What to Do When Kidney Stones Cause Constipation-Like Symptoms (But It's Actually Ureteral Irritation)

Experiencing an urgent, persistent urge to have a bowel movement—but being unable to pass stool—can be deeply unsettling. While many assume this is a gastrointestinal issue, it's often a surprising red flag for ureteral stones, especially when the stone lodges in the lower or mid-portion of the ureter. Due to shared nerve pathways between the urinary and digestive systems (specifically the autonomic plexus), irritation from a stone can send confusing signals to the brain—mimicking constipation, bloating, cramping, or even rectal pressure. This phenomenon, known as referred sensation, explains why patients frequently report "feeling like I need to poop" despite having perfectly normal bowel function.

Why This Happens: The Neurological Link Between Urinary & Digestive Tracts

The lower ureter runs in close anatomical proximity to the sigmoid colon and rectum—and both structures are innervated by overlapping branches of the hypogastric plexus and pelvic splanchnic nerves. When a stone triggers inflammation or mechanical pressure on the ureteral wall, those shared neural circuits become overstimulated. As a result, the brain misinterprets the signal—not as urinary pain, but as intestinal urgency or tenesmus (a painful, ineffective urge to defecate). This is especially common with stones measuring 4–7 mm, which are large enough to cause significant irritation but too small to pass spontaneously without intervention.

Effective, Evidence-Based Solutions

1. Medical Expulsive Therapy (MET) – First-Line Treatment

For eligible patients, alpha-1 adrenergic blockers—such as tamsulosin (Flomax®) or silodosin—are clinically proven to relax smooth muscle in the distal ureter, increasing stone passage rates by up to 60% compared to placebo. These medications reduce neurogenic spasm and decrease referred bowel symptoms within 48–72 hours—often before the stone fully passes.

2. Targeted Pain & Spasm Management

While waiting for spontaneous passage—or preparing for intervention—antispasmodics (e.g., hyoscyamine or dicyclomine) combined with short-term NSAIDs (like ibuprofen or ketorolac) provide dual relief: reducing ureteral peristalsis and calming downstream nerve signaling that triggers false bowel urges. Avoid narcotics unless absolutely necessary—they can worsen constipation and mask critical symptom changes.

3. Interventional Options When Conservative Care Isn't Enough

If symptoms persist beyond 4–6 weeks, the stone is >7 mm, or complications arise (e.g., hydronephrosis, infection, or renal impairment), minimally invasive procedures become essential:

Extracorporeal Shock Wave Lithotripsy (ESWL): Non-invasive fragmentation ideal for mid-to-distal ureteral stones under 10 mm.
Ureteroscopy with Laser Lithotripsy (URS): Gold-standard for larger, impacted, or proximal stones—with immediate stone removal and >95% success rates.
Temporary Stent Placement: Provides rapid symptomatic relief by bypassing obstruction while planning definitive treatment.

When to Seek Immediate Medical Attention

Don't wait if you experience any of the following—these may indicate serious complications requiring urgent urologic evaluation:

Fever above 101.5°F (38.6°C) or chills (signs of obstructive pyelonephritis)
Uncontrolled nausea/vomiting preventing oral hydration or medication
Complete inability to urinate (anuria) or significantly reduced urine output
Severe flank or abdominal pain unrelieved by standard analgesics

Remember: That "constipation" feeling isn't about your colon—it's your body sounding the alarm about a blocked ureter. Early recognition and targeted treatment not only resolve the uncomfortable bowel-like sensations but also protect long-term kidney health. If symptoms linger beyond 48 hours or worsen, consult a board-certified urologist—not a gastroenterologist—to get the right diagnosis and fastest path to relief.