Do Ureteral Stents Hurt? Managing Stent Discomfort

Ureteral stents cause noticeable discomfort in the majority of people who receive them, with symptoms affecting over 80% of patients according to multiple studies.¹ The pain ranges widely from mild annoyance to severe disruption of daily life, and the specific mix of symptoms varies from person to person. The good news is that several medications, stent design choices, and self-care strategies can meaningfully reduce stent-related suffering, and the discomfort resolves once the stent comes out.

What Stent Discomfort Actually Feels Like

Stent-related symptoms are not just “pain” in the way you might think of it after surgery. The discomfort is usually a combination of urinary irritation and actual body pain, and many patients find the urinary symptoms more bothersome than the pain itself. Common complaints include needing to urinate frequently and urgently, a burning sensation during urination, a persistent feeling of incomplete bladder emptying, and flank or lower abdominal pain that can flare with physical activity or urination.¹ Some people also experience blood in the urine, which looks alarming but is usually harmless, and episodes of incontinence.

Researchers developed a standardized questionnaire (the USSQ) specifically because stent symptoms are so varied and affect so many dimensions of life. It covers urinary symptoms, pain, general health, work performance, sexual matters, and additional problems, and it has consistently shown that patients with stents in place score significantly worse across all these domains compared to both healthy people and patients with kidney stones who don’t have stents.² The pattern that emerges from this research is that stent discomfort is real, common, and multi-faceted. It is not something patients are imagining or exaggerating.

Why Stents Cause Pain

The exact mechanism behind stent discomfort is still not fully pinned down, but the leading explanation centers on two things: the lower curl of the stent irritating the bladder wall, and urine refluxing backward through the stent up toward the kidney. The stent’s coiled end sits inside the bladder, where it rubs against sensitive tissue every time the bladder contracts or fills. That mechanical irritation is likely responsible for much of the urgency, frequency, and burning that patients experience.³ Meanwhile, the hollow tube of the stent allows urine to flow upward when bladder pressure rises, transmitting that pressure to the kidney and causing flank pain. This reflux phenomenon helps explain why stent pain often spikes during urination or straining.

The positioning of the bladder coil matters too. When the stent is too long and its lower curl crosses the midline of the bladder to the opposite side, patients tend to report worse urinary symptoms.⁴ Stents that are too long can also cause more irritation as they shift around with body movement. Getting the length right is genuinely important: too long worsens symptoms, and too short raises the risk of the stent migrating out of position.⁵

Who Suffers More and Why

Not everyone experiences stent discomfort equally, and the factors that predict worse symptoms are not always the ones you would expect. A large study from the Ureteral Stent Discomfort Research Network found that older patients actually reported less pain, while people with pre-existing chronic pain conditions, a history of severe stent pain from prior procedures, and depressive symptoms at baseline all experienced significantly worse stent-related pain.⁶ The study found that sex, stone location, the use of a ureteral access sheath during surgery, and stent characteristics did not independently drive pain intensity. Separately, another prospective study found that younger patients and women tended to be more affected by stent symptoms overall.⁷

The picture that emerges is that stent discomfort is shaped substantially by individual factors like pain sensitivity, mental health, and prior pain experiences, rather than by purely mechanical variables. If you have dealt with chronic pain or depression, it is worth flagging this for your urologist before stent placement so your pain management plan can be adjusted accordingly.

Medications That Help

The most-studied medication class for stent discomfort is alpha-blockers, particularly tamsulosin. These drugs relax smooth muscle in the lower urinary tract, and multiple trials have shown they reduce urinary symptoms and the need for painkillers while a stent is in place. One randomized trial found that patients taking tamsulosin had lower urinary symptom scores than those on placebo, along with reduced pain scores, fewer hospital visits, and less need for antibiotics.⁸ Another prospective study confirmed a positive effect on both urinary symptoms and quality of life.⁹ The benefit is real but not dramatic: tamsulosin takes the edge off rather than eliminating discomfort entirely.

Medications that target bladder overactivity have also shown promise. Mirabegron, a drug that works by relaxing the bladder muscle through a different pathway than traditional anticholinergics, reduced daytime frequency, nighttime urination, and urgency in a randomized controlled trial of stent patients.¹⁰ A head-to-head comparison found mirabegron outperformed solifenacin (a traditional anticholinergic) for both pain and urinary symptoms, with better tolerability.¹¹ In a prospective study, both tamsulosin and mirabegron reduced painkiller use compared to placebo, though tamsulosin had a stronger effect on urinary symptoms specifically while mirabegron performed similarly on other measures.¹²

Does Combining Drugs Work Better?

The logic seems straightforward: if alpha-blockers help urinary flow and anticholinergics calm bladder spasms, combining them should be even better. The evidence on this is mixed. A meta-analysis pooling results from several trials did find that combining an alpha-blocker with an antimuscarinic produced significantly better symptom scores and quality-of-life ratings than using an alpha-blocker alone.¹³ However, a double-blind randomized trial specifically looking at tamsulosin plus tolterodine found no improvement over tamsulosin alone for urinary symptoms, pain, or quality of life.¹⁴ A study using a different combination (tamsulosin plus solifenacin) did show additional benefit, particularly on the day of stent removal.¹⁵

Combining mirabegron with solifenacin has shown more consistent results. In a prospective study, the combination significantly reduced urgency, frequent urination, and incontinence at both two and four weeks compared to solifenacin alone, while improving quality of life without increasing side effects.¹⁶ The practical takeaway is that combination therapy can help, but the specific drugs paired together seem to matter. Your urologist will typically start with a single medication and add a second only if symptoms remain poorly controlled.

Does Stent Size Make a Difference?

Stents come in different diameters, and two separate meta-analyses have concluded that thinner stents produce fewer symptoms. One review found that larger-diameter stents (6 French) were associated with significantly worse urinary symptoms and higher pain index scores compared to smaller stents, without any tradeoff in effectiveness for their primary purpose.¹⁷ A second meta-analysis confirmed that smaller-diameter stents yielded lower overall symptom scores and fewer urinary complaints, with no significant difference in stent migration rates, pain medication use, or stone-free rates.¹⁸

That said, the relationship between stent properties and symptoms is not perfectly straightforward. A narrative review of stent polymer types found conflicting evidence on whether softer stent materials reduce irritation, with one landmark study finding no differences between materials and another claiming soft stents caused fewer symptoms.¹⁹ The same review noted that even small-diameter stents do not eliminate symptoms entirely. A recent European Association of Urology review cataloged various design modifications, including loop-tail, extraction-string, magnetic-tip, and anti-reflux stents, all introduced to try to improve comfort for specific situations.²⁰ The field is actively searching for the design that minimizes discomfort, but no single innovation has solved the problem yet.

Impact on Daily Life, Work, and Sex

Stent discomfort spills over into virtually every area of life for many patients. In a large study, more than 80% of patients reported stent-related pain that affected daily activities, about 58% reported reduced work capacity with a negative economic impact, and roughly a third reported sexual dysfunction.²¹ In-depth interviews with stent patients revealed a wide spread in impact: some experienced minimal disruption to sleep, mood, exercise, and social activities, while others found their daily lives substantially altered, with most landing somewhere in between.²²

Sexual function is a topic many patients feel uncomfortable asking about, but the data suggests it deserves a direct conversation. A prospective multivariate study found that the vast majority of men reported impaired erectile function while the stent was in place, and nearly a third of women in that study avoided sex entirely due to stent-related anxiety.²³ A separate prospective cohort study found significant declines in sexual function scores for both men and women four weeks after stenting, but most patients recovered to their baseline levels within four weeks of stent removal.²⁴ Interestingly, at least one study found no significant change in erectile function scores with stents in place, suggesting the impact may vary between individuals and is not universal.²⁵ The reassuring consistent finding is that sexual function tends to bounce back after stent removal.

Stent Removal and the String Question

Stent removal is an anxious moment for many patients, and how it is done actually affects the experience. Some stents are placed with an extraction string that hangs out through the urethra, allowing the patient or a healthcare provider to pull the stent out at home without a separate procedure. Others require removal by cystoscopy in a clinic.

Cystoscopic removal tends to produce the highest pain scores during the procedure itself. In one study, the average experienced pain during office cystoscopy removal was 5.3 out of 10, and about a third of patients experienced delayed severe pain afterward, with 9% returning for emergency care.²⁶ String-based removal, by contrast, was associated with significantly less pain in a controlled trial, particularly for men, who experienced less urethral discomfort compared to cystoscopic removal.²⁷

Strings are not without their own drawbacks. A randomized study found that while pain during removal was significantly lower with a string, a higher proportion of string-group patients reported stopping sexual intercourse due to stent-related problems while the string was in place, and some experienced more difficulty with heavy physical activity.²⁸ The string itself can cause irritation, and the awareness of having a thread hanging out of your body is understandably uncomfortable for some people. First-time stent patients who remove their stent at home also appear to make more unplanned calls and emergency visits, possibly because the process is unfamiliar and any discomfort triggers alarm.²⁹

Unplanned ER Visits and When to Worry

A significant number of stent patients end up contacting their doctor or visiting the emergency room due to symptoms. In one cohort, about 20% had at least one unplanned clinical encounter: roughly 13% called the clinic and about 10% returned to the ER.³⁰ Another study found even higher rates, with 28% making unplanned phone calls and about 15% visiting the ER, with pain being the most common reason in both cases.²⁹ First-time stone patients and those who had stents placed as outpatients were more likely to reach out.

Some stent symptoms are normal, even when they feel alarming. Intermittent blood in the urine, especially after physical activity, is common and usually harmless. Urgency and frequency, while miserable, are expected. However, you should contact your doctor promptly if you develop a fever over 101°F (38.3°C), which could signal infection; if you experience complete inability to urinate; if pain becomes severe and unresponsive to prescribed medications; or if you notice the stent string has moved significantly or is no longer visible when it was there before. These situations warrant urgent evaluation rather than waiting for your scheduled follow-up.

Practical Self-Care While Living with a Stent

Beyond medication, a few practical strategies can make stent life more bearable. Staying well hydrated helps dilute the urine, which can reduce the burning sensation during urination. Avoiding caffeine and alcohol, which are bladder irritants, tends to calm urgency and frequency. Many patients find that avoiding strenuous exercise reduces flank pain, though gentle walking and light activity are generally fine and encouraged.

Heat therapy deserves mention. While not studied specifically in stent patients living at home, a randomized trial of patients undergoing cystoscopy found that applying heat reduced both pain and anxiety compared to controls.³¹ A heating pad on the lower back or abdomen is low-risk and many stent patients report it helps during pain flares. Timing pain medication so that it is on board before activities known to trigger symptoms, such as before going to bed (nighttime urgency wakes many stent patients) or before commuting, can also make a real difference.

Why Knowing What to Expect Changes the Experience

One consistent finding across stent research is that patients are often blindsided by how uncomfortable a stent can be. Many go into the procedure having been told “you might have some discomfort” and then find themselves in significant pain, unsure what is normal and what signals a problem. This mismatch between expectations and reality appears to drive a large share of those unplanned ER visits.

A pilot randomized trial tested whether enhanced preoperative education, going beyond the standard consent process to specifically prepare patients for stent-related symptoms, could reduce pain and emergency visits. The intervention group trended toward lower pain scores on the first day after surgery and fewer unplanned ER visits, though the study was too small to reach statistical significance.³² A separate trial using a peer education model delivered through a messaging platform found significant reductions across all symptom dimensions and improved self-management behaviors compared to standard care.³³ The evidence is still early-stage, but the direction is clear: understanding what stent discomfort looks and feels like, knowing which symptoms are normal, and having a plan for managing them appears to meaningfully improve the experience. If your urologist does not walk you through this in detail before your procedure, ask.

How Long the Discomfort Lasts

For most patients, the answer is: as long as the stent is in place, with rapid improvement after removal. In a validation study of the USSQ, symptom scores were substantially higher while the stent was in situ and dropped significantly after removal.³⁴ In that cohort, urinary symptom scores dropped from 29 on the seventh day with the stent to 18 after removal, and no patients reported pain four weeks after the stent came out. Sexual function similarly tends to return to baseline within about a month of removal.²⁴

Stents are typically left in place for one to two weeks after uncomplicated ureteroscopy, though some situations like pregnancy, large stones, or ureteral injury require longer dwell times. The longer a stent stays in, the more encrustation and biofilm can build up on its surface, which tends to worsen symptoms over time and can make removal more difficult. If your scheduled stent removal is approaching and you can tolerate the symptoms, it is almost always better to wait for the planned removal rather than seeking an unscheduled one. But if symptoms become truly unmanageable, your urologist can sometimes remove the stent earlier than planned and substitute alternative drainage or simply monitor you closely.

Emerging Stent Designs Aimed at Comfort

The conventional double-J stent, with its curled ends resembling the letter J in both the kidney and bladder, has been the standard for decades. But its dominance is being challenged by newer designs. Pigtail suture stents, which replace the rigid lower bladder curl with a soft suture loop, were specifically introduced to reduce bladder irritation.³⁵ Anti-reflux stents incorporate a valve mechanism to prevent urine from flowing backward toward the kidney, targeting the reflux component of stent pain. Magnetic-tip stents are designed to make removal easier and less painful by allowing the stent to be retrieved with a magnetic catheter rather than a full cystoscopy.²⁰

None of these designs has become the new universal standard, in part because each addresses only one piece of the discomfort puzzle. The bladder curl causes irritation, but so does reflux, and so does the stent’s mere presence inside the ureter. A stent that fixes the curl problem but does nothing about reflux will still leave some patients uncomfortable. What the breadth of innovation signals, though, is that the urology field takes stent discomfort seriously as a problem worth solving, and the options available to patients are expanding beyond the one-size-fits-all approach of a few years ago.