How does renal colic manifest in women? Cutting pain in the lower back, also known as renal colic: symptoms and causes in women. Urolithiasis

Quite often, patients learn about a diagnosis of urolithiasis at the onset of renal colic syndrome, with which they are admitted to the hospital by ambulance.

As a rule, until the formed stone moves through the urinary tract, the pathological process is completely asymptomatic. Although the patient’s body is already experiencing quite severe metabolic disorders, patients do not even realize that they have stones and do not know what renal colic is.

Renal colic is a symptom complex that has a clear clinical picture of what is happening, characterized by a severe attack of pain in the patient and changes in his urinary sediment (traces of blood, pathological impurities, etc. appear in the urine).

This condition occurs in people of different genders and age groups. In children and pregnant women, renal colic is quite severe, which requires a doctor to special approach for pain relief.

Renal colic, as a rule, is unbearable and begins suddenly (against the background of complete well-being). They completely incapacitate a person for a certain period of time, and if treatment is delayed, they can cause serious and dangerous complications.

Main reasons

In order for an attack of colic to develop, there must be a disturbance in the outflow of urine, which leads to a reflex spasm of the smooth muscle fibers of the ureter and the appearance of a strong pain impulse in the cerebral cortex.

Stagnation of urine increases the pressure gradient in the collecting apparatus of the affected kidney, which disrupts the processes of microcirculation and venous outflow in it. There is an increase in the parenchymal component of the organ and stretching of the capsule rich in nerve endings. This significantly increases the pain and worsens the patient's well-being.

The causes of renal colic in more than 90% of cases are associated with the formation of stones at different stages of the urinary tract. It is this disease that urological doctors most often have to deal with. The process is based on metabolic disorders, which leads to stone formation from urates, oxalates and other substances.

Among the predisposing factors, one way or another, influencing the onset of ICD, it is necessary to highlight:

genetic predisposition to metabolic disorders (more than half of the cases);
work associated with heavy physical exertion or intense sports that lead to dehydration;
improper diet, small amount of fluid consumed during the day;
birth defects urinary tract, leading to pathological stagnation of urine, etc.

An attack of renal colic can be provoked by any inflammatory process in the collecting apparatus of the kidney, in which the urine output is disrupted due to a clot of pus that has closed the lumen of the duct (for example, against the background acute pyelonephritis or exacerbation of its chronic form).

Destructive changes in the tissues of one or both kidneys can also cause the onset of sudden pain. This is observed during cancerous degeneration of an organ or a tuberculous process in it.

Against the background of oncology, normal tissues and walls are destroyed blood vessels, which often leads to closure of the lumen of the ureter or urethra with tumor fragments

Severe traumatic impact on the organ (can cause exit blood clot into the lumen of the urinary tract and block them, for example, when falling from a height).

Compression of the ureters or urethra from the outside (growing oncological processes in the pelvis, massive hematoma, etc.).

Symptoms

As a rule, the initial manifestations of the process go unnoticed by the patient (if we are talking about the formation of stones). It is extremely rare that they pay attention to the fact that in the area of the kidneys there is sometimes colitis or aching for no reason, until the disease begins to progress.

The typical and most striking symptom of the onset of the process is intense, often unbearable pain, which occurs suddenly and is paroxysmal in nature (sometimes preceded by intense physical activity).

The pain is localized on the side of the blockage of the ureter or excretory duct from the collecting apparatus

The pain syndrome forces the patient to rush around in bed in search of the most comfortable position that can reduce the pain, however, these attempts are in vain. They are very excited and moan during the attack.

If the calculus is localized in the lumen of the urethra, then painful sensations in the lower abdomen are diffuse in nature. Dysuric disorders appear, the process of emptying is disrupted Bladder. Patients complain of pain when urinating, and the desire to urinate becomes painful and constant.

A characteristic symptom of the process is the presence of blood in the urinary sediment (hematuria), the appearance of which is noted by the patient himself, because, as a rule, it is visible to the naked eye

Irradiation of pain into the genitals, different parts of the abdomen, and rectum is typical, which is accompanied by a painful urge to empty the bowel. Intestinal bloating may occur, simulating the clinical picture of an acute abdomen.

At the peak of pain, attacks of nausea and vomiting appear, which do not relieve the symptoms and do not bring relief to the patient. If the temperature rises to febrile levels or higher, then this is direct evidence of the addition of bacterial flora, which can threaten the patient with a number of serious complications.

If a stone passes spontaneously, pain syndrome ends as suddenly as it began, which indicates the restoration of urine outflow.

Renal colic in children and pregnant women

Treatment of pathology in this category of patients is carried out only in a specialized hospital.

In children, stone formation is usually caused by poor nutrition and genetic predisposition. During pregnancy, processes that were previously latent are often activated, including urolithiasis.

Renal colic during pregnancy is often mistaken for the onset of premature labor, especially if it occurs in the last stages, as a result of which the woman is mistakenly hospitalized in the maternity hospital. If disturbances in the outflow of urine are observed in young children, then making a diagnosis can also cause difficulties, since children cannot always explain what exactly is bothering them.

When choosing an anesthetic for renal colic in children and pregnant women, preference is given to the safest antispasmodics that are administered subcutaneously or intramuscularly (for example, No-shpa).

Complication

An unfavorable outcome is observed if the treatment of renal colic is delayed for one reason or another (for example, it hurts long time tried to relieve attacks of pain by taking large doses of painkillers and did not consult a doctor).

Complications of the process include:

inflammation of one or both kidneys (obstructive pyelonephritis);
cicatricial deformities of the affected ureter (development of strictures in it);
septic condition of the patient (urosepsis) and others.

Cicatricial narrowing of the lumen of the ureter can only be restored by surgical intervention

Diagnostic principles

When a patient is admitted to a hospital, the doctor must very carefully collect his medical history. To do this, a question is asked about the presence of similar symptoms previously both in the patient himself and in his relatives (family history).

Subjective complaints are assessed, because on their basis it is possible to exclude a number of others pathological processes. The characteristics of pain, their exact localization and irradiation, what provokes them, and what, on the contrary, helps relieve renal colic, are asked in detail.

When examining a patient, the doctor palpates the abdomen and pelvic organs. There is sharp pain on the side of the lesion, that is, in the place where the lumen of the ureter or urethra is blocked. The stomach is usually tense. When you tap on the lumbar region, a sharp pain occurs.

The main importance in differential diagnosis is given to methods of laboratory and instrumental research.

All patients are prescribed:

blood test (general and biochemical);
urine analysis and Nechiporenko test;
plain X-ray and excretory (intravenous) urography;
Ultrasound of the pelvic organs and urinary tract;
CT or MRI of the urinary tract;
other studies as indicated ( diagnostic laparoscopy etc.).

The presence of kidney stones can be diagnosed using X-ray and ultrasound methods.

Principles of differential diagnosis

Unfortunately, there are no pathognomonic symptoms characteristic only of an attack of acute colic, so the process must be differentiated from a number of other diseases.

Below is a list of the main diseases that occur with symptoms reminiscent of renal colic:

acute processes in organs abdominal cavity(inflammation of the appendix, acute cholecystitis or pancreatitis, peptic ulcer stomach or duodenum with perforation, intestinal obstruction);
acute processes in the pelvic organs in women (inflammation of the fallopian tubes or ovaries, ectopic pregnancy and pipe rupture, torsion cystic formation and necrosis of its legs and others);
inflammation of the urinary system (cystitis, urethritis, prostatitis and others);
pathological processes of organs of cardio-vascular system(attack of myocardial infarction, dissecting aortic aneurysm);
pain syndrome associated with diseases of the musculoskeletal system (intercostal neuralgia, osteochondrosis of the thoracic or lumbar regions spine, prolapsed hernia and others).

Each of these conditions requires careful laboratory testing. instrumental examination sick.

If sudden pain occurs, it is necessary to call as soon as possible ambulance, which will refer the patient to the hospital for further examination and specialized treatment.

It’s worth saying what you can’t do with renal colic:

for a long time trying to independently relieve pain by taking huge doses of analgesic drugs from different pharmacological groups;
warm the area of greatest pain if you are not sure that the cause of the symptoms is related to the movement of the stone. Before the medical team arrives, you should do the following:
you need to calm down as much as possible and try to breathe deeply during each attack of pain;
find a home first aid kit (analgesics and antispasmodics, or a combination of them, for example, Baralgin, will help temporarily relieve an unbearable attack of renal colic).

You can also take 2 tablets of No-shpa or Drotoverine. If there is a person in the family with a medical education, then intramuscular administration is recommended.

When none of the above-described remedies are in the medicine cabinet, then a Nitroglycerin tablet is used as pain relief, which is taken under the tongue until it is completely dissolved (cannot be chewed or washed down with water).

Specialized emergency therapy

In order to reduce the severity of pain as quickly as possible, all drugs are administered intravenously; if this is not possible, intramuscularly.

Among the most common and effective painkillers are Ketorol, Diclofenac, Tramadol, Baralgin M and others.

Before the doctor begins to relieve an attack of colic, it is necessary to tell him in detail about all the drugs and their dosages that were taken previously

Antispasmodics for renal colic help fight the spastic component of the pathological condition, so their prescription is mandatory (No-shpa, Platyfillin, Papaverine and others).

Treatment of renal colic in the hospital

When a patient is admitted to a specialized department, the basis of treatment for the patient is painkillers and antispasmodics. This continues until the stone passes or until the patient feels better.

If a patient experiences complications of an infectious nature due to the addition of bacterial agents, adequate antibacterial therapy. Antibiotics are prescribed taking into account the microflora, which is sown in urine tests (protected penicillins, cephalosporins, macrolides and others).

All patients are prescribed a salt-free diet, and all foods that can, in one way or another, influence the formation of stones (fatty meats and fish, confectionery, etc.) are completely excluded from their diet. Selecting a Specific Type dietary nutrition depends on the type of stones (urate, oxalate and others).

Surgery

Further management of the patient directly depends on the size of the stones, their number, location, age of the patient, etc.

If an attack of colic can be easily stopped, and the stone is small (up to 1 cm in diameter), and there is a possibility of natural passage, then, as a rule, it is not touched. This is not an indication for surgical intervention, so the patient continues to be treated conservative methods(they prescribe the necessary diet, prescribe medications that help dissolve stones, etc.).

In the case where the severity of pain is unbearable, and there are also signs of kidney dysfunction, surgery is started immediately.

The choice of surgical approach is determined by the patient’s condition and the specifics of the process ( abdominal surgery, endoscopic intervention, etc.)

Conclusion

Every patient who has suffered an attack of renal colic associated with urolithiasis at least once in his life must subsequently adhere to a number of rules and principles of nutrition. Even surgical removal stone does not guarantee the patient a complete absence of relapse of the disease.

The combination of symptoms accompanied by the appearance of severe lower back pain is called renal colic. Renal colic and acute urinary retention are interrelated. Many people believe that this disease is associated with kidney problems, but in reality it is a complication of other acute and chronic processes occurring in the body and is associated with acute blockage of the urinary tract ( purulent discharge, stones, blood clots, etc.) Adults over the age of 40, older people, as well as those whose work involves lifting heavy objects and hypothermia are susceptible to this disease. Children do not get this disease very often.

Causes of colic

Main factors

urolithiasis (UCD);
kidney prolapse;
disruption of the formation of the genitourinary system;
glomerulo- and pyelonephritis;
malignant neoplasms of the kidneys;
kinking of the urinary canal;
injuries;
neoplasms (adenomas, uterus, rectum).

Related factors

dehydration (with chronic intestinal disorders);
taking large doses of diuretics;
work involving frequent heavy lifting;
hypothermia;

Urolithiasis disease- the most common reason colic.

Most often, renal colic can be caused by urolithiasis. Kidney stones, which form with this disease, clog the urinary canal, impairing the flow of urine. In this case, a lot of fluid collects, which overstretches the renal pelvis, disrupts blood circulation in the organ and causes an attack of acute renal pain.

Symptoms in men and women

Symptoms of colic in men and women are:

pain;
urinary disturbance;
increased body temperature;
dyspeptic disorders.

On initial stage The disease exhibits the same symptoms for men and women.

Women get this disease less often than men, but the symptoms of renal colic in men are the same. The leading symptom of renal colic is the presence of cramping pain. First, spasms are localized in the lumbar region. Then the pain expands and radiates to the groin, genitals (in men - to the penis and scrotum, in women - to the labia), top part hips. Renal colic is characterized by a protracted course. During this time, the pain is localized in the lower torso. The manifestation of this disease is the urge to frequent urination, but due to blockage of the urethra it is difficult. Vomiting with renal colic is observed when the pain moves to the upper abdomen. Dyspeptic disorders appear (colitis, constipation, nausea, vomiting, patients feel fever). The main feature that makes them more painful is that patients often change their body position.

Pregnancy and colic

During pregnancy, existing diseases worsen and new ones appear. At this time they decrease protective functions the body, immunity decreases, stones form in the kidneys. Then there will be renal colic syndrome. Pregnant women more often notice the appearance of renal colic on the right. The signs of renal colic in pregnant women are no different from the symptoms of ordinary colic, but are more violent. Right-sided renal colic during pregnancy is accompanied by severe pain, problems with urination, and fever. A spasm of the smooth muscles of the uterus occurs and is accompanied by an increase in tone, which leads to the threat of miscarriage.

Symptoms of colic in children

Colic is very rarely diagnosed in children, so treatment is carried out in a hospital.

Renal colic occurs very rarely in children. Pain may appear during the school period at the age of 10−14 years. The main causes of the disease are:

heredity;
congenital defects in the development of the urinary system;
environmental problems (presence of high levels of Ca in drinking water);
increased physical activity and sports;
hypothermia.

The pain associated with this disease in children is not as severe as in adults. Therefore, they cannot show exactly where it hurts, pointing either to the stomach or to the lower back. Renal colic occurs more often on the right (affects right kidney). In such cases, it is necessary to consult a doctor to establish an accurate diagnosis. These manifestations are treated in a hospital.

Complications of renal colic

The occurrence of complications depends on the timeliness and quality of the care provided. medical care, physical condition, factors that caused the disease. These include:

acute purulent pyelonephritis;
septic shock;
renal failure;
the appearance of narrowing of the ureter.

At untimely treatment Ulcers form in the kidneys.

In case of untimely provision medical care Small pustules form in the kidneys, the contents of which spread throughout the body, causing severe intoxication. Patients experience chills, fever that is difficult to control, dry mouth, and pain when urinating. Later, septic shock may develop. It can be triggered by an increase in toxins in the blood. Patients experience fever, confusion, seizures, weak pulse, and hypotension. This is very dangerous complication renal colic, which carries a high risk of death.

With severe hypotension (caused by shock), renal failure occurs. This manifestation of complications occurs due to the fact that blood circulation in the affected kidney is disrupted, as a result of which the pressure in the kidney rises and it does not perform the function of filtering and producing urine, metabolism is disrupted, which leads to the failure of all systems of the human body. This disease may cause narrowing of the ureter. Normally, it is an elastic, hollow tube that helps move urine from the kidney to the bladder. But after suffering from an illness, narrowings form in it, which prevent the free flow of fluid through the ureter, causing stagnation.

Diagnosis of renal colic

Examination by a urologist.
General analysis of urine and blood.
Blood chemistry.
Ultrasound and CT (shows the condition of the kidney tissue and the presence of stones).
Excretory urography - intravenous administration of contrast helps to find out where the stone is located (be sure to do a contrast tolerance test).
Chromocystoscopy - detects the absence of contrast secretion through a blocked ureter.

A urologist will prescribe a comprehensive diagnosis.

The urologist's task is to collect anamnesis. The patient's description of his symptoms makes it possible to determine the severity of the disease. Objective examination: - pain will occur on the side where the stone is located. Percussion will reveal pronounced pain sensations. They can be on the left or right (left-sided or right-sided colic). IN laboratory tests Blood in the urine, urate salts, and oxalates were detected. With renal colic, an increase in leukocytes and protein is observed in the urine. Blood tests show increased ESR and leukocytes. A change in the amount of creatinine and urea indicates impaired renal function, and an increase in calcium and a decrease in magnesium and phosphorus confirms metabolic disorders and the risk of cameos.

Differential diagnosis

This disease has many common symptoms with other diseases of the abdominal cavity, therefore, to confirm this pathology, differential diagnosis is needed:

With appendicitis, the onset of the disease is the same as that of renal colic - sudden appearance pain in the lower abdomen, but with appendicitis it decreases if the patient lies down. The nature of the pain in appendicitis is local, and the pain in renal colic is radiating to other organs.

home medicine cabinet

“No-spa” is an antispasmodic that is injected intravenously with 2 ml of a 2% solution.
"Baralgin" is an analgesic, anti-inflammatory substance that should be administered intravenously to children over 15 years of age and adults.
"Diclofenac sodium" - reduces inflammation and swelling in the area of inflammation. 75 mg is administered parenterally.

The occurrence of unbearable pain in the lower back, which does not leave the patient alone, forces him to rush about in bed and does not allow him to sit or lie quietly, is almost always a symptom of acute renal colic. This is not a disease, but a symptom of some pathology.

But in any emergency condition, it is initially necessary to eliminate unbearable pain in order to alleviate the patient’s condition. Treatment of the pathology itself is a secondary task.

In order to detect an attack of renal colic, provide adequate assistance and eliminate the cause of the pathology, you need to have reliable information regarding this pathological condition. This is exactly what will be presented in the article.

Fundamentals of the structure of the human urinary system

It is quite difficult to understand the causes of renal colic and the basic principles of its treatment without having data on the process of urination. It all starts with the production of urine by the kidney tissue, then it passes into the pelvis - hollow formations that are located at the outlet of the kidneys. Quite often, stones are located in the pelvis, since their lumen is quite narrow, only a few mm.

The next organ of the urinary system, the ureter, originates from the pelvis. To put it quite simply, it is a hollow tube that communicates with the bladder and kidneys. The ureter is the second “favorite” location for stones. The diameter of the lumen of this organ ranges from 5 to 15 mm, as a result of which blockages of its lumen can form in narrow areas.

After accumulation in the bladder, the fluid moves further along the urethra and is discharged out. This area most often quite rarely becomes the cause emergency.

Causes

The development of colic can be caused by various pathologies, however, they have one thing in common common feature– obstruction (blockage) of urine drainage tract. Each of the pathologies leads to disruption of the outflow of fluid and leads to the development characteristic symptoms. Blockage of the lumen of the urinary tract can occur at various levels (in the ureter, pelvis and even in the bladder itself), but the manifestations of the pathology are almost identical.

What pathologies can provoke obstruction? Today the most common diseases are:

Disease	Obstruction mechanism
Urolithiasis disease	Most often (in 92% of cases) the cause of colic is a stone that clogs the ureter and pelvis. If characteristic symptoms develop, doctors must first exclude the presence of urolithiasis.
Pyelonephritis	Infection in the kidney most often occurs under the influence of microorganisms: influenza bacillus, streptococcus, staphylococcus, E. coli. The inflammatory process quite often occurs with desquamation of the epithelium and fibrin, the formation of pus, which, when passing through the urinary tract, leads to blockage. If there is an excess of these formations, the lumen of the ureter, which in places of narrowing can reach only 5 mm in diameter, can be blocked. It should also be noted that pyelonephritis quite often develops against the background of the formation of kidney stones.
	Mechanical damage to the organs of the excretory system can lead to the development of hematomas and compression of the channels by these formations or the formation of blood clots in the lumens of the channels.
Congenital organ features	This group of causes includes conditions such as abnormal attachment of the ureter to the bladder, incorrect position (dystopia) or prolapse (nephroptosis) of the kidneys. Most often, such features do not cause concern to the patient and quite often go unnoticed throughout life. But under the influence of provoking factors ( infectious process, trauma) the outflow of urine may be disrupted and an acute condition may develop.
The tumor is benign or malignant	Pathological growth of tissue can compress the pelvis or ureter in two cases: if the tumor is located next to the structures of the excretory system, or if it grows in these organs.
Kidney tuberculosis	According to modern statistical reports, about 30% of patients in tuberculosis dispensaries have tuberculosis, which is located outside the lungs. Kidney tissue is one of the sites of localization of microorganisms that cause this pathology. Therefore, in the event of colic in a patient with confirmed tuberculosis or the presence of it typical signs (low-grade fever, significant loss of body weight, persistent cough), it is necessary to exclude kidney damage by this pathology.

You also need to select one important point– with the development of symptoms of renal colic after treatment emergency care, you must first determine the absence/presence of a stone in the lumen of the pelvis or ureter. Only after this can you move on to excluding other diseases.

Symptoms

To diagnose this condition in a patient, only one symptom is enough - characteristic pain. In addition to the pain, two more symptoms may occur: changes in urination and vomiting. These are not necessarily manifestations of colic, but they are quite often observed in patients with such an emergency condition.

Pain

The main complaint for all patients with this pathological condition is the presence of pain in the clinical picture. What kind of pain occurs with renal colic? This is a very intense, cutting pain that patients describe as “unbearable.” Unpleasant sensations haunt you, preventing you from sitting or lying down normally; patients become overexcited and cannot find a place to sit.

The pain is located in the lumbar region and most often radiates to:

into the perineum;

on the front surface of the thigh;

renal colic in women radiates to the vagina and labia;

colic in men spreads to the head of the penis, scrotum, testicle.

This symptom may intensify when palpating the abdomen (in certain places, usually 3-5 cm on either side of the navel) or tapping the lower back. The first sign is not obligatory and develops only when the ureter is damaged.

Dysuria (impaired urination)

Blockage of the urinary tract in most cases leads to the development this symptom. The patient feels false urges to urination, but the amount of urine released is quite small. The process of urination itself is quite unpleasant, since cutting pain occurs in the lower back and perineum. Due to injury to the walls of organs and bleeding (small), urine quite often becomes reddish or pinkish.

Can urine have a normal color? Yes, but only if it comes from healthy kidney. Unfortunately, it is impossible to determine the path of urine outflow at home, so this symptom has additional significance.

Vomit

The development of such a symptom is caused by two mechanisms. The first one is strong pain, which the brain cannot cope with on its own. As a result of unsuccessful attempts, they develop autonomic disorders: general weakness, increased sweating, nausea, vomiting. The second mechanism is the disruption of the solar plexus nerves (at the location of pain), as a result, the functioning of most of the digestive tract is disrupted.

Most often, vomiting is repeated and has nothing to do with ingestion of water or food and develops spontaneously. Taking various sorbents (Smecta, Neosmectin, activated carbon) does not help cope with her attacks.

Can all symptoms suddenly subside? Yes, it is quite. The reason for spontaneous improvement is a change in the position of the stone and normalization of urine outflow. In the case of a small stone size (3-5 mm), it may well come out on its own, which will provoke the disappearance of all the above symptoms. Unfortunately, such self-healing is a rather rare phenomenon, and you should not rely on it; it is better to seek specialized help as quickly as possible.

Features of the course of renal colic in children

It is sometimes quite difficult to recognize the presence of this condition in a child. Due to the characteristics and mentality nervous system, the symptoms of renal colic most often differ from the generally known symptoms. In children, renal colic in most cases manifests itself as widespread pain throughout the abdomen in combination with impaired urination and the presence of dyspeptic symptoms: constipation/loose stools, vomiting, flatulence, nausea. All these signs lead to difficulties in diagnosis and misdiagnosis.

How to act correctly in such cases? You need to pay attention to the presence of dysuria. If this symptom is combined with abdominal pain, then renal pathologies must be excluded.

Treatment

Help with the development of renal colic should consist of two stages. The first is to relieve pain. Restoring the normal flow of urine and eliminating discomfort is very important, not only to improve the patient’s well-being, but also to preserve the functioning of the kidney. After achieving this goal, you need to move on to the next stage. This stage consists of treating the pathology that led to the development of the emergency condition. This problem is dealt with by highly specialized specialists after graduation. acute period.

First aid

How to behave if renal colic occurs at home? First of all, you should call an ambulance. Considering the fact that the team will not be able to arrive instantly, you need to start relieving the condition yourself. To do this, perform the following activities:

Warm the lumbar area. A warm bath (water temperature in which is 38-40 degrees) will give the optimal effect, since it affects not a specific area, but the whole body. An alternative to a bath is a heating pad. But it is worth remembering that if kidney tuberculosis is suspected, heat is contraindicated.

Give the patient a pain reliever. For these purposes, products with a combined effect that combine antispasmodics and NSAIDs are best suited. Together, these drugs have a relaxing and anti-inflammatory effect on the organs of the excretory system. Examples of such drugs: “Baralgin”, “Spazmalgon”, “Revalgin”. As an alternative, you can use conventional non-steroidal anti-inflammatory drugs - Citramon, Paracetamol, Ketorolac, Diclofenac.

These actions are performed simultaneously, since it takes about half an hour for the tablets to take effect. The combined effect of first aid measures can slightly improve the patient’s well-being before the arrival of a paramedic or doctor.

How to relieve pain if first aid has no effect? In such cases, the patient needs to perform a blockade - local anesthesia nerve and then urgently restore the outflow of urine. But such assistance can only be performed in a hospital setting.

Who needs mandatory hospitalization?

The emergency doctor almost always recommends continuing treatment for renal colic in the hospital. Unfortunately, not all patients agree to this offer for personal reasons. This may cause the lack of adequate therapy and relapse of the attack in the future.

But there is a group of patients for whom hospitalization is vital necessary measure. Even after the acute period of pathology has subsided, you should seek help from a hospital if the following conditions exist:

signs of a severe complication appear: pressure drop below 100/70 mmHg. Art., impaired consciousness, increased body temperature above 38 degrees;

when pain occurs on both sides;

the patient has only one kidney.

If patients with the problems listed above do not restore urinary function within several hours, the result may be irreversible organ destruction and even death.

Restoring urine flow

The standard algorithm for the presence of renal colic, which is resistant to conventional methods of therapy, is surgical intervention. In modern surgical practice, the intervention is performed through the urethral opening or through making one hole in the skin. The following options for restoring the outflow of urine are also possible:

Percutaneous nephrostomy is most often an emergency treatment method when the surgeon is unable to use endoscopic techniques or they are ineffective. The principle of the method is to introduce drainage into the cavity of the pelvis using a puncture in the skin.

Ureteral stenting – another type of endoscopic intervention is the installation of a special drainage into the pelvis. This method provides a bypass for urine and relieves colic symptoms.

Endoscopic stone removal is the most effective operation, which is performed through the external opening of the urethra. It makes it possible to restore the process of urine outflow in the shortest possible time and with minor trauma.

Only after urine output has been normalized does it make sense to begin treatment for the underlying pathology. If the patient has been hospitalized, the entire necessary diagnostics performed in a hospital. When outpatient treatment the patient is referred to a local physician.

Complications

If assistance is provided in a timely manner, the prognosis for an emergency condition is favorable. Complications can only arise if treatment is delayed or incorrect. The severity of such conditions can vary, it all depends on the condition of the patient and the duration of stagnation of urine. Among the most common complications are:

persistent narrowing of the ureter;

pyelonephritis – inflammation of kidney tissue with suppuration;

kidney atrophy or nephrosclerosis.

IN clinical practice There are even cases of fatal pathology after attempts at independent long-term treatment folk remedies. All of the above complications (except for pyelonephritis) are quite difficult to treat, but it is much easier to prevent - to do this, just contact a specialist for help.

FAQ

How are renal colic and vomiting related?

The reason lies in the structure of the nervous system. Gastrointestinal tract and the kidneys receive innervation from one nerve plexus - the celiac trunk or nerve plexus. If there is a disturbance in the outflow of urine, which is always present when a stone passes through the ureter, the solar plexus is irritated. Irritation leads to a reflex disturbance of the innervation of the gastrointestinal tract. This leads to nausea and vomiting, and also causes bloating during an attack and constipation.

Why does your bladder always feel like it's full, but when you urinate, very little urine comes out?
This is due to the structural features of the human nervous system. As the stone passes through the lower third of the ureter, receptors are irritated, which provoke a false urge to urinate. This sign can be regarded as positive because most of The path of the stone has already been passed. However, this should also cause some concern, since the junction of the ureter and bladder is the narrowest in the entire system, so the stone is most likely to get stuck there.

What can trigger the onset of renal colic?

Most often it begins without previous actions, spontaneously, while performing normal activities or at rest. But this does not always happen; some patients had a long train or car ride before the attack occurred. Also among the provoking factors, one should highlight the use of herbal preparations intended for the treatment of urolithiasis, since they provoke the release of stones. Sometimes the stone begins to move along excretory system after strong blow in the back. There are also cases in practice where a patient limited himself to fluids for a long time, and then drank a lot of water, which became the cause of an attack.

What is the mechanism of development of pain syndrome?

If the ureter is blocked by a stone, the process of urine outflow is disrupted. New portions continue to be produced and enter the system, but due to blockage of the duct they accumulate in pyelocalyceal system kidneys Over time, the expansion increases and leads to compression of the vessels feeding the kidney, causing circulatory problems.

It is worth noting that the size of the macrolite cannot affect the severity of pain; even when a stone with a diameter of 1-1.5 mm comes out, a severe attack of renal colic can occur.

Can this condition be confused with symptoms of other diseases?

There are many known pathologies that mimic kidney pain. Among them:

acute pleurisy;

radiculitis;

kidney infarction;

ectopic pregnancy;

torsion of ovarian cyst;

acute appendicitis in adults.

Accordingly, the obvious conclusion suggests itself - to engage self-treatment this emergency condition is strictly prohibited. First, you need to accurately establish the cause of the pain and carry out a differential diagnosis, and then proceed to treatment, which is only possible in a hospital setting.

Can a stone reach the bladder and not come out?

This happens quite rarely, for example, in the presence of an adenoma prostate gland or urethral strictures, when the urethra. Most often, after a stone enters the bladder, it comes out through the urethra, since its diameter is much larger than the diameter of the ureter.

What diagnostic techniques are used for renal colic?

Diagnosis begins with collecting an anamnesis of the pathology (when it began, how it manifested itself, how the nature of the symptoms changed over time). After this, the patient is examined, laboratory research, among which biochemical analysis blood and general analysis urine and blood. Among the instrumental techniques used are urography (excretory or intravenous) and ultrasound.

What does a physical examination of the patient show?

During the examination, pain is detected in the projection of the ureter and in the kidney area. Differential diagnosis with other acute surgical pathologies is also performed.

Why is ultrasound examination needed?

This method is safe, relatively inexpensive and accessible. Using ultrasound, you can see the expansion of the renal pelvis, macrolites and stones in the ureter, and determine the level at which the stone has stopped. But this method is not always highly informative, when increased gas formation and obesity, visualization may be impaired. Also, diagnosis may be difficult in the presence of certain anomalies of the urinary system. Therefore, it is important not to settle on one diagnostic method.

What does excretory urography show and what is it for?

This diagnostic method is the most informative. It is performed in several stages. To begin with they do X-ray, after which a contrast agent is injected. It quickly penetrates into the urine. After this, another photograph is taken, which clearly shows the filling of the ureter and renal pelvis, as well as the level at which the stone is located and its size. A contraindication to this procedure is an allergy to iodine or thyrotoxicosis, since the coloring substance is iodine.

What therapies are used?

If the patient has confirmed renal colic, then treatment is selected based on the origin of this symptom. If the cause is urolithiasis, then there may be three treatment options. The first is lithokinetic therapy. When the examination results confirm that this method will not be effective, they move on to extracorporeal lithotripsy or open surgery. The latter is used quite rarely today.

What is the essence of lithokinetic therapy?

If the stone has big size and the likelihood of it coming out on its own is quite high, a number of drugs are prescribed that can speed up this process. Among them are non-steroidal anti-inflammatory drugs (relieve swelling of the ureter and relieve pain), alpha blockers (relax the smooth muscles that line the ureter), antispasmodics (expand the lumen of the ureter).

How long does it take for a stone to pass when using lithokinetic therapy?

This usually takes several days, but if after 2-3 days the stone does not come out on its own, a re-examination is carried out. Quite often, treatment tactics are changed after this, but if positive dynamics are observed, then conservative treatment continue. If a stone stays at one point for a long time, it is dangerous for the development of fibrosis of the ureter in this place.

What should be understood by extracorporeal lithotripsy?

This method is the “gold standard” in the treatment of urolithiasis. It has been around for three decades and has proven itself to be excellent. Its essence lies in the fact that with the help of a directed beam of mechanical waves they influence the calculus and thus lead to its destruction. The procedure is performed under ultrasound or x-ray control. The effectiveness of this procedure is over 95%.

What should you do if the pain has disappeared, but the stone has not come out?

Stones must be removed even when they are not bothering you. If the stone remains in the ureter, but does not block the outflow of urine, trauma to the walls of the ureter continues to occur. The outflow is impaired, and overflow of the renal pelvis leads to the development of hydronephrosis with damage renal parenchyma. Therefore, to avoid the development of these complications, the stone should be removed, regardless of the presence of symptoms.

Only a patient who has at least once experienced an incredible spasm that twists and does not let go can understand exactly what renal colic is. Severe pain in renal colic is similar in intensity to appendicitis or acute stage passing of kidney stones. That is why the patient requires immediate help, mandatory heat and other procedures to stop the spasm and prevent complications from developing. However, you should still understand what the pathology is, the causes, treatment and prevention of spasms.

What is renal colic?

Renal colic is an acute attack of pain in the form of contractions caused by spasm of smooth muscle muscles. Representing a complex of symptoms, colic in the kidneys is associated with obstruction of the upper urinary tract, which provokes the accumulation of urine in the kidneys, bladder, increased pressure and provides the same pain syndrome.

Important! More recently, it was believed that acute renal colic most often occurs in men, which is justified by increased physical activity. However, recent studies have “equalized” the frequency of manifestations due to the fact that women also engage in heavy physical labor, plus one of the reasons for the development of colic is mental fatigue

More than 13% of cases of pathology appear due to other diseases: focal infections, tuberculosis, fibrosis, tumor formations, accumulation of pus, mucus. Temporary blockage of the urinary tract and stretching of the pelvis lead to signs of renal colic and cause unbearable pain.

Factors causing spasms

Doctors agree that the main cause of the pathology is kidney stones. For a spasm to occur, the presence of a stone with a diameter larger than the narrow section of the ureter and the beginning of the process of stone passage are required. Therefore, an attack can occur in a patient at any age, regardless of gender. More than 90% of spasms are caused by irritation fibrous capsule organ, which also appears due to blockage of the upper urinary tract. In addition, renal colic may occur, the causes of which are as follows:

Genetic inheritance: if relatives have been diagnosed with urolithiasis;
Previously occurring paroxysmal pain in the lower back: often the patient does not even know that he has had sand and kidney stones for a long time, but relapse of the pathology has a probability of approximately 75% of occurrence for at least 10 years;
Intensive exercise stress: sometimes it is enough to work out in the gym for an hour or lift something very heavy for renal colic to appear, the symptoms of which appear instantly;
A febrile state with a stable increase in body temperature for 30-60 days: the infection quickly enters the kidneys through the bloodstream or lymph, which provokes the spread of the disease;
Low fluid intake;
Diseases that provoke the formation of kidney stones;
Chronic or acute urinary tract infections.

There are certain risk factors for the appearance of renal colic of the “female” type:

hydronephrosis, cystitis, nephritis;
pathological diseases of the uterus;
polycystic kidney disease;
inflammation of the appendages, damage to the uterine tubes;
torsion of ovarian cysts;
rupture of ovarian tissue;
ectopic pregnancy;
pregnancy;
spontaneous abortion.

Important! The risk factors for the appearance of the pathology are numerous, so almost anyone can get renal colic, because nephrosis is a disease that is not only one of the most common, but also often begins asymptomatically. And nephrosis is the cause of urolithiasis, and, as a consequence, organ spasms

Symptoms of pathology

First, let's look at the symptoms in women, although they differ little from the generally accepted ones. It should be remembered that renal colic syndrome does not have any patterns; the pathology occurs from jogging, shaking when driving bad road, long walk. The lower back and stomach hurt; if it is right-sided renal colic, then the pain is localized on one side; if both organs are affected, then the pain is “smeared” over the entire lower back. In addition, the sensations spread to the thigh, perineum, and the following clinical manifestations of renal colic appear, and the symptoms are common to both women and men:

pale skin;
increased sweating;
severe weakness;
attacks of nausea, sometimes vomiting;
jumps in temperature, pressure;
thirst;
chills;
bloating and problems with gases;
pain shock.

Important! An attack of spasm sometimes lasts from 3 hours or more, while the nature of the pain and its irradiation changes. Severe attacks cause shock, but after the colic ends, the fluid leaves the bladder freely; with renal colic, sediment is observed in the urine, especially if the fluid is allowed to stand for a while. With very severe spasms, hematuria is sometimes noticeable

When reviewing symptoms and treatment, it is important for the doctor to “read” correctly Clinical signs diseases. In women, the attack is similar in condition to diseases such as:

acute appendicitis;
pancreatitis in the acute stage;
cholecystitis;
perforated stomach ulcer with bleeding;
spinal hernia.

Diagnosis of the disease

To know how to treat, you must first identify the disease - this law also works in the event of kidney spasm. Treatment of pathology involves eliminating the root causes that provoked the spasm. Otherwise, recurrence of attacks is possible, and the period of remission may become shorter and the duration of the spasm may increase.

If there was an attack of renal colic, treatment is prescribed based on the medical history and the following tests:

Laboratory tests of urine, blood;
Ultrasound of the kidneys and urinary system, performed on a full bladder;
Excretory urography - an X-ray method with the introduction of contrast agents;
Chromocystoscopy - an instrumental examination that helps to understand the speed and nature of tinted urine excreted;
CT or MRI of the kidneys. This examination is extremely important to identify general clinical picture diseases, the condition of the renal pelvis, organs in general, the dynamics of pathology and the search for the underlying disease.

Important! To clarify the course of the disease, additional studies are often required; you may have to be observed by your doctor and stay in the hospital for some time. With renal colic, diagnosis can be complicated by additional complications, pain and subtle symptoms of the disease.

Treatment of kidney spasm

Treatment for renal colic sets the first task to relieve renal colic, since it is impossible to begin examination and selection of therapy for pain. To relieve spasms, the following measures are taken:

Taking non-steroidal analgesics such as: ketanov, diclofenac, sometimes it is possible to replace tablets with solutions;
The use of alternative herbal preparations such as cystenal;
Hot bath or heating pad on the affected organ.

First aid procedures can be pre-medical if you have to wait for an ambulance. After the team arrives, doctors assess the patient’s condition and apply the following treatment for renal colic:

Novocaine blockade relieves pain during a prolonged attack;
If there are stones, the stones are crushed for the purpose of their subsequent removal;
Availability inflammatory processes in the body dictates taking a course of antibiotics or special antiseptics;
Therapy with painkillers continues.

Important! All patients treated medicinal methods treatment and are observed in the hospital. You should not refuse to go to the hospital, even if the attack has been relieved - there may be only a short interval between pains, the spasm will return with increasing intensity, especially if the patient has “got stones”.

Reasons and factors for hospitalization of the patient:

Old age, painful condition;
Having only one kidney;
Bilateral renal colic;
Complication after drug administration and/or drug intolerance;
Continuation of left-sided renal colic or spasm of the right organ, ineffectiveness of medication administration;
Severely elevated temperature;
The presence of inflammatory processes;
Exacerbation of chronic pain or transition of the disease to the acute stage.

In any of the above cases, the patient is immediately hospitalized, and treatment for renal colic is selected in a hospital setting. The disease requires complete rest, bed or semi-bed rest, adherence to strict diet. The diet is selected taking into account individual characteristics patient, but on the standard platform of “table No. 10”. This is a diet that excludes baked goods, fatty, spicy, peppered and smoked foods, limits meat, some dairy products, and chocolate. You also need to follow the drinking regime and daily routine.

Important! In extremely rare cases, treatment of spasm requires surgery. Surgery is performed for blockage of the urinary system, rupture of a cyst, purulent abscesses and other indications

Complications

Colic in the kidneys is only a symptom of the manifestation of the underlying disease, therefore, with prolonged attacks and lack of treatment, serious pathologies are possible. Complications are:

Urinary retention, resulting in deformation of the renal pelvis;
Pyonephrosis – inflammatory disease, in which the kidneys fill with pus;
Urosepsis;
Hydronephrosis;
Pyelonephritis;
Bacteremic shock.

Any of the listed pathologies occurs against the background of untreated spasm, which can lead to the need for more expensive, lengthy therapy, removal of the kidney, and even the death of the patient.

Prevention

To prevent a recurrence of spasm, you should follow these recommendations:

Do not violate the drinking regime by consuming a sufficient amount of liquid, including lingonberry and raspberry fruit drinks;
Introduce natural uroseptics into the diet: watermelons, melons;
Follow a diet;
Take a urine test every 12 months;
See your doctor regularly;
Contact a specialist if you feel unpleasant symptoms from a diseased organ, for example, if there was renal colic on the left, then pay attention to this particular kidney.

Important! Prevention of renal colic requires preventing the development of infectious diseases and inflammatory processes in the body, and this applies not only to the kidneys, but also to any other organ. Any infection can trigger another attack of pain and lead to cramps.

This condition occurs with urolithiasis (blockage of the ureter with a stone), prolapse of the kidney (kink of the ureter) and others. pathological conditions(for injuries, tumors, tuberculosis).

Renal colic is characterized by a sudden, cramping increase in pain in the lumbar region with frequent irradiation to the groin, genitals, and leg. Renal colic is often accompanied by nausea and vomiting.

Diagnostics

Emergency hospitalization is indicated and mandatory inspection a urologist to determine the causes of renal colic and conduct differential diagnosis with acute surgical diseases.

The most valuable method for diagnosing renal colic is intravenous urography ( X-ray examination kidneys after intravenous administration contrast agent). It allows you to detect stone and changes urinary tract, expansion of the pelvis and calyces, displacement of the kidney and bending of the ureter. Intravenous urography also reveals other, more rare causes renal colic.

Treatment

If renal colic is caused by urolithiasis, along with stopping the attack, remote lithotripsy (crushing the stone with ultrasound) is successfully used.

An attack of renal colic can be alleviated by the use of heat - a heating pad, a bath at a temperature of 37-39 C. Be sure to use antispasmodics and painkillers in injection form (including narcotic analgesics).

In case of a prolonged attack, the doctor can perform a novocaine blockade of the spermatic cord (in men) or the round ligament of the uterus (in women) from the side of colic. Renal colic, accompanied by an increase in temperature, is a direct indication for hospitalization in the urology department, where therapeutic purpose Ureteral catheterization may be performed.

Forecast

If the fragment of stone that caused the obstruction of urine outflow is small, then renal colic often ends with its passage in the urine.

Otherwise, if medical care is not provided in a timely manner, acute obstructive pyelonephritis develops, which can cause death in a short time.