Expert: Dr. J. Shawn Leatherman - 1/3/2007

Question
For the past 10 months now, I have had pain in my right side, flank area, right under the ribs.  I also had blood in my urine.  My doctor first ordered urinalysis, blood work, and x-rays.  Everything came back normal, except recurring blood in my urine.  My doctor sent me to a urologist.  My urologist said my kidney was normal, but that I had constriction on my urethra and that it was inflamed.  He put me on Bactrim for 6 months.  It is over 6 months now, and I still have the pain in my right side flank area.  The pain is usually just a dull, aching pain, but sometimes, it's more like a throbbing pain.
I am a 38-year-old female, recently diagnosed with high blood pressure (the high blood pressure was a surprise to me because I've always had low blood pressure!)  I've had several miscarriages, and fibroids.

Answer
Dear Audrey,

You have a lot of compounding issues that most likely are creating an overlap, but there has to be a central cause to the problem.  My area of expertise is more concerned with the spine, but here my take on your issue.  At first glance of the symptoms you had described, I would have thought the same thing your doctor did, and ordered the blood tests and urinalysis looking primarily for a kidney and/or bladder infection.  Concerning the urethral problem, the normal pain patterns for lower urinary tract problems is in the pubic area, not the flank, but pain doesn't always follow the textbook descriptions.

With the history you have of fibroids and miscarriages, you must also consider issues in the uterus or ovaries, and I would suggest that you have a check-up from your OB/GYN if you have already not done so.

Now if obstetrical and gynecological problems are ruled out, the kidney and urinary tract are not the cause, then you are left with a few more issues to check.  Considering your age, you are approaching the time where we see gall bladder problems begin to emerge, and gall-pain can be referred to the right flank, as well as the tip of the shoulder blade.  The profile is this:  female, forty, fat, flatulent, fatty stools...obviously you do not need to have all those conditions, but the more you have the more likely you fit the profile.  The gall bladder can easily be evaluated with an ultrasound of the abdomen to look for stones.    NOTE: the gall bladder can be inflammed without the presence of stones, and dietary cleanses can eliminate this problem, but it is very important to rule out stones first.  Gall bladder cleanses stimulate the gall bladder to empty completely and if there are stones in there they can become stuck in the bile duct and cause worse problems.

High blood pressure:  Again this can be related to kidney function as well.  The kidneys actually help to regulate blood pressure by a chemical called angiotension and an enzyme called angiotension converting enzyme.  But if there was no protein found in your urine, and your blood pressure diagnosis was only recent, it is probably not contributory at this point.  **(The criteria for High blood pressure diagnosis is three consecutive readings...on separate office visits...of a BP of 140/90)

Moving on, depending on the exact location of the dull achy pain, a musculoskeletal issue can be the problem, but this type of pain will usually not only be in the flank area.  It tends to be more central to the spine, or worse with specific movements.  Specific muscles called the illiopsoas, and the quadratus lumborum can elicit flank pain on occasion, but again the pain is usually considered to be in the low back pain and not out at the flank.

Audrey, what I would recommend is that you get a second opinion either from your current general practitioner, your OB/GYN, or another doctor whom you do not normally see and take another look.  Pain that has been ongoing for over six months needs to be figured out.  The possibilities that I have mentioned above should not be considered to be complete, and you should take another look at the situation.  If the doctors can't find anything of significance, then I would look into the musculoskeletal aspect, and a local chiropractor would be a good choice for that.

Good luck Audrey. Feel free to write back if you have any further comments or questions.

Respectfully,
Dr. J. Shawn Leatherman