Is It Normal to Have Back Pain After Kidney Removal?

Back pain after kidney removal is one of the most commonly reported postoperative complaints, and in the vast majority of cases it is entirely normal. The pain stems from a combination of factors, including the surgical incision itself, the awkward body position maintained during the operation, and the disruption of muscles and nerves in the flank and lower back. How long it lasts and how intense it feels depends on the type of surgery performed, your general health going in, and a few psychological factors that are easy to overlook. Most people see meaningful improvement within the first few weeks, though a smaller percentage develop pain that lingers for months or longer.

Why Kidney Surgery Causes Back Pain in the First Place

During a nephrectomy, you are typically placed in what surgeons call the “kidney position,” lying on your side with your body bent over a raised portion of the operating table. This hyperextended posture opens up the space around the kidney so the surgical team can reach it, but it also stretches muscles, compresses soft tissue, and puts strain on the spine and shoulder on the opposite side of the body. A pilot study on patients undergoing kidney surgeries found that this positioning is directly linked to postoperative low back pain and contralateral shoulder pain, and that patients who practiced the position before surgery reported significantly less back pain during the first three days of recovery compared to those who did not.¹ The wound itself also contributes, but the study found no significant difference in wound pain between the two groups. In other words, the back pain you feel after surgery is often not coming from where they cut; it is coming from how your body was held for hours on the table.

Beyond positioning, the surgery itself can injure the intercostal nerves that run between your ribs and through your flank muscles. Open nephrectomy requires a large incision through layered abdominal and flank muscles, and retractors hold those muscles apart for an extended period. This mechanical stress can damage the nerves that supply sensation and motor control to the area, leading to pain, numbness, or a feeling of weakness in the flank and lower back that may persist well beyond the initial healing period.²

Open Surgery Versus Laparoscopic Surgery

The type of surgical approach has a major influence on how much pain you experience afterward and how quickly it resolves. Open nephrectomy involves a large flank incision, sometimes including partial rib resection, and the recovery is more painful and prolonged. Laparoscopic nephrectomy uses several small incisions and a camera, which means less muscle disruption and generally a faster return to normal activity. A randomized trial comparing the two approaches in living kidney donors found that at one month after surgery, significantly fewer donors in the laparoscopic group reported pain or had used painkillers.³

A prospective trial comparing the two approaches confirmed that the highest pain scores in both groups occurred within the first hour after surgery. At two months, chronic pain had developed in about 16% of open nephrectomy patients and about 11% of laparoscopic patients. By six months, those numbers dropped to roughly 4% in each group, with no statistically significant difference between them.⁴ So while laparoscopic surgery gives you a head start on recovery, the long-term chronic pain rates converge. The surgical approach matters most in the first weeks and months; after half a year, your odds of lingering pain are similar regardless of technique.

What Chronic Pain Looks Like After Nephrectomy

Most post-nephrectomy pain resolves within a few weeks to a couple of months. But for a meaningful minority, the pain doesn’t fully go away. Researchers studying 512 living kidney donors found that about 6% reported chronic pain related to their nephrectomy, with the highest rate of around 12% occurring in those who were between three and 24 months out from surgery. The pain was most frequently felt in the flank on the side of surgery, followed by the groin and the lower abdomen.⁵

Another study of 333 living kidney donors painted a somewhat more striking picture. At a median of about 19 months after surgery, roughly a quarter of donors reported some degree of ongoing symptoms, and a third reported at least some pain when assessed with a simple pain scale. Complaints came up most often during bending over and exercising, suggesting that the pain is frequently tied to physical exertion and core movement rather than being constant.⁶ The discrepancy between the roughly 6% and the roughly 25% in these two studies likely reflects differences in how pain was measured and what threshold was used to call it “chronic.” The takeaway is that some degree of lingering discomfort, especially with movement, is not uncommon, even if severe, constant pain is relatively rare.

The Flank Bulge Problem

One source of ongoing back and flank discomfort that often catches people off guard is the flank bulge. When an open flank incision is used, the muscles and nerves of the abdominal wall can be permanently weakened. A study of 70 patients who had a radical nephrectomy through a flank incision found that nearly half developed a persistent flank bulge more than a year after surgery. About a quarter experienced durable flank pain, though only around 3% described it as severe.⁷ This isn’t always a true hernia where tissue pushes through a gap in the muscle wall. More often it is a “pseudo-hernia” caused by muscle weakness and denervation, which means the wall is intact but has lost enough tone to visibly bulge outward.

A separate study examining patients after open partial nephrectomy found that about 31% reported abdominal wall abnormalities, and 18% reported ongoing pain. Pain and stiffness were significantly more common in the group that developed abdominal wall changes compared to those who did not.⁸ If your back pain seems to accompany a visible change in the shape of your flank, that connection is well documented and worth discussing with your surgeon. The good news is that the pain associated with flank bulge tends to be manageable, though it rarely resolves entirely on its own.

Risk Factors That Predict More Pain

Not everyone experiences the same recovery, and some people are at higher risk for developing chronic pain after nephrectomy. A study that followed patients after kidney removal for both benign and malignant disease found that chronic pain occurred in about 29% of patients at three months and about 9% at six months. The factors that predicted chronic pain at three months included higher preoperative anxiety scores, lower physical quality-of-life scores going into surgery, having multiple other health conditions, and reporting more intense pain during the first postoperative week.⁹

The finding about anxiety is worth sitting with. It does not mean the pain is “in your head.” What it means is that the nervous system processes pain differently when it is already in a heightened state. People who are anxious before surgery tend to have a stronger pain response afterward, and that early intense pain itself is a risk factor for the pain becoming chronic. If you know you are a worrier, talking to your medical team about anxiety management before surgery might genuinely reduce your odds of difficult pain later.

When Back Pain After Nephrectomy Is Not Normal

While most post-surgical back pain is part of a routine recovery, certain patterns warrant urgent attention. One rare but serious complication is rhabdomyolysis, a breakdown of muscle tissue that can be triggered by prolonged compression during surgery. Case reports describe patients who developed redness and firmness of the skin over the muscle bed on the side they were lying on, accompanied by lower back or lower extremity pain. These findings together should raise suspicion for rhabdomyolysis, which can lead to kidney injury if not treated promptly.¹⁰ You would typically notice dark or cola-colored urine along with unusually severe pain in the back or legs, and this combination is a signal to seek immediate medical care.

Other warning signs that your back pain could signal a complication rather than normal healing include:

Fever: a temperature above 101°F along with increasing pain could indicate infection at the surgical site or deeper in the abdomen.
Sudden worsening: pain that had been improving and then sharply intensifies might point to a bleed or fluid collection such as a retroperitoneal hematoma.
New neurological symptoms: numbness spreading down a leg, difficulty with bladder control, or weakness that goes beyond the expected flank area suggests nerve involvement that may need evaluation.
Visible swelling or redness: firmness and skin color changes over the muscles of the back or flank, as seen in rhabdomyolysis cases, are not typical surgical inflammation.

Retroperitoneal hematomas themselves can sometimes cause unusual cascading problems. A case report documented a large hematoma after nephrectomy that was associated with subsequent duodenal ulceration and significant bleeding, possibly from chemical irritation as the hematoma was being absorbed by the body.¹¹ These are rare complications, but they underscore the point that pain which follows an unexpected trajectory deserves investigation rather than reassurance alone.

Living Donors and the Unique Psychology of Recovery

If you donated a kidney, the emotional dimension of recovery is different from someone who had a nephrectomy for cancer or other disease. You went into surgery healthy, and any lasting pain or physical limitation represents a net loss from your baseline that you agreed to take on for someone else. A study tracking quality of life in living donors found that two-thirds had lower health scores after donation compared to before, with musculoskeletal pain being one of the comorbidities contributing to the decline.¹² This doesn’t mean donation ruined their health; many of those declines may reflect aging and other unrelated factors over time. But it does mean that living donors should expect a realistic adjustment period and not feel that something is wrong simply because their body doesn’t feel exactly the same as it did before.

Fear of movement after kidney-related surgery is a recognized barrier to physical recovery. Research on renal transplant recipients, who share some of the same surgical and psychological landscape as donors, found that fear of movement was strongly associated with lower physical activity levels. Most of that relationship was explained by low physical self-efficacy, essentially not believing your body can handle the activity.¹³ For donors and nephrectomy patients alike, this creates a cycle: you feel pain, so you move less; moving less weakens the muscles that support your back; weaker muscles produce more pain when you finally do move, which reinforces the fear. Gradual, guided return to activity, ideally with some reassurance from your surgical team that movement won’t damage anything, is one of the most effective ways to break this pattern.

What Actually Helps With Recovery

Pain management after nephrectomy typically involves a combination of medications, starting with stronger options in the hospital and tapering to over-the-counter analgesics as the weeks pass. But the non-pharmacological side of recovery matters just as much, especially for the musculoskeletal back pain that comes from positioning and muscle disruption rather than from the incision itself.

Gentle movement is the single most consistently recommended strategy for reducing post-surgical back pain. Walking short distances starting on the first or second day after surgery helps restore circulation, prevents muscle stiffness, and counters the deconditioning that sets in fast when you are confined to bed. As recovery progresses over weeks, core-strengthening exercises become relevant because the muscles of the flank and abdominal wall need to be rebuilt after being cut, retracted, or denervated during surgery. This is especially true for people who had open surgery and may be at risk for the flank bulge described above.

The preoperative positioning practice mentioned earlier is a genuinely interesting finding that has practical implications. If you know you are scheduled for kidney surgery and your hospital offers any kind of preoperative rehabilitation program, the evidence suggests that even familiarizing your body with the surgical position beforehand may reduce the intensity of back pain in the days immediately following the operation.¹ It is a small, low-risk intervention that addresses a source of pain most patients never think about until they wake up from anesthesia wondering why their opposite shoulder hurts.

How Long Should You Expect Pain to Last

Setting realistic expectations is one of the most useful things you can do for your own recovery. Based on the evidence, here is a rough timeline for most people:

First few days: pain is at its worst, concentrated around the surgical site but also commonly felt in the lower back and opposite shoulder. Managed with prescription pain medication in the hospital.
First two to four weeks: pain gradually decreases. You transition to lighter medications. Laparoscopic patients tend to feel significantly better by this point than open-surgery patients.
One to three months: most people have returned to normal daily activities. Some ongoing stiffness or discomfort with certain movements is common. Roughly 10 to 16% of patients may still have some pain at the two-month mark.
Three to six months: the window where chronic pain either establishes itself or resolves. If you still have pain at three months, the odds are it will improve by six months, when chronic pain rates drop to single digits in most studies.
Beyond six months: a small percentage, roughly 4 to 9%, continue to experience some level of chronic pain. This is more likely to be activity-related than constant.

These numbers come from studies with different surgical techniques and patient populations, so treat them as a general map rather than a personal prediction. Your own recovery depends on factors like the type of surgery, whether there were complications, your fitness level going in, and how aggressively you pursue physical rehabilitation afterward. The overarching pattern, though, is consistent: sharp improvement in the first month, continued improvement over several months, and a small tail of people who deal with some degree of lasting discomfort, usually manageable and usually provoked by specific activities rather than present all the time.