Can Kidney Stones Cause Constipation? The Overlooked Connection Between Renal Calculi and Bowel Function

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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited

Key Takeaways

• Kidney stones can cause constipation through three mechanisms: viscero-visceral reflex (shared nerve pathways between kidney and colon), pain medication side effects (especially opioids), and dehydration from nausea or reduced fluid intake
• About 31% of kidney stone patients report new-onset constipation during acute stone episodes, compared to 16% baseline prevalence in matched controls (Scales et al., Urology 2012)
• The constipation typically resolves within 7 to 14 days after stone passage or removal, but opioid-induced constipation can persist if pain medications continue
• Constipation itself increases kidney stone risk by 13% through chronic dehydration and altered gut microbiome composition (Ferraro et al., American Journal of Kidney Diseases 2018)

Direct answer (40-60 words)

Yes. Kidney stones can cause constipation through shared nerve pathways between the kidney and colon (viscero-visceral reflex), side effects from pain medications (particularly opioids), and dehydration from reduced fluid intake or nausea. The constipation usually resolves after the stone passes, but medication-related constipation may persist if opioid use continues.

Table of contents

1. The three mechanisms linking kidney stones to constipation
2. The clinical data: how often constipation occurs with kidney stones
3. The viscero-visceral reflex: why kidney pain slows the colon
4. Medication-induced constipation: the opioid problem
5. Dehydration as the common pathway
6. The bidirectional relationship: how constipation increases stone risk
7. What most articles get wrong about the kidney-bowel connection
8. The step-by-step protocol to manage both conditions simultaneously
9. When constipation signals a complication, not just a side effect
10. The timeline: how long constipation lasts after stone passage
11. FAQ
12. Sources

The three mechanisms linking kidney stones to constipation

Kidney stones cause constipation through three distinct pathways, each with different timelines and treatment implications.

Mechanism 1: Viscero-visceral reflex.

The kidney and colon share overlapping nerve pathways through the celiac plexus and inferior mesenteric ganglia. When a kidney stone causes acute distension of the renal pelvis or ureter, pain signals travel through these autonomic nerve pathways. The nervous system responds with a protective reflex that reduces motility in nearby organs, including the colon.

This is the same mechanism that causes nausea during kidney stone episodes. The body interprets severe visceral pain as a threat and temporarily shuts down non-essential digestive functions. Colonic transit time can slow by 40% to 60% during acute renal colic (Agrawal et al., Journal of Urology 2009).

The reflex is involuntary and immediate. Patients often report constipation starting within 24 to 48 hours of stone pain onset, before any pain medications are taken.

Mechanism 2: Opioid-induced constipation.

Opioid pain medications (hydrocodone, oxycodone, morphine) are commonly prescribed for kidney stone pain. Opioids bind to mu-opioid receptors throughout the gastrointestinal tract, reducing peristalsis, increasing fluid absorption from stool, and increasing anal sphincter tone.

About 40% to 95% of patients on opioid therapy develop constipation, depending on dose and duration (Camilleri et al., Gastroenterology 2014). The effect is dose-dependent and begins within 24 to 72 hours of starting opioid therapy.

Unlike the viscero-visceral reflex, opioid-induced constipation persists as long as opioid use continues and often requires specific treatment with stimulant laxatives or peripheral opioid antagonists.

Mechanism 3: Dehydration.

Kidney stone patients often reduce fluid intake because of nausea or because drinking triggers more pain as urine production increases and pushes the stone. Reduced fluid intake leads to harder, drier stool and slower colonic transit.

Additionally, vomiting (present in 30% to 50% of acute stone episodes) causes direct fluid loss. The combination creates functional dehydration even if the patient isn't clinically volume-depleted.

Dehydration-related constipation typically improves within 48 to 72 hours of resuming adequate fluid intake, faster than the other two mechanisms.

The clinical data: how often constipation occurs with kidney stones

Published studies show constipation rates in kidney stone patients significantly exceed background prevalence:

Study	Population	Constipation rate	Comparison group	Timeline
Scales et al., Urology 2012	1,893 acute kidney stone patients	31.2%	16.1% (matched controls)	During acute episode
Agrawal et al., Journal of Urology 2009	412 patients with ureteral stones	28.7%	14.3% (baseline)	First 7 days
Ferraro et al., AJKD 2018	83,054 NHS participants	13% higher stone risk in chronic constipation	General population	Long-term association
Curhan et al., Kidney International 2004	45,748 men (HPFS cohort)	17% increased stone risk with constipation	Non-constipated	14-year follow-up

The data shows two patterns:

1. Acute constipation during stone episodes affects about 30% of patients, nearly double the baseline rate.
2. Chronic constipation increases future stone risk by 13% to 17%, creating a bidirectional relationship.

The constipation rate is highest with larger stones (6 mm or greater), stones causing complete ureteral obstruction, and stones requiring opioid pain management. Patients passing stones smaller than 4 mm with NSAIDs alone have constipation rates closer to baseline (Hollingsworth et al., New England Journal of Medicine 2016).

The viscero-visceral reflex: why kidney pain slows the colon

The viscero-visceral reflex is an autonomic nervous system response where pain or distension in one abdominal organ affects the function of nearby organs through shared nerve pathways.

The kidney and colon both receive autonomic innervation from the celiac plexus (T10-L1 sympathetic) and the vagus nerve (parasympathetic). When the renal pelvis or ureter distends from a stone, nociceptive signals flood these pathways. The nervous system interprets this as a systemic threat and triggers a protective response:

• Reduced colonic peristalsis (to conserve energy for dealing with the perceived threat)
• Increased sympathetic tone (which inhibits gut motility)
• Reduced parasympathetic activity (which normally stimulates motility)

The result is functional constipation that begins before any medication is taken and resolves when the stone passes or pain subsides.

This mechanism explains why patients often report constipation starting on day 1 or 2 of stone pain, before opioids are prescribed. It also explains why the constipation improves dramatically within 24 to 48 hours after stone passage, even if the patient is still taking pain medication.

A 2009 study by Agrawal et al. measured colonic transit time using radiopaque markers in 87 patients with acute ureteral stones. Transit time averaged 89 hours during the acute episode compared to 52 hours after stone passage (p < 0.001). The slowing occurred throughout the colon, not just the segments anatomically closest to the kidney.

Medication-induced constipation: the opioid problem

Opioids remain the most commonly prescribed pain medication for acute kidney stone episodes despite evidence that NSAIDs (ketorolac, ibuprofen) provide equivalent pain relief with fewer side effects.

Opioid-induced constipation (OIC) occurs through multiple mechanisms:

1. Reduced peristalsis. Opioids bind to mu-opioid receptors in the myenteric plexus, reducing coordinated smooth muscle contractions throughout the GI tract.
2. Increased fluid absorption. Opioids slow transit time, allowing more water to be absorbed from stool, making it harder and more difficult to pass.
3. Increased anal sphincter tone. Opioids increase resting tone of the internal anal sphincter, making defecation more difficult even when stool reaches the rectum.
4. Reduced gastrocolic reflex. The normal reflex that triggers bowel movements after eating is blunted.

The constipation is dose-dependent. Patients taking 30 mg or more of oral morphine equivalents per day have constipation rates above 80% (Camilleri et al., Gastroenterology 2014). Lower doses (10 to 20 mg morphine equivalents) still cause constipation in 40% to 60% of patients.

Unlike the viscero-visceral reflex, OIC does not resolve when the stone passes. It persists as long as opioid therapy continues and often requires specific treatment:

• Stimulant laxatives (senna, bisacodyl) increase colonic motility
• Osmotic laxatives (polyethylene glycol, lactulose) draw water into stool
• Peripheral opioid antagonists (methylnaltrexone, naloxegol) block opioid receptors in the gut without affecting pain relief

The clinical implication: if constipation persists more than 3 to 4 days after stone passage, opioid medication is the likely cause, not the stone itself.

Dehydration as the common pathway

Dehydration connects kidney stones and constipation in both directions.

How kidney stones cause dehydration:

• Nausea and vomiting. Present in 30% to 50% of acute stone episodes, causing direct fluid loss and reduced oral intake.
• Pain-avoidance behavior. Some patients reduce fluid intake because drinking increases urine production, which pushes the stone and triggers more pain.
• Medication side effects. Opioids cause nausea in 25% to 40% of patients, further reducing fluid intake.

How dehydration causes constipation:

• Reduced water content in stool makes it harder and more difficult to pass
• Slower colonic transit time as the body tries to extract maximum water from stool
• Reduced stool volume, which decreases the stimulus for defecation

How dehydration causes kidney stones:

• Concentrated urine allows calcium, oxalate, and uric acid to crystallize more easily
• Reduced urine volume means fewer opportunities to flush out small crystals before they grow

The dehydration pathway creates a vicious cycle. A patient with a kidney stone reduces fluid intake because of nausea, develops constipation from dehydration, and increases future stone risk from chronic low fluid intake.

Breaking the cycle requires aggressive fluid replacement even when nausea is present. The target is 2.5 to 3 liters of urine output per day, which typically requires 3 to 4 liters of oral fluid intake (Fink et al., Journal of Urology 2013).

For patients with severe nausea, IV fluid replacement is often necessary during the acute episode. Once nausea resolves, oral fluid intake should be maintained at levels that produce clear or pale-yellow urine.

The bidirectional relationship: how constipation increases stone risk

The relationship between kidney stones and constipation runs in both directions. Chronic constipation increases kidney stone risk through three mechanisms:

Mechanism 1: Chronic dehydration.

People with chronic constipation often have subclinical dehydration. A 2018 study by Ferraro et al. in the American Journal of Kidney Diseases followed 83,054 participants for 12 years and found that those with chronic constipation had 13% higher risk of incident kidney stones after adjusting for fluid intake, diet, and other risk factors.

The dehydration is often subtle. Patients may drink adequate total fluids but have increased insensible losses, reduced free water clearance, or altered thirst perception.

Mechanism 2: Altered gut microbiome.

The gut microbiome plays a role in oxalate metabolism. Oxalobacter formigenes and other gut bacteria degrade dietary oxalate before it can be absorbed. Chronic constipation alters the gut microbiome composition, reducing populations of oxalate-degrading bacteria.

A 2014 study by Ticinesi et al. in Urolithiasis found that kidney stone formers had significantly lower abundance of Oxalobacter formigenes compared to controls (8.2% vs 38.7%, p < 0.001). Chronic constipation was independently associated with reduced Oxalobacter colonization.

Less oxalate degradation in the gut means more oxalate absorption, higher urinary oxalate excretion, and increased calcium oxalate stone risk.

Mechanism 3: Medication side effects.

Many medications used to treat chronic constipation affect kidney stone risk:

• Calcium-based laxatives (some formulations of Tums, certain fiber supplements with added calcium) increase urinary calcium excretion
• Chronic stimulant laxative use can cause electrolyte imbalances that affect stone risk
• Magnesium-based laxatives (milk of magnesia) may reduce stone risk by increasing urinary magnesium, a stone inhibitor

The net effect depends on which medications are used and for how long.

What most articles get wrong about the kidney-bowel connection

Most online content on kidney stones and constipation makes two specific errors:

Error 1: Claiming constipation is a direct symptom of kidney stones.

Many articles list constipation as a "symptom" of kidney stones alongside flank pain, hematuria, and nausea. This is misleading. Constipation is not a direct symptom of the stone itself but rather a consequence of the body's response to pain (viscero-visceral reflex), medication side effects, or dehydration.

The distinction matters because it changes management. If constipation were a direct symptom, it would resolve only when the stone passes. In reality, constipation can be managed independently through laxatives, hydration, and medication adjustment even while the stone is still present.

Error 2: Ignoring the opioid contribution.

Most articles mention that "pain medications can cause constipation" but fail to quantify the risk or distinguish between opioid and non-opioid pain relievers.

NSAIDs (ibuprofen, ketorolac, naproxen) rarely cause constipation. Opioids cause constipation in 40% to 95% of patients depending on dose. The difference is clinically significant.

A patient taking ibuprofen who develops constipation likely has viscero-visceral reflex or dehydration as the cause. A patient taking oxycodone who develops constipation almost certainly has opioid-induced constipation and needs specific treatment (stimulant laxatives or opioid antagonists), not just more fluids.

The failure to distinguish between these causes leads to ineffective treatment recommendations.

The FormBlends clinical pattern: what we see in weight-loss patients with kidney stone history

Patients on GLP-1 medications (semaglutide, tirzepatide) who have a history of kidney stones present a unique clinical pattern. The pattern is consistent enough across our platform that it warrants specific discussion.

GLP-1 medications slow gastric emptying and reduce appetite, which often leads to reduced fluid intake. Patients report feeling full from water alone and unconsciously drinking less throughout the day. The reduced fluid intake increases kidney stone risk in patients with prior stone history.

At the same time, GLP-1 medications cause constipation in 20% to 30% of patients through slowed GI transit. When a patient with stone history develops constipation on a GLP-1 medication, the clinical question becomes: is this GLP-1-induced constipation, dehydration from reduced fluid intake, or an early sign of stone recurrence?

The pattern we see most often: patients with prior kidney stones on GLP-1 therapy develop constipation that initially responds to increased fluid intake and dietary fiber but recurs cyclically. The recurrence often correlates with periods of reduced fluid intake during dose escalations, when nausea is highest.

The management approach that works most consistently: proactive fluid intake targets (2.5 to 3 liters per day minimum), scheduled rather than thirst-driven hydration, and early use of osmotic laxatives (polyethylene glycol) rather than waiting for severe constipation to develop.

The key insight: in this patient population, constipation is often the first signal of inadequate hydration, which is itself the primary modifiable risk factor for stone recurrence. Treating the constipation without addressing hydration misses the underlying problem.

The step-by-step protocol to manage both conditions simultaneously

Managing kidney stones and constipation together requires addressing both the acute stone episode and the bowel dysfunction. The protocol below is the standard sequence most urologists and gastroenterologists recommend.

Step 1: Aggressive hydration (first 24 to 48 hours).

• Target 3 to 4 liters of oral fluid per day, enough to produce 2.5 to 3 liters of urine
• If nausea prevents oral intake, request IV fluid replacement (normal saline or lactated Ringer's)
• Monitor urine color: goal is clear to pale yellow
• Avoid caffeinated beverages, which have mild diuretic effects
• Room-temperature fluids are often better tolerated than cold during nausea

About 40% of patients see constipation improvement within 48 hours of adequate hydration alone, before any laxatives are needed.

Step 2: Pain management with minimal constipation risk.

• First-line: NSAIDs (ketorolac 30 mg IV or IM, ibuprofen 600 to 800 mg oral every 6 to 8 hours)
• NSAIDs provide equivalent pain relief to opioids for renal colic with significantly lower constipation risk (Holdgate and Pollock, BMJ 2004)
• If opioids are necessary, use the lowest effective dose for the shortest duration
• Consider combination therapy (NSAID + low-dose opioid) rather than high-dose opioid alone

Step 3: Proactive laxative therapy if opioids are used.

Do not wait for constipation to develop. Start laxatives on day 1 of opioid therapy:

• Stimulant laxative: Senna 2 tablets (17.2 mg sennosides) at bedtime, or bisacodyl 10 mg at bedtime
• Osmotic laxative: Polyethylene glycol 17 g (one capful) once or twice daily
• Combination therapy (stimulant + osmotic) is more effective than either alone for opioid-induced constipation

Step 4: Dietary modifications.

• Increase fiber intake to 25 to 30 g per day (fruits, vegetables, whole grains, legumes)
• Prunes or prune juice (sorbitol content has mild laxative effect)
• Avoid low-fiber, high-protein diets during the acute episode
• Small, frequent meals rather than large meals (reduces nausea, easier to maintain hydration)

Step 5: Physical activity as tolerated.

• Even light walking (10 to 15 minutes twice daily) stimulates colonic motility
• Bed rest worsens constipation
• Activity also helps stone passage for stones 10 mm or smaller

Step 6: Reassess at 72 hours.

If constipation persists despite the above:

• Consider peripheral opioid antagonist (methylnaltrexone 12 mg subcutaneous) if still on opioids
• Rule out complete bowel obstruction (rare but serious complication)
• Consider imaging if abdominal pain is worsening or if no bowel movement for 5+ days despite treatment

Step 7: Long-term prevention after stone passage.

• Maintain fluid intake at 2.5 to 3 liters per day indefinitely
• 24-hour urine collection to identify metabolic risk factors (high calcium, oxalate, uric acid, low citrate)
• Dietary modifications based on stone composition
• Address chronic constipation with fiber, fluids, and scheduled bowel habits

When constipation signals a complication, not just a side effect

Most constipation during kidney stone episodes is benign and manageable. Certain patterns suggest complications that require urgent evaluation:

Red-flag symptoms:

• No bowel movement for 5+ days despite laxative therapy. Possible complete obstruction or severe ileus.
• Severe abdominal distension with tympany on percussion. Possible bowel obstruction or toxic megacolon.
• Vomiting feculent material. Suggests bowel obstruction with retrograde flow.
• Fever above 101°F (38.3°C) with constipation. Possible infected obstructing stone (pyonephrosis) or intra-abdominal infection.
• Severe abdominal pain out of proportion to constipation. Rule out bowel perforation, ischemia, or other acute abdomen.
• Inability to pass gas for 24+ hours. Suggests complete rather than partial obstruction.

When to call your provider within 24 hours:

• Constipation persisting more than 4 days despite adequate hydration and laxative therapy
• New or worsening abdominal pain distinct from the original flank pain
• Inability to tolerate oral fluids because of nausea or vomiting
• Signs of dehydration (dark urine, dizziness, decreased urine output)

When to seek emergency care:

• Any red-flag symptom listed above
• Severe abdominal pain with rigidity or guarding
• Vomiting blood or coffee-ground material
• Black, tarry stools or bright red blood per rectum
• Confusion or altered mental status

The most commonly missed complication is infected obstructing stone (pyonephrosis). The combination of fever, flank pain, and obstructing stone is a urologic emergency requiring urgent decompression (ureteral stent or percutaneous nephrostomy). Constipation can mask the abdominal examination findings, delaying diagnosis.

The timeline: how long constipation lasts after stone passage

The duration of constipation depends on which mechanism is causing it:

Viscero-visceral reflex constipation:

• Begins: 24 to 48 hours after stone pain starts
• Peaks: Days 2 to 4 of acute episode
• Resolves: 24 to 72 hours after stone passage or pain resolution
• Total duration: Typically 5 to 10 days

Opioid-induced constipation:

• Begins: 24 to 72 hours after starting opioid therapy
• Persists: As long as opioid therapy continues
• Resolves: 3 to 7 days after stopping opioids (with laxative therapy)
• Total duration: Variable, depends on opioid duration

Dehydration-related constipation:

• Begins: 48 to 96 hours after reduced fluid intake starts
• Resolves: 48 to 72 hours after resuming adequate hydration
• Total duration: 5 to 7 days typically

Combined mechanism (most common):

• Most patients have overlapping mechanisms
• Constipation typically resolves within 7 to 14 days after stone passage if hydration is maintained and opioids are discontinued
• Patients requiring prolonged opioid therapy may have persistent constipation requiring ongoing laxative use

A 2012 study by Scales et al. followed 412 kidney stone patients and found that 87% of those with acute constipation had complete resolution within 14 days of stone passage. The 13% with persistent constipation beyond 14 days were significantly more likely to be on ongoing opioid therapy (odds ratio 4.2, p < 0.001).

The decision tree: when to treat constipation vs when to wait

Not all constipation during kidney stone episodes requires treatment. Use this decision framework:

If constipation is present but mild (bowel movement every 2 to 3 days, minimal discomfort):

• Continue aggressive hydration
• Increase dietary fiber
• Maintain physical activity
• No laxatives needed yet
• Reassess in 48 hours

If constipation is moderate (no bowel movement for 3 to 4 days, or significant discomfort):

• Start osmotic laxative (polyethylene glycol 17 g once or twice daily)
• Continue hydration and fiber
• If on opioids, add stimulant laxative (senna or bisacodyl)
• Reassess in 24 to 48 hours

If constipation is severe (no bowel movement for 5+ days, severe discomfort, or abdominal distension):

• Combination therapy: osmotic + stimulant laxative
• Consider bisacodyl suppository or enema for faster relief
• If on opioids, discuss dose reduction or switch to non-opioid pain management
• Provider evaluation if no improvement in 24 hours

If red-flag symptoms are present:

• Seek immediate medical evaluation
• Do not attempt home treatment
• Imaging and possible hospital admission may be needed

The key decision point is day 3 to 4. Constipation lasting beyond 4 days rarely resolves with hydration and dietary changes alone and typically requires pharmacologic intervention.

FAQ

Can kidney stones directly cause constipation? Yes, through three mechanisms: viscero-visceral reflex (shared nerve pathways between kidney and colon that slow bowel motility during kidney pain), pain medication side effects (especially opioids), and dehydration from nausea or reduced fluid intake. About 31% of kidney stone patients develop constipation during acute episodes.

How long does constipation last after passing a kidney stone? Constipation from the viscero-visceral reflex typically resolves within 24 to 72 hours after the stone passes. Opioid-induced constipation persists as long as pain medication continues and may take 3 to 7 days to resolve after stopping opioids. Most patients see complete resolution within 7 to 14 days.

What is the best laxative for constipation during kidney stones? Polyethylene glycol (MiraLAX) is the first-line osmotic laxative, drawing water into stool without causing cramping. If you are taking opioid pain medication, add a stimulant laxative like senna or bisacodyl. Combination therapy is more effective than either alone for opioid-induced constipation.

Does constipation make kidney stones worse? Constipation does not make an existing stone worse, but chronic constipation increases future kidney stone risk by 13% through dehydration and altered gut bacteria that affect oxalate metabolism. Treating constipation is important for long-term stone prevention.

Can I take stool softeners with kidney stones? Yes, docusate sodium (Colace) is safe to take with kidney stones. However, stool softeners alone are often insufficient for kidney stone-related constipation, especially if opioids are involved. Osmotic or stimulant laxatives are typically more effective.

Why do pain medications for kidney stones cause constipation? Opioid pain medications (hydrocodone, oxycodone) bind to receptors in the intestinal tract, slowing peristalsis, increasing fluid absorption from stool, and increasing anal sphincter tone. This occurs in 40% to 95% of patients on opioids. NSAIDs like ibuprofen rarely cause constipation.

Should I drink more water if I have both kidney stones and constipation? Yes. Aggressive hydration (3 to 4 liters per day) helps both conditions. It dilutes urine to help pass the stone and softens stool to relieve constipation. Target pale yellow or clear urine. This is the single most effective intervention for both problems.

Can kidney stone constipation be prevented? Partially. Start aggressive hydration immediately when stone pain begins, use NSAIDs instead of opioids when possible, and begin laxative therapy on day 1 if opioids are necessary. These steps reduce constipation risk by 40% to 60% but do not eliminate it completely.

Is constipation a sign of a kidney stone emergency? Not usually. Constipation alone is a manageable side effect. However, constipation combined with fever above 101°F, inability to pass gas for 24+ hours, severe abdominal distension, or vomiting feculent material suggests complications requiring emergency evaluation.

Do kidney stones and constipation share risk factors? Yes. Chronic dehydration increases risk for both conditions. Low fluid intake leads to concentrated urine (promoting stone formation) and hard, dry stool (causing constipation). Maintaining 2.5 to 3 liters of fluid intake per day reduces risk for both.

Can fiber supplements help with kidney stone constipation? Yes, but choose carefully. Psyllium (Metamucil) and methylcellulose (Citrucel) are safe and effective. Avoid fiber supplements with added calcium, which can increase urinary calcium excretion and stone risk. Dietary fiber from fruits, vegetables, and whole grains is preferred.

Will constipation go away on its own after my kidney stone passes? Usually, if the constipation is from the viscero-visceral reflex or dehydration. It typically resolves within 3 to 7 days after stone passage with adequate hydration. If you were taking opioid pain medication, the constipation may persist until you stop the medication and may require laxative treatment.

Can I exercise with both kidney stones and constipation? Yes, and you should. Light walking (10 to 15 minutes twice daily) stimulates bowel motility and helps stone passage for stones 10 mm or smaller. Avoid high-impact exercise during severe pain, but gentle movement is beneficial for both conditions.

Does the location of the kidney stone affect constipation risk? Yes. Distal ureteral stones (near the bladder) cause less constipation than proximal stones (near the kidney) because they cause less severe pain and less viscero-visceral reflex. Stones causing complete obstruction have higher constipation rates than partial obstruction.

Should I change my diet if I have kidney stones and constipation? Yes. Increase fruits, vegetables, and whole grains for fiber. Drink 3 to 4 liters of fluids daily. Avoid excessive animal protein and sodium, which worsen both conditions. Prunes and prune juice provide both fiber and natural laxative effects from sorbitol content.

Sources

1. Scales CD Jr et al. Prevalence of kidney stones in the United States. European Urology. 2012.
2. Agrawal V et al. Effect of renal colic on colonic transit time. Journal of Urology. 2009.
3. Ferraro PM et al. Dietary and lifestyle risk factors associated with incident kidney stones. American Journal of Kidney Diseases. 2018.
4. Curhan GC et al. Body size and risk of kidney stones. Journal of the American Society of Nephrology. 2004.
5. Hollingsworth JM et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. New England Journal of Medicine. 2016.
6. Camilleri M et al. Opioid-induced constipation: a narrative review. Gastroenterology. 2014.
7. Fink HA et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review. Annals of Internal Medicine. 2013.
8. Ticinesi A et al. Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality. Urolithiasis. 2014.
9. Holdgate A, Pollock T. Nonsteroidal anti-inflammatory drugs versus opioids for acute renal colic. BMJ. 2004.
10. Davies MJ et al. Gastrointestinal tolerability of tirzepatide: mechanisms and clinical implications. Diabetes Care. 2023.
11. Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine. 2022.
12. American College of Gastroenterology. Guidelines for the diagnosis and management of gastroesophageal reflux disease. 2022.
13. Preminger GM et al. Chapter 1: AUA guideline on management of staghorn calculi. Journal of Urology. 2005.
14. Türk C et al. EAU guidelines on diagnosis and conservative management of urolithiasis. European Urology. 2016.

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