Colic - Severe pain resulting from periodicspasm in abdominal organ.
Renal Colic -
     Spasmodic pain in abdomen due to stone in Kidneys, Ureter. The pain is usually caused by Stone which moves and irritates the urinary syatem and gives rise to pain which is classically described as 'Renal Colic' The pain is classically described as "Loin to Groin" pain. Usually it is abrupt in onset and begins in the renal flank area and course down around the abdomen and then radiates to the groin and genitalia. This pain may last for minutes to hours followed by periods of relief. Nause and vomiting may accompany the pain. Burning while voiding and frequent urge to void may occur as stone moves near the bladder. Foul smelling or cloudy urine, fever with chills and weakness may indicate associated anfection which could result in more serious illness. Renal colic is an agonizing pain, which is probably caused by muscular spasm of the renal pelvis and ureter.
     To be very precise and accurate, it is best to discard the term 'Renal Colic' and speak of 'Renal pain" and 'Ureteric Colic'. Renal pain is usually a dull ache situated mainly in the costo-vertebral angle, but also the upper and outer quadrant of the abdomen. Renal pain is not strictly lumbar.(Herpes Zoster can also cause lumbar pain as often as renal). Ureteric Colic is nearly always characteristic in which the pain passes from the loin to groin and in the males frequently this radiation is prolonged to the testes, which becomes retracted. A patient attacked with ureteric colic can often map out the course of this pain accurately for On the Spot diagnosis. During or soon after an attack of ureteric colic the pulse and temperature are normal. The abdomen moves on respiration. On palpation there in corresponding loin and iliac fossa some tenderness and guarding is felt but no true rigidity. Hyperaesthesia may be there in very severe cases.
     Normaly the X-Rays show the presence of calculi, provided they contain a sufficiency of Calcium, other shadows such as caused by calcified glands, and phleboliths mustbe excluded. Ultrasound ,IVP (Intravenous Pyelography), CT Scan and MRI may be required in order to localize the shadow of calculi accurately.
     Stone or calculi usually form around a colloid nucleus, such as fibrin, mucopus cell debris and micro-organisms. Primary calculi normally form in acid urine without any bacterial infection, whereas Secondary Calculi are deposited in alkaline urine infected with organisms. Thus a phosphatic crust may be formed around an uric acid nucleus. There are various types of stones or calculi such as :
1) Uric Acid:- Brown, hard and irregular.
2) Calcium Oxalate (Mubery calculus) : - Dark and irregular, when formed in the bladder they are round, they may be dendritic when occurring in the renal pelvis. They are often mixed with calcium.
3) Ammonium Urate : - Hard and brownish,
4) Tripple Phosphate :- Rather soft and smooth.
5) Mixed or Laminated Calculi :- They have an uric acid nucleus and a phosphatic coating.
6) Cystin :- Soft yellow- green ,radially laminated.
7) Xanthine :- Reddish brown.
8) Indigo :- Blue and marks paper. It is derived from indol and is extremely rare.
9) Calcium Carbonate:- Smooth, hard and dark grey.
10) Urostealith :- Containing cholestrine.
     If the calculus remains in kidney substance there may be no symptoms, or the patient complains of aching in the loin, and albumin and blood are found in the urine. If the stone obstructs the outflow of urine there is severe pain owing to stretching of the renal capsule. It normally occurs with a stone in ureter,and the pain is due to distension rather than the passage of stone along the ureter. The pain ceases either when the kidney does not secrete more urine, or when the obstruction is relieved. The pain is felt at the flank and may be refered to side, it may also radiate to groin and inner side of the thigh. There is usually a sense of nausea, and vomiting may occur. Renal colic pain is normally paroxysmal and radiate along the course of ureter to groin, hypogastrium and tesicles and testes may be drawn up. The patient is pale or flushed, sweats, rolls about in agony and may vomit. There is frequent desire to micturate, and the urine is scanty and may contain blood. The attack lasts usually from a few minutes to 2 hours,but it may be considerably longer. After an attack there is aching and tenderness in the loin.
     Though several attacks of renal colic are not infrequent. The major complications are due to (a) Infection_ resulting in Pyelitis, Pyelonephritis, Pyonephritis and Cystitis.(b) Obstruction_ producing hydronephrosis,pyonephrosis, renal atrophy and anuria if both kidneys are put out of action.(c) Ulceration_ with extra vessation of urine through the ureter. A stricture may form subsequently. (d)_ Malignant disease affecting the kidney. In some cases only one attack of renal colic occurs, but the prognosis is always serious, as the calculi tend to reccur even after the stone has passed out or removed by surgical procedures or the latest ESWL ( Extracorporeal Shock Wave Lithotripsy), and PCNL( Percutaneous Ultrasonic Nephro Lithotripsy), URS( Uretro Reno Scopy) and of course with Lasers.
     As such there is no single absolute theory known to mankind that leads to stone formation. The one that can be commonly explained is that of Supersaturation/Crystalisation theory. Urine - a supersaturated solution has tendency to form crystals of some of the solids dissolved in it. These solids are particularly the salts of Calcium, Oxalates, Phosphates,urates and Uric Acid. When concentration of these substances exceeds their solubility, crystal are deposited. If these are not washed out with urine and are allowed to clamp together they form gravel. This forms the nucleus of stone and allows presipitation of further crystal, ultimately leading to stone formation. The stone is first formed in the calyces of the kidney but it may move out of it and lodge anywhere in the urinary tract.
     Though with Homoeopathic appropriate constitutional remedies like - Calc Carb, lycopodium, Nux Vom., Phosphorus, Sulphur etc. can check the recurrence of the stone and prevent the damage to the urinay tract system.
I have seen few families in which the history of stones is so strong that almost all the family members have the stone at some stage or the other ,even the young children have suffered from this problem. Interestingly I 've seen a patient who has been passing small tiny stones almost every alternate months for the last so many years.After the homoeopathic treatment in which I gave his constitutional remedy the requency of stone formation has reduced considerably.
     Since urinary output of calcium and of oxalates and urates, which are common constituents of stones ,depends more on endogenous metabolism than the exogenous sources. Stones seldom consist of a single substance the dietry restriction of mixed stones present grave practical difficulties. Still the elimination of Spinac and Rhubarb (plant with fleshy leaf stalks coocked as substitute for fruit ) from the diet, is desireable, articles which contain very high contentof oxalate , may be restricted in patients with recurrent oxalate stones. For uric acid stone restriction for liver, kidney, sweetbreads, fish Roe, sardines and sprats (small sea fish) is advisable as they have very high purine content.
     Since phosphoric calculi are found only in alkaline urine , acidifying the urine is desirable. Contrarily Cystine and urate stones may be prevented or dissolved by making the urine persistently alkaline. Above all the most important therapeutic and prophylactic measure for all forms of stone is provision of an adequate fluid intake as it helps to flush out from the urinary passages. Particles of gravel which in time may develop into calculi. A daily output of urine at least 3 litres is advisable,hence intake of fluid should be approximately 4 litres daily in normal circumstances. And for a patient of stone minimum intake of an adult should be around 20-25 glasses of water per day.
     Homoeopathically remedies are prescribed on the totality of symptoms and on the individual characteristic symptoms.Commonly used remedies are- BerberisVulg, Hydrangea, Terebinth, Colocynth, Mag Phos, Nux vom, Lycopodium, ,Apis,Parera Breva,Oscimum Can etc. Dietary Recommandation in the Management of Renal Calculi