Health: Common complaints: Colic

COLIC has an old-fashioned ring about it, like dropsy or ague. Grandmothers talk about babies having colic, for which they recommend gripe water; house painters used to get attacks of lead colic when paint contained lead pigments. The term colic is still, however, in common use in medicine: it has a strict technical meaning - pain caused by a muscular tube contracting strongly in an attempt to overcome a blockage. True colic is usually unmistakable; the pain is gripping and severe - as severe as any known to humans - and may require drugs as powerful as heroin to relieve it. Often sweating and vomiting add to the misery.

Biliary colic is caused by a gallstone blocking the cystic duct (the exit tube from the gall bladder) or the main bile duct leading from the liver to the intestine. The pain is felt in the upper abdomen on the right side and may spread up to the shoulder or round to the back. Severe attacks of pain occur, lasting several minutes, and between attacks there is a constant ache. With luck, the colic will achieve its aim within an hour or so, forcing the gallstone to the end of the duct and so getting rid of the obstruction. If this does not occur, an operation will eventually be needed. Drugs will be given to ease the pain and to relieve the muscular spasms.

An attack of biliary colic is a warning that the gall bladder probably contains multiple stones, and the only way to guarantee freedom from further attacks is for the gall bladder and the stones to be removed. The new technique of laparoscopic cholecystectomy - removal of the gall bladder using viewing tubes rather than a long surgical incision - has made this operation less daunting. Only a couple of days need be spent in hospital.

Renal colic is caused by a stone blocking the ureter, the tube leading from the kidney to the bladder. The pain is felt in the loin (between the ribs and the hip) and spreads down to the groin. Like biliary colic, renal colic is a severe, constant ache with more powerful pains which come in waves; and again, one has to hope that the stone will be pushed out of the end of the ureter into the bladder. If it is not passed out, surgery will be needed. Whatever the outcome, further tests will be arranged to find out whether there are more stones in the kidney and what their cause might be. Often the origin of a single stone remains unexplained. Kidney stones may sometimes be dispersed without surgery by using ultrasound to pulverise them.

Colic in the intestines may be due to a tumour; to the intestine being trapped in a hernia, or behind a scar from previous surgery; to twisting of the intestine; or to narrowing from chronic inflammation such as Crohn's disease. Intestinal colic is unlikely to be mistaken for indigestion or some minor abdominal upset: the victim is obviously ill, with severe pain and repeated vomiting which does not relieve the pain. Emergency surgery is needed to remove the obstruction.

What about colic in infants? Doctors still use the term 'three month colic' to explain attacks of crying in a baby in which the child draws up the legs, goes red in the face, and seems to be in considerable pain. Attacks may occur every evening for several weeks; the baby is otherwise well, feeding and gaining weight, and eventually the condition disappears as mysteriously as it came.