Sudden onset of unbearable pain in the flank area should be thought of as renal colic. The discomfort results from blockage of the ureter by a urinary stone. The physician can prescribe effective analgesics, monitor the progress of renal colic, and intervene surgically if necessary.
What is renal colic?
Renal colic refers to an acute painful condition that is usually unbearable for the affected person and occurs in episodes. The pain begins in one of the flanks and extends to the lateral abdomen and genitals. In addition, the pain may cause vomiting and profuse sweating. The trigger for renal colic is a large urinary stone from the renal pelvis that suddenly blocks the ureter on its way to the bladder. As a result, the muscles surrounding it continually contract to loosen the stone and transport it to the bladder. As this happens, the increasing contraction of the muscles leads to the typical wave-like pain of renal colic.
Causes
The cause of renal colic is a blockage of the ureter by a urinary stone. Often, the affected person has several stones in the renal pelvis in this case, which already cause him dull pain in the flank independently of the spontaneously occurring colic. Smaller stones can usually pass through the ureter without any problems. Urinary stones occur more frequently in patients with frequent urinary tract infections. Sufficient fluid intake is therefore important on the one hand to prevent the infections and also to counteract the formation of urinary stones. Urinary stones can also develop after weight loss and the associated change in diet. In case of narrowing and malformation of the ureter, there is also a higher probability for the occurrence of urinary retention and the formation of urinary stones as a consequence. Renal colic may therefore occur more frequently in these patients.
Symptoms, complaints, and signs
Characteristic of renal colic is unilateral, severe to unbearable pain. It begins acutely at the affected kidney, that is, in the back at the level of the short ribs. The severity depends on the shape and size of the causative kidney stone and the condition of the ureter. The pain may radiate throughout the back or forward into the chest and abdomen. If a kidney stone is stuck in the ureter, the pain stays in one spot and may increase and decrease in episodes. If the stone moves through the ureter toward the bladder, then the point from which the pain radiates moves slowly downward into the posterior abdomen and eventually obliquely toward the center of the body. Bloody urine is possible, but does not occur in all sufferers. The pain may end suddenly when the kidney stone enters the urinary bladder. During urination, the stone may now enter the urethra. This causes the pain to recur, this time in the middle of the pelvis. Acute pain travels down the urethra until the stone gets outside. Some patients report hearing the excreted kidney stone fall into the toilet.
Diagnosis and course
The diagnosis of renal colic is usually already suspected by the physician based on the typical pain along the patient’s flank. They are often so unbearable for the patient that he immediately visits the doctor or the emergency service is called. A laboratory examination of the urine serves to exclude infections of the urinary bladder or kidney. If the patient has chills or fever, an additional inflammation of the renal pelvis must also be considered. Urinary stones as the trigger of renal colic can be visualized by ultrasound examination or by X-ray examination with contrast medium. Rarely, a computed tomography (CT) scan is necessary.
When should you see a doctor?
If stabbing pain, nausea and vomiting, or signs of bowel obstruction are noticed, a visit to the doctor is recommended. If the symptoms do not go away on their own, they need to be checked out by a doctor, as there may be a serious underlying cause, such as renal colic. Reduced urine volume and swelling in the area of the kidneys also indicate a medical emergency. Affected persons should be taken to hospital or, in the event of severe symptoms, the emergency services must be called.If there is already a concrete suspicion that the symptoms could be due to renal colic, the family doctor must be consulted immediately. Such symptoms must be clarified if they occur in conjunction with a urinary stone disease or an acute urinary outflow disorder. The same applies if renal colic occurs in conjunction with a diagnosed tumor disease in the area of the ureter or kidney, past blood clots or diseases of the connective tissue. Renal colic is treated by a nephrologist or a gastroenterologist. In case of a medical emergency, the sufferer must be treated as an inpatient in the hospital. During drug treatment, careful attention must be paid to any side effects caused by the prescribed drugs and these must be reported to the physician to rule out further complications.
Treatment and therapy
Treatment of renal colic should first relieve the patient’s severe pain with analgesics. These are usually taken every two to three hours. Stones of a size of up to five millimeters should detach themselves from the ureter and move further into the bladder. To do this, the patient must drink plenty of fluids and exercise sufficiently to additionally stimulate the onward transport of the stone. Up to 80 percent of urinary stones disappear in this way without surgical therapy. However, if renal colic occurs again or the urinary stone is larger, shock wave lithotripsy (ESWL) can be performed under local anesthesia. The stones are destroyed by shock waves generated outside the body, and the resulting fragments can then pass easily through the ureter. Large urinary stones and especially those that fill the renal pelvis can also be removed endoscopically through the abdominal skin from the renal pelvis using a procedure called percutaneous nephrolithoplaxy (PNL). A combination of both methods is also possible. In patients with large urinary stones that cause repeated renal colic with unbearable pain, ureterorenoscopy can also be performed if all other measures fail to provide relief. In this surgical procedure, the stones, and thus the triggers of renal colic, are removed endoscopically through the urethra.
Complications
Renal colic is always an emergency and should be treated as soon as possible. Although the kidney stone that causes it often resolves on its own with the help of fluid intake, exercise, and drug treatment, the kidney stone may not resolve on its own. However, it is possible for the stone to become lodged, leading to a dangerous urinary retention. If this urinary retention is not treated, severe kidney damage occurs, which can lead to the complete destruction of the kidneys. However, after acute urinary retention, the kidneys’ ability to function can be fully restored if treated immediately. However, if the symptoms of renal colic are left untreated, chronic urinary retention may develop, in which urine outflow is only partially guaranteed. As a result, a saccular expansion of the renal cavity often develops. This leads to the loss of functional kidney tissue with the development of a so-called shrunken kidney. In the case of urine outflow obstruction, an infection of the urinary tract may also develop. Under certain circumstances, this then leads to a septic urinary stasis kidney, which is associated with severe fever, chills, severe pain and inflammation of the renal pelvis. If left untreated, the stasis kidney can lead to death. This is especially the case if the bacteria are washed into the bloodstream, causing blood poisoning.
Outlook and prognosis
Renal colic represents an acute health condition requiring immediate action. Without the fastest possible medical care, the affected person risks irreversible organ damage as well as a threat to his or her life. The sooner the medical emergency is treated professionally, the better the further course of the disease and thus the prognosis. Under optimal conditions, in addition to the supply of fluids, drug treatment is initiated and special exercise therapy is carried out. These measures can already lead to a significant alleviation of the symptoms and, in the further course, to freedom from symptoms. If there are no complications or permanent tissue damage to the kidney, the patient can be discharged from treatment after a few weeks as recovered.In most cases, despite all efforts, the complete functioning of the kidney cannot be restored. There may be a need for long-term therapy. In addition to drug treatment, dialysis is another possible health measure to achieve an improvement in the overall situation. This poses a particular challenge for coping with the daily life of the affected person. Often the emotional stresses are so severe that psychological sequelae occur. This must be taken into account when determining the prognosis. For some patients, transplantation remains as the last course of treatment. Otherwise, the average life expectancy is considerably shortened because of the threat of organ failure.
Prevention
Renal colic can be prevented with adequate fluid intake. This is especially important in summer temperatures and the increased sweating associated with them. Frequent urinary tract infections, which also promote the formation of urinary stones, can also be prevented by this. Rapid loss of body weight without adequate drinking also promotes the development of urinary stones and thus the occurrence of renal colic.
Follow-up
After treatment of renal colic, follow-up care is indicated to provide targeted relief of any symptoms and to monitor the course of the disease beyond recovery. Depending on the type and severity of colic, the risk of complications varies greatly. Metaphylaxis is necessary in all cases, otherwise kidney damage may go unnoticed or renal colic may develop again and further damage the organ. The first follow-up examination primarily involves a check of the affected kidney. For this purpose, the physician uses imaging techniques as well as a physical examination. The anamnesis serves to answer open questions and to clarify any complaints. Insofar as no abnormalities are found, the follow-up can be completed. Renal colic, once resolved, should not cause any further complaints. It is sufficient if the patient attends the normal check-ups. In addition, continued attention must be paid to signs of renewed renal symptoms. Drug treatment for pain or persistent inflammation can be monitored by the primary care physician. Finding the cause of renal colic may also be part of follow-up care, insofar as the trigger has not already been identified during the actual treatment.
Here’s what you can do yourself
To support a natural passing of the urinary stone, the affected person should exercise sufficiently. Regular sports activities and specific movements of the pelvis can lead to spontaneous detachment of the foreign body. This avoids surgical intervention and reduces the need for medical treatment. At the same time, it is necessary to warn against overexertion or overloading the organism, otherwise the general condition will deteriorate. As soon as the urinary stone is completely removed, spontaneous healing occurs and the patient is normally free of symptoms. Various measures can also be taken to minimize the risk of renal colic in the long term. Changing the diet can counteract the formation of new urinary stones. The consumption of meat as well as offal should be reduced or avoided. The intake of coffee, a stimulant, should also be limited to improve health. In addition, drinking black tea and consuming dairy products should be avoided. With a healthy and balanced diet, as well as regular exercise, a sustained maintenance of health is promoted. The intake of two liters of fluid per day is recommended for adults. If renal colic is present, increase the amount of fluid intake. This will stimulate kidney activity and increase the likelihood of natural removal of the foreign body.
