What should I do if I have severe pain in my right groin that radiates to my back and down my leg, accompanied by a large amount of urine?

Acute Renal Colic: Immediate Management

You need urgent medical assessment within 30 minutes—this presentation is classic for acute renal colic (kidney stone), and you require immediate pain control with intramuscular diclofenac 75 mg as first-line treatment. 1

Immediate Actions Required

Seek Medical Care NOW

• Contact your general practitioner immediately or go to the emergency department if you cannot be seen within 30 minutes 1
• Your symptoms—severe unilateral flank pain radiating from groin to back and down the leg—are the hallmark presentation of acute renal colic and require urgent assessment 1

What to Expect During Assessment

Physical examination priorities:

• Abdominal examination to establish maximal tenderness location and exclude peritonitis 1
• Vital signs assessment (pulse, blood pressure, temperature) to exclude shock and systemic infection 1
• If you have fever or signs of shock, you must be admitted to hospital immediately 1

Urinalysis (if feasible):

• Over 80% of renal colic patients have blood in their urine (hematuria), which supports the diagnosis 1
• However, inability to provide a urine sample should not delay treatment 1

Pain Management Protocol

First-Line Treatment

Intramuscular diclofenac 75 mg is the recommended first-line analgesic 1, 2

• Pain relief should be achieved within 30 minutes 1
• This route is preferred because oral and rectal administration are unreliable in acute severe pain 1

If NSAIDs Are Contraindicated

• Use an opioid combined with an antiemetic (such as morphine sulfate with cyclizine) 1
• Avoid morphine, codeine, or tramadol if you have any kidney problems 2, 3

Critical Decision Point at 1 Hour

If severe pain does not remit within one hour of initial treatment, you must be admitted to hospital immediately 1, 2

• This can be arranged by telephone without requiring another visit 1
• Failure of analgesia indicates need for hospital-based interventions 1

Home Management Instructions (If Pain Controlled)

Immediate Self-Care

• Drink large amounts of fluids 1
• Attempt to void urine through a tea strainer or gauze to catch any stone—this helps confirm diagnosis 1

Follow-Up Requirements

• Your doctor should call you one hour after initial assessment to check pain control 1
• Contact your doctor immediately if pain worsens or new distressing symptoms develop 1

Urgent Investigations Needed

All patients with suspected renal colic require imaging within 7 days 1

• CT scan with contrast is the standard imaging to identify stone location and size 1
• Urgent urology appointment within 14 days if a stone is identified requiring intervention 1

Red Flags Requiring Immediate Hospital Admission

Go to the emergency department immediately if you have:

• Fever or signs of infection 1
• Inability to urinate (anuria) 2
• Signs of shock (rapid pulse, low blood pressure, confusion) 1
• Pain uncontrolled after one hour of appropriate analgesia 1, 2

Critical Pitfall to Avoid

Do not delay seeking care hoping symptoms will resolve spontaneously—while some small stones pass without intervention, the severe pain you describe requires immediate medical assessment to exclude dangerous alternative diagnoses (such as leaking abdominal aortic aneurysm if you're over 60 years old) and to provide adequate pain control 1