Why Does Kidney Stone Pain Make You Feel Like You Need to Poop—but Can't?

Understanding the Surprising Link Between Kidney Stones and Bowel Urgency

It's not uncommon for people experiencing kidney stones—especially those lodged in the lower ureter or near the ureterovesical junction—to report an intense, persistent urge to have a bowel movement, even when there's little or no stool present. This phenomenon, medically known as tenesmus, can be both confusing and distressing. Contrary to what many assume, it's rarely caused by actual constipation or fecal impaction. Instead, it stems from nerve cross-talk between the urinary and gastrointestinal systems.

How Ureteral Stones Trigger False Bowel Urges

The lower ureter runs in close anatomical proximity to the rectum and pelvic nerves—including the inferior hypogastric plexus. When a stone becomes lodged here, it exerts mechanical pressure and inflammatory irritation on surrounding nerve pathways. These shared neural networks often misinterpret urinary tract signals as rectal or colonic stimuli—leading the brain to generate strong, repeated urges to defecate. In reality, the colon and rectum may be completely empty; the sensation is purely neurological.

Relief Comes With Stone Passage—Here's What to Expect

Once the stone passes into the bladder, this "phantom bowel urgency" typically resolves rapidly—often within hours. Simultaneously, classic urinary symptoms like frequent urination, painful voiding (dysuria), and suprapubic discomfort also begin to ease. This swift improvement is a strong clinical clue that the underlying cause is indeed a distal ureteral stone—not a primary gastrointestinal issue.

What to Do If You're Experiencing This Symptom

If you're struggling with unrelenting bowel urgency alongside flank pain, hematuria, or urinary discomfort, don't dismiss it as simple constipation. Prompt urologic evaluation is essential. A non-contrast CT scan remains the gold standard for detecting even tiny ureteral calculi—and helps rule out other serious conditions like diverticulitis or pelvic masses.

Depending on stone size, location, and patient factors, treatment options may include:

• Extracorporeal shock wave lithotripsy (ESWL) for stones under 10 mm in the distal ureter
• Ureteroscopy with laser lithotripsy for larger or impacted stones
• Medical expulsive therapy (MET) using alpha-blockers like tamsulosin to relax ureteral smooth muscle and support natural passage

Don't Overlook the Obvious—Rule Out True Constipation Too

While neurogenic tenesmus is common with lower ureteral stones, true fecal impaction—especially near the anal verge—can mimic identical symptoms. This is particularly relevant in older adults, individuals with chronic constipation, or those on opioid medications. If digital rectal exam or abdominal imaging reveals significant stool burden, coordinated care with a gastroenterologist or colorectal surgeon may be warranted.

Bottom line: Persistent "I need to poop but can't" sensations paired with urinary symptoms should raise immediate suspicion of a distal ureteral stone. Early diagnosis and targeted intervention not only relieve discomfort but also prevent complications like hydronephrosis, infection, or permanent kidney damage.