I have pain in my right lower back for about a week now. The pain radiates to the right side of my abdomen and groin area. It is not a constant pain but can be extremely uncomfortable at times. What is this in your opinion, and what course of action should be taken?
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Right loin to groin pain is a classic presenting pain of ureteric colic, which can be due to stone in the right ureter blocking your kidney cause renal capsule stretch and pain. The pain can be severe, and patients keep searching for a comfortable position to reduce the pain attack. Medications can be effective in controlling the pain, and in most cases, it is Diclofenac sodium after checking the kidney functions. This pain can also be due to other causes, mainly muscular after a muscle pull due to exercise, or it can be neurological due to nerve compression at the back. Working towards diagnosis needs proper history about exercise or stone problems and previous accidents to the back or fall, amount of water consumption per day, or history of gout (high uric acid).
Investigations include creatinine to measure the kidney function and urine analysis and culture to make sure no infection and a CT KUB (computerized tomography of kidneys, ureter, and bladder) have more than 95% accuracy in diagnosing ureteric stones then further plan is after the investigations.
For now, control the pain with tablet Diclofenac sodium 50 mg twice daily, but if pain persists or increased or you get a fever, you might need admission to the hospital for injectable pain killers and further workup for the diagnosis.
Kindly follow up and update me on the required investigations, then we can go more towards your treatment.
Urine analysis. Urine culture. Creatinine level. CT KUB.Treatment plan:
Diclofenac sodium 50 mg twice daily.Preventive measures:
Maintain hydration.Regarding follow up:
Thank you doctor,
It does not appear to be muscular. Will the stone pass on its own? How long should I wait to seek medical help? How long does it take a stone to pass? Are there any other liquids I should drink to speed up the process? Could an energy drink cause stone formation?
Welcome back to icliniq.com.
Usually, stone passage depends on the location and size of the stone. Stones of 5 mm or less in the distal ureter will pass in one to four weeks with Tamsulosin 0.4 mg once daily. Poor indicators for stone passage are bigger stone than 6 mm and mainly in upper ureter moderate blockage of the kidney with less than 25% chance for spontaneous passage. That is why CT KUB is recommended before even starting Tamsulosin to confirm the diagnosis and estimate the time and rate of stone passage.
Liquids like Potassium citrate 10 ml thrice daily seem helpful. Jogging and adequate hydration are also helpful. And hospital admission is required if the pain was not relieved by oral medication or if you get a fever. The dose of Diclofenac sodium is 50 mg twice daily.
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