KUALA LUMPUR, Aug 12 — Back pain is one of the most common complaints among working adults, often blamed on long hours at the desk, poor posture or fatigue after a busy day.
However, a medical expert cautioned that in some cases, what appears to be routine back discomfort could actually signal an underlying condition such as kidney stones.
Sunway Medical Centre, Sunway City (SMC) Urology specialist Dr S. Sivaprakasam said distinguishing between ordinary muscular back pain and pain caused by urinary tract stones can sometimes be challenging, as both may occur in similar areas of the body.
He said patients often cannot differentiate the source of the pain based on location alone because both musculoskeletal pain and kidney stone-related pain may occur in the lower back or side.
“Musculoskeletal back pain is usually triggered by movement or physical activity and often improves with rest, especially after lying down. It also tends to worsen toward the end of the day.
“In contrast, pain caused by urinary tract stones is typically sudden, severe and unpredictable, sometimes waking a person from sleep. The pain often occurs in waves, coming and going in cycles, unlike the more constant pain associated with musculoskeletal problems,” he told Bernama when met at SMC recently.
Dr Sivaprakasam, who has over 15 years specialising in urology, said that persistent or recurring back pain should not be ignored, particularly if it does not improve after a few days of rest.
A simple urine test at a general practitioner’s clinic can often provide the first indication of kidney stones.
“If a patient has back pain of uncertain origin and the urine test detects blood, even if it is not visible to the patient, it can be an early sign of a urinary tract stone,” he said, adding that patients may then be referred for imaging tests such as a Computed Tomography (CT) scan to confirm the presence, size and location of the stone.
A low-dose non-contrast CT scan is currently the most reliable diagnostic tool, providing detailed information that helps doctors determine the most appropriate treatment approach, he noted, stressing that advancement in medical technology had also transformed how kidney stones are treated, adding that open surgery, once the standard treatment several decades ago, is now rarely required.
Today, many procedures involve miniaturised instruments inserted through the natural urinary pathway, allowing doctors to access stones without making large incisions. Laser technology can then break the stones into tiny fragments that are easily removed or eliminated naturally.
“These techniques significantly reduce pain and recovery time. In many cases, patients can return home the next day and resume normal activities within one or two days.
“If patients do experience any discomfort, it is usually due to irritation in the bladder caused by the stent. However, this is only temporary, as stents are not left in place indefinitely and are typically removed after 10 to 14 days during a follow-up day-care procedure,” Dr Sivaprakasam said.
For smaller stones, typically less than five millimetres, doctors may recommend medical therapy and increased fluid intake to help the stones pass naturally.
Asked about the group with higher risk, Dr Sivaprakasam said that while kidney stones can affect anyone, lifestyle factors such as inadequate hydration remain a major contributor, particularly among urban workers who spend long hours in air-conditioned environments.
He said many office workers underestimate their daily fluid needs because they do not sweat as much as those working outdoors.
“They often feel they do not need to drink as much water. But low water intake increases the concentration of minerals in the urine, which raises the likelihood of crystal formation.
“Another common habit among office workers is delaying trips to the toilet for long periods due to meetings or busy schedules. Regularly holding in urine may allow minerals in the urine to remain in the urinary tract for longer periods, which can encourage crystals to form and eventually develop into stones,” he said.
Relying on beverages such as coffee, tea or sugary drinks instead of plain water can also worsen the situation.
“Although these beverages contain liquid, caffeine acts as a mild diuretic, causing the body to lose more water through urine. The net effect is that if someone drinks only coffee or tea during office hours, they may actually lose more water than they take in,” he explained.
For optimal hydration, Dr Sivaprakasam recommends adults consume around 2.5 to three litres of fluids daily, with most of it coming from plain water, while the rest is contributed from food.
He said dietary habits may also influence kidney stone risk, including high intake of animal protein - particularly red meat - fast foods, and excessive consumption of certain foods rich in oxalate, such as cocoa and pepper has been associated with a higher likelihood of stone formation.
In contrast, foods containing citrate, a natural compound found in fruits such as lemons, limes and pineapples, may help inhibit stone formation by preventing crystals from binding together in the urine, he said.
He advised that simple lifestyle measures, particularly drinking sufficient water, reducing excessive caffeine and limiting highly processed or sugary beverages, both rich in salt, can go a long way in lowering the risk.
“At the end of the day, hydration remains the most important factor. Keeping the urine diluted and the urinary system active reduces the chances of crystals forming and eventually becoming stones,” he added. — Bernama
