Colic

Colic is a special type of abdominal pain that is characteristic by recurrent sudden starts and sudden withdrawals. It accompanies conditions with obstruction of a hollow tube organ like bile duct, ureter or intestine. Smooth muscles in wall of the affected organ rhythmically move to overcome the obstruction. Muscle spasms are perceived as attacks of pain and these are alternated by moments of relief during muscle relaxations. It is these moments of pain alternating with periods of calm that are characteristic for colic attacks.

Causes

Biliary colic

In this case, gallstone is the source of problem. A gallstone obstructs outlet of the gallbladder or a bile duct. Pain is localized in the right upper abdominal quadrant and it may radiate to the back.

Renal colic

Most often it is caused by urinary stones that obstruct some part of urinary tract (usually a ureter). Urine outflow from kidney on the affected side may be blocked. Shocking colic pain occurs in lower abdomen on side of the affected kidney and it usually radiates towards groin.

Bowel obstruction

There are more types of bowel obstruction (ileus). Colic pain is typical for so-called mechanical ileus. Pain in this case can not be precisely localized and patient often refers that the whole abdomen hurts. Ileus is a potentially fatal when untreated. Over time, intestinal muscles get exhausted and contractions stop. Mechanical ileus changes into so-called paralytic ileus. There is no more colic pain, but otherwise consequences are dangerous. Stool accumulates above location of obstruction, integrity of intestinal wall deteriorates gradually and bacteria begin to penetrate from intestine into abdominal cavity causing peritonitis and sepsis.

Diagnostic approach

Cautious medical history and physical examination of abdomen should be performed, optimally by a surgeon. Imaging methods are very important, especially abdominal X-ray that may reveal presence of bowel obstruction and possibly some types of urinary stones. Gallstones and urinary stones with their complications are well visible in abdominal ultrasound. To specify the diagnosis abdominal computed tomography can be done.

Treatment

Conservative treatment consists of bed rest, plenty of fluids (for nausea administered mainly in infusions) and in some cases muscle relaxant drugs. However, usually a more invasive approach is needed. Gallstones can be often extracted by ERCP, urinary stones are extracted by urological interventions and intestinal obstruction often requires a classic abdominal surgical intervention with localizing the problem and restoration of intestinal integrity.