You’re halfway through your shift when Mr. Henderson mentions a dull ache in his lower back that won’t go away. While you might initially think he just needs repositioning, understanding the ureters helps you recognize that this discomfort could actually signal a urinary blockage requiring immediate attention.
What are Ureters?
Ureters (YER-ih-ters) are the thick, muscular tubes that act as the body’s drainage pipelines for urine. There are two of them—one attached to each kidney—and their sole job is to transport urine from the kidneys down to the bladder. They work automatically using wave-like muscle contractions called peristalsis, pushing urine downward even when you are lying down or sleeping.
Why Ureter Issues Matter in Your Daily Care
Although you cannot see the ureters, problems here usually cause significant pain and can quickly lead to serious kidney infections or damage. If a kidney stone blocks a ureter, urine backs up into the kidney, causing severe distress. As a CNA, you are the frontline for spotting changes in behavior or comfort. Recognizing the signs of a blockage allows the nurse to intervene fast, protecting the resident’s kidney function and relieving their pain.
What You’ll See During Your Shift
You will rarely “treat” the ureters directly, but you will encounter the results of their function—or malfunction. You might see a resident clutching their side or back (flank pain), or they may appear restless and unable to find a comfortable position. You might also notice a sudden drop in urine output if a blockage is present.
“Ms. Lopez is reporting severe sharp pain on her right side, just below her ribs. She looks really uncomfortable and hasn’t produced much urine in her Foley bag for the last two hours. Her vitals are stable, but she’s very distressed.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Confusing the ureters with the urethra. The urethra is the tube exiting the body where you see urine come out, while the ureters are internal tubes connecting kidneys to the bladder. Mixing these up can lead to inaccurate documentation.
Pro Tip: Remember “Ureter = Upper” (Kidneys to Bladder) and “Urethra = Under/Out” (Bladder to outside). When a resident complains of “side pain” or flank pain, think ureter/kidney. If the pain is during urination, think urethra/bladder.
Memory Aid for Ureters
Think of the “Two-Tube Transport System.”
Just like a house has plumbing pipes leading from the water heater to the sink, the body has ureters leading from the kidneys (the water filters) to the bladder (the holding tank). If the pipe gets clogged, the system backs up.
State Test Connection
Expect questions on anatomy in the CNA exam, specifically asking you to identify the correct order of the urinary system: Kidneys → Ureters → Bladder → Urethra.
Related Care Concepts
Understanding ureters connects directly to monitoring urinary output, as a blockage here will drastically reduce the amount you collect. It is also linked to kidney stones and flank pain assessment, and it reinforces the importance of Intake and Output (I&O) records to catch drops in urine production early.
Quick Reference
✓ Key function: Muscular tubes moving urine from kidneys to bladder ✓ When to report: Sudden severe side/back (flank) pain, drastic drop in urine output, visible blood in urine ✓ Care reminders: • Ask specific questions about pain location (side vs. lower abdomen) • Monitor Foley bags or toileting frequency closely for changes • Report restlessness or grimacing in non-verbal residents immediately • Never ignore a sudden decrease in urine output
By understanding how the ureters work, you become a sharper observer who can connect the dots between back pain and urinary health—ensuring your residents get the help they need sooner.