What is Renal Colic?
Renal colic is mainly an extreme level of pain caused by the stones present in the urinary tract, also known as urolithiasis. This pain can appear in any region of the urinary tract depending upon the position of the stone ranging from ureters, bladder and urethra.
Stones in the urinary tract develop mainly because of the accumulation of substances like minerals, uric acid etc., which creates a hard mass formation causing troubles in urine passage and pain, which is renal colic.
Several treatment options are available for different types of urinary stones. Some of these just require treatment with medications without any surgical procedure. However, managing renal colic during the actual pain is a difficult thing since it is a very painful phase caused by the blockage of the urinary tract due to stones.
What are the Causes of Renal Colic?
Renal colic happens mainly because of obstruction or blockage caused by a stone in the urinary tract region(1) This is very common in the ureter region since the stone usually stretches out the tissue of this area while trying to pass through and causes pain and inflammation in the region. The stones also cause a pressure buildup in the bladder due to urine flow restriction. This is a really painful situation and the ureter might also undergo spasms while accommodating stones inside it; since it is not meant to retain any stone inside.
The main cause of stone buildup can vary greatly from the accumulation of minerals to certain chemicals inside the body or kidney, which are not passed out at times and accumulate to form stones over time. Following are few listed risk factors,(1) which might contribute to the renal colic due to stones:
- Ulcerative colitis.
- Gout or excessive uric acid present in the body.
- Certain prescribed or over the counter medications.
- GI tract surgeries like gastric bypass etc.
- A family history of urolithiasis.(2)
- Excess of calcium in the urine.(4)
- Crohn’s disease or any other GI disease, etc.
What are the Symptoms of Renal Colic?
Symptoms of renal colic might vary from one person to another depending upon the location and size of the stone in the urinary tract. Smaller stones usually cause mild renal colic issues.(5) However, bigger ones might cause severe renal colic with excruciating pain needing even immediate surgery especially, in cases of obstruction and blockage caused by the stones. A complete evaluation of the condition is a must before starting with any therapy.
Usually, the smaller ends or curves in the urinary tract are more prone to renal colic, since it leads to complete blockage of urine flow due to a stone presence at those areas.
The renal colic pain is mainly felt in the form of waves lasting from 20 to 60 minutes. The pain is mainly felt along the sides of the abdomen between the ribs and the hip section, which further radiates towards groin and lower abdominal region.(5) Few other symptoms of renal colic might include:(5)
- Painful micturition or pain during urinating.
- Blood in the urine color might vary from pink, red or brownish.
- Foul odor in urine.
- Nausea, vomiting and in some cases uncontrollable vomiting can even happen.
- Fine particles are present in the urine.
- A constant urge to urinate all the time.
- Alteration in urination frequency either more or can be less than normal.
- Cloudy urine.
- Fever of 101°F and above due to some infection caused by the stone.
Signs of urinary tract infection surface in some cases with fever, cold sweat and chills etc. In case of presence of any of these symptoms, emergency medical attention must be sought for.
How is Renal Colic Diagnosed?
Doctors prefer complete blood tests for evaluation of the causes of stone formation and the substances, which makes the stone in the body. Further, imaging tests like computed tomography (CT) scan, ultrasound and X-ray scan are often used to help locate the exact position of the stones inside the urinary tract of the body.
Few tests are listed below, which helps in diagnosing the renal colic:
Blood Tests to Diagnose Renal Colic: Blood tests help in revealing the presence of excess calcium and uric acid levels in the body. This even helps in monitoring kidney health and evaluates other medical conditions, which can complicate the situation.
Urine Tests: The 24-hour urine collection test helps in evaluating if any stone forming minerals are present in the urine sample.
Diagnosis of Renal Colic with Imaging Tests: Imaging tests like X-ray of the abdomen, and CT scan of the kidneys and bladder show if any stones are present in the entire urinary tract. Sometimes small sized stones are missed during scans and nothing comes up. However, a high-speed dual energy CT scan might help in revealing small stones as well. Ultrasound is another noninvasive imaging option, which helps in evaluation of the stone.
Analysis of Stones, Which Are Passed Via Urine: Urine sample collection passing through a strainer leaves stone residuals over the strainer, which can further be evaluated. This information can be helpful for the doctor to understand the main cause of the stone formation and hence accordingly treatment can be decided.
Types of Stones Causing Renal Colic
Medical treatment of renal colic is usually done after evaluating the type of stones. Following are the few different types of stones which occur in the urinary tract system (6):
- Calcium Stones: These are the most commonly occurring type amongst all. These are made up of calcium oxalate crystals in the body, which is formed due to excess of calcium accumulation.
- Uric Acid Stones: These stones are formed due to excess uric acid accumulation in the body and it is easily identified from the urine sample or a blood sample.
- Cystine Stones: These are such stones, which are rare and its main cause is cystinuria.
- Struvite Stones: These stones are mainly formed by some bacterial action in the urinary tract.
Most of the stones pass out on their own and nearly 80 percent of the kidney stones pass out via urine with proper hydration along with pain-relieving medications. Further, proper monitoring of the stone is also required to avoid any complication.
What are the Treatment Options of Renal Colic?
Treatment of renal colic varies from medications to procedures depending upon the patient’s requirement as per the stone location and size. The medications often help in reducing stone accumulation and in relieving symptoms like pain, etc. Treating stones with the medications(1) usually involves the following line of treatment:
- Alkalinizing agents.
- Calcium channel blockers mainly in calcium stones.
- Antibiotics mainly in bacterial involved stones or infections caused by stones.
- Selective alpha-1 blockers.
If the stones do not pass out, then further procedures might be required. Depending upon the type of stone present, there are different procedure options(1) available to help and relieve renal colic:
Ureteroscopy Guided Stone Extraction: This procedure involves surgical invasion for the removal of stones. In this, a thin scope having light and camera is inserted inside the urinary tract to locate and remove the stone causing renal colic.
Percutaneous Nephrolithotomy to Treat Renal Colic: Percutaneous nephrolithotomy is done under the effect of general anesthesia. A small cut is made at the back to get easy access inside the kidney for the removal of stone using light and camera attached instruments.
Stent Placement for Renal Colic: Sometimes, in order to relieve obstruction and allow urine to pass through, a thin tube is inserted inside the ureter. This helps in relieving problems in micturition and pain, i.e. renal colic.
Extracorporeal Shock Wave Lithotripsy: This is a noninvasive treatment option which utilizes sound waves to breakdown the small stones. Such tiny pieces can easily pass through the urine.
Open Surgery to Treat Renal Colic: This is the last option for such patients who cannot pass out the stones causing renal colic. This option requires a long recovery period.
How Long Can Renal Colic Last?
Most of the stones usually pass out on their own; however, it might end up in renal colic. The doctor is the best person to decide on the surgical or medical or even a combination of both while helping the large stones to breakdown and pass through. So, there is no definite time period for renal colic to last since it entirely depends upon the patient’s condition and size of the stone.
The treatment might take from a few weeks to a couple of months and even longer at times depending upon the size of the stones. At times, even after a completing a successful treatment, renal colic might recur, as the stones can reform time and again. So, post-treatment of renal colic, it is always important to take a few recommended precautions to avoid recurrence of the stones.
- Giannossi L., Summa V. A review of pathological biomineral analysis techniques and classification schemes. In: Aydinalp C., editor. An Introduction to the Study of Mineralogy. InTech, IMAA-CNR, Italy: InTechOpen; 2012.
- Obligado S. H., Goldfarb D. S. The association of nephrolithiasis with hypertension and obesity: a review. American Journal of Hypertension. 2008;21(3):257–264.
- Heilberg I. P., Schor N. Renal stone disease: causes, evaluation and medical treatment. Arquivos Brasileiros de Endocrinologia & Metabologia. 2006;50(4):823–831.