How to remove or soothe the pain of renal colic?

“The pain caused by renal colic is often compared to the pain that occurs during labour” renal colic hurts, and it hurts a lot: in The Ante-operative Room we will try to resolve any doubts regarding its causes, diagnosis and treatment.

The acute and intense pain of renal colic is the manifestation of renal lithiasis (calculus) in most cases. It hurts because we have a stone obstructing the urinary tract and causing over-distension of the urinary tract. Therefore, we have something obstructing our urinary tract, usually moving through it, and this causes intense pain.

Stones can be composed of different substances. We can find calcium oxalate stones (the most common), calcium phosphate, non-calcium phosphate, uric acid or amino acids, among other substances.

Diagnosis of renal colic

Diagnosis is primarily clinical. That is, based on the symptoms presented by the patient. Renal colic usually presents as pain that appears progressively in the affected lumbar fossa and radiates towards the groin and genitals. The patient presents with very intense pain that does not subside with rest and may have accompanying symptoms such as nausea, vomiting and sweating.

The diagnosis is completed with a urine analysis that will generally show haematuria and leucocyturia (red blood cells and leucocytes in urine) and with imaging tests such as simple abdominal X-ray (90% of stones can be seen), ultrasound (which also helps to assess the level of renal involvement) and intravenous urography (by which we can visualise any type of stone). The disadvantage of the latter test is that it requires the use of iodinated contrast.

Treatment of renal colic

The first thing is to control the pain. We are dealing with a patient who is in great pain. The pain is very intense and the patient is very affected. Drugs such as NSAIDs (non-steroidal anti-inflammatory drugs) and certain spasmolytics are usually used. Analgesics such as metamizol or tramadol may also be used (if the pain does not subside).

It is also important to rule out some situations in which renal colic becomes an emergency requiring hospitalisation:

📌 Severe urinary tract obstruction. Caused, for example, by large stones

📌 Fever

📌 Uncontrollable pain

📌 Monorenal patient. That is, a patient who has only one kidney

Around 10-30% of cases recur, i.e. they recur. In these cases it would be necessary to carry out an adequate evaluation and treatment of renal lithiasis. The objective? To try to find, through a metabolic study, the cause of the renal colic, i.e. the type of stone, in order to be able to adapt the treatment to the patient’s conditions.

what happens when stones cannot be expelled?

Occasionally, stones that have already formed and cannot be expelled require more “aggressive” treatment. In these cases, extraction surgery, endoscopic manipulation of the urinary tract or extracorporeal shock wave lithotripsy (ESWL) may be used.

Extracorporeal shock wave lithotripsy consists of waves that are transmitted through the body tissues until they reach the lithiasis, producing compression and decompression phenomena in the lithiasis that lead, if successful, to its fragmentation.

what can we do during the crisis?

First of all, go to your medical centre or consult a specialist so that he/she can make a proper diagnosis, rule out serious pathology requiring hospitalisation and prescribe the correct treatment. NO MEDICATION SHOULD BE TAKEN WITHOUT THE SUPERVISION OF A SPECIALIST.

However, once hospital admission has been ruled out, there are things that the patient can do at home:

✅ Take the prescribed medication, as prescribed

✅ Adequate fluid intake

✅ Rest

✅ Apply dry heat to the painful area. For example, with a hot water bottle or electric blanket

✅ Take a hot water bath

✅ Patience. In most cases the episode resolves spontaneously and more aggressive measures are not necessary

✅ Follow a healthy diet with a moderate salt content

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