Loin pain - Clinical Symptoms

Clinical 

Symptoms

Loin pain

Definition

Loin pain or flank pain is pain felt unilaterally or bilaterally in the back, below the twelfth rib. It has two main causes: obstruction and inflammation. Most kidney diseases do not cause loin pain.

On taking the history of any pain consider the Site, Onset, Character, Radiation, Alleviating factors, Timing, Exacerbating factors and Symptoms associated with the pain (SOCRATES).

The classic form of loin pain is from obstruction to the outflow of urine, usually caused by a renal stone (often called renal colic, although the pain may not always be colicky).

·        Site: The pain is usually unilateral, as bilateral renal obstruction is uncommon without there being bladder obstruction as well.

·        Onset tends to be sudden.

·        Character: The pain can be dull, but is usually severe and constant if the stone has obstructed the kidney, or may come in spasms (colicky) if the stone is in the ureter, and the patient will often walk around, or roll around, trying to get comfortable.

·        Radiation occurs down towards the symphysis pubis, groin or into the testis.

·        Alleviating factors: Nothing relieves the pain until either the stone is passed (which may be felt as ‘gravelly’ urine), or strong analgesia is given.

·        Associated symptoms include nausea, vomiting, frank haematuria (blood in the urine).

Loin pain is associated with fever, and loin tenderness is strongly suggestive of infection of the kidney (pyelonephritis). There may be nausea and vomiting, but lower urinary tract symptoms (such as stinging, burning on passing urine or urinary frequency may be minimal or absent). Pain felt in the loin may also result from other abdominal organs (see under Gastrointestinal System and Liver Biliary Pancreas), and musculoskeletal pain. Rarer causes include psoas haematoma and abscess.