Kidney stones suck. Sorry to be blunt, but they just do. I feel pain myself every time I see one of my patients doubled over in pain, begging me to remove their kidney stone.
As many of you who have had a kidney stone in the past already know, the pain doesn’t end with the kidney stone removal. There is the dreaded ureteral stent. Ugh.
Sometimes, the ureteral stent pain is worse than the kidney stone itself. Medicine fails us if the cure is worse than the disease.
You may be asking yourself, “why are ureteral stents necessary?” or “why do ureteral stents hurt so much?” or “what the heck is a ureteral stent?”. Well you’re in the right place.
At VirtuCare we believe that education and patient awareness is essential to better healthcare. Allow the kidney stone expert to walk you through a class called Ureteral Stents 101 so you can be better prepared for that evil tube in your plumbing system. You’re not alone in your ureteral stent pain.
What are ureteral stents?
A ureteral stent is a thin, long tube that is placed inside your urinary tract. They are usually plastic although longer term metallic stents also exist. A ureteral stent has two curls at each end to hold it in place. The stent runs from the kidney, down the entire length of the ureter, and into your bladder.
Ureteral stents are typically placed for 2 reasons:
- Relieve a blockage of the kidney/ureter from a stone, cancer or scar tissue.
- As a preventative measure after a scope procedure of the ureter (ureteroscopy).
With a ureteral stent in place, urine is able to flow from the kidney both through and around the stent which acts as a bypass around the obstruction. This keeps your kidney healthy because a blocked kidney is a sad kidney. The reason a kidney stone hurts so bad is that the kidney is blocked, and the plumbing system is distended. A stent solves this problem.
But, ureteral stents hurt as well. So . . .
Why do ureteral stents cause pain?
Here are the top 3 reasons why ureteral stents can cause you, and your urologist, misery:
- Irritation of the urethra
In order to place a stent, or remove kidney stones, a scope (aka metal rod) needs to be placed in your urethra and bladder. It’s not a surprise then why most patients require general anesthesia. Even in the most skilled hands with LOTS of lubrication, placement and manipulation of the scope cause an irritation of the urethra.
Burning with urination is most common for the first 72 hours after a ureteral stent placement as a result. If a string is left attached to the ureteral stent, then the string can cause persistent irritation of the urethra as well.
- Our bladders are “dumb”
Please don’t take offense. My bladder is definitely dumber than yours. And by dumb, what I really mean is that our bladders can’t figure out that there’s a stent sitting inside.
When our bladder is full of urine it sends a signal to our brain that we should probably go tinkle. When a stent is in our bladder, it also sends a signal to our brain. Unfortunately since the stent is still in place, this signal is constant and stronger. Thus the urge to urinate every 5-10 minutes is quite common while having a stent in place.
It is not unusual to have bladder spasms or pelvic pain prior to or after urination as well.
- Backwards flow of urine to the kidneys
Ureteral stents are meant to allow the forward flow of urine from the kidneys down the ureter and into the bladder. But, since there’s no one-way valve, the urine can also flow back up the ureters and stretch out the kidney. As you recall from earlier, this stretching or distention is why kidney stones hurt in the first place.
This leads to flank or abdominal pain. It is most common with a full bladder. Drinking too much fluid after surgery can make this worse. So does trying to hold your urine for too long.
How can you relieve ureteral stent pain?
You came here for help. Now that you have a better understanding of these medieval torture devices, let’s get you relief from ureteral stent pain.
The best therapy for ureteral stent pain depends again on which sort of pain you are experiencing. If it’s urethra, bladder, and kidney pain, then fear not! We will guide you through all the options.
As a disclaimer, we have no financial incentive to promote any medication over another. When in doubt, over-the-counter (OTC) and generics are preferred to save you money. We will list alternative names and ingredients when appropriate.
How to treat burning with urination from a ureteral stent:
Phenazopyridine (Pyridium, AZO)
This little miracle drug should be your go-to pain reliever if it feels like the pee tube is on fire. Most commonly referred to as Pyridium or AZO, this urinary analgesic soothes the urethra if you have a UTI or a trauma from a recent urology surgery. Pyridium for stent relief is a great, safe option.
Although there are limits on how long you can take phenazopyridine (2 days according to the manufacturer), anecdotally patients have reported to me taking this on a daily basis for a week plus. We obviously cannot recommend therapy length beyond these recommendations, but side effects are rare. The main side effect is it will turn your urine BRIGHT ORANGE and will stain everything.
AZO is available OTC in doses up to 99.5 mg. Prescription grade versions are available at 100-200 mg up to twice daily. You can do the math and get relief without requiring a prescription.
Avoid bladder irritants
Don’t stoke the fire in your urethra with food and beverages that will make things worse. Caffeine, sugar, acid and alcohol are the worst offenders. Stick with water.
Avoid overhydration
Too much of a good thing can cause you trouble in many areas of life. Drinking too much water will just cause you to pee more which is not the most fun activity with a ureteral stent in place. 60-80 oz of water should be a reasonable amount for most patients after a ureteral stent.
Of course once that stent is out, water intake should increase to 80-100 oz to prevent future kidney stones.
Uribel/Uro-MP/Urogesic Blue
These combination medications also relieve ureteral stent pain in the urethra. They are manufactured by several companies under different names, but share many of the following ingredients:
- Methenamine
- Methylene blue
- Hyoscyamine
- Monobasic sodium phosphate
These products are most commonly used to relieve UTI symptoms, but have been helped patients with ureteral stents as well. Methenamine helps to prevent bacterial growth. Hyoscyamine prevents bladder spasms (see below). Together all the medications help to make your bladder and urethra happier.
How to treat bladder spasms/urinary frequency from a ureteral stent:
In addition to the above recommendations of a bladder friendly diet and reasonable fluid intake, you can consider:
Anticholinergics
There are too many medications in this category to list them all. Some of the more common ones include oxybutynin (Ditropan), tolterodine (Detrol) and hyoscyamine. They are anti-spasm medications that tell the bladder to calm the heck down.
Although this should improve bladder pain and frequency, they also cause side effects. Dry mouth and constipation are most common. Make sure you take a stool softener like Miralax (polyethylene glycol 3350) because constipation is the last thing you need with a stent in place (see below).
Alpha blockers
Tamsulosin (Flomax) is commonly used before kidney stone surgery to help increase the likelihood of spontaneous stone passage. Obviously if you have a ureteral stent, this was not successful. However, Tamsulosin may still provide a purpose.
In a review of several trials, Tamsulosin was shown to improve both “urinary and body pain scores.” when a ureteral stent is in place. In other words, Tamsulosin can improve urinary frequency in addition to bladder/kidney pain.
Alpha blockers are well tolerated but can cause a stuffy nose and lightheadedness.
Treat constipation
Infrequent or hard bowel movements can worsen the urinary symptoms associated with a ureteral stent. Why is this? There’s only so much room in the human pelvis. When stool is sitting in the rectum it can compress the bladder. Which in turn worsens bladder pain and frequency.
Constipation is common after kidney stone surgery due to side effects of the pain medications, decreased activity, and general anesthesia. As previously stated Miralax is a great preventative OTC medication you can safely take if you get backed up. It’s a tasteless powder that is well tolerated. Just be near a bathroom!
How to treat kidney pain from a ureteral stent:
In addition to some of the above remedies (e.g. Tamsulosin), here are some other ways to relieve ureteral stent kidney pain:
NSAIDs
Non-steroidal anti-inflammatories like ibuprofen/naproxen are a mainstay of ureteral stent pain relief. Always check with your doctor to see if it is safe to take ibuprofen. Some patients with chronic kidney disease or a history of stomach ulcers, should avoid these medications.
For everyone else, check with your doctor for their dosage recommendations (200 – 600 mg up to 3 times a day with meals is common). Of course if you develop any stomach pain, decreased urination or symptoms of an allergic reaction (e.g. lip swelling, difficulty breathing), stop the medication immediately and contact your physician for immediate care.
Opiods
The opioid crisis in the U.S. has forced physicians to be very cautious with prescribing narcotics. Rightfully so. However, sometimes the only relief of ureteral stent pain is “the strong stuff.”
There are a number of choices for oral opioids including tramadol, hydrocodone and oxycodone. It is best to use these as your last resort if nothing else is relieving the ureteral stent pain. Make certain you follow the directions, start a stool softener, and wean yourself off of these medications ASAP.
Decrease heavy activity
With a stent in place, you do not have any physical restrictions. However, you may find that strenuous work causes more kidney pain with a ureteral stent in place. Use your best judgement. If it hurts, then don’t do it silly.
One common question is whether or not you can have sex with a ureteral stent in place. The answer is “yes”. If your stent isn’t bothering you and you can rise to the occasion, then have at it hoss.
Conclusions on relieving ureteral stent pain
We hope that you are now better prepared for dealing with that nasty little tube known as a ureteral stent. We urologists don’t like the stents anymore than you do. Unfortunately they are a necessary evil at times to keep your kidneys healthy while recovering from a kidney stone removal or other blockage.
Please make certain that your urologist is adequately addressing your ureteral stent pain. If he or she is not, then you may want to consider a telemedicine visit with VirtuCare. Our board-certified urologists are selected for their compassion. We will listen to your concerns and get you the care you deserve (however, please note that we cannot prescribe narcotics via telemedicine).
The kidney stone was bad enough. Don’t suffer more than necessary, give us a call.
