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Dr. Andrew Rynne

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Suggest treatment for severe flank pain

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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3594 Questions

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Posted on Mon, 26 Oct 2015 in General Health
Question: Hello. I was admitted to the hospital last week after having severe flank pain. When in the ER, I had a CT scan done which showed a few kidney stones, one which was in the "proximal left ureter creating severe hydronephrosis". After a 48 hour stay and no passing of the stone, I was released as the pain was finally under control. I followed up with a urologist 2 days post-release and had an xray done that was inconclusive so was sent for another CT scan. I have not heard back as to the results of that scan but I am still having fairly consistent lower pelvic/bladder pain although not debilitating like before.

The first scan from the ER included a summary with the films that I rec'd when I was released which stated the following in addition to the information on the stones:

1. Pelvis: No pelvic mass is seen. The retroverted uterus is prominent is in size, 11.3 x 6.2 x 9.4 cm., suggestive of underlying fibroids.

2. Bowel: No abnormal bowel dilation. The cecum appears prominent in caliber. There is an air-fluid level in the cecum as well as ascending and transverse colon and scattered loops of small bowel, without sig small bowel dilation to suggest obstruction.

3. Small fat containing periumbilcal hernias.

My questions are:

1. Could my retroverted and enlarged uterus be causing underlying issues that would ultimately be causing urinary tract issues and kidney stones? I've never had kidney stones or urinary tract issues until now though I urinate frequently and have always thought I simply had a small bladder. I normally drink 6-8 bottles of water a day, no sodas, tea, etc. Primarily water...juice on occasion and 1 cup of coffee a day. Generally healthy, exercise regularly.

2. The pain I am still having is a constant feeling of pressure like someone is squeezing my bladder. It is worse when I am laying or sitting down. Is that normal if a stone is just sitting in my bladder?

3. Could my retroverted and enlarged uterus be causing constipation and is that basically what #2 above is stating? I have more recently been having long battles with constipation no matter what I eat or how many stool softeners I take. I try not to take laxatives but occasionally will drink a tea that helps.

4. How abnormally large is my uterus based on the measurements provided and what would typically be the treatment if fibroids are causing the enlargement? I am 44, 3 vaginal births, uterine ablation 8 years ago, fairly heavy periods.

5. Is there any cause for concern over # 3 above, the hernia findings?

Thank you very much! I am very concerned over this sudden health issue that has me basically laid-up and I can't seem to get passed. Any advise would be greatly appreciated!
doctor
Answered by Dr. Panagiotis Zografakis 1 hour later
Brief Answer:
many questions, please read the answers...

Detailed Answer:
Hello,

1. Big fibroids may cause urinary tract symptoms but they are not related to stone formation.
2. If a stone is just sitting (and not obstructing) in the bladder then no symptoms are really expected. The stones usually cause symptoms as they pass through narrow lumens and obstruct the fluid flow. If the stone is obstructing (even partially) the ureter-bladder junction or the bladder outlet then it will cause symptoms.
3. Sometimes big fibroids may cause constipation but this is not very common. The feeling of pressure on the bladder probably originates from the urinary tract (the stone is more likely to be causing it rather than the fibroid). Regarding your constipation I would suggest increasing the fiber in your diet, drinking enough water (you do already), be physically active and try to go the toilet at about the same time every day, even if you don't feel like going. The bowels love to be on schedule!
4. The normal uterine size for a nulliparous woman is about 8.5x5.0x4.0 (cm). For a mutliparous woman the size is usually larger: 9.1x5.2x4.3.
Your uterine is enlarged, so it needs to be investigated. The treatment may depend on the severity of the symptoms and your will to remain fertile. If the symptoms are very severe and you don't mind giving the uterus away, it can be removed completely. Otherwise there are various treatment (including medical-conservative ones).
5. Umbilical hernias are usually harmless. Every hernia has the potential for complications though. The most feared one is strangulation of the intestine (if part of the intestine 'escapes' the peritoneal cavity). This is not very common in umbilical hernias but it can't be excluded. The best person to assess your hernias is a general surgeon.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Panagiotis Zografakis 1 hour later
Thank you Dr. Zografakis. Unfortunately, most of what you posted I am aware of and are fairly "standard" answers. I guess I was looking for something a little out-of-the box but I know that can't happen without more history. I'm just having a hard time wrapping my head around being a fairly healthy person with no history (or family history) of kidney stones, kidney problems in general or of urinary tract issues to being brought to the floor by stones without warning...and still dealing with pain. After seeing the CT scan report and some of the other findings, my gut feeling keeps telling me that there's got to be something else going on that could be causing all this especially with some of my other more recent issues like the constipation. I know how to treat normal constipation and all about the importance of fiber in the diet, regularity, activity, water intake, etc....all of which I do and all of which kept me regular in the past. This is all new and I have not changed anything which is what has me concerned so I guess I was looking for a common denominator. Maybe none of it is related but it just seems so strange for me. I pride myself on being healthy, active, eating right, etc. I'd say the worst thing I've had to deal with health-wise is migraines which I've had since puberty but that is one reason I try my best to do everything else right...it helps with those on top of all the other benefits! And I had some heavy bleeding after my 3rd child which is why I had the uterine ablation but that was nothing terribly abnormal I was told.

Some other things that have been happening recently that I never thought could be related but I guess should be mentioned is I keep getting a bumpy red rash on my upper eyelids. And my skin is like an oil field so it has been breaking out like crazy and healing very slowing. And I haven't changed any products or routines. Oh...and I have major insomnia so I have to take OTC sleep aids and melatonin. I was chalking all that up to being 44, having a stressful business, and possibly going thru "changes" though....and maybe that's all it is!

So...I do thank you but still have so many questions that I guess I will have to try to get from multiple local "specialists" here over time. I'm not a very patient person so was looking for some direction in between waiting for results and more appts.;) Thanks again and if you do have any more insight, anything is welcome!
doctor
Answered by Dr. Panagiotis Zografakis 20 minutes later
Brief Answer:
I have some more thoughts about your problems

Detailed Answer:
You're welcome!

You shouldn't expect to substitute a real visit to the doctor with this kind of discussion of course... Online doctors can only provide information, you didn't have the chance to ask your doctor or perhaps evaluate a patient's situation broadly because many clinical and historical data are lacking and cannot be obtained.

Regarding the constipation issue which seems to be a major problem for you. If you've done everything I've mentioned but you still had no luck with it, then perhaps you should consider endoscopic evaluation of your intestine (colonoscopy). Some basic tests may be helpful like a complete blood count, electrolytes (including calcium), thyroid function tests, etc.

Anxiety is another issue which may make small problems look big! A stressful life is the best way to develop anxiety. The intestine is particularly sensitive to psychological changes.

Regarding the stone issue, an ultrasound scan should provide enough clues about the 'whereabouts' of the stone and whether obstruction is the cause of your symptoms. A urinalysis would be a very helpful addition, because the same symptoms can be elicited by urinary tract infections (cystitis).

Perhaps if you'd like to ask a more specific question, I could be more specific too! Obviously any of the subjects you've mentioned could be analyzed in much greater detail, but that would be beyond the scope of this discussion and it wouldn't be very helpful to you either, because it's not the details themselves that matters but their evaluation.

Kind Regards!

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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