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Flank pain can be caused, for example, by impairments of the musculoskeletal system, but it can also be an indication of diseases of the internal organs - especially the kidneys. The "flank" is usually the area between the chest and pelvis on the side of the body and the back - where, for example, the "side stabbing" occurs after a heavy physical exertion. In particular, if further symptoms such as nausea and vomiting, fever, chills or hematuria (blood in the urine) occur in connection with the flank pain, urgent medical help should be sought.
Where are the flanks?
The flanks are the two sides of the torso 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 limited at the top by the costal arch, at the bottom by groin and hips.
Anatomically, the last, so-called “free” ribs and some muscles are located externally in the area mentioned. Nerves emerge in the layer below and the hip flexor muscle, the Iliopsoas muscle, attaches to the depths on the inside of the spine. A little further ahead is the ascending part of the large intestine on the right and the descending part on the left. The kidneys lie even deeper. All of these tissue structures can have damage or diseases associated with flank pain.
The spectrum of possible causes for flank pain is extremely broad and ranges from muscle complaints, diseases of internal organs (e.g. kidneys and spleen) to acute life-threatening aortic dissection (damage to the wall layers in a main artery) or an aortic rupture (tear in the main artery) . An infection with herpes zoster (shingles) or a tissue break in the so-called area of Grynfeltt, a small muscle-framed space below the 12th (last) rib can also be the cause of the flank pain.
Diseases of the kidneys and other internal organs Flank pain is a typical accompanying symptom in numerous kidney diseases. The term kidney pain should actually be used in these cases, but due to the location of the kidneys in the flank area to the right and left in front of the spine, approximately between the 11th and 12th. Thoracic vertebrae and the 3rd / 4th Lumbar vertebrae, the complaints are usually perceived and referred to as flank pain by those affected. Possible causes of kidney pain can be, for example, kidney infections, kidney pelvic infections, kidney stones, cystic kidneys, urinary retention or urinary reflux, renal vein thrombosis, urogenital tuberculosis, a walking kidney or kidney cancer. Both the intensity of the pain and the possible accompanying symptoms can differ significantly in the various kidney diseases. For example, acute kidney colic with violent cramp-like pain in the flank, back and groin can often be observed in kidney stones or urinary stones. Abdominal pain, nausea and vomiting can also be part of the symptoms here.
Kidney pelvic inflammation is often characterized by persistent pain and symptoms such as fever, chills, nausea, and vomiting. Chronic pelvic inflammation is often accompanied by non-specific symptoms such as poor concentration, chronic fatigue, loss of appetite and headache. Warning signals for more serious kidney problems include flank pain, blood residues in the urine (hematuria), proteinuria (increased protein excretion with the urine) and a significant decrease in urine production. In general, medical advice should be sought as soon as possible if you suspect kidney disease.
A so-called kidney trauma is also to be considered as a possible cause of the flank pain, although the connection is usually clear to those affected, since the complaints were preceded by violent external violence, for example in the event of a fall or a traffic accident. The injury to the kidneys is usually accompanied by clearly visible hematomas (bruising). If the spleen (rupture of the spleen) is damaged during such external violence, this is equally associated with severe pain in the flank regions.
Diseases of the urinary tract are often the cause of the symptoms. In particular, acute bladder infection (cystitis) should be considered as a possible cause of the symptoms. As a rule, it is accompanied by clearly perceptible symptoms when urinating (e.g. pain and burning, increased urge to urinate when urine output is low) and possibly with other symptoms such as abdominal pain, incontinence or hematuria
Flank pain can also appear as radiating pain in connection with diseases of the liver, bile or pancreas, but is more of a non-specific accompanying symptom here.
Muscle discomfort and pinched nerves
In addition to the previously mentioned tissue fracture in the Grynfeltt area, hardening of the hip flexor muscle should also be considered as a possible muscular cause. Since the hip flexor is closely interwoven with the protrusions of the diaphragm on the spine, tensions or restrictions on movement can mutually influence each other. If the hip flexion is impaired, back pain and hip pain can often be observed in addition to flank pain. Conversely, complaints in the back area can also radiate into the flank.
If a nerve is pinched, this leads to complaints in the supplied area. The nerve pathways of the flank region run between the oblique abdominal muscles and can be squeezed if the abdominal muscles are tight or tense, which causes corresponding pain in the flank. Chiropractic explanatory models also partially assume that the 11th or 12th rib is restricted as the cause of the flank pain, which should be improved by straightening the affected rib. At the 12th rib there is a muscle that leads to the iliac crest - the quadratus lumborum muscle. This can also be tense and cause complaints in the flank area.
It is also conceivable with this phenomenon that there are hardenings in the hip flexor muscles that lead to so-called trigger points. These are points where the pH value is not correct and the body's own substance that triggers pain is increased. The doctor of the former US President Kennedy had found it with a colleague and had successfully treated it with strong pressure, ice spray or local injections of narcotics. Since the hip flexor is closely interwoven with the protrusions of the diaphragm on the spine, tensions or restrictions on movement can mutually influence each other.
Another trigger can be depressed nerves in the flank region. They run between the oblique abdominal muscles and can be pinched off if the latter is under a lot of tension. It is assumed that they may be irritated on the spine beforehand by a herniated disc or a bulging. If structural causes, especially of the kidneys, have been excluded as the cause of pain in the flank region, pure mobility can be restricted. In osteopathy, the gliding surfaces of the organs can be seen like joints. If the mobility is restricted, complaints can arise. Chiropractic explanatory models partially assume that the 11th rib is restricted in movement, which should be improved by straightening the affected rib. Rib attaches to a muscle that leads to the iliac crest - the quadratus lumborum muscle. He too can be tense and cause complaints.
The particularly serious possible causes include aortic dissections, which are associated with circulatory disorders in the intestine and / or kidneys. Sudden onset, severe abdominal pain is usually also part of the symptoms here. In aortic dissections with internal bleeding, blood loss can lead to circulatory symptoms such as an accelerated pulse, a drop in blood pressure and loss of consciousness, and even fainting. Aortic dissection is a potentially life-threatening event that desperately needs medical attention, but fortunately is rarely a cause of pain.
A special form of flank pain can be observed in connection with the so-called shingles, which is due to the reactivation of a herpes zoster infection. The varicella zoster virus triggers chickenpox on initial infection, but then slumbers in the organism and can multiply again under certain conditions, which leads to a painful reddish itchy rash in the flank area. The affected skin is covered with blisters. The pain is perceived rather superficially here.
Unilateral flank pain
Unilateral flank pain may indicate kidney cancer or cancer, kidney abscess, renal vein thrombosis, or kidney infarction.
After a detailed questioning of the patients about the complaints that occur, a routine check is usually first carried out for possible diseases of the internal organs or, in particular, diseases of the kidneys. This is done by examining a urine sample and possibly a blood sample in the laboratory. If organ disease is suspected, ultrasound examinations follow and, if necessary, other imaging methods such as X-ray examinations, computer tomography and magnetic resonance tomography are used. With their help, possible aortic dissections can also be identified. If no diseases of the internal organs or aortic damage can be determined, the further examinations concentrate on possible impairments of the muscles and nerves. A check of the spine structure can also be useful here, since there is sometimes a connection with the flank pain.
Therapy for flank pain
If the complaints on the flank are based on a disease of the kidneys or other internal organs, a certain set of measures is usually defined with which therapy is carried out. For example, inflammation of the kidney pelvis usually provides antibiotics. Ureteral stones are removed either with medication or with the help of special techniques for crushing the urinary stones (for example extracorporeal shock wave lithotripsy or inserting an endoscope with subsequent stone crushing using shock waves or lasers). Subsequently, a so-called ureteral splint is inserted in order to enlarge the ureter and to facilitate the excretion of the crushed urinary stones. Kidney cancer requires surgical removal of the tumor or the entire kidney if necessary (nephrectomy). Surgical removal of the organ may also be necessary for a cystic kidney. If the patient no longer has a functioning kidney, dialysis (blood washing) is essential, at least as long as no donor kidney is available or a kidney transplant cannot be performed. In the case of urinary congestion, in addition to the necessary elimination of the drainage obstruction, a drainage of the pent-up urine (nephrostomy) may be necessary.
Aortic dissection immediately requires close medical monitoring and, if necessary, emergency surgery. Pain relievers are said to alleviate the symptoms of the patient and medicines to lower blood pressure minimize the risk of aortic rupture. Ultimately, however, there is usually no way around an operation in the long term. As part of the procedure, either the damage to the vessel wall is repaired or the affected aorta section is replaced by a prosthesis made of artificial tissue.
If shingles is the cause, special antiviral medicines (antivirals) are used, which are usually applied externally. However, these do not always have the desired effect, so that it may be necessary to switch to intravenous administration. An accompanying prescription of pain relievers is often 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. Acupuncture can often help alleviate symptoms, especially if there is a connection with impairments of the spinal structures and the surrounding muscles. The positive effect of warm compresses, for example in the form of so-called ginger compresses, for muscle-related flank pain is also known from the field of naturopathy.
Ultimately, the therapy must be tailored to the respective causes of the pain in the side, which is why the precise diagnosis during treatment is of particular importance and, in case of doubt, it is definitely worthwhile to obtain a second medical opinion. (fp)
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Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
- Bernhard Hellmich: Fallbuch Internal Medicine, Thieme Verlag, 5th edition, 2017
- Elvira Bierbach: Naturopathy today - textbook and atlas, Urban & Fischer Verlag / Elsevier GmbH, 5th edition, 2013
- Rudolf Schweitzer: Urology with Andrology, The Heilpraktiker Academy, Elsevier GmbH, Urban & Fischer Verlag, Munich, 1st edition, 2012