Could Kidney Stones Be The Cause of Back Pain
Dr. Prakash Maniam discusses the symptoms of kidney stones and if they could cause back pain.
Featuring:
Prakash Maniam, MD
Prakash Maniam, MD is Board Certified in Urology and a member of the American Urological Association. After completing his undergraduate degree at The Ohio State University in Columbus, Ohio, he received his medical degree at The Ohio State University College of Medicine. Dr. Maniam completed his General Surgery and Urology residencies at Case Western Reserve University in Cleveland, Ohio. He joins Medical Specialty Group at Poinciana from his practice in the Augusta Georgia area, where he was in private practice for the past twelve. Dr. Maniam specializes in general urologic care including treatment for cancers of the urinary tract, kidney stones, prostate diseases, sexual dysfunction, and urinary incontinence. He is trained to perform certain robotic procedures. Transcription:
Prakash Chandran (Host): Most of us experience back pain at some point in our lives but for some with lower back pain, it could be a side of a kidney problem. Let’s talk about it today with Dr. Prakash Maniam, a Urologist at Oviedo Medical Center.
This is Helmet of Health, the podcast from Oviedo Medical Center. I’m Prakash Chandran. So, Dr. Maniam, to get us started, I just want to start with a basic question for those of us that don’t know. What exactly are kidney stones?
Prakash Maniam, MD (Guest): Well kidney stones are concretions or aggregates of minerals that are normally found and excreted through the urine. But in the case of kidney stones, these minerals combine together, and they precipitate, or they form salts or solid materials which are really crystals which then – these crystals then aggregate further to form what we know as stones. And when these stones become large enough, they can obstruct the kidney from it’s natural drainage and that’s how they produce the problems that they do produce.
Host: Right and so, what exactly causes a kidney stone to occur?
Dr. Maniam: Well there can be various causes as there are various types of kidney stones. So, each have their causes. But generally speaking, kidney stones are caused by the fact that in some people, in some instances, these naturally occurring chemicals and minerals like calcium or oxalate or uric acid are present in too high a concentration and when they are in too high a concentration, they aggregate and that can be from diet, it could be related to a lack of fluid, in other words, dehydration. Lack of urine allows these minerals to then precipitate and cause the problems that kidney stones form.
Other underlying medical conditions, certain cancers, or disorders of calcium metabolism or the mineral metabolism can form these stones as well. In most cases, it’s a combination of factors like diet, dehydration, maybe being in the heat too much and underlying medical problems.
Host: Yeah, it really does sound like there are a number of different factors that play into getting a kidney stone but I’m curious as to how you know you have one? I remember in college, my roommate had one then he was just keeled over on the couch and it was a terrible experience for him. But maybe describe some of the things that he was feeling.
Dr. Maniam: Sure. The classic symptoms with a kidney stone is flank pain. So it’s more towards the back, into the side, usually just one side, not both. And it doesn’t usually cross the midline. It’s usually located to one side and that pain can radiate down to the lower quadrant of the abdomen and then it can radiate into the groin and then into the scrotum. And the pain is not necessarily a sharp pain, like a needle prick type pain, it’s a very deep, visceral type pain and it can be quite excruciating, very high in severity. And along with the pain, one usually gets some nausea as well.
Host: So, we’re talking about the relationship between back pain and kidney stones today and you mentioned like a flank pain or having it being concentrated to one section of the back. Maybe talk a little bit about if someone is experiencing severe, potentially lower back pain, does that mean that they have kidney stones? Talk a little bit about that relationship.
Dr. Maniam: Yeah, that’s a good question because as a urologist, seeing patients every day, we often see patients with back pain, and they may believe they have kidney stones and it’s our job to kind of distinguish rather quickly what the problem is so we can treat it appropriately. So, a typical patient with kidney stones will have their pain radiating in a particular pattern, often down to the front whereas a patient with back pain usually from musculoskeletal causes will usually have pain in the back but radiating down the legs, down the back into the legs. And that’s often associated with some type of numbness or tingling or maybe weakness in the leg and it’s usually made worse by a particular movement in one direction or another.
Whereas with kidney stones, the movement doesn’t necessarily make the problem worse. The problem is going to be there regardless of what the position or any movement or lack of movement. So, the hallmark with kidney stones is as you said, somebody is usually doubled over in pain and they can’t get comfortable and they can’t make it better. It just persists. So, kidney stone pain is not made better by any particular position whereas pure back pain can often be made better in one position where you don’t exacerbate that nerve or muscle that’s being inflamed.
Host: Okay, so let’s say someone is listening to this and at some point, they experience this, this back pain that cannot be cured by moving around like you said, it’s just kind of a consistent pain that they are dealing with; talk a little bit about how you diagnose that it is a kidney stone and then how you treat it.
Dr. Maniam: Kidney stones are diagnosed by a combination of methods. The simplest is just a physical examination. Usually the tenderness will be right where the spine and the ribs join, there will be tenderness in that area. Other tests that we use are common lab tests like a simple urinalysis usually will show blood in the urine and in more severe cases, will show blood and also infection as well. And getting beyond the quicker exams like the physical exam and then the urinalysis; we can get imaging tests. Imaging tests that are used in the emergency department most commonly are CT scans, not necessarily with contrast but just a non-contrasted CT scan is a very highly sensitive for picking up a stone. It will pick up almost 100% of a stone. There is almost no stone that this scan cannot detect. So, it’s very sensitive and very specific for kidney stones as well.
The nice thing about these scans is that they are fast, they are easy to get, almost every emergency department will have access to it, and not only do they detect the stone; they can also detect other potential problems that may mimic pain that one may think is from a kidney stone. So, if it’s not a kidney stone; it also helps us to find out what it in fact is.
Host: Yeah, really interesting to hear about all of that technology that’s available. So, Dr. Maniam, thank you so much for your time today. That’s Dr. Prakash Maniam, a Urologist at Oviedo Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.oviedomedicalcenter.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): Most of us experience back pain at some point in our lives but for some with lower back pain, it could be a side of a kidney problem. Let’s talk about it today with Dr. Prakash Maniam, a Urologist at Oviedo Medical Center.
This is Helmet of Health, the podcast from Oviedo Medical Center. I’m Prakash Chandran. So, Dr. Maniam, to get us started, I just want to start with a basic question for those of us that don’t know. What exactly are kidney stones?
Prakash Maniam, MD (Guest): Well kidney stones are concretions or aggregates of minerals that are normally found and excreted through the urine. But in the case of kidney stones, these minerals combine together, and they precipitate, or they form salts or solid materials which are really crystals which then – these crystals then aggregate further to form what we know as stones. And when these stones become large enough, they can obstruct the kidney from it’s natural drainage and that’s how they produce the problems that they do produce.
Host: Right and so, what exactly causes a kidney stone to occur?
Dr. Maniam: Well there can be various causes as there are various types of kidney stones. So, each have their causes. But generally speaking, kidney stones are caused by the fact that in some people, in some instances, these naturally occurring chemicals and minerals like calcium or oxalate or uric acid are present in too high a concentration and when they are in too high a concentration, they aggregate and that can be from diet, it could be related to a lack of fluid, in other words, dehydration. Lack of urine allows these minerals to then precipitate and cause the problems that kidney stones form.
Other underlying medical conditions, certain cancers, or disorders of calcium metabolism or the mineral metabolism can form these stones as well. In most cases, it’s a combination of factors like diet, dehydration, maybe being in the heat too much and underlying medical problems.
Host: Yeah, it really does sound like there are a number of different factors that play into getting a kidney stone but I’m curious as to how you know you have one? I remember in college, my roommate had one then he was just keeled over on the couch and it was a terrible experience for him. But maybe describe some of the things that he was feeling.
Dr. Maniam: Sure. The classic symptoms with a kidney stone is flank pain. So it’s more towards the back, into the side, usually just one side, not both. And it doesn’t usually cross the midline. It’s usually located to one side and that pain can radiate down to the lower quadrant of the abdomen and then it can radiate into the groin and then into the scrotum. And the pain is not necessarily a sharp pain, like a needle prick type pain, it’s a very deep, visceral type pain and it can be quite excruciating, very high in severity. And along with the pain, one usually gets some nausea as well.
Host: So, we’re talking about the relationship between back pain and kidney stones today and you mentioned like a flank pain or having it being concentrated to one section of the back. Maybe talk a little bit about if someone is experiencing severe, potentially lower back pain, does that mean that they have kidney stones? Talk a little bit about that relationship.
Dr. Maniam: Yeah, that’s a good question because as a urologist, seeing patients every day, we often see patients with back pain, and they may believe they have kidney stones and it’s our job to kind of distinguish rather quickly what the problem is so we can treat it appropriately. So, a typical patient with kidney stones will have their pain radiating in a particular pattern, often down to the front whereas a patient with back pain usually from musculoskeletal causes will usually have pain in the back but radiating down the legs, down the back into the legs. And that’s often associated with some type of numbness or tingling or maybe weakness in the leg and it’s usually made worse by a particular movement in one direction or another.
Whereas with kidney stones, the movement doesn’t necessarily make the problem worse. The problem is going to be there regardless of what the position or any movement or lack of movement. So, the hallmark with kidney stones is as you said, somebody is usually doubled over in pain and they can’t get comfortable and they can’t make it better. It just persists. So, kidney stone pain is not made better by any particular position whereas pure back pain can often be made better in one position where you don’t exacerbate that nerve or muscle that’s being inflamed.
Host: Okay, so let’s say someone is listening to this and at some point, they experience this, this back pain that cannot be cured by moving around like you said, it’s just kind of a consistent pain that they are dealing with; talk a little bit about how you diagnose that it is a kidney stone and then how you treat it.
Dr. Maniam: Kidney stones are diagnosed by a combination of methods. The simplest is just a physical examination. Usually the tenderness will be right where the spine and the ribs join, there will be tenderness in that area. Other tests that we use are common lab tests like a simple urinalysis usually will show blood in the urine and in more severe cases, will show blood and also infection as well. And getting beyond the quicker exams like the physical exam and then the urinalysis; we can get imaging tests. Imaging tests that are used in the emergency department most commonly are CT scans, not necessarily with contrast but just a non-contrasted CT scan is a very highly sensitive for picking up a stone. It will pick up almost 100% of a stone. There is almost no stone that this scan cannot detect. So, it’s very sensitive and very specific for kidney stones as well.
The nice thing about these scans is that they are fast, they are easy to get, almost every emergency department will have access to it, and not only do they detect the stone; they can also detect other potential problems that may mimic pain that one may think is from a kidney stone. So, if it’s not a kidney stone; it also helps us to find out what it in fact is.
Host: Yeah, really interesting to hear about all of that technology that’s available. So, Dr. Maniam, thank you so much for your time today. That’s Dr. Prakash Maniam, a Urologist at Oviedo Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.oviedomedicalcenter.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.