Loin To Groin Pain
- 1 Where is loin pain located?
- 2 What is flank loin syndrome?
- 3 Which condition presents with loin pain?
- 4 Can cystitis cause groin pain?
- 5 Can a bacterial infection cause groin pain?
- 6 Why does the area between my stomach and groin hurt?
- 7 Why does lower back pain radiate to groin?
- 8 Why does my back pain radiate to my groin?
- 9 What is colicky flank pain radiating to the groin?
Why does pain radiate from loin to groin?
Pain radiating from the loin into the groin can be caused by: ureteric colic. abdominal aortic aneurysm. pyelonephritis.
What nerve causes loin to groin pain?
Treatment / Management – There are multiple strategies to treat chronic groin pain. The pain of neuropraxia is typically temporary and disappears with time. Sometimes, the chronic groin pain persists and interferes with the activities of daily living. A) Conservative treatment : Lifestyle modification:
Walking, stooping, or hyperextension of the hip joint exacerbates chronic groin pain – the recumbent position and flexion of the hip joint and thigh relieves pain.
Includes non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antiepileptics, and antidepressants
Transcutaneous electric nerve stimulation, myofascial release, and acupuncture can control symptoms of the ilioinguinal neuralgia.
B) Ultrasound-guided n erve block : Aim: interruption of the neuronal transmission leading to temporary pain relief. Substances injected: local anesthetics (with or without steroids) or neurolytic agents. Principal: injection of these chemicals prevent neuronal transmission through ilioinguinal nerve fibers either by blocking membrane ion channels or by denaturation of axon proteins. Technique:
- Patient position: supine
- Use a linear probe with a frequency ranging from 5 to 10 MHz
- Place the probe transversely and start scanning from the anterior superior iliac spine.
The nerve lies between transversus abdominis and internal oblique muscles lateral to the inferior epigastric artery and the iliohypogastric nerve. Operators introduce a needle from lateral to medial using an in-plane approach to place the injectate accurately around the nerve.
Where is loin pain located?
If you would like to discuss your kidney diagnosis with our trained members of staff ring the free to call number 0800 169 0936. The NKF Helpline is available Monday to Thursday 08:30am – 5:00pm Friday 9.00am – 1.00pm on 0800 169 09 36 or email, WHERE ARE THE KIDNEYS? The kidneys are in the back, one on each side of the spine.
They are about 2 inches (5cm) deep, just behind the lower ribs. Pain in a kidney is usually felt as lower back pain, on one side or the other. The pain can run down into the groin, or further down the back. The kidneys lie next to the muscles of the back, so that it can sometimes be difficult to tell the difference between muscle pain, back pain or kidney pain.
WHAT CAUSES KIDNEY PAIN? There are many causes of kidney pain. Infection in the kidney and kidney stones are common causes. X-ray tests will detect kidney stones. Samples of urine will be sent to the laboratory for culture tests to see if infection is present.
Other conditions which cause some swelling or irritation of the kidneys may also cause pain, and a more rarely coined term would be loin pain-haematuria syndrome. WHAT IS LOIN PAIN-HAEMATURIA SYNDROME? Loin pain-haematuria syndrome (also known as LPHS) is a combination of loin (ie kidney) pain and haematuria, which is a medical term for blood in the urine.
The loin pain may be a continuous dull ache, or intermittent, coming on only occasionally and could be from one side or both. The blood in the urine may be visible to the naked eye, coming in occasional attacks. There may even occasionally be blood clots.
- In other cases, the amount of blood is so small that it cannot be seen, but is detected when the urine is tested in the clinic.
- WHAT ARE THE CAUSES OF LOIN PAIN-HAEMATURIA SYNDROME? There are several conditions which can cause this problem.
- A kidney biopsy, or sometimes an angiogram test, is used in many people to make a clear diagnosis.
The conditions are all essentially abnormalities within the tissue of the kidney. The commonly encountered explanation of loin pain-haematuria are:
IgA nephropathy. This is a condition in which small amount of a type of normal antibody (called IgA) get stuck in the kidney as it passes through in the bloodstream. This is a chronic condition, which sometimes goes away on its own but occasionally can cause damage to the kidneys. A related condition called IgM nephropathy can sometimes cause pain. (Click on the following links for more information on IgA and IgM ). Thin membrane disease. In this condition the membrane that filters the blood to make urine is too thin, and blood can pass across it in very small amounts. In a few cases of this condition, there is pain in the kidneys, usually occurring in attacks every so often. Although this condition can be painful, kidney failure does not seem to occur in the long term, so that the only real problem is the symptoms. In some cases, loin pain-haematuria syndrome occurs after a bladder infection with involvement of the kidney. Even when the infection has been treated and bugs can no longer be found in the urine, pain may persist for 6 months, or even longer in some cases. ‘Nut-cracker syndrome’ is when the large main artery of the body can compress on the left kidney’s vein, interrupting blood flow. Common treatments include monitoring, stenting or surgery but not always successful at irradicating symptoms. “Classic loin pain-haematuria syndrome”. Some patients have none of the above diagnoses. In these cases there may be minor abnormalities on a kidney biopsy. Angiogram tests to look at the blood vessels in the kidney may show abnormal blood flow, perhaps causing a cramp like pain. The cause is not fully understood. It certainly is commoner in women than in men, and there may be hormonal influences. Some women find the pain is worse at different times of their menstrual cycle, or comes on during pregnancy, or if they are taking the oral contraceptive. This condition may persist for some years, and can be lifelong. Damage to the kidneys leading to kidney failure does not occur.
WHAT ARE THE TREATMENTS FOR KIDNEY PAIN? If infection is suspected, a course of antibiotics may be given. Long term preventative antibiotics may be necessary in some cases. Loin pain-haematuria syndrome may, in a few people, responds to anticoagulant treatment with warfarin or aspirin – this reduces the tendency for blood flow in the kidney to be interrupted.
In the majority of cases, however, little can be done apart from trying to ensure adequate treatment for the pain itself. The types of treatment that may be effective vary from person to person, and advice from a doctor specialising in pain relief may be needed. PSYCHOLOGICAL ASPECTS OF KIDNEY PAIN Pain that will not go away easily is very unpleasant.
Read more on how to cope with pain. WHERE CAN I GO FOR FURTHER HELP? A joint approach from the kidney specialist, general practitioner and, if necessary, a pain specialist or psychologist may not always be enough. If you want further advice or treatment, please discuss this with your specialist.
Can UTI cause loin to groin pain?
UTI – The loin pain occurs in UTI usually due to spread of infection from bladder to kidneys or can happen due to primary kidney infection itself. Stone or structural abnormalities of urinary tract itself are primary causes of spread of infection to kidneys,
Can pain in lower abdomen radiate to groin?
Treatment – Pelvic floor physical therapy, including exercises, can help. Sometimes, people also require surgery to repair damaged tissue. Overall, the right treatment approach depends on the type of pelvic floor disorder. Learn more about the available treatments here.
Appendicitis refers to inflammation and infection of the appendix. A person first experiences pain near the belly button. The pain later extends to the lower right side of the abdomen, just above the hips and groin. The pain can begin suddenly and worsen when the person moves, takes a deep breath, or sneezes.
Other symptoms can include:
a loss of appetitevomitingnauseaconstipationan inability to pass gasabdominal swellinga low fever
Can vitamin D deficiency cause flank pain?
Abstract – Loin pain is frequently not associated with any urinary abnormality. Musculoskeletal abnormalities are not uncommon as alternative cause of flank pain. Osteomalacia of the ribs was infrequently encountered as the cause of flank pain. Vitamin D deficiency has been reported as a common problem worldwide with special predilection to the Middle East area.
In this study, we looked for vitamin D deficiency in patients with flank pain associated with tenderness over the tips of the lowermost ribs. Out of 783 patients presenting with unilateral or bilateral flank pain to a single center over a period of 3 years, 316 did not have a definite urologic cause (group B).
One hundred and eighty-seven of these patients had distinct tenderness over the costal margin (group B1) that could not be explained by history and radiology. All patients of group B were tested for serum levels of 25(OH) vitamin D. Very low serum levels of 25(OH) vitamin D was detected in all cases of group B1 and in only in only 26.4% of the remaining cases of group B (group B2).
- Relief of flank pain was noticed within 2 months in 55.1% of vitamin D deficient cases.
- In patients presenting with flank pain, the existence of tenderness of the last ribs instead of the renal angle proper should alert to a possible cause in the rib cage.
- Estimation of serum vitamin D level should be performed in these cases.
Keywords: Flank pain; Loin pain; Nephrolithiasis; Osteomalacia; Vitamin D deficiency.
Can a pinched nerve cause groin pain?
Uncommon Causes of Groin Pain – Other causes of groin pain are less common but may be just as serious. Testicular Conditions Conditions affecting the testicles (testes) may cause groin pain. These include:
Epididymitis : This is inflammation of the epididymis, a duct located at the back of the testes. The pain may begin in the groin and move to the testicle. Swelling of the testicle may occur. Less commonly, there may be fever and chills. This condition is most often caused by a sexually transmitted infection, Testicular torsion : This urgent concern occurs when the structure that carries nerves to the testicles twists. This causes severe and sudden groin and testicle pain.
Nerve Problem A pinched nerve in the lower spine may cause groin pain. Numbness and tingling in the groin area may also happen. This condition is called lumbar radiculopathy, Compression of a nerve (called nerve entrapment) may cause burning or stabbing groin pain, as well as middle- thigh pain,
Diverticulitis, an inflammatory condition of the bowel Abdominal aortic aneurysm, when part of the aorta, a major blood vessel, becomes enlarged Pelvic conditions such as ovarian cysts, small pockets of fluid that form on or in the ovaries
Osteitis Pubis Osteitis pubis is an inflammatory condition affecting the pubic symphysis (the joint that connects your two pubic bones). It can cause dull, aching pain in the groin and pelvis. It can occur in both athletes and non-athletes. Osteitis pubis is more common in people with certain things in their medical history, such as:
Inflammatory arthritis Pregnancy Pelvic injury Pelvic surgery
What is flank loin syndrome?
From Wikipedia, the free encyclopedia
|Loin pain hematuria syndrome|
|Sagittal section of the kidney and its capsule. Pain in LPHS is thought to result from distension of the kidney capsule,|
Loin pain hematuria syndrome ( LPHS ) is the combination of debilitating unilateral or bilateral flank pain and microscopic or macroscopic amounts of blood in the urine that is otherwise unexplained. Loin pain-hematuria syndrome (LPHS) is a poorly defined disorder characterized by recurrent or persistent loin (flank) pain and hematuria that appears to represent glomerular bleeding.
Most patients present with both manifestations, but some present with loin pain or hematuria alone. Pain episodes are rarely associated with low-grade fever and dysuria, but urinary tract infection is not present. The major causes of flank pain and hematuria, such as nephrolithiasis and blood clot, are typically not present.
Renal arteriography may suggest focally impaired cortical perfusion, while renal biopsy may show interstitial fibrosis and arterial sclerosis. The pain is typically severe, and narcotic therapy is often prescribed as a way to manage chronic pain. Sleep can be difficult because the supine position increases pressure on the flank.
Which condition presents with loin pain?
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Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications, BJU Int 2003; 91 : 429–430 51. Playford D, Kulkarni H, Thomas M, et al. Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications, BJU Int 2002; 90 : 518–521 52. Bultitude MI. Capsaicin in treatment of loin pain/haematuria syndrome, Lancet 1995; 345 : 921–922 53. Greenwell TJ, Peters JL, Neild GH, et al. The outcome of renal denervation for managing loin pain haematuria syndrome, BJU Int 2004; 93 : 818–821 54. Gambaro G, Fulignati P, Spinelli A, et al. Percutaneous renal sympathetic nerve ablation for loin pain haematuria syndrome, Nephrol Dial Transplant 2013; 28 : 2393.55. Chin JL. Loin pain-hematuria syndrome: role for renal autotransplantation, J Urol 1992; 147 : 987–989 56. Sheil AG, Ibels LS, Pollock C, et al. Treatment of loin pain/haematuria syndrome by renal autotransplantation, Lancet 1987; 2 : 907–908 57. Andrews BT, Jones NF, Browse NL. The use of surgical sympathectomy in the treatment of chronic renal pain, Br J Urol 1997; 80 : 6–10 58. de Beus E, Blankestijn PJ, Fox JG, et al. Catheter-based renal denervation as a novel treatment for loin pain haematuria syndrome, Nephrol Dial Transplant 2013; 28 : 2197.59. Turini D, Barbanti G, Beneforti P, et al. Autotransplantation for intractable loin pain: report of a case with longterm followup, J Urol 1995; 153 : 389–391 60. Burke JR, Hardie IR. Loin pain haematuria syndrome, Pediatr Nephrol 1996; 10 : 216.61. Karvelas JP, Ramsey EW. Renal autotransplantation in patients with loin pain-hematuria syndrome, Can J Surg 1996; 39 : 121–125 62. Harney J, Rodgers E, Campbell E, et al. Loin pain-hematuria syndrome: how effective is renal autotransplantation in its treatment? Urology 1994; 44 : 493–496 63. Casingal VP, Asolati M, Hunter D, et al. Emergent autotransplantation of a renal allograft, Clin Transplant 2005; 19 : 563–565 64. Spitz A, Huffman JL, Mendez R. Autotransplantation as an effective therapy for the loin pain-hematuria syndrome: case reports and a review of the literature, J Urol 1997; 157 : 1554–1559 65. Talic RF, Parr N, Hargreave TB. Anephric state after graft nephrectomy in a patient treated with renal autotransplantation for bilateral metachronous loin pain/hematuria syndrome, J Urol 1994; 152 : 1194–1195 66. Aber GM, Higgins PM. The natural history and management of the loin pain/haematuria syndrome, Br J Urol 1982; 54 : 613–615 67. Goroszeniuk T, Khan R, Kothari S. Lumbar sympathetic chain neuromodulation with implanted electrodes for long-term pain relief in loin pain haematuria syndrome, Neuromodulation 2009; 12 : 284–291 Articles from Clinical Kidney Journal are provided here courtesy of Oxford University Press
Can cystitis cause groin pain?
Abstract – PIP: Women with a common bladder infection and those with interstitial cystitis (IC) both suffer from severe groin pain, a strong desire to urinate with just small amounts of urine emerging, and waking up during the night to urinate. The sole symptomatic difference between common bladder infections and IC is that women with a common bladder infection note burning or stinging during urination while those with IC find relief from pain only during urination.
Bacteria cause common bladder infections so antibiotics can treat these infections. The causes of IC are unknown, thus making it difficult to treat. IC consists of small, pin point holes in the lining of the bladder. A healthy bladder prevents bacteria from adhering to the bladder and causing infections.
It also prevents acid and other toxins in the urine from irritating the bladder. Bacteria in the bladder are not uncommon. They take the following path to enter the bladder: the colon, bowel movement, vagina where body’s defenses usually kill the bacteria, urethral opening, urethral opening, and bladder.
In women with an intact bladder lining, the bacteria stay in the urine until they are released with the urine. In bladders with small, pin point holes, the bacteria cause an infection. The in and out motion of sexual intercourse or massaging of the genital area tend to push bacteria up into the urethra.
Women using the diaphragm experience twice as many bladder infections as those who do not use the diaphragm. Possible reasons include a change in the chemical balance of the vagina, maybe inducing more bacteria growth, and the diaphragm’s hard rim pushed against the neck of the bladder, resulting in bruising and swelling and making women more vulnerable to infection.
Can a bacterial infection cause groin pain?
Groin infections can be caused by: fungus (such as tinea or ‘jock itch’) sexually transmitted infections (STIs) like herpes. other viral or bacterial skin infections.
Can kidney problems cause groin pain?
In these cases, the symptoms of kidney stones can include: a persistent ache in the lower back, which is sometimes also felt in the groin – men may have pain in their testicles and scrotum. periods of intense pain in the back or side of your abdomen, or occasionally in your groin, which may last for minutes or hours.
How long should groin pain last?
How Are Groin Strains Treated? – With rest and proper treatment, most groin strains heal on their own in about 4–8 weeks. More severe groin strains can take longer. It is very important to let the strain heal fully and get the doctor’s OK before going back to activities.
Rest the area and avoid activities that cause pain. For the first day or two, put an ice pack on the area 3–4 times a day for 15 minutes at a time. Put a towel between the ice and the skin to protect it from the cold. Use an elastic wrap to help support the groin and keep the swelling down. Raise the groin by lying down and putting pillows under the hips to lift the hips and thighs. Take medicine for pain such as ibuprofen (Advil, Motrin, or store brand) or acetaminophen (Tylenol or store brand). Follow the directions that come with the medicine for how much to take and how often.
When the doctor says it’s OK, people with a groin strain can do strengthening and stretching muscles through physical therapy (PT) or an at-home exercise program.
Can colon problems cause groin pain?
Constipation – Chronic constipation can have many etiology causes, but if you are dealing with a new pattern, it is best to consult your primary doctor. Chronic constipation can cause additional groin pain by causing a hernia or tearing muscles with a difficult bowel movement.
Why does the area between my stomach and groin hurt?
A common cause of groin pain, most often found in athletes, is a strain of the muscles, ligaments or tendons. Another common cause is an inguinal hernia, which is a lump in the groin that occurs when the bowels or other tissues are pushed through a defect in the muscular wall of the lower part of the abdomen wall.
Can pancreatitis cause groin pain?
Acute scrotal pain as sole presentation of acute pancreatities Pancreatitis has a myriad of different presentations although commonly presents with epigastric pain radiating to the back, nausea and vomiting. There are five case reports in the English literature of scrotal pain and swelling in severe alcoholic pancreatitis, two of which underwent surgical exploration. We present the first case of mild pancreatitis presenting with scrotal pain in the absence of any other symptoms or signs. We conclude that in any patient with unexplained scrotal pain, even in the absence of physical signs the possibility of pancreatitis should be considered. Keywords: Pancreatitis, Scrotal pain, Diagnosis Pancreatitis has a myriad of different presentations although commonly presents with epigastric pain radiating to the back, nausea and vomiting. There are five case reports in the English literature of scrotal pain and swelling in severe alcoholic pancreatitis, two of which underwent surgical exploration. We present the first case of mild pancreatitis presenting with scrotal pain in the absence of any other symptoms or signs. A 44 year old male presented to the Emergency Department with acute scrotal pain. He had no associated urinary or bowel symptoms and no groin lumps. He was evaluated by his general practitioner (GP) prior to admission where an urgent ultrasound of his scrotum was reported as normal and urinary tract ultrasound noted a fatty liver but was otherwise normal. At presentation, he complained of severe pain in his scrotum. There was no associated fever, nausea, vomiting, urinary or bowel symptoms and no history of trauma. He had a past medical history of a single episode of alcoholic pancreatitis 10 years previously with no subsequent symptoms. He estimated his current alcohol intake as 60 units per week. On examination he was afebrile and haemodynamically stable. There was no visible bruising or discolouration of the abdomen. His abdomen, which was not distended, was soft with no tenderness, guarding or rebound tenderness. Bowel sounds were normal. There were no clinically demonstrable hernias. The scrotum appeared normal and was non-tender with no bruising or visible oedema. Both testicles felt normal. Digital rectal examination revealed a normal sized, non-tender prostate. Blood tests revealed an amylase of 636 U/L (20–105), CRP of 46 mg/L (<10) and WCC of 13.6 × 10.9/L (3.8–11.0). Arterial blood gas showed a mild respiratory alkalosis and chest x-ray was normal. He was scored as 3 (mild pancreatitis) using the modified Glasgow score. CT scan of the abdomen revealed inflammatory changes of the body and tail of the pancreas and a thin rim of fluid indicating acute pancreatitis. He was treated conservatively with intravenous fluids, analgesia, antibiotics and a proton pump inhibitor. The patient continued to improve, his scrotal pain resolved and he was discharged. The common differential diagnoses of acute scrotal pain include torsion of testes or hydatid of Morgagni, epididymo-orchitis, strangulated hernia and epididymal cyst. Symptoms and signs can lead to the diagnosis but surgical exploration is sometimes necessary to exclude testicular torsion. Pancreatitis as a cause of scrotal pain is extremely rare. There are just five case reports of pancreatitis associated scrotal swelling, all alcohol related pancreatitis. Three cases describe typical presentations of pancreatitis where scrotal pain and swelling developed later in the course of the disease, In one of these cases the patient underwent surgical exploration to exclude testicular torsion. The two remaining case reports describe pancreatitis presenting with scrotal swelling, with one case undergoing emergency scrotal exploration, The pancreatitis was reported to be severe in all five cases and all had significant scrotal physical signs. As pancreatitis progresses, fluid arising from the pancreas can leak into the retroperitoneal and peritoneal spaces. Fluid containing pancreatic exudates and debris can also track down the retroperitoneum into the inguinal canal and scrotum causing local irritation and/or fat necrosis, This is the first case in which a patient with a mild pancreatitis presents solely with scrotal pain. The diagnosis of acute pancreatitis was serologically and radiologically confirmed. The chronological association and the complete resolution of scrotal pain when the pancreatitis resolved suggests a causal relationship. We assume that a minute amount of fluid rich in pancreatic exudate tracked down the spermatic cord, causing the pain. Unfortunately, the CT scan was only limited to the abdomen and therefore cannot confirm this. In a 2012 British study, the cost of a single pancreatic enzyme level was £0.69 (lipase or amylase) and the cost of both amylase and lipase levels when measured together was £0.99, This is minimal compared with the ongoing costs of misdiagnosis or the expense of an unnecessary scrotal exploration. We conclude that in any patient with unexplained scrotal pain, even in the absence of physical signs the possibility of pancreatitis should be considered. This should be investigated with serum amylase and/or lipase levels and appropriate imaging. Maintaining a high index of suspicion will avoid a delayed diagnosis, misdiagnosis and inappropriate surgery.1. Dennison A.R., Royle G.T. Acute pancreatitis—presentation as a discoloured lump in the groin. Postgrad. Med.J. (Case Reports) 1984; 60 :374–375.2. Zimin A.F., Satsukevich V.N., Molchanov N.P. Acute pancreatitis with hemorrhagic flow into the scrotum. Vestn Khir Im I I Grek (Case Reports) 1979; 122 :47–48.3. Kim S.B., Je B.K., Lee S.H. Scrotal swelling caused by acute necrotizing pancreatitis: CT diagnosis. Abdom. Imaging.2011; 36 :218–221.4. O'sullivan K.E., Larkin J.O., Guiney M., Reynolds J.V. Necrotising pancreatitis presenting as a painful mass in the groin and sepsis. BMJ Case Rep.2013 5. Nazar M.A., D'souza F.R., Ray A. Unusual presentation of acute pancreatitis: an irreducible inguinoscrotal swelling mimicking a strangulated hernia. Abdom. Imaging (Case Reports) 2007; 32 :116–118.6. Gomez D., Addison A., De Rosa A., Brooks A., Cameron I.C. Retrospective study of patients with acute pancreatitis: is serum amylase still required? BMJ Open.2012; 2 (5):e001471. Articles from International Journal of Surgery Case Reports are provided here courtesy of Elsevier : Acute scrotal pain as sole presentation of acute pancreatities
Why does ureteric colic radiate from loin to groin?
Introduction – Renal colic classically refers to acute severe loin pain that occurs secondary to a urinary stone, Urinary stones, also termed urolithiasis, refer to stone formation anywhere within the urinary tract. They may be asymptomatic or cause acute loin-to-groin pain due to ureteric obstruction.
Why does lower back pain radiate to groin?
Arthritis – Arthritis is a common condition many individuals begin to experience as they age. While there are many types (over 100, in fact), many of the most common are caused by wear and tear on the body as you age. This can cause pain and limited range of motion, sometimes beginning in the back and radiating into the groin area.
Why does my back pain radiate to my groin?
While there are many causes of lower back pain, a commonly overlooked cause is the sacroiliac joint. The sacroiliac joint (SIJ) is a commonly underdiagnosed cause of both acute and chronic back pain. This is because the pain is typically located in the lower back and can radiate to the groin and buttock which is also common with hip problems, sciatica or even a pinched nerve. Then SIJ is located in the pelvis and connects the base of the spine (sacrum) to the hip bones (ilium). Your SI joint is supported by various muscles and ligaments that let your body transfer energy from your legs to your body when you walk, run or move around.
These muscles and ligaments also act as shock absorbers from your lower body and reduce compression on your spine. There are several potential causes of SI joint pain, but the most common include injury, such as a fall on the buttock, a sudden twist or lifting from a twisted position. Other causes of SIJ pain include osteoarthritis, intense exercise, or biomechanical problems such as an abnormal walking pattern.
SI joint pain is also common during pregnancy. Diagnosis is typically made through history and physical examination by your healthcare provider, and sometimes through a diagnostic injection of anesthetic and steroid to the SIJ. Treatments usually begin with the most conservative and least invasive options first, such as chiropractic care or physical therapy.
- Manipulation or mobilization of the SIJ in combination with stretching and exercises alleviates most episodes.
- However, in some patients with resistant cases, sacroiliac injections, or ablations may be necessary.
- Stretching the muscles around your SI joint may help reduce pain by relieving tension in your lower back.
Doing a few stretches for a couple of minutes each day can be beneficial. It’s important to note that when stretching it’s always better to be too gentle than too aggressive. Stretching too vigorously can worsen your symptoms. Here are a few stretches you can try at home:
- Lie flat on your back on a mat or other comfortable surface.
- While keeping one leg on the floor, grab your other knee and gently pull in toward your chest until you feel a stretch in the back of your leg.
- Hold for a minute and then repeat on the other side.
- If you have trouble reaching your knee you can hook and a yoga strap or light resistance band behind your knee.
Figure 4 stretch :
- Lie on your back on a mat or other comfortable surface with your knees bent and feet flat on the floor.
- Raise your left leg so that your hips and knee are both roughly at a 90-degree angle.
- Raise your right leg and place your ankle just above your left knee.
- Gently pull your left leg towards your chest until you feel a stretch.
- Hold for a minute and repeat on the other side.
Trunk rotation stretch :
- Lie on your back on a mat or other comfortable surface with your knees bent and feet flat on the floor.
- Stretch your arms out to your sides in a T-position. Your knees should be together and pointed towards the ceiling.
- While keeping your knees together, twist to one side as far as you comfortably can. Stop immediately if your lower back starts to hurt.
- Switch to the other side and perform a few twists on each side.
Quad stretch :
- Stand tall with your hips shoulder-width apart.
- Hold onto a sturdy chair or wall if you need help balancing.
- Grab your left ankle and gently pull your foot towards your buttocks with your knee pointing down. Don’t force your heel to your butt – just bring it as close as your comfortably can to feel a light stretch.
- Hold for a minute and repeat on the other side.
In addition to regular stretching here are some other ways to help reduce or prevent SI joint pain:
- Use proper lifting techniques
- Maintain good posture while sitting, standing and sleeping
- Regular exercise and stretching/strengthening
- Set up an ergonomic work area
- Eat a healthy diet and drink plenty of water
- Learn how to effectively manage stress
- Don’t smoke
If you are dealing with SI joint pain that does not improve with rest and gentle stretching you should seek professional medical assistance. Your doctor may recommend chiropractic care or physical therapy so a custom stretching and strengthening program can be tailored to you to help manage your pain.
What is colicky flank pain radiating to the groin?
Non-Parenchymal Renal Etiologies – Most non-parenchymal etiologies of renal pain involve obstruction of the urinary tract. Such obstruction, whether intrarenal, in the proximal ureter, or as distal as the bladder or urethra, can produce classic renal colic due to dilation of the intrarenal collecting system.
Additionally, the upper urinary tract itself is well innervated and irritation by a foreign body (eg, kidney stone, ureteral stent) can trigger flank pain even if no hydronephrosis is present. Nephrolithiasis Flank pain is the classic presenting symptom of urinary calculi and is the predominant cause of flank pain in the absence of fever.
Nephrolithiasis is becoming increasingly common in the industrialized world and the amount of healthcare utilized to treat these patients is growing accordingly. Flank pain from nephrolithiasis can result from marked dilation of the proximal urinary tract as well as local inflammation and possible ischemia.
- In some settings, renal colic pain rarely, if ever, occurs without obstruction.
- Classic renal colic is described as crampy flank pain radiating downward to the groin and is often accompanied by nausea and vomiting.
- On examination, flank palpation and percussion often confirm the pain.
- Hematuria and pyuria are often present and may result from scraping and irritation of the urinary tract by the stone, although a urine culture in this setting is needed to rule out infection.
If an upper tract stone is suspected, imaging is necessary to confirm the diagnosis. Studies of various modalities (eg, ultrasound, computed tomography, x-ray) have shown varying leves of diagnostic efficacy, with patient-specific factors often playing a part.
In the setting of uncontrollable pain, inability to tolerate oral intake, or concomitant urinary tract infection, urologic consultation to pursue surgical management should be considered. See Nephrolithiasis for more information. Stricture disease Broadly defined, a stricture is a concentric narrowing within the wall of a tubular structure.
Within the urinary tract, this can occur at any level from the intrarenal collecting system, through the ureter, to the urethra. If a stricture is severe enough, urinary drainage can be impaired and the urinary system proximal to this level can become dilated.
- Stricture may result from congenital problems (eg, infundibular stenosis, ureteropelvic junction obstruction, posterior urethral valves) or be iatrogenically induced (eg, repeated endoscopic procedures, laser damage, inadvertent electrocautery ).
- Patients with obstruction in this setting will present with renal colic that may worsen after fluid intake.
The pain can be confirmed on examination by flank palpation or percussion. Diagnosis involves imaging with modalities similar to those used for nephrolithiasis. Specialized studies to assess renal function and drainage are also often employed. A urologist should be consulted for treatment, which involves drainage of the obstructed proximal urinary tract and often provides immediate relief.
See Ureteral Stricture for more information. Extrinsic compression Similar to stricture disease, wihch is an intrinsic obstruction of the urinary tract, almost all portions of the urinary tract are also at risk for extrinsic obstruction. Large pelvic or retroperitoneal masses may directly compress the ureter, impairing renal drainage and leading to proximal dilation of the urinary tract, which causes pain.
Retroperitoneal fibrosis is another common cause of ureteral distortion and obstruction. Endometriosis has also been noted to result in ureteral compression. Finally, iatrogenic compression of the ureter can occur as a result of surgical clips, sutures, or staples placed along the course of the ureter; this highlights the relevance of obtaining an accurate surgical hstory.
Symptoms are similar to those of other obstructive processes and workup is pursued similarly, as well. Consultation with a urologist is warranted for drainage of the obstructed proximal urinary tract. Definitive treatment of the extrinsic process can be pursued to resolve the obstruction. See Retroperitoneal Fibrosis for more information.
Bladder outlet obstruction Any impairment of bladder emptying can result in the backup of urine into the ureters, and subsequently the kidneys. Like other obstructive etiologies, such backup and dilation can result in flank pain. A patient with bladder outlet obstruction will generally present with suprapubic fullness and urinary urgency.
If this is acute, uncomfortable bladder distention can be a symptom. However, if the obstruction is chronic and developed gradually over a long time period, no such symptoms may be present. Abdominal examiation may reveal a palpably full bladder and enlarged prostatate on digital rectal examination. Treatment involves urethral catheter placement to drain the bladder.
If that is not possible, then consultation with a urologist is indicated to pursue other drainage options. See Benign Prostatic Hypertrophy for more information. Intraluminal obstruction With hematuria of renal origin, the development of blood clots within the renal pelvis can lead to subsequent ureteral obstruction and flank pain as the clots pass.
These blood clots may result from iatrogenic causes, such as percutaneous renal biopsies or stone procedures, or from underlying medical problems, such as blood dyscrasias, renal tumors, hemophilia, sickle cell disease, or glomerulonephritis. Examination and workup are similar to those with other obstructive processes.
Treatment involves urologic consultation for hematuria workup and relief of the obstruction. See Hematuria for more information. Papillary necrosis can cause ureteral obstruction as sloughed papilla pass down the ureter. Analgesic abuse, liver cirrhosis, and diabetes are the most common risk factors for this condition; other known causes are sickle cell disesase, vasculitis, and tuberculosis.