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Kidney Diseases

Flank Pain on left side

06/06/2006

Question:

I have been having pain in my mid-back left flank area for about a year. The CT with dye has shown, a silent small stone in "right" kidney. The only thing found on the "left" side is a 2-3 mm phlebolith (spelling?) outside the left ureter. CT also showed "numerous" diverticulitus in the colon. (I have been suffering with long-term constipation too). My doctor has put me on Cipro and Metamucil. I continue to have pain. Do you think the source of my pain is the colon or phlebolith ? or could it me something more serious ?

Answer:

It's hard to determine the most likely cause of the pain without having a little more info. Is the pain constant or does it come and go in waves? Does it get better or worse with eating? Better or worse with bowel movements?

Pain that is in waves suggests that it's related to the bowel, especially if it is related to either eating or BMs. Have you lost any weight? Phleboliths do not cause pain, and diverticuli don't usually cause pain either unless they become infected ("diverticulitis"), in which case the pain is usually in either the right or the left lower abdomen in the front. Sometimes the pancreas causes pain, but this is usually felt right in the middle of the upper abdomen (just below the breastbone) and feels like it's piercing straight through to the back, not around to the side.

Flank pain (if truly flank, i.e., in the back just below the lower ribs, to the left of the spine and travelling around the left side of the trunk) is usually from either the kidney or the muscles in the area. Flank pain related to the kidneys can be caused, for instance, by stones (not in your case), infection (this could not remain undetected for a year), or a tumor (which should show up on CT scan or ultrasound). Usually there would be some abnormality in the urinalysis as well (such as red blood cells or white blood cells).

If the pain is getting worse and it's been a while since the CT scan, it might be worth repeating it to see if anything's changed. An ultrasound can also provide useful information. If the pain is constant but aggravated by movement, it may just be muscular and may be improved with nonsteroidal meds like Motrin or Naprosyn.

The best thing to do is to try to make as many observations as you can about the type, location, and characteristics of the pain, then discuss this with your doctor again. The history that you give is probably the most valuable thing to help determine the appropriate tests and ultimately the cause of the pain.

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Response by:

Mildred   Lam, MD Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University