If you’ve ever had a kidney stone, then you know how painful they can be. Although you may decide to head to the emergency room (ER) for kidney stone relief, your experience can be more painful than the kidney stone. Long wait times, overcrowded waiting rooms and chaos. This is not what you need right now.
Before you call an ambulance for kidney stones or yell at your spouse to drive you to the ER, you should have a reasonable expectation of “what will the ER do for my kidney stones?”
As a board-certified urologist who's been on call for the ER, allow me to guide you. You don’t have to go through this painful experience alone.
Why do kidney stones hurt?
Before we discuss going to the ER for kidney stones, it helps to understand why stones hurt so much in the first place.
Kidney stones cause pain when they cause a blockage of urine in the ureter (the tube connecting your kidney to your bladder). When a stone is stuck in the ureter, it blocks the flow of urine. This causes a backflow of pressure that distends or stretches out the plumbing system of the kidneys.
Internal organ pain due to lack of blood flow, blockage or severe trauma is known as visceral pain. This is the most severe type of pain because our body is notifying us that a vital organ is “in trouble and you better get help!”
When should you go to the ER for kidney stones?
If you are experiencing any of the following symptoms, GO IMMEDIATELY TO THE EMERGENCY ROOM:
- Intolerable kidney stone pain despite prescription pain medications
- Vomiting
- Fever > 101 F
- Mental status changes (passing out, not able to hold a conversation)
These can be signs of a urinary tract infection along with a kidney stone blockage. A kidney infection at the time of a kidney stone requires emergent drainage of your kidney (usually with a stent) to prevent sepsis or even death.
Should you go to the ER or urgent care for kidney stones?
There are situations when a kidney stone can be managed without needing a trip to the ER.
Urgent care clinics are convenient care clinics which usually accept walk-in or same day appointments. However, they are more similar to your primary care provider’s office than an ER. Providers can prescribe medications and order tests like your regular doctor. But, expect to have to make a separate trip elsewhere for anything other than lab tests.
So how do you decide on an urgent care vs. an ER for your kidney stone pain? It depends on how bad of shape you’re in. Again if you’re having fevers, vomiting, or intolerable pain then the ER should be your first choice for kidney stones.
As long as you’re not having any of the above serious symptoms, then an urgent care provider may be able to help you. However, realize that you’ll likely be seeing a nurse practitioner or physician’s assistant with a primary care background. You typically won’t have immediate access to a specialist if a procedure or further advice is needed.
What tests will the ER do for kidney stones?
If a kidney stone is suspected based on your history, then the ER provider will often start with blood and urine samples. They will look for microscopic blood in the urine which is a sign of a kidney stone (although blood in the urine is absent in 10% of patients). A blood count will evaluate for signs of an infection. Kidney function tests (creatinine or GFR) will make sure your kidneys are working properly.
The best imaging test is a CT scan of the abdomen and pelvis without any contrast. This is 99% accurate for detecting kidney stones. If a kidney stone is present it will be important to know the following:
- Is the kidney stone causing an obstruction or blockage?
- What size is the stone?
- Where is the stone located?
Based on these factors the ER doctor can help make a determination if you need a urology consultation now or if the evaluation can wait.
What medications will help my kidney stone pain?
A variety of intravenous medications are used for kidney stone pain. The most commonly used is ketorolac (Toradol). This is a strong NSAID (similar to ibuprofen) that is more effective than most opioids. It should be used with caution if you have acid reflux, ulcers, or kidney dysfunction.
Opioids or narcotics (hydrocodone, oxycodone, morphine, hydromorphone) are often used in combination with NSAIDS. These medications are very effective for pain relief but are also associated with nausea, vomiting and constipation.
Additionally there is an opioid epidemic in our country due to heroin and prescription pain medications. The medical community is being asked to be very cautious with the amount and frequency with which we prescribe these medications.
A safe, prescription medication called tamsulosin (Flomax) has been shown to decrease kidney stone pain and increase the likelihood of stone passage. This is a prostate medication but has been used “off-label” for years in kidney stone patients (don’t worry ladies, you won’t grow a mustache on this pill. It’s not a hormone.)
Can you use telemedicine for kidney stones?
At Pazona MD we certainly appreciate the desire to avoid the ER for kidney stones. If you are interested in using telemedicine for kidney stones here’s how we can help:
1. Direct Access to a Specialist
Why not skip the middle-man and go right to the expert?! As board-certified urologists, managing kidney stones is our specialty. You’ll have the best counseling and care from the comfort of your home.
2. Prescribe Medications
Non-narcotic pain medications can be called in to the local pharmacy of your choice. Due to federal and state laws, we are unable to prescribe narcotics or opioids. So if you need oxycodone you’ll unfortunately have to go see someone in person.
The good news is that often tamsulosin and ketorolac will be enough to relieve your pain.
3. Order Imaging and Labs
After a thorough history via telemedicine, our experts can send orders for labs or imaging to a local facility. We can even receive the results and follow up with you to discuss the next steps.
4. Refer to Surgeon
If we find a stone that is unlikely to pass (usually >5 mm in size) then we can help you find the closest and best urologist to discuss a stone removal or lithotripsy.
5. Follow Up Visits for Kidney Stone Prevention
Once you’ve recovered from this terrible episode, make sure to schedule a follow up visit with your PazonaMD urologist to discuss stone prevention. We will cover the latest dietary recommendations for a kidney stone diet. If necessary, at that point a 24 hour urine collection can be ordered to perform a deep dive analysis of why you’re forming kidney stones.
With telemedicine we offer discounted follow-up visits and annual membership plans so you can continue seeing the same urologist.
We are there for you in the moments when you need help the most!
