Symptoms of Ureter Spasm
Ureter spasm presents primarily as severe flank pain due to ureteral hyperperistalsis, typically accompanied by hematuria, and may include nausea, vomiting, and urinary urgency or frequency. 1
Primary Clinical Manifestations
Pain Characteristics
- Severe flank pain is the hallmark symptom, resulting from ureteral hyperperistalsis and spasm in response to obstruction (typically from stones) 1
- Pain may radiate to the costovertebral angle with associated tenderness 1
- The pain is often colicky in nature, representing intermittent waves of ureteral contraction 2
- Pain severity is typically severe enough that it does not respond to conventional systemic analgesics like pethidine in many cases 2
Associated Urinary Symptoms
- Hematuria (microscopic or gross) occurs due to irritation and trauma to the ureter from the spasm and any obstructing stone 1
- Urinary frequency and urgency may develop secondary to bladder irritation 1
- Dysuria can occur as the condition affects the lower urinary tract 1
Systemic Symptoms
- Nausea and vomiting are common accompaniments to severe ureteral colic 1
- Fever (>38°C) suggests progression to pyelonephritis or infection and is NOT a typical feature of uncomplicated ureter spasm 1
- Chills may occur if infection supervenes 1
Important Clinical Distinctions
What Ureter Spasm Is NOT
- Fever, chills, and systemic symptoms suggest complicated infection (pyelonephritis or urosepsis) rather than simple ureter spasm 1
- Persistent suprapubic pain or pressure with urgency and frequency in the absence of infection suggests bladder pain syndrome/interstitial cystitis, not primary ureter spasm 1
- Chronic or recurrent urethral pain with voiding suggests urethral pain syndrome, which is a distinct entity 3, 4
Critical Pitfall to Avoid
Do not confuse ureter spasm with obstructive pyelonephritis—the latter requires urgent imaging and intervention as it can rapidly progress to urosepsis. Any patient with flank pain AND fever should be evaluated immediately with ultrasound or CT to rule out obstruction 1. Prompt differentiation is crucial as obstructive pyelonephritis represents a urological emergency 1.
Pathophysiology Context
The pain mechanism involves ureteral hyperperistalsis attempting to overcome obstruction, leading to increased intraluminal pressure and distention 1. This spasm is believed to be the primary pain generator, which is why antispasmodic approaches (historically including calcium channel blockers and smooth muscle relaxants) have been investigated, though with variable clinical efficacy 5, 6.