are urinating normally. Even then, you need clear instructions on when to return.
Conditions That Can Look Like Kidney Stones
Not every man with flank, groin, or urinary pain has a kidney stone. The symptom pattern matters, but testing is often needed because several conditions overlap.
A urinary tract infection can cause burning, urgency, cloudy urine, pelvic discomfort, fever, and sometimes blood. In men, UTIs are often treated as more complicated than in women because prostate involvement, urinary blockage, stones, or structural issues may be present. If burning and fever are stronger than flank waves, compare the pattern with UTI symptoms in men.
Prostatitis can cause pelvic pain, painful urination, painful ejaculation, fever, chills, or a deep ache between the scrotum and anus. Chronic prostatitis may cause long-lasting pelvic discomfort without the dramatic flank waves of renal colic.
A pulled back muscle can cause one-sided pain, but it usually changes with movement, lifting, twisting, coughing, or pressing on the sore area. Kidney stone pain often feels internal and does not reliably improve with a new position.
Appendicitis often starts near the belly button and moves to the lower right abdomen. It may cause fever, nausea, loss of appetite, and worsening pain with movement. A right-sided stone can sometimes mimic it.
Diverticulitis, bowel obstruction, gallbladder disease, and hernias can also cause abdominal pain that may be mistaken for urinary pain. Severe belly pain, a rigid abdomen, black or bloody stool, or persistent vomiting needs urgent evaluation.
Testicular torsion is a separate emergency. It usually causes sudden, severe testicular pain, swelling, nausea, and a testicle that may sit higher than usual. A kidney stone can refer pain to the testicle, but torsion cannot be safely ruled out by guessing.
Bladder cancer is less common than stones but important because painless visible blood in urine can be an early sign. This is why men should not assume every bleeding episode is from a stone, especially when there is no classic colicky flank pain.
How Doctors Confirm a Kidney Stone
Doctors usually combine the story, exam, urine testing, blood testing, and imaging. The goal is not only to find a stone. It is also to check whether the kidney is blocked, whether infection is present, and whether another condition is causing the pain.
A typical evaluation may include:
- Medical history. The clinician asks when the pain started, where it moved, whether there is blood in urine, whether you have fever or vomiting, and whether you have had stones before.
- Physical exam. This may include checking the abdomen, flank tenderness, temperature, heart rate, hydration, and sometimes the testicles or prostate depending on symptoms.
- Urinalysis. A urine test can look for blood, white blood cells, bacteria, crystals, pH, and other clues.
- Urine culture. This is used when infection is possible.
- Blood tests. These may check kidney function, white blood cell count, calcium, electrolytes, and signs of infection.
- Imaging. Ultrasound or non-contrast CT may be used to look for a stone, blockage, kidney swelling, or another cause of pain.
Non-contrast CT is very good at finding ureteral stones and showing size and location. It can also reveal other causes of abdominal or flank pain. Ultrasound avoids radiation and can show kidney swelling or some stones, but it may miss small ureteral stones. The choice depends on age, stone history, severity, kidney function, body size, radiation concerns, and how certain the diagnosis already is.
For a first severe stone-like episode, imaging is often more important because the diagnosis is not yet proven. For a man with repeated stones and a familiar pattern, a clinician may use ultrasound, low-dose CT, or selective imaging depending on the risk.
Stone size matters because it helps predict whether the stone may pass. Location also matters. A smaller stone low in the ureter has a better chance of passing than a larger stone high near the kidney.
If you catch or pass a stone, save it. A lab can identify its type, such as calcium oxalate, uric acid, struvite, or cystine. Stone type helps guide prevention. Without analysis, advice may be too general.
Men with repeated stones, young age at first stone, family history, one kidney, bowel disease, gout, recurrent urinary infections, or unusual stone types may need a more detailed workup. This can include 24-hour urine testing to measure urine volume, calcium, oxalate, citrate, uric acid, sodium, and pH.
What to Do During a Stone Attack
The first priority is safety: control pain, prevent dehydration, and watch for infection or blockage. Do not force large amounts of water during severe nausea or vomiting. Drinking enough is helpful, but chugging water will not instantly push out a stuck stone and may worsen nausea.
If you have severe first-time flank pain, fever, vomiting, or trouble urinating, get medical care rather than trying to manage it alone.
If a clinician has already diagnosed a small stone and told you home care is appropriate, the usual steps are:
- Use pain medicine exactly as directed. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, are often used for renal colic when safe for the person. They may not be appropriate for men with kidney disease, stomach ulcers, blood thinners, certain heart conditions, or other risks.
- Drink steady fluids. Sip water rather than forcing huge amounts at once. Aim for pale yellow urine unless your clinician has given fluid limits.
- Strain the urine. A urine strainer can catch the stone. Bring the stone to your clinician for analysis.
- Use nausea medicine if prescribed. Vomiting can quickly lead to dehydration and may make oral pain medicine useless.
- Track symptoms. Write down pain location, fever, urine output, visible blood, and whether the stone passes.
- Follow the imaging and follow-up plan. Pain relief does not always prove the stone is gone. It may have moved or temporarily stopped causing spasm.
Some men are prescribed an alpha blocker such as tamsulosin to relax the ureter and help certain stones pass, especially stones in the lower ureter. This is not for every stone or every patient. Side effects can include dizziness, low blood pressure symptoms, and ejaculation changes.
Avoid driving if pain is severe, you feel faint, or you have taken medicines that cause drowsiness. Renal colic can come in sudden waves, and a pain surge while driving is unsafe.
Do not take leftover antibiotics for stone symptoms unless a clinician prescribes them. Antibiotics do not dissolve stones, and the wrong antibiotic can delay care if an obstructed infection is present.
Treatment Options and Passing Timeline
Many small ureteral stones pass without surgery, but “small” and “safe to wait” are not the same thing. A stone may need intervention if it causes infection, kidney damage, uncontrolled pain, repeated vomiting, or persistent blockage.
A stone’s chance of passing depends mainly on size and location:
- Stones under 5 mm often pass on their own.
- Stones around 5–10 mm have a lower chance of passing without help.
- Stones over 10 mm often need a procedure.
- Stones closer to the bladder usually pass more easily than stones higher in the ureter.
- Stones with ongoing blockage, infection, or kidney injury need faster action.
Passing a stone can take days to several weeks. Pain may stop suddenly when the stone enters the bladder or passes out through the urethra. Some men feel brief burning or a sharp sensation at the penis when the stone exits.
Procedures may be considered when waiting is unsafe or unlikely to work. Common options include:
| Treatment | How it works | When it may be used |
|---|---|---|
| Observation with pain control | Allows the stone to pass naturally while symptoms are managed | Small stone, no infection, normal urine flow, controlled pain |
| Medical expulsive therapy | Medication may relax the ureter and help some stones pass | Selected ureteral stones, often lower ureter stones |
| Ureteroscopy | A small scope passes through the urethra and bladder into the ureter to remove or break the stone | Ureteral stones, failed passage, larger stones, certain urgent cases |
| Shock wave lithotripsy | Sound waves break a stone into smaller pieces that can pass | Selected kidney or upper ureter stones depending on size, density, and anatomy |
| Percutaneous nephrolithotomy | A small incision in the back allows direct removal from the kidney | Large kidney stones, complex stones, staghorn stones |
| Urgent drainage with stent or nephrostomy | Bypasses the blockage so infected or trapped urine can drain | Blocked kidney with infection, sepsis risk, kidney function threat |
A ureteral stent is a thin tube placed inside the urinary tract to help urine drain from the kidney to the bladder. It can be very helpful, but it may cause urinary urgency, bladder discomfort, flank pain during urination, or blood in the urine until removed.
After a procedure, follow-up matters. Stone fragments can remain, stents need removal or exchange, and infection must be cleared. Do not skip the follow-up visit because symptoms improved.
Men with prostate enlargement, weak stream, or incomplete bladder emptying may need separate evaluation. A kidney stone may explain sudden flank pain, but it does not explain months of slow urination. Ongoing stream changes fit better with issues such as prostate enlargement or urethral narrowing; learn more about weak urine stream causes if that symptom was present before the stone attack.
Preventing Another Stone After Recovery
After one kidney stone, the goal is to lower the chance of another. Prevention works best when it is based on stone type, urine chemistry, diet, medical history, and medications.
The most common prevention step is increasing fluid intake enough to keep urine diluted. Many men underestimate how much fluid they lose through sweat, workouts, outdoor work, sauna use, or hot weather. Dark yellow urine during the day is a sign you may not be drinking enough.
Useful prevention steps often include:
- Drink enough fluid to produce pale urine through most of the day.
- Reduce excess sodium, especially from restaurant meals, processed foods, salty snacks, and cured meats.
- Keep normal dietary calcium unless a clinician says otherwise. Very low calcium diets can raise oxalate absorption in some people.
- Moderate large portions of animal protein if you form calcium or uric acid stones.
- Pair high-oxalate foods with calcium-containing foods when appropriate.
- Limit sugar-sweetened drinks.
- Review supplements, especially high-dose vitamin C, calcium pills, and bodybuilding products.
- Treat gout, recurrent UTIs, bowel disease, or metabolic problems that increase risk.
- Complete 24-hour urine testing if recommended.
Do not assume that “kidney stone diet” is the same for everyone. A man with uric acid stones may need urine alkalinization and gout management. A man with calcium oxalate stones may need changes in sodium, oxalate, calcium timing, and citrate. A man with struvite stones needs infection-focused treatment. A man with cystine stones needs specialized prevention.
High-protein diets can be reasonable for some men, but very high intake may be a problem for certain stone formers, especially when fluid intake is low and sodium is high. If you are using a muscle-building diet and have had stones, review high-protein diet kidney concerns with your clinician rather than guessing.
Men who have recurrent stones should ask whether they need a urologist, nephrologist, or both. A urologist often handles obstruction, procedures, and anatomy. A nephrologist may help with recurrent stones, unusual urine chemistry, kidney disease, or complex prevention. If you keep passing stones, have blood in urine, or have urinary symptoms that do not resolve, it may be time to see a specialist; here are common reasons men should see a urologist.
References
- Symptoms & Causes of Kidney Stones 2017 (Official Page)
- Treatment for Kidney Stones 2017 (Official Page)
- EAU Guidelines on Urolithiasis – GUIDELINES 2026 (Guideline)
- Acute Renal Colic 2024 (Review)
- Renal Calculi, Nephrolithiasis 2024 (Review)
- Urological Guidelines for Kidney Stones: Overview and Comprehensive Update 2024 (Review)
Disclaimer
This article is educational and does not replace care from a qualified health professional. Flank pain with fever, vomiting, inability to urinate, severe testicular pain, or worsening weakness can be urgent and should be evaluated promptly. Treatment choices depend on stone size, location, kidney function, infection risk, medications, and your overall health.
