Renal colic: what to do when severe lower back pain strikes and when to seek emergency medical care

A sudden, sharp, and excruciating pain in the lower back that may radiate to the groin or abdomen is how most people describe renal colic. This condition causes significant distress and is one of the most common reasons for seeking emergency urological care.

Knowing how to respond appropriately can help reduce suffering and prevent potentially serious complications.

What is renal colic?

Renal colic is not a disease itself but an acute pain syndrome.

It occurs when the flow of urine from the kidney becomes suddenly blocked, causing the renal pelvis to stretch and pressure inside the kidney to rise rapidly.

In most cases, the obstruction is caused by kidney stones (nephrolithiasis) or blood clots.

The pain is typically colicky, meaning it comes in waves—becoming unbearable, then easing slightly—but it rarely resolves completely without medical treatment.

How can you recognize the symptoms?

Severe pain in the side or lower back. The pain often radiates along the ureter toward the groin.

Nausea and vomiting. These commonly occur at the peak of the pain attack.

Frequent urge to urinate. Small amounts of urine may be passed each time.

Restlessness. Patients constantly change body position in an attempt to find relief. Unlike musculoskeletal back pain, changing position usually does not improve the pain.

What can you do at home?

If you or someone close to you experiences an attack of renal colic, it is important to remain calm and follow evidence-based recommendations until medical evaluation is possible.

1. Apply heat

Applying local heat to the lower back (such as a heating pad or a warm bath) may help relax the smooth muscles of the urinary tract and temporarily relieve discomfort.

Important: Heat should only be used if you are confident that the pain is caused by a kidney stone and you do not have a fever.

2. Take pain relief medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered the first-line treatment for pain relief in renal colic.

Ibuprofen and similar medications help reduce both pain and inflammation.

Acetaminophen (paracetamol) may be used as an alternative or in combination to improve pain control, although it is generally less effective in treating the inflammatory component of renal colic.

3. Stay moderately hydrated

Maintaining adequate hydration is important.

Drink according to your thirst and aim to keep your urine a light yellow color.

However, avoid excessive fluid intake (more than 2 liters per day) during an acute attack, as this may increase pressure inside the obstructed kidney and worsen the pain.

Red flags: when you should seek emergency medical care

Some symptoms indicate that home management is not appropriate and that delaying treatment may be dangerous.

Seek emergency medical attention immediately if you experience:

— a high fever (above 37.7°C) and chills, which may indicate a kidney infection (acute pyelonephritis);

— gross hematuria (visible blood in the urine, making it appear tea-, cola-, or bright red-colored);

— urinary retention — inability to urinate despite feeling the urge;

— persistent vomiting that prevents you from taking medications by mouth;

— confusion or severe weakness.

Diagnosis and treatment: what will the urologist do?

After arriving at the clinic or emergency department, the urologist will perform a physical examination and recommend appropriate diagnostic tests.

The gold standard for diagnosing renal colic is a non-contrast computed tomography (CT) scan of the abdomen and pelvis. This allows the physician to accurately determine the size, density, and exact location of the stone.

For pregnant women and children, ultrasound of the kidneys and bladder is recommended as the initial imaging method to avoid radiation exposure.

Conclusion

Renal colic is a serious medical condition.

Trying to endure the pain or relying on self-treatment without medical supervision may lead to loss of kidney function or life-threatening septic complications.

If severe lower back pain occurs for the first time or is accompanied by any of the red flags described above, medical attention should be sought without delay.

Remember: pain relief at home is only a temporary measure before seeing a healthcare professional. Only a urologist can determine the cause of renal colic and recommend the appropriate treatment to prevent future episodes.