[41F] With lower left back and side pain, dark urine, and frequent urination

Patient Description

A 41-year-old female presents with sharp, dull, and throbbing pain in the lower left back and side since last night. The pain worsens with movement and has not been alleviated by any measures. The patient also reports dark urine and a frequent urge to urinate. There is no fever or blood in the urine. The patient has experienced some nausea but no pain radiating to the groin and no changes in bowel movements. The patient has a history of kidney stones and urinary tract infections, and recently experienced hypokalemia treated with intravenous potassium. No follow-up tests have been conducted for the hypokalemia. The patient's medical history includes ulcerative colitis (diagnosed in 2012) and interstitial cystitis (diagnosed in 2008). Allergies include doxycycline, Seroquel, trazodone, and tramadol. Current medications are ibuprofen (800mg every 6 hours), potassium chloride (dosage unknown, taken twice daily), and esomeprazole magnesium (20mg once daily). The patient uses tobacco and has not made any recent changes to diet or fluid intake.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

Kidney Stones

  • Rationale: Sharp, throbbing pain in the lower back and side, dark urine, and frequent urge to urinate are classic symptoms of kidney stones. Your history of kidney stones and urinary tract infections further supports this possibility.
  • Typical Treatments/Testing: Diagnosis often involves a urine test, blood test, and imaging like an ultrasound or CT scan. Treatment may include pain management, increased fluid intake, and sometimes medications to help pass the stone. In severe cases, surgical intervention may be required.

Urinary Tract Infection (UTI)

  • Rationale: Frequent urge to urinate and dark urine can also indicate a UTI. Given your history of interstitial cystitis and UTIs, this is another possibility.
  • Typical Treatments/Testing: Diagnosis usually involves a urine test to check for bacteria. Treatment typically includes antibiotics and increased fluid intake.

Hypokalemia Complications

  • Rationale: Recent hypokalemia (low potassium levels) can cause muscle weakness and cramping, which might contribute to your back pain. However, this is less likely to be the primary cause of your symptoms.
  • Typical Treatments/Testing: Blood tests to monitor potassium levels and appropriate supplementation.

What you can do

Kidney Stones

  • Immediate Steps:
    • Hydration: Drink plenty of water to help flush out the stone.
    • Pain Management: Continue taking ibuprofen as prescribed, but avoid exceeding the recommended dose.
    • Seek Medical Attention: Consult a healthcare provider for further evaluation and possible imaging tests.
  • At Home:
    • Dietary Changes: Avoid foods high in oxalates (like spinach and nuts) and reduce salt intake.
    • Monitor Symptoms: Keep track of any changes in pain, urine color, or frequency of urination using the MDandMe journal.

Urinary Tract Infection (UTI)

  • Immediate Steps:
    • Hydration: Drink plenty of water to help flush out bacteria.
    • Seek Medical Attention: Consult a healthcare provider for a urine test and possible antibiotics.
  • At Home:
    • Hygiene: Maintain good personal hygiene to prevent further infections.
    • Monitor Symptoms: Use the MDandMe journal to track symptoms and any changes.

General Tips

  • Avoid Tobacco: Smoking can exacerbate many health issues, including kidney and urinary problems.
  • Follow-Up on Hypokalemia: Ensure you have follow-up tests to monitor your potassium levels and adjust your potassium chloride dosage as needed.

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe Pain: If the pain becomes unbearable or is accompanied by fever.
  • Changes in Urine: If you notice blood in your urine or if the dark color persists.
  • Nausea and Vomiting: If these symptoms worsen, as they could indicate a more serious condition.

Remember, while I can provide guidance, it's crucial to consult a healthcare professional for a formal diagnosis and treatment plan. Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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4 mo ago

People Also Ask


What are the common symptoms of kidney stones?

Common symptoms of kidney stones include sharp, throbbing pain in the back or side, dark or cloudy urine, frequent urge to urinate, nausea, and sometimes blood in the urine.


How can I differentiate between a urinary tract infection and kidney stones?

Kidney stones often cause severe, sharp pain in the back or side, while a urinary tract infection typically causes a burning sensation during urination, frequent urination, and cloudy or strong-smelling urine. Both conditions can cause dark urine and frequent urination, so medical tests are needed for accurate diagnosis.


What are the potential complications of untreated hypokalemia?

Untreated hypokalemia can lead to muscle weakness, cramping, fatigue, and in severe cases, it can cause heart rhythm disturbances and paralysis. It's important to monitor and manage potassium levels to avoid these complications.


What lifestyle changes can help prevent kidney stones?

To help prevent kidney stones, increase your water intake, reduce salt and oxalate-rich foods (like spinach and nuts), limit animal protein, and maintain a healthy weight. Avoiding tobacco and managing any underlying health conditions are also beneficial.


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