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Flank pain / flank pain
contents
- Where are the flanks?
- links
- causes
- Unilateral flank pain
- diagnosis
- Therapy for flank pain
Where are the flanks?
Flanks are the two body sides of the body that extend from the navel region to the lumbar vertebrae. The flanks are not protected by skeletal bones, but represent an area characterized by skin, muscles and connective tissue, which is bounded at the top by the costal arch, at the bottom by groin and hip.
Flank pain can have organic, but also muscular causes. (Image: underdogstudios - fotolia) links
Anatomically located in the area mentioned the last, so-called "free" ribs and some muscles. In the layer underneath nerves emerge and in the depth, on the inside of the spinal column, the hip flexor muscle, the iliopsoas muscle, sets in. A little further to the right is the ascending part and on the left the descending part of the large intestine. Further down in the depth are the kidneys. All of these tissue structures may have lesions or diseases associated with flank pain.
causes
The spectrum of possible causes of flank pain is extremely broad, ranging from muscle discomfort, to diseases of internal organs (such as kidneys and spleen) to an acute life-threatening aortic dissection (damage to the wall layers in a major artery) or an aortic rupture (rupture of the main artery) , Also, an infection with herpes zoster (shingles) or a tissue break in the so-called space of Grynfeltt, a small muscle-framed gap below the 12th (last) rib can be the cause of flank pain.
Diseases of the kidneys and other internal organs
Flank pain is a typical concomitant symptom of numerous kidney diseases. Actually, in these cases, the term kidney pain would apply, but due to the location of the kidneys in the flank area right and left of the spine approximately between the 11./12. Thoracic vertebra and the 3./4. Lumbar vertebrae, the complaints are usually perceived by the affected person as flank pain and referred to. Possible causes of kidney pain may be, for example, kidney inflammation, pyelonephritis, kidney stones, cystic kidney, urinary or urinary reflux, renal vein thrombosis, genitourinary tuberculosis, migratory kidney, or kidney cancer. Both the intensity of the pain and the possible concomitant symptoms can be significantly different in the various kidney diseases. For example, kidney stones or urinary stones often cause acute renal colic with severe spasmodic pain in the flank, back and groin. Also abdominal pain, nausea and vomiting can be part of the symptoms here.
However, pelvic inflammatory disease is often characterized by persistent pain and symptoms such as fever, chills, nausea and vomiting. Chronic inflammation of the kidneys often accompanies nonspecific symptoms such as lack of concentration, chronic fatigue, loss of appetite and headache. In addition to flank pain, blood uric acid (hematuria), proteinuria (increased urinary protein excretion) and a marked decrease in urine output are signs of more serious kidney disease. In general, medical help should be sought as soon as possible if kidney disease is suspected.
A so-called kidney trauma is also to be considered as a possible cause of the flank pain, but the persons affected the connection is usually clear, since the complaints a violent external violence has preceded, for example, in a fall or traffic accident. The injury to the kidneys is usually accompanied by clearly visible hematomas (bruises). Damage to the spleen (splenic rupture) is also associated with severe pain in the flank regions.
Not infrequently, diseases of the urinary tract are triggers of the complaints. In particular, an acute cystitis (cystitis) is to be considered as a possible cause of the complaints. It is usually associated with clearly perceptible urinary symptoms (eg pain and burning, increased urination with low urine output) and possibly with other symptoms such as abdominal pain, incontinence or hematuria
Flank pain may also appear as radiating pain associated with liver, bile or pancreas disorders, but is more of a non-specific concomitant symptom.
Muscle complaints and pinched nerves
As a possible muscular cause in addition to the already mentioned tissue break in the area of Grynfeltt also hardening of the hip flexor muscle into consideration. Since the hip flexor muscle is closely interwoven with the spurs of the diaphragm on the spine, tensions or movement restrictions can have a strong influence on each other here. In addition to flank pain, back pain and hip pain are often observed when the hip flexor muscle is impaired. On the other hand, complaints in the back area can also radiate into the flank.
If a nerve is pinched, it causes discomfort in the area being treated. The nerve tracts of the flank region run between the oblique abdominal muscles and can be squeezed under strong tension or tension of the abdominal muscles, which brings corresponding pain in the flank with it. In addition, chiropractic models of explanation partially assume that the 11th or 12th rib is restricted in movement as the cause of flank pain, which should be improved by restraining the affected rib. At the 12th rib, a muscle begins that leads to the iliac crest - the quadratus lumborum muscle. This too can be tense and cause corresponding complaints in the flank area.
It is also conceivable in this phenomenon that there are indurations in the hip flexor muscle, which lead to so-called trigger points. These are points whose pH is abnormal and a body-inducing pain-inducing substance is elevated. The doctor of former US President Kennedy had found this with a colleague and successfully treated her with heavy pressure, ice spray or local injections of narcotic drugs. Since the hip flexor muscle is closely interwoven with the spurs of the diaphragm on the spine, tensions or movement restrictions can have a strong influence on each other here.
Another trigger may be crushed nerves in the flank region. They run between the oblique abdominal muscles and can be clamped under strong tension the latter. It is assumed that they may already be irritated on the spinal column by a herniated disc or protrusion. If structural causes, especially of the kidneys, have been excluded as pain causative agents in the flank region, pure mobility may be limited. In osteopathy, one sees the sliding surfaces of the organs as joints. If mobility is limited, it can cause discomfort. Chiropractic explanatory models are based in part on a movement restriction of the 11th or 12th rib, which should be improved by a narrowing of the affected rib again. At the 12th rib a muscle sets in, which leads to the iliac crest - the M. quadratus lumborum. He too can be tense and cause discomfort.
aortic dissection
Among the most serious possible causes include aortic dissections, which are associated with circulatory disorders of the intestine and / or the kidneys. Sudden onset, severe abdominal pain are usually also part of the symptoms. In aortic dissections with internal bleeding, the loss of blood can lead to circulatory symptoms such as an accelerated pulse, a drop in blood pressure and impaired consciousness to fainting. An aortic dissection is a potentially life-threatening event that needs urgent medical attention, but fortunately is rarely a trigger of pain.
shingles
A special form of flank pain is observed in connection with the so-called shingles, which is due to the reactivation of a herpes zoster infection. The varicella zoster virus causes chickenpox in a first infection, but then slumbers in the organism and can reproduce again under certain conditions, resulting in a painful reddish itchy rash in the flank area. The affected skin is covered with vesicles. However, the pain is perceived superficially here.
Unilateral flank pain
Unilateral flank pain may indicate a kidney tumor or kidney cancer, renal abscess, renal vein thrombosis or renal infarction.
diagnosis
After a detailed survey of the patients on the symptoms that occur, a routine check is usually first made for possible diseases of the internal organs or, in particular, kidney diseases. This is done by examining a urine sample and possibly a blood sample in the laboratory. If there is a suspicion of an organ disease, ultrasound examinations follow and, if necessary, further imaging procedures such as X-ray examinations, computed tomography and magnetic resonance tomography are used. With their help, possible aortic dissections can be detected. If no disorders of the internal organs or aortic damage can be detected, the further investigations concentrate on possible impairments of the musculature and nerves. A review of the spine structure may be useful here, since sometimes there is a connection with the flank pain.
Therapy for flank pain
If the symptoms in the flank are caused by a disease of the kidneys or other internal organs, a certain set of measures is usually defined, with which a therapy takes place. For example, a pyelonephritis usually provides a supply of antibiotics. Ureteral stones are removed either by medication or by means of special techniques for comminuting the urinary stones (for example, extracorporeal shockwave lithotripsy or else inserting an endoscope with subsequent stone crushing by shockwaves or lasers). Subsequently, a so-called ureteral splint is used to the sufferers, in order to widen the ureter and to facilitate the excretion of the crushed urinary stones. Renal cancer requires surgical removal of the tumor or, if applicable, the entire kidney (nephrectomy). An operative removal of the organ may also be required in a cystic kidney. If the patients no longer have a functioning kidney, dialysis (blood washing) is essential at least as long as no donor kidney is available or no kidney transplantation can be performed. In case of a urinary retention, in addition to the necessary elimination of the discharge obstruction, a discharge of the accumulated urine (nephrostomy) may also be necessary.
An aortic dissection requires immediate close medical control and, if necessary, an emergency surgery. Painkillers are designed to relieve patient discomfort and antihypertensive drugs minimize the risk of aortic rupture. In the long run, however, there is usually no way around an operation. As part of the procedure either the damage to the vessel wall is repaired or there is a replacement of the affected aortic section by a prosthesis made of artificial tissue.
If a shingles cause, special anti-viral drugs (antivirals) are used, which are usually applied externally. However, these do not always show the desired effect, so that optionally switched to an intravenous administration. An accompanying prescription of painkillers is often also part of the therapy.
If the flank pain is based on impairments of the musculoskeletal system, massages and physiotherapy are usually used. Manual treatment methods such as osteopathy or Rolfing also offer promising therapeutic approaches to counteract the pain in the flank. Also, acupuncture can often help alleviate the discomfort, especially if it is associated with impairments of the spinal structures and surrounding musculature. From the field of naturopathy is also the positive effect of warm compresses, for example in the form of so-called ginger compresses known for muscle-related flank pain.
Ultimately, the therapy must be tailored to the specific causes of pain in the site, which is why the precise diagnosis in the treatment is of particular importance and in case of doubt well worth the second medical opinion. (Fp)
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