Ureteral Pain - Causes, Treatment & When to See a Doctor

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What is Ureteral Pain?

The ureters are two thin, muscular tubes that carry urine from each kidney down to the bladder. Ureteral pain (often described as “flank pain” or “loin pain”) is discomfort that originates from one or both of these tubes. The pain is usually sharp, cramping, or colicky and can radiate from the side of the back toward the lower abdomen, groin, or even the genital area. Because the ureters are located deep in the retroperitoneal space, the pain may feel “internal” and is often mistaken for muscle or back problems.

Ureteral pain is most commonly a symptom of an underlying condition that obstructs or irritates the urinary flow. Prompt identification of the cause is essential, as some underlying problems—such as a kidney stone—can lead to kidney damage or infection if left untreated.

Common Causes

Many different medical conditions can trigger ureteral pain. The most frequent culprits are listed below.

• Kidney stones (nephrolithiasis) – Crystalline deposits that block the ureter, causing intense colicky pain.
• Ureteral obstruction from strictures – Narrowing of the tube due to scar tissue, congenital anomalies, or radiation.
• Urinary tract infection (UTI) that spreads to the ureter – Typically presents with pain plus fever, urgency, and dysuria.
• Ureteral tumors – Benign (e.g., fibroepithelial polyps) or malignant (urothelial carcinoma) growths that impede urine flow.
• Pregnancy – The enlarging uterus can compress the ureters, especially on the right side, leading to intermittent pain.
• Retroperitoneal or pelvic masses – Enlarged lymph nodes, ovarian cysts, or gastrointestinal tumors may press on the ureters.
• Endometriosis involving the ureter – Ectopic endometrial tissue can cause inflammation and obstruction.
• Extracorporeal shock‑wave lithotripsy (ESWL) or other urologic procedures – May cause temporary ureteral spasm or injury.
• Neurogenic bladder or dysfunctional voiding – Abnormal bladder pressure can reflux urine up the ureters, causing pain.
• Hydronephrosis secondary to any cause – Swelling of the kidney from urine buildup stretches the ureter and capsule, producing pain.

Associated Symptoms

The presence of additional signs can help pinpoint the underlying cause.

• Flank or side pain that comes in waves (colic)
• Radiating pain to the lower abdomen, groin, or inner thigh
• Hematuria (blood in the urine) – often visible as pink, red, or brown urine
• Urinary urgency, frequency, or burning sensation
• Nausea and vomiting (common with kidney stones)
• Fever, chills, or chills (suggestive of infection)
• Difficulty passing urine or a weak urine stream
• Inability to find a comfortable position because pain worsens with movement
• Swelling of the abdomen or lower back in severe obstruction

When to See a Doctor

Ureteral pain can be harmless, but it frequently signals a problem that needs medical attention. Seek care promptly if you experience any of the following:

• Severe, sudden onset pain that does not improve within an hour
• Fever > 100.4 °F (38 °C) or chills
• Persistent vomiting or inability to keep fluids down
• Blood in the urine that is heavy or clotted
• Sudden decrease in urine output or complete inability to urinate
• Pain accompanied by shortness of breath, faintness, or chest pain
• History of kidney stones, urinary tract abnormalities, or recent surgery

These signs may indicate infection, a large obstructing stone, or a complication that could damage the kidney if not treated quickly.

Diagnosis

Evaluation begins with a thorough history and physical examination, followed by targeted imaging and laboratory studies.

History & Physical Exam

• Location, quality, timing, and radiation of pain
• Prior stones, UTIs, surgeries, or trauma
• Associated symptoms (fever, vomiting, hematuria)
• Hydration status and vital signs (fever, tachycardia, hypotension)
• Palpation of the flank for tenderness or a palpable mass

Laboratory Tests

• Urinalysis – Looks for blood, white cells, bacteria, and crystals.
• Urine culture – If infection is suspected.
• Blood chemistry – Creatinine and BUN assess kidney function; electrolytes check for dehydration.
• Serum calcium, uric acid, and phosphate – Helpful when evaluating stone composition.

Imaging Studies

• Non‑contrast helical CT scan – Gold standard for detecting kidney stones; shows size, location, and obstruction.
• Ultrasound – First‑line in pregnancy or for patients who should avoid radiation; identifies hydronephrosis and large stones.
• Plain X‑ray (KUB – kidney, ureter, bladder) – Useful for radiopaque stones but less sensitive than CT.
• Intravenous pyelogram (IVP) – Rarely used today; provides functional imaging of the urinary tract.
• CT urography or MR urography – Employed when tumors, strictures, or complex anatomy are suspected.

Treatment Options

Management is directed at the underlying cause, relieving pain, and preventing complications.

Acute Pain Relief

• NSAIDs (e.g., ibuprofen, naproxen) – First‑line for colicky pain; reduce prostaglandin‑mediated ureteral spasm.
• Opioids (e.g., hydromorphone, oxycodone) – Reserved for severe pain not controlled by NSAIDs.
• Hydration – Encouraging oral fluids (2–3 L/day) helps stone passage and dilutes urine.
• Heat therapy – Warm compresses on the flank may ease muscular tension.

Specific Treatments Based on Cause

Condition	Medical / Procedural Management
Kidney stones (≤5 mm)	Conservative management – increased fluid intake, NSAIDs, and α‑blockers (e.g., tamsulosin) to facilitate passage.
Kidney stones (>5 mm or obstructing)	Ureteroscopy with laser lithotripsy, extracorporeal shock‑wave lithotripsy (ESWL), or percutaneous nephrolithotomy for large stones.
Ureteral stricture	Endoscopic dilation, balloon catheter, or ureteral stent placement; surgery for refractory cases.
UTI/pyelonephritis	Empiric antibiotics (e.g., ciprofloxacin, trimethoprim‑sulfamethoxazole) tailored to culture results; possible hospital admission if septic.
Ureteral tumors	Oncologic work‑up; surgical resection, ureteroscopic tumor removal, or systemic therapy depending on pathology.
Pregnancy‑related ureteral compression	Conservative measures – hydration, analgesics safe in pregnancy (acetaminophen), and positioning; ureteral stent if obstruction is severe.
Endometriosis involving ureter	Hormonal therapy (e.g., GnRH agonists) and laparoscopic surgical excision.

Home Care & Lifestyle Adjustments

• Drink enough water to produce at least 2 L of urine per day.
• Limit foods high in oxalates (spinach, nuts) if calcium oxalate stones are a risk.
• Maintain a balanced calcium intake (avoid excessive supplements).
• Reduce sodium intake; high salt raises calcium excretion.
• Moderate animal protein consumption; excess protein can increase uric acid.
• For recurrent infections, practice proper perineal hygiene and consider postpartum or post‑menopausal estrogen therapy when appropriate.

Prevention Tips

Many of the factors that cause ureteral pain are modifiable.

• Stay Hydrated – Aim for a urine output of ~1.5–2 L/day; color should be pale straw.
• Dietary Adjustments – Tailor your diet to the type of stone you’re prone to (e.g., low‑oxalate for calcium oxalate, low‑purine for uric acid).
• Regular Physical Activity – Helps maintain healthy weight, lowering the risk of stone formation.
• Medication Review – Some drugs (e.g., certain diuretics, antacids containing calcium) increase stone risk; discuss alternatives with your doctor.
• Prompt Treatment of UTIs – Completing full antibiotic courses reduces the chance of ascending infection to the ureters.
• Manage Underlying Conditions – Control diabetes, gout, and hyperparathyroidism which can predispose to stone formation.
• Pregnancy Monitoring – Regular prenatal visits to assess for hydronephrosis; early intervention if pain is severe.

Emergency Warning Signs

Bottom Line

Ureteral pain is most often a symptom of an obstructive or infectious process within the urinary tract. While many cases resolve with hydration and pain control, conditions like kidney stones, infections, or tumors can quickly become serious. Understanding the associated signs, seeking timely medical evaluation, and adopting preventive habits are key to protecting kidney health and avoiding complications.

References:

• Mayo Clinic. “Kidney Stones – Symptoms and Causes.” May 2023.
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Ureteral Stone Treatment.” 2022.
• American Urological Association. “Guideline for the Management of Upper Urinary Tract Stones.” 2022.
• Cleveland Clinic. “Ureteral Strictures: Causes and Treatment.” 2021.
• World Health Organization. “Urinary Tract Infections.” 2020.

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