Ulcerative Colitis & Kidney Stones

Hi,

I have a friend who has ulcerative colitis. I believe by the time he was diagnosed, it was too late for surgery to accomplish anything but he remains on medication. However, he's had his second kidney stone recently (with the CT scan showing a lot more on the way.) As someone who's passed dozens of kidney stones, I feel his pain.

The problem is, due to his ulcerative colitis, the ER doctor didn't think it was wise to give him anything more powerful than Tylenol 3. In my experience, codeine does very little to relieve kidney stone pain, and he felt the same way. My GP, urologist, and ER doctors always sent me home with hydromorphone and I found it to make a huge difference. I realize it might not be the best idea for his circumstances, but surely there's SOMETHING he can take to help with the pain. I was always under the impression that codeine, when compared to other opioids in doses of equal analgesic effects, affected gut motility the most - other than loperamide, of course. What are your thoughts?

Any help would be greatly appreciated. Thanks.

Hi, 1. Ulcerative colitis

Hi,

1. Ulcerative colitis (UC) can potentially be treated surgically if a person fails to respond to medications. To my knowledge, there is no such thing as "too late" in regards to surgical treatment and UC.

2. 10% percent of the population fails to metabolize codeine to it's active pain-killing metabolite. This may explain why your friend
fails to obtain relief with codeine, Tyl#3 (which contains codeine).

3. As long as the kidney stone is relatively small, it will pass on it's own. However, as you are aware, this is usually a very painful process for which many people seek emergency room care.

Your friend's family doctor may want to try percocet, as this is a common medication prescribed for acute pain. If he experiences
constipation, then senokot can be given along with the percocet.

I would suggest that his gastroenterologist be consulted if anti-inflammatories (i.e. NSAIDs) are going to be prescribed, as this class of medication can cause UC TO FLARE UP / WORSEN. In particular, indomethacin suppositories (indomethacin is an NSAID) are frequently used in the ER for patients presenting with renal stone pain.

PLEASE NOTE THAT THESE ARE SUGGESTIONS AND NOT INTENDED AS MEDICAL ADVICE. YOUR FRIEND NEEDS TO FOLLOW UP WITH HIS DOCTOR FOR TREATMENT OF HIS PAIN.

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