Kidney cancer
of cancer, cancer types in adults

Kidney cancer is the eighth most common cancer in adults in the UK.

Signs and symptoms of kidney cancer can include:

blood in your urine  a constant pain in your side, just below the ribs a lump or swelling in the kidney area (on either side of the body)

Speak to your GP as soon as possible if you experience any of these symptoms. They will examine you and may refer you to a specialist clinic for further tests.

In around half of all cases of kidney cancer, there are no symptoms, and the condition is detected during tests for other unrelated conditions.

Read more about the symptoms of kidney cancer and diagnosing kidney cancer.

Symptoms

Most cases of kidney cancer don’t cause any symptoms in the early stages.

The most common symptoms of mid- to advanced-stage kidney cancer are:

blood in your urine (haematuria) – the amount of blood is usually high enough to change the colour of your urine to a reddish or dark brown colour a persistent pain in your side, just below the ribs a lump or swelling in the area of your kidneys (on either side of the body)

However, in around half of all cases, the cancer causes no symptoms and is only detected during a routine ultrasound scan.

Less common symptoms of kidney cancer include:

extreme tiredness (fatigue) or anaemia unintentional weight loss a high temperature of 38C (100.4F) or above night sweats  a general sense of feeling unwell swelling of the veins in the testicles (in men) loss of appetite high blood pressure (hypertension)

Causes

The exact cause of kidney cancer is unknown, but there are risk factors that can increase the chances of developing the condition.

The 3 main risk factors for kidney cancer are:

obesity smoking family history and genetics

Diagnoses

In many cases, kidney cancer is diagnosed after routine scans and check-ups, as the condition doesn’t always have obvious symptoms.

You should speak to your GP if you have any symptoms of kidney cancer, such as blood in your urine or a constant pain below your ribs.

Your GP will examine you and, if they think your symptoms need further assessment, refer you to a specialist urologist (a doctor who specialises in conditions that affect the urinary tract).

If you notice blood in your urine, your GP will usually carry out a blood test and take a urine sample. The results will help rule out other possible causes, such as infection or kidney stones.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of renal (kidney) cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected kidney cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

If you need to be referred urgently, you’ll usually be seen within 2 weeks.


If your GP refers you to a hospital specialist, further tests will help determine whether you have kidney cancer.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of an organ in the body. It can often detect changes in the shape of the kidney that might be caused by a cancerous tumour.

An ultrasound scan may be needed if the cause of the blood in your urine can’t be found.

Computerised tomography scan

You may also be referred for a computerised tomography (CT) scan. During a CT scan, a series of detailed images of the inside of your body are taken and put together by a computer.

If you have a CT scan, you may be given a special dye to drink, or it may be injected. The dye makes the results of the CT scan clearer.

Image-guided biopsy

In some cases of kidney cancer, an image-guided biopsy is carried out. It’s a minor surgical procedure performed under local anaesthetic. This means you’ll be awake during the procedure, but the area surrounding the affected kidney will be numbed, so that you don’t feel anything.

During an image-guided biopsy, a radiologist or surgeon will use an ultrasound or CT scan to guide a needle through your skin and into your kidney. A small tissue sample will be removed from your kidney and examined under a microscope to check for cancerous cells.

Magnetic resonance imaging (MRI) scan

You may also need to have a magnetic resonance imaging (MRI) scan, which can be used to produce detailed images of your kidneys. The images can help identify a tumour and determine its size.

Cystoscopy

A cystoscopy is a medical procedure that uses an instrument called a cystoscope to examine the inside of your bladder and urinary system.

This procedure doesn’t look at the kidneys, but it can rule out or confirm whether any bleeding is coming from problems in the bladder.

Intravenous pyelogram (IVP)

An intravenous pyelogram (IVP) test involves injecting a dye into your bloodstream. X-rays are taken after a short time, with the dye highlighting any growths present in the kidneys.

Treatments

The earlier kidney cancer is diagnosed, the easier it is to treat.

How it’s treated will depend on the size and spread of the cancer. Surgery to remove the cancerous cells is usually the first course of action.

Unlike most other cancers, chemotherapy isn’t very effective at treating kidney cancer. However, non-surgical treatments are available, such as radiotherapy or targeted therapies. These are most commonly used in the more advanced stages of kidney cancer, when the cancer has spread beyond the kidney.

Read more about treating kidney cancer.


Speak to your GP immediately if you have pain or a swelling or lump in your kidney area (on either side of your body, just below your ribcage).

You should also speak to your GP if you have blood in your urine. Although it’s highly unlikely to be caused by kidney cancer, it could be a symptom of a less serious condition that still requires treatment, such as a kidney stone or bladder stone.


The treatment of kidney cancer depends on the size and spread of the cancer. Surgery is the most common first course of action, with the aim of removing the cancer cells.

Unlike most other cancers, chemotherapy isn’t very effective in treating kidney cancer. However, there are non-surgical treatments available, such as radiotherapy or targeted drug therapies.

The main treatments for kidney cancer include:

nephrectomy embolisation radiotherapy  targeted therapies  immunotherapy


You can expect to be cared for by a multidisciplinary team, often comprising a specialist cancer surgeon, an oncologist (who specialises in radiotherapy and chemotherapy), a radiologist, a nephrologist (a kidney specialist) and a specialist nurse.

You’ll be given a key worker, usually the specialist nurse, who will be responsible for coordinating your care.

Your team will recommend what they think is the best treatment option, but the final decision will be yours.

When deciding what treatment is best for you, your doctors will consider:

the stage and grade of your cancer (how big it is and how far it’s spread) your age and general health

If the cancer hasn’t spread out of your kidney (T1 or T2 kidney cancer), it can usually be cured by removing some or all of the kidney.

If the cancer has spread out of your kidney (T3 or T4 kidney cancer), a complete cure may not be possible. However, it should be possible to slow the cancer’s progression and treat any symptoms.


Nephrectomy

A nephrectomy is an operation to remove a kidney.

If the tumour is less than 4cm (1.5 inches) in diameter, it may only be necessary to remove some of your kidney. This is known as a partial nephrectomy. A partial nephrectomy may also be required if your remaining kidney is in poor health.

If the tumour is more than 4cm in diameter, your entire kidney will need to be removed. Even if the cancer has spread beyond your kidney, you may still benefit from having your kidney removed.

Removing the kidney can help resolve the pain, and make other types of non-surgical treatment more effective.

It’s possible to live a normal life with only 1 kidney, because the other kidney will be able to compensate.

During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure the cancer hasn’t spread beyond the kidney.

There are 2 ways that both a partial and open nephrectomy can be performed They are an:

open nephrectomy – where the kidney is removed through a large incision in your abdomen (stomach) laparoscopic or keyhole nephrectomy – where a series of smaller incisions are made in your abdomen, and the kidney is removed using small surgical instruments

Both techniques have advantages and disadvantages.

A laparoscopic nephrectomy has a considerably quicker recovery time than an open nephrectomy.

However, the procedure requires surgeons with specialised training, so you may have to wait longer to receive treatment than you would if you decided to have an open nephrectomy.

Some types of kidney cancer, where the tumour is located in the centre of the kidney, may not be suitable for a laparoscopic nephrectomy.

One of the main disadvantages of an open nephrectomy is that it’s a major surgical procedure that can place a considerable strain on the body. This means it may not be suitable for people who are particularly frail or unwell.

You should discuss the pros and cons of both procedures with your surgical team.

Embolisation

If you’re unable to have a nephrectomy, you may benefit from an alternative operation known as embolisation.

During embolisation, the surgeon will insert a small tube called a catheter into your groin, then use X-ray images to guide the catheter into the blood supply of your kidney. A substance will then be injected through the catheter to block the blood supply to your kidney.

By blocking blood supply to the kidney, any tumours that are present will become starved of oxygen and nutrients, causing them to shrink.


Kidney cancer is one of the few types of cancer that’s less responsive to chemotherapy (where powerful medication is used to kill cancerous cells).

However, a number of clinical trials are underway that are looking at new combinations of chemotherapy medications that appear to be benefiting some people.

There are also a number of different non-surgical treatments that can slow the spread of the cancer and help control its symptoms.

Radiotherapy

Radiotherapy can’t usually cure kidney cancer, but it can slow down its progress and help reduce pain. You should only need a few minutes of radiotherapy every day, for a number of days.

When radiotherapy is used to control the symptoms of cancer rather than cure it, the side effects tend to be mild. Possible side effects may include fatigue (tiredness), nausea and vomiting.

Cryotherapy

Cryotherapy involves killing cancer cells by freezing them. It may be used if a person isn’t fit enough for surgery, or if their tumour is small.

Cryotherapy is usually classed as either percutaneous (where needles are passed through the skin) or laparoscopic (where needles are placed directly into the kidney through a small incision).

Side effects include bleeding around the kidney and injury to the tube that carries urine from the kidney to the bladder (the ureter).

Radiofrequency ablation

Radiofrequency ablation (RFA) uses heat generated by radio waves to kill cancer cells. This is a percutaneous treatment, meaning no incision is needed.

This treatment is only available at specialist centres. It’s mainly used if you’re not strong enough for surgery or your kidney cancer is in the early stages.

RFA can’t be used if the cancer is too close to other organs, such as the bowel.

Side effects include bleeding in the treatment area, a collection of blood (haematoma) near the kidney, and problems passing urine due to the narrowing of the tube that joins the kidney to the bladder (the ureter).

Preventions

As the causes of kidney cancer aren’t fully understood, it’s not possible to fully prevent it.

However, leading a healthy lifestyle may reduce the chances of developing the condition. A combination of a healthy diet and regular exercise will help to avoid becoming overweight or obese, which is a significant risk factor for kidney cancer.

If you’re overweight or obese, you can lose weight and maintain a healthy weight by combining regular exercise with a calorie-controlled diet.

Read more about treating obesity.


As the causes of kidney cancer aren’t fully understood, it’s not possible to completely prevent it.

However, leading a healthy lifestyle may help reduce your chances of developing the condition.

Read about the causes of kidney cancer.

Combining a healthy diet and regular exercise will help you avoid becoming overweight or obese, which are both significant risk factors for kidney cancer.

If you’re overweight or obese, you can lose weight and maintain a healthy weight by combining regular physical activity with a calorie-controlled diet.

Read more about healthy weight loss and treating obesity.

Kidney infection
of kidneys bladder and prostate

A kidney infection (pyelonephritis) is a painful and unpleasant illness caused by bacteria travelling from your bladder into one or both of your kidneys.

It’s more serious than cystitis, a common infection of the bladder that makes urinating painful.

If treated promptly, a kidney infection doesn’t cause serious harm, but will make you feel very unwell. If a kidney infection isn’t treated, it can get worse and cause permanent kidney damage.

Symptoms of a kidney infection often come on within a few hours. You can feel feverish, shivery, sick and have a pain in your back or side.

Read more about the symptoms of a kidney infection

Symptoms

The symptoms of a kidney infection usually develop quite quickly over a few hours or days.

Common symptoms include:

pain and discomfort in your side, lower back or around your genitals high temperature (it may reach 39.5C or 103.1F) shivering or chills feeling very weak or tired loss of appetite feeling sick or being sick  diarrhoea

You may have other symptoms if you also have cystitis or urethritis (an infection of the urethra). These additional symptoms may include:

pain or a burning sensation during urination need to urinate frequently or urgently feeling that you’re unable to urinate fully blood in your urine cloudy or foul smelling urine pain in your lower abdomen

Causes

A kidney infection usually happens when bacteria – often a type called E. coli – gets into the urethra (the tube which carries urine out of the body) and travels up through the bladder and into the kidneys.

Read more about the causes of a kidney infection


A kidney infection happens when bacteria infects your kidneys. The bacteria are usually a type called E. coli, which live in your bowel.

The bacteria get in through the opening of the urethra and move upwards through your urinary tract, first infecting your bladder and then your kidneys.

It’s thought the bacteria can get into your urinary tract by accidentally spreading from your anus to your urethra. This can happen if you wipe your bottom after going to the toilet and the soiled toilet paper comes into contact with your genitals. It can also happen during sex.

In rare cases, a kidney infection can develop if bacteria or fungi infect the skin and the infection spreads through your bloodstream into your kidney. However, this type of infection usually only occurs in people with weakened immune systems.

Diagnoses

To work out if you have a kidney infection, your GP will ask you about your symptoms and your recent medical history.

They will usually also assess your general health by taking your temperature and measuring your blood pressure.


A urine test can help to establish whether you have a urinary tract infection (UTI). The test involves taking a small sample of urine and checking it to see if there are any bacteria in it.

You’ll be given a container and told how to collect the urine, which you can do in the surgery or at home. If you do it at home, you’ll need to label the container, seal it in a plastic bag and store it in the fridge. Ideally, hand it in to the surgery within four hours.

A urine test can’t tell whether the infection – if you have one – is in your kidneys or another part of your urinary system, such as your bladder.

For your GP to be confident you have a kidney infection, you need to have a positive urine test plus certain symptoms, such as a fever or a pain in your side.

Treatments

See your GP if you have a fever and persistent tummy, lower back or genital pain, or if you notice a change to your usual pattern of urination.

Most kidney infections need prompt treatment with antibiotics to stop the infection from damaging the kidneys or spreading to the bloodstream. You may also need painkillers.

If you’re especially vulnerable to the effects of an infection, for example, if you have a pre-existing health condition or are pregnant, you may be admitted to hospital and treated with antibiotics through an intravenous drip.

After taking antibiotics, you should feel completely better after about 2 weeks.

In rare cases, a kidney infection can cause further problems. These include blood poisoning (sepsis) and a build-up of pus in the kidney called an abscess.

Read more about treating a kidney infection and the complications of a kidney infection


Contact your GP if you have a high temperature, persistent pain, or if you notice a change to your usual pattern of urination. Contact your GP immediately if you think your child may have a kidney infection.

If you have blood in your urine, you should always see your GP so the cause can be investigated.

Kidney infections require prompt treatment with antibiotics to help relieve symptoms and prevent complications developing.

Your GP can carry out some simple tests to help diagnose a kidney infection.

See diagnosing kidney infections for more information


Most people with a kidney infection can be treated at home with a course of antibiotics, and possibly painkillers as well.

See your GP if you have a fever and persistent tummy, lower back or genital pain, or if you notice a change to your usual pattern of urination.

All children with symptoms of a urinary tract infection (UTI) or kidney infection, including cystitis, should see their GP or out-of-hours emergency service.


Your GP may refer you to hospital if you have an underlying problem with your urinary tract, which makes you vulnerable to kidney infections.

It’s standard practice to further investigate all men with a kidney infection simply because the condition is much rarer in men. Only women who have had 2 or more kidney infections tend to be referred. Most children with a kidney infection will be treated in hospital.

Hospital treatment may also be needed if:

you’re severely dehydrated you’re unable to swallow or keep down any fluids or medications you have additional symptoms that suggest you may have blood poisoning, such as a rapid heartbeat and losing consciousness you’re pregnant and you also have a high temperature you’re particularly frail and your general health is poor  your symptoms fail to improve within 24 hours of starting treatment with antibiotics you have a weakened immune system you have a foreign body inside your urinary tract, such as a kidney stone or a urinary catheter you have diabetes you’re over the age of 65 you have an underlying condition that affects the way your kidneys work, such as polycystic kidney disease or chronic kidney disease

If you’re admitted to hospital with a kidney infection, you’ll probably be attached to a drip so you can be given fluids to help keep you hydrated. Antibiotics can also be given through the drip.

You’ll have regular blood and urine tests to monitor your health and how effectively the antibiotics are fighting off the infection.

Most people respond well to treatment. As long as there are no complications, they’re usually well enough to leave hospital within three to seven days. Treatment will usually switch to tablets or capsules after you stop receiving antibiotics through a drip.


Constipation can increase your chances of developing a urinary tract infection (UTI), so try to treat any constipation promptly.

Recommended treatments for constipation include:

increasing the amount of fibre in your diet to 20g to 30g of fibre a day using a mild laxative on a short-term basis drinking plenty of fluids

See your GP if your symptoms don’t improve after 14 days (or 7 days for children with constipation).

Read more about treating constipation

Preventions

You can reduce your chances of developing a kidney infection by keeping your bladder and urethra free from bacteria. This can include drinking plenty of fluids, keeping your genitals clean and treating any constipation.

Read more about preventing a kidney infection


The best way to prevent a kidney infection is to keep your bladder and urethra free from bacteria.

These self-help tips explain how you can do this.

Complications

Most kidney infections are treated successfully without complications, although some people may develop further problems.

Complications of a kidney infection are rare, but you’re more likely to develop them if you:

are a child are over 65 are pregnant have diabetes, chronic kidney disease or sickle cell anaemia have had a kidney transplant (particularly in the first three months after the transplant) have a weakened immune system developed the kidney infection while in hospital

Kidney stones
of kidneys bladder and prostate

Kidney stones can develop in one or both kidneys and most often affect people aged 30 to 60.

They’re quite common, with around 3 in 20 men and up to 2 in 20 women developing them at some stage of their lives.

The medical term for kidney stones is nephrolithiasis, and if they cause severe pain it’s known as renal colic.

Symptoms

Small kidney stones may go undetected and be passed out painlessly in the urine. But it’s fairly common for a stone to block part of the urinary system, such as the:

ureter – the tube connecting the kidney to the bladder urethra – the tube urine passes through on its way out of the body

A blockage can cause severe pain in the abdomen or groin and sometimes causes a urinary tract infection (UTI).

Read more about the symptoms of kidney stones.


Very small kidney stones are unlikely to cause many symptoms. It may even go undetected and pass out painlessly when you urinate.

Symptoms usually occur if the kidney stone:

gets stuck in your kidney starts to travel down the ureter (the tube that attaches each kidney to the bladder) – the ureter is narrow and kidney stones can cause pain as they try to pass through causes an infection

In these cases, the symptoms of kidney stones can include:

a persistent ache in the lower back, which is sometimes also felt in the groin – men may have pain in their testicles and scrotum periods of intense pain in the back or side of your abdomen, or occasionally in your groin, which may last for minutes or hours feeling restless and unable to lie still nausea (feeling sick) needing to urinate more often than normal pain when you urinate (dysuria) blood in your urine (haematuria) – this may be caused by the stone scratching the kidney or ureter

Causes

The waste products in the blood can occasionally form crystals that collect inside the kidneys. Over time, the crystals may build up to form a hard stone-like lump.

This is more likely to happen if you don’t drink enough fluids, if you’re taking some types of medication, or if you have a medical condition that raises the levels of certain substances in your urine.

Read more about the causes of kidney stones.

After a kidney stone has formed, your body will try to pass it out when you go to the toilet (in the urine). This means it will often travel through the urinary system (the kidneys, kidney tubes and bladder).


Kidney stones are usually formed following a build-up of certain chemicals in the body.

This build-up may be any of the following:

calcium ammonia uric acid – a waste product produced when the body breaks down food to use as energy cysteine – an amino acid that helps to build protein

Certain medical conditions can lead to an unusually high level of these substances in your urine.

You’re also more likely to develop kidney stones if you don’t drink enough fluids.

Diagnoses

Your GP will usually be able to diagnose kidney stones from your symptoms and medical history.

It will be particularly easy if you’ve had kidney stones before.

You may be given tests, including:

urine tests to check for infections and pieces of stones an examination of any stones that you pass in your urine blood tests to check that your kidneys are working properly, and to also check the levels of substances that could cause kidney stones, such as calcium

You can collect a kidney stone by urinating through some gauze or a stocking.

Having a kidney stone to analyse will make a diagnosis easier, and may help your GP determine which treatment method will be of most benefit to you.

If you have severe pain that isn’t controlled by painkillers, or if you have a high temperature as well as pain, you may be referred to a urologist (a specialist in treating urinary problems).


If you’re referred to hospital for an imaging test, a number of different techniques may be used. Imaging tests can help confirm the diagnosis, or identify precisely where a kidney stone is.

These tests include:

a computerised tomography (CT) scan – where a series of X-rays at slightly different angles are taken and a computer is used to put the images together X-ray – an imaging technique that uses high-energy radiation to highlight abnormalities in body tissue an ultrasound scan – uses high-frequency sound waves to create an image of the inside of your body an intravenous urogram (IVU) or intravenous pyelogram (IVP) – a dye that shows up on X-ray is injected into a vein in your arm; the X-ray image highlights any blockages as the kidneys filter the dye out of your blood and into your urine

CT scans are now often used because they’re thought to be more accurate. IVUs were previously the preferred imaging method. The imaging technique you have may depend on what’s available at your local hospital.

Treatments

Most kidney stones are small enough to be passed in your urine, and it may be possible to treat the symptoms at home with medication.

Larger stones may need to be broken up using ultrasound or laser energy. Occasionally, keyhole surgery may be needed to remove very large kidney stones directly.

Read more about treating kidney stones.

It’s estimated that up to half of all people who have had kidney stones will experience them again within the following 5 years.

To avoid getting kidney stones, make sure you drink plenty of water every day so you don’t become dehydrated. It’s very important to keep your urine diluted (clear) to prevent waste products forming into kidney stones.

Read more about preventing kidney stones.


Most kidney stones are small enough (less than 4mm in diameter) to be passed out in your urine and can probably be treated at home.

But even small kidney stones can be painful, although this usually only lasts a couple of days and disappears when the stone has been passed.


If a kidney stone is too big to be passed naturally – 6mm to 7mm (about 0.23in to 0.27in) in diameter or larger – you may need treatment to remove it another way.

This could include:

extracorporeal shock wave lithotripsy (ESWL) ureteroscopy percutaneous nephrolithotomy (PCNL) open surgery

The type of treatment you have will depend on the size and location of your stones. 

Extracorporeal shock wave lithotripsy (ESWL)

ESWL is the most common way of treating kidney stones that can’t be passed in the urine.

It involves using ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is. Ultrasound shock waves are then sent to the stone from a machine to break it into smaller pieces, so it can be passed in your urine.

ESWL can be an uncomfortable form of treatment, so it’s usually carried out after giving painkilling medication.

You may need more than one session of ESWL to successfully treat your kidney stones. ESWL is up to 99% effective for stones up to 20mm (0.8in) in diameter. 

Ureteroscopy

If a kidney stone is stuck in the ureter, you may need to have a ureteroscopy, which is also sometimes known as retrograde intrarenal surgery (RIRS).

It involves passing a long, thin telescope called a ureteroscope through your urethra (the tube urine passes through on its way out of the body) and into your bladder. It’s then passed up into your ureter to where the stone is stuck.

The surgeon may either try to gently remove the stone using another instrument, or they may use laser energy to break it up into small pieces so that it can be passed naturally in your urine.

Ureteroscopy is carried out under general anaesthetic (where you’re unconscious), so you shouldn’t drive or operate machinery for up to 48 hours after the procedure.

For stones up to 15mm (0.6in), a ureteroscopy is effective in 50% to 80% of cases.

A plastic tube called a stent may need to be temporarily inserted inside you to allow the stone fragments to drain into the bladder.

Percutaneous nephrolithotomy (PCNL)

PCNL is an alternative procedure that may be used for larger stones. It may also be used if ESWL isn’t suitable – for example, because the person being treated is obese. 

PCNL involves using a thin telescopic instrument called a nephroscope. A small incision is made in your back and the nephroscope is passed through it and into your kidney. The stone is either pulled out or broken into smaller pieces using a laser or pneumatic energy.

PCNL is always carried out under general anaesthetic, so you shouldn’t drive or operate machinery for up to 48 hours after the procedure.

PCNL is 86% effective for stones that are 21mm to 30mm (0.8in to 1.2in) in diameter.  

Open surgery

Nowadays, open surgery for kidney stones is rare. Less than 1% of cases require this type of surgery. It’s only usually used if there’s a very large stone or abnormal anatomy. 

During open surgery, an incision will be made in your back so that your surgeon is able to access your ureter and kidney. The kidney stone can then be removed. 


If you have a uric acid stone, you may be advised to drink around 3 litres (just over 5 pints) of water each day to try to dissolve it.

Uric acid stones are much softer than other types of kidney stone, and they can be made smaller if they’re exposed to alkaline fluids.

You may need to take some medication to make your urine more alkaline before the uric acid stone starts to dissolve.


Complications can occur following the treatment of large kidney stones. Your surgeon should explain these to you before you have the procedure.

Possible complications will depend on the type of treatment you have and the size and position of your stones. Complications could include:

sepsis – an infection that spreads through the blood, causing symptoms throughout the whole body a blocked ureter – caused by stone fragments; the ureter is the tube that attaches the kidney to the bladder an injury to the ureter a urinary tract infection bleeding during surgery pain

It’s estimated that 5% to 9% of people may experience complications after having a ureteroscopy.

Preventions

Most kidney stones are small enough to be passed in your urine, and it may be possible to treat the symptoms at home with medication.

Larger stones may need to be broken up using ultrasound or laser energy. Occasionally, keyhole surgery may be needed to remove very large kidney stones directly.

Read more about treating kidney stones.

It’s estimated that up to half of all people who have had kidney stones will experience them again within the following 5 years.

To avoid getting kidney stones, make sure you drink plenty of water every day so you don’t become dehydrated. It’s very important to keep your urine diluted (clear) to prevent waste products forming into kidney stones.

Read more about preventing kidney stones.


The best way of preventing kidney stones is to make sure you drink plenty of water each day to avoid becoming dehydrated.

Keeping your urine diluted helps to stop waste products getting too concentrated and forming stones.

You can tell how diluted your urine is by looking at its colour. The darker your urine is, the more concentrated it is.

Your urine is usually a dark yellow colour in the morning because it contains a build-up of waste products that your body has produced overnight.

Drinks such as tea, coffee and fruit juice can count towards your fluid intake, but water is the healthiest option and is best for preventing kidney stones developing.

You should also make sure you drink more when it’s hot or when you’re exercising, to replenish fluids lost through sweating.

Read more about preventing dehydration.

Complications

Complications can occur following the treatment of large kidney stones. Your surgeon should explain these to you before you have the procedure.

Possible complications will depend on the type of treatment you have and the size and position of your stones. Complications could include:

sepsis – an infection that spreads through the blood, causing symptoms throughout the whole body a blocked ureter – caused by stone fragments; the ureter is the tube that attaches the kidney to the bladder an injury to the ureter a urinary tract infection bleeding during surgery pain

It’s estimated that 5% to 9% of people may experience complications after having a ureteroscopy.

Labyrinthitis
of ears nose and throat

Labyrinthitis is an inner ear infection. It causes a delicate structure deep inside your ear called the labyrinth to become inflamed, affecting your hearing and balance.

The most common symptoms are dizziness, hearing loss (from mild to total loss of hearing) and vertigo – the sensation that you, or the environment around you, is moving.

These symptoms can range from mild to severe, with some people feeling that they are unable to remain upright. Other symptoms include:

a feeling of pressure inside your ear(s) ringing or humming in your ear(s) (tinnitus) fluid or pus leaking out of your ear(s) ear pain feeling sick (nausea) or being sick a high temperature (fever) of 38C (100.4F) or above changes in vision, such as blurred vision or double vision mild headaches 

Certain things can make the dizziness worse, including:

colds or illness  the dark being in crowded areas or small rooms tiredness a women’s period walking

See your GP if you have these symptoms. You should also avoid driving, using tools and machinery, or working at heights if you’re feeling dizzy.

Causes

Labyrinthitis is caused by inflammation of part of the inner ear known as the labyrinth. This is caused by an infection.

Diagnoses

Many conditions can cause dizziness and vertigo. Your GP will usually diagnose labyrinthitis based on your symptoms, your medical history and a physical examination.

Your GP may carry out the following tests:

a physical examination – you may be asked to move your head or body and your ears will be checked for signs of inflammation and infection hearing tests – labyrinthitis is more likely if you have hearing loss

Your GP will also check your eyes. If they are flickering uncontrollably, it is usually a sign that your vestibular system (the body’s balancing system) is not working properly.


Further testing is usually only required if you have additional symptoms that suggest you may have a more serious condition, such as meningitis or a stroke. Symptoms can include:

severe headache mental confusion slurred speech weakness or paralysis on one side of your body

These tests can include:

a lumbar puncture – a fluid sample is taken from the base of your spine and checked for infection computerised tomography (CT) scan – to give a three-dimensional picture of your brain magnetic resonance imaging (MRI) scan – to give a detailed image of your brain blood tests

Treatments

In most cases, the symptoms pass within a few weeks. Treatment involves a combination of bed rest and medication to help you cope better with the symptoms. You may need additional medication to fight the underlying infection, although antibiotics are not often required as the cause is most commonly due to a virus.

Contact your GP if you do not notice any improvement after three weeks. You may need to be referred to an ear, nose and throat (ENT) specialist.

A small number of people have persistent symptoms that last for several months, or possibly years. This requires a more intensive type of treatment called vestibular rehabilitation therapy (VRT).

Read more about treating labyrinthitis


Labyrinthitis is usually treated using a combination of self-help techniques and medication. Chronic labyrinthitis may be treated with vestibular rehabilitation therapy (VRT).

Complications

Bacterial labyrinthitis carries a higher risk of causing permanent hearing loss, particularly in children who have developed it as a complication of meningitis.

Because of this high risk, a hearing test is recommended following bacterial labyrinthitis.

Severe hearing loss following bacterial labyrinthitis can sometimes be treated with a cochlear implant. This is not a conventional hearing aid, but a small electronic device fitted under the skin behind the ear during surgery.

Read more information about hearing loss


Permanent hearing loss can be a common complication of labyrinthitis, particularly in children who have developed bacterial labyrinthitis as a complication of the brain infection meningitis.

It’s estimated that as many as one in five children will develop hearing loss after having meningitis. The hearing loss can either be partial or complete.

Because of the high risk of hearing loss occurring after bacterial labyrinthitis, it is recommended that a person is given a hearing test once they have recovered from the infection.

Permanent, severe hearing loss following bacterial labyrinthitis can sometimes be treated with a cochlear implant. This is not a conventional hearing aid, but a small electronic device fitted under the skin behind the ear during surgery.

Read more information about hearing loss.

Lactose intolerance
of nutritional

Lactose intolerance is a common digestive problem where the body is unable to digest lactose, a type of sugar mainly found in milk and dairy products.

Symptoms of lactose intolerance usually develop within a few hours of consuming food or drink that contains lactose. They may include:

flatulence (wind) diarrhoea bloated stomach stomach cramps and pains stomach rumbling feeling sick

The severity of your symptoms and when they appear depends on the amount of lactose you’ve consumed.

Some people may still be able to drink a small glass of milk without triggering any symptoms, while others may not even be able to have milk in their tea or coffee.

Causes

The body digests lactose using a substance called lactase. This breaks down lactose into two sugars called glucose and galactose, which can be easily absorbed into the bloodstream.

People with lactose intolerance don’t produce enough lactase, so lactose stays in the digestive system where it’s fermented by bacteria. This leads to the production of various gases, which cause the symptoms associated with lactose intolerance.

Depending on the underlying reason why the body isn’t producing enough lactase, lactose intolerance may be temporary or permanent. Most cases that develop in adults are inherited and tend to be lifelong, but cases in young children are often caused by an infection in the digestive system and may only last for a few weeks.

Read more about the causes of lactose intolerance


Lactose intolerance is usually the result of your body not producing enough lactase.

Lactase is an enzyme (a protein that causes a chemical reaction to occur) normally produced in your small intestine that’s used to digest lactose.

If you have a lactase deficiency, it means your body doesn’t produce enough lactase.

Diagnoses

It’s important to visit your GP if you think you or your child may have lactose intolerance, as the symptoms can be similar to other conditions.

Before seeing your GP, keep a diary of what you eat and drink, and what symptoms you experience. Tell your GP if you notice any patterns, or if there are any foods you seem particularly sensitive to.

Your GP may suggest trying to remove lactose from your diet for two weeks to see if it helps to relieve your symptoms. This will provide further evidence of whether you’re lactose intolerant.


Other tests aren’t usually needed, but your GP may sometimes suggest further tests to:

help confirm the diagnosis find out how much lactase (the enzyme used to digest lactose) your body is producing try to determine what might be causing your lactose intolerance

Some of the main tests that may be used are described below.

Hydrogen breath test

A hydrogen breath test is a simple way of determining if you may be lactose intolerant.

You’ll be asked to avoid eating or drinking during the night before the test. When you arrive for the test, you’ll be asked to blow up a balloon-like bag. This sample of your breath will be tested to find out how much hydrogen is present, measured in parts per million (ppm).

You’ll then be given a drink of lactose solution and your breath will be tested every 15 minutes over the next few hours to see if the level of hydrogen changes.

If your breath contains a large amount of hydrogen (more than 20ppm above your baseline) after consuming the lactose solution, it’s likely that you’re lactose intolerant. This is because lactose intolerance can cause the bacteria in the colon (large intestine) to produce more hydrogen than normal.

Lactose tolerance test

In a lactose tolerance test, you’ll be given a drink of lactose solution and a blood sample will be taken from your arm using a needle. The blood will be tested to see how much glucose (blood sugar) it contains.

If you’re lactose intolerant, your blood sugar levels will either rise slowly, or not at all. This is because your body is unable to break down the lactose into glucose.

Milk tolerance test

In a milk tolerance test, you’ll be given a glass of milk (about 500ml) and your blood sugar levels will be tested. If your blood sugar levels don’t rise after drinking the milk, you may be lactose intolerant.

Small bowel biopsy

A small bowel biopsy is rarely used to diagnose lactose intolerance. However, it may be carried out to see if your symptoms are being caused by another condition, such as coeliac disease.

In a small bowel biopsy, a sample of your small intestinal lining is taken using an endoscope (a thin, flexible tube with a light and a tiny cutting tool at the end) that’s passed down your throat. This will be carried out under local anaesthetic, so it won’t hurt.

The sample of intestinal lining will be tested to see how much lactase it contains. If it only contains a small amount of lactase, it’s likely you’re lactose intolerant. The sample can also be examined to look for signs of possible underlying conditions such as coeliac disease.

Treatments

The symptoms of lactose intolerance can be similar to several other conditions, so it’s important to see your GP for a diagnosis before removing milk and dairy products from your diet.

For example, the symptoms above can also be caused by:

irritable bowel syndrome (IBS) – a long-term disorder that affects the digestive system milk protein intolerance – an adverse reaction to the protein in milk from cows (not the same as a milk allergy)

If your GP thinks you have lactose intolerance, they may suggest avoiding foods and drinks containing lactose for two weeks to see if your symptoms improve.

Read more about diagnosing lactose intolerance


There’s no cure for lactose intolerance, but limiting your intake of food and drink containing lactose usually helps to control the symptoms.

Depending on what dairy products you’re able to eat, you may also require additional calcium and vitamin D supplements to keep your bones strong and healthy. In some cases, your GP may refer you to a dietitian for further advice.

In addition to dietary changes, lactase substitutes may also be helpful. These are drops or tablets you can take with your meals or drinks to improve your digestion of lactose.

Read more about treating lactose intolerance


There’s no cure for lactose intolerance, but most people are able to control their symptoms by making changes to their diet.

Some cases of lactose intolerance, such as those caused by gastroenteritis, are only temporary and will improve within a few days or weeks. Other cases, such as those caused by an inherited genetic fault or a long-term underlying condition, are likely to be lifelong.

Complications

Milk and other dairy products contain calcium, protein and vitamins such as A, B12 and D. Lactose also helps your body absorb a number of other minerals, such as magnesium and zinc. These vitamins and minerals are important for the development of strong, healthy bones.

If you’re lactose intolerant, getting the right amount of important vitamins and minerals can prove difficult. This may lead to unhealthy weight loss and put you at increased risk of developing the following conditions:

Osteopenia – where you have a very low bone-mineral density. If osteopenia is not treated, it can develop into osteoporosis. Osteoporosis – where your bones become thin and weak. If you have osteoporosis, your risk of getting fractures and broken bones is increased. Malnutrition – when the food you eat doesn’t give you the nutrients essential for a healthy functioning body. If you’re malnourished, wounds can take longer to heal and you may start to feel tired or depressed.

If you’re concerned that dietary restrictions are putting you at risk of complications, you may find it helpful to consult a dietitian. They can advise you on your diet and whether you require food supplements.

Your GP should be able to refer you to an NHS dietitian free of charge. Alternatively, you can contact a private dietician. The British Dietetic Association has information on how to find a private dietitian.


Milk and other dairy products are an important part of a healthy diet. They contain calcium, protein and vitamins such as vitamins A, B12 and D.

Lactose is also important because it helps your body absorb a number of other minerals, including magnesium and zinc. These vitamins and minerals are important for the development of strong, healthy bones.

If you are lactose intolerant, getting the right amount of important vitamins and minerals can prove difficult. This may lead to unhealthy weight loss and put you at increased risk of developing the following conditions.

Osteopenia – where you have a very low bone-mineral density. If osteopenia is not treated, it can develop into osteoporosis. Osteoporosis – where your bones become thin and weak. If you have osteoporosis, your risk of getting fractures and broken bones is increased. Malnutrition – when the food you eat does not give you the nutrients essential for a healthy functioning body. If you are malnourished, wounds can take longer to heal and you may start to feel tired or depressed.

If you are concerned that dietary restrictions are putting you at risk of complications, you may find it helpful to consult a dietitian. They can advise you on your diet and whether you require food supplements.

Your GP should be able to refer you to an NHS dietitian free of charge. Alternatively, you can contact a private dietician. The British Dietetic Association has information on how to find a private dietitian.

Laryngeal (larynx) cancer
of cancer, cancer types in adults

Laryngeal cancer is a type of cancer that affects the larynx (voice box).

The larynx is part of the throat found at the entrance of the windpipe (trachea). It plays an important role in helping you breathe and speak.

The condition is more common in people over the age of 60. It’s about 4 times more common in men than women.

Symptoms

The main symptoms of laryngeal cancer include:

a change in your voice, such as sounding hoarse pain when swallowing or difficulty swallowing  a lump or swelling in your neck a long-lasting cough a persistent sore throat or earache in severe cases, difficulty breathing

Some people may also experience bad breath, breathlessness, a high-pitched wheezing noise when breathing, unexplained weight loss, or fatigue (extreme tiredness).

Causes

It’s not clear exactly what causes laryngeal cancer, but your risk of getting the condition is increased by:

smoking tobacco regularly drinking large amounts of alcohol having a family history of head and neck cancer having an unhealthy diet exposure to certain chemicals and substances, such as asbestos and coal dust

By adopting a healthy lifestyle, including avoiding alcohol and tobacco, you can significantly reduce your chances of developing laryngeal cancer.

Read more about the causes of laryngeal cancer and preventing laryngeal cancer.


Laryngeal cancer is caused by changes in the cells of the larynx, although it’s not clear exactly why this happens.

All cancers begin with a change in a cell’s DNA. DNA provides our cells with a basic set of instructions, such as when to grow and reproduce.

A change in DNA can alter the instructions that control cell growth, which means cells continue to grow instead of stopping when they should. This causes the cells to reproduce in an uncontrollable manner, producing a growth of tissue called a tumour.

It’s not known why the DNA inside the cells of the larynx is affected in cases of laryngeal cancer. But it appears that exposure to things that can damage the cells and tissue of the larynx increases the risk of cancer developing.

Diagnoses

If you have symptoms of laryngeal cancer, such as a hoarse voice and pain when swallowing, your GP will ask about your symptoms and recent medical history.

They may also examine the inside and outside of your throat for abnormalities, such as lumps and swellings.

If laryngeal cancer is suspected, you’ll probably be referred to the ear, nose and throat (ENT) department of your local hospital for further testing.

The National Institute for Health and Care Excellence (NICE) recommends that anyone aged 45 or over with persistent unexplained hoarseness or an unexplained lump in their neck should have an appointment with a specialist within 2 weeks.


If the results of the biopsy show you have cancer and there’s a risk it may have spread, you’ll probably be referred for further testing to assess how widespread the cancer is. The tests may include:

a computerised tomography (CT) scan – a series of X-rays are taken to build up a more detailed three-dimensional picture of your larynx and the surrounding tissue a magnetic resonance imaging (MRI) scan – a strong magnetic field and radio waves are used to produce a more detailed image of your larynx and the surrounding tissue a PET-CT scan – a CT scan is used to take pictures of the inside of your body after you’ve been injected with a mildly radioactive substance that helps to show cancerous areas more clearly an ultrasound scan – high-frequency sound waves are used to check for signs of cancer in the lymph nodes (glands found throughout the body) near the larynx

Treatments

You should speak to your GP if you have had any of the main symptoms for more than 3 weeks.

These symptoms are often caused by less serious conditions, such as laryngitis, but it’s a good idea to get them checked out.

If necessary, your GP can refer you to a hospital specialist for further tests to confirm or rule out cancer.

Read more about diagnosing laryngeal cancer.


The main treatments for laryngeal cancer are radiotherapy, surgery and chemotherapy.

Radiotherapy or surgery to remove the cancerous cells from the larynx can often cure laryngeal cancer if it’s diagnosed early.

If the cancer is advanced, a combination of surgery to remove part or all of the larynx, radiotherapy and chemotherapy can be used.

If you have surgery to remove your larynx, you’ll no longer be able to speak or breathe in the usual way. Instead, you will breathe through a permanent hole in your neck (stoma) and you will need additional treatment to help restore your voice.

This may include an implant in your throat, or an electrical device you hold against your throat to produce sound.

Read more about treating laryngeal cancer and recovering from laryngeal cancer surgery.


The treatment for laryngeal cancer largely depends on the size of the cancer. The main treatments are radiotherapy, surgery and chemotherapy.

Most hospitals use multidisciplinary teams (MDTs) of specialists that work together to decide the best way to proceed with your treatment.

Members of your MDT will probably include a surgeon, a clinical oncologist (a specialist in the non-surgical treatment of cancer), and a specialist cancer nurse who will be responsible for co-ordinating your care.

Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you’d like to ask your care team. For example, you may want to find out the advantages and disadvantages of particular treatments.


Your recommended treatment plan will depend on the stage of the cancer (see diagnosing laryngeal cancer for more information on staging).

If you have early-stage laryngeal cancer, it may be possible to remove the cancer using surgery (endoscopic resection) or radiotherapy alone. This may also be the case with slightly larger cancers, although a combination of surgery and radiotherapy is sometimes required.

In later-stage laryngeal cancer, more extensive surgery may be needed. Radiotherapy and chemotherapy will probably be used in combination. In some cases, the entire larynx may have to be removed.

A medication called cetuximab may be used in cases where chemotherapy is not suitable.

Preventions

It’s thought that most laryngeal cancers can be prevented by adopting a healthy lifestyle.

Avoiding tobacco products, cutting down on how much alcohol you drink and having a healthy diet are particularly important in reducing your chances of developing the condition.

Laryngitis
of ears nose and throat

Laryngitis is inflammation of the larynx (voice box). In most cases, it gets better without treatment in about a week.

Symptoms of laryngitis can begin suddenly and usually get worse over a period of two to three days. Common symptoms of laryngitis include:

hoarseness difficulty speaking sore throat mild fever irritating cough a constant need to clear your throat

The hoarse voice and speaking difficulties usually get worse each day you’re ill and may last for up to a week after the other symptoms have gone.

In a few cases, the larynx can swell and cause breathing difficulties. This isn’t common in adults but can occur in young children who have smaller, narrower windpipes.

Laryngitis is often linked to another illness, such as a cold, flu, throat infection (pharyngitis) or tonsillitis, so you might also have other symptoms such as:

a headache swollen glands runny nose pain when swallowing feeling tired and achy

Causes

In most cases, laryngitis is caused by either: 

a viral infection – such as a cold or flu, or  damage to your larynx – usually by straining your voice

In these cases, most of the symptoms usually pass within a week. This is known as acute laryngitis.

Laryngitis can occasionally have other causes, such as smoking, alcohol misuse or an allergic reaction, and the symptoms can last much longer. This is known as chronic laryngitis.

Read more about the causes of laryngitis


Laryngitis occurs when the larynx (voice box) becomes irritated and swollen. It’s usually caused by an infection or damage to the larynx.


As well as infection and damage to the larynx, laryngitis can also be caused by:

smoking and alcohol misuse, which can dry out and irritate your larynx gastro-oesophageal reflux disease (GORD) – when stomach acid leaks out of your stomach and up into your throat, where it can irritate your larynx allergic reactions to substances such as dust, fumes, chemicals and toxins

These causes are most often associated with long-term (chronic) laryngitis.


In some cases, it’s possible to treat the underlying cause of laryngitis. For example:

bacterial infections (but not viral infections) can be treated with antibiotics if smoking or alcohol misuse is causing laryngitis, stopping smoking or cutting down how much you drink can help gastro-oesophageal reflux disease (GORD) can be treated with medication to reduce the amount of acid your stomach produces – see treating GORD for more information if an allergy is causing laryngitis, you may be able to avoid the substance you’re allergic to or take antihistamines to control your body’s response to the substance – see treating allergies for more information if straining your voice is causing laryngitis, you may benefit from vocal therapy (see below)

Vocal therapy is a type of speech and language therapy that involves studying how you use your voice and how this may contribute to your symptoms. You may be given information and advice about any changes you can make or voice exercises you can do to prevent further damage to your larynx.

Diagnoses

Laryngitis often gets better without treatment, so you don’t usually need to see your GP unless you have particularly severe or long-lasting symptoms.

If you see your GP with laryngitis, they’ll discuss with you what could be causing the condition, including:

overusing your voice smoking misusing alcohol allergies

Your GP may refer you for blood tests and take a throat swab using a small cotton bud on a plastic shaft. This is to check for a possible viral, bacterial or fungal infection.

They may also examine your larynx using a mirror to look for redness or swelling.

Treatments

As laryngitis often gets better quickly without treatment, you normally only need to see your GP if the symptoms are particularly severe or they last longer than two weeks.

You should seek immediate medical help if you or your child experience breathing difficulties.

If you see your GP, they’ll discuss the possible causes with you and may refer you for tests or to a specialist in hospital.

Read more about diagnosing laryngitis


Most cases of laryngitis get better without treatment within a week. To help your vocal cords heal, it’s important not to smoke, to avoid smoky environments, drink plenty of fluids (particularly water) and try to rest your voice as much as possible.

In some cases, it may be possible to treat the underlying cause of laryngitis. For example, if the symptoms are caused by an allergic reaction, you may be able avoid the substance you’re allergic to, or take medication to help control your body’s response to the substance.

Read more about treating laryngitis


In most cases, laryngitis gets better within a week without treatment. See your GP if your symptoms are severe or haven’t improved after two weeks.


You may be able to help your recovery by:

not smoking and avoiding smoky, dry or dusty environments drinking plenty of fluids to avoid dehydration – particularly water (avoid alcohol and caffeinated drinks), even though swallowing may be painful taking painkillers, such as paracetamol or ibuprofen – which may ease any associated pain, headaches and fever (children under the age of 16 shouldn’t take aspirin) gargling with a mouthwash of warm, salty water or an over-the-counter solution, or sucking lozenges – this may help to soothe a sore throat using menthol inhalation and air humidifiers – which may soothe your airways and help keep them clear avoiding speaking when possible and only speaking softly when you need to – but don’t whisper because this can put more strain on your larynx


In some cases, it’s possible to treat the underlying cause of laryngitis. For example:

bacterial infections (but not viral infections) can be treated with antibiotics if smoking or alcohol misuse is causing laryngitis, stopping smoking or cutting down how much you drink can help gastro-oesophageal reflux disease (GORD) can be treated with medication to reduce the amount of acid your stomach produces – see treating GORD for more information if an allergy is causing laryngitis, you may be able to avoid the substance you’re allergic to or take antihistamines to control your body’s response to the substance – see treating allergies for more information if straining your voice is causing laryngitis, you may benefit from vocal therapy (see below)

Vocal therapy is a type of speech and language therapy that involves studying how you use your voice and how this may contribute to your symptoms. You may be given information and advice about any changes you can make or voice exercises you can do to prevent further damage to your larynx.

Preventions

As laryngitis is often caused by a common viral infection, such as a cold or flu, it’s not always possible to prevent it.

However, you can reduce your risk of developing the condition by:

making sure you have the annual flu vaccine (if recommended by your GP) practising good personal hygiene  – such as washing your hands before and after eating and after using the toilet avoiding close contact with people who have respiratory infections, such as a cold or flu – particularly if you’re prone to laryngitis avoiding irritants, such as smoke or dust – particularly if you have a cold or other respiratory tract infection not smoking not drinking more than the recommended limits of alcohol consumption not regularly clearing your throat – as this can irritate the larynx (try swallowing instead) raising your head with pillows when you’re sleeping – to protect your larynx from any acid reflux from your stomach during sleep not shouting or singing loudly or for long periods of time – it’s important for people who regularly use their voice excessively to receive proper training so they don’t damage their larynx

Leg cramps
of muscle bone and joints, conditions

Cramps usually occur in the calf muscles, although they can affect any part of your leg. This includes your feet and thighs. Cramps can last from a few seconds up to 10 minutes. Thigh muscle cramps tend to last the longest.

During a cramping episode, the affected muscles will become tight and painful and the feet and toes will be stiff.

After the cramping has passed, you may have pain and tenderness in your leg for several hours.

Cramps often happen during the night when you’re sleeping.


During a cramping episode, the affected muscles will become tight and painful and the feet and toes will be stiff.

After the cramping has passed, you may have pain and tenderness in your leg for several hours.

Cramps often happen during the night when you’re sleeping.

Symptoms

A leg cramp is an episode of sudden pain in the muscles of the leg. It’s caused by an involuntary contracting (shortening) of the leg muscle.

Cramps usually occur in the calf muscles, although they can affect any part of your leg. This includes your feet and thighs. Cramps can last from a few seconds up to 10 minutes. Thigh muscle cramps tend to last the longest.

During a cramping episode, the affected muscles will become tight and painful and the feet and toes will be stiff.

After the cramping has passed, you may have pain and tenderness in your leg for several hours.

Cramps often happen during the night when you’re sleeping.

Causes

The cause of leg cramps is sometimes unknown (idiopathic). In other cases, there may be an underlying condition or identifiable cause (secondary leg cramps).

Idiopathic leg cramps

Idiopathic leg cramps may be caused by:

abnormal nerve activity during sleep excessive strain placed on leg muscles, for example during exercise a sudden restriction in the blood supply to the affected muscles

Also, tendons naturally shorten over time as a person gets older. This may explain why older people are particularly affected by leg cramps. Tendons are tough bands of tissue that connect muscles to bone. If your tendons become too short, they may cause the muscles connected to them to cramp.

Secondary leg cramps

Secondary leg cramps are caused by an underlying condition or another identifiable cause like:

pregnancy – the extra weight of pregnancy can place strain on the leg muscles, making them more vulnerable to cramping exercise – leg cramps are often experienced when resting after exercise neurological conditions – for example, motor neurone disease or peripheral neuropathy liver disease – if your liver stops working properly, toxins will build up in your blood, which can make your muscles spasm infection – some types of bacterial infection, like tetanus, can cause muscle cramps and spasm toxins – in some people, high levels of toxic (poisonous) substances in the blood, like lead or mercury, can cause leg cramps dehydration – in some people, low levels of water in the body can lead to a drop in your salt levels, which can trigger muscle cramps

Treatments

Leg cramps might be a sign of a more serious health condition.

Speak to your GP urgently if: leg cramps last longer than 10 minutes and don’t get better when you start to move leg cramps develop after you’ve come into contact with a substance like mercury, lead or dirt that gets in a cut If your GP is closed, phone 111.

Speak to your GP if: your leg cramps are affecting your quality of life you’re having frequent leg cramps your leg cramps are interfering with your sleep you also have numbness or swelling in your legs your leg muscles are shrinking or becoming weaker

Your GP will ask about your symptoms and examine your legs and feet. They may also ask if you have other symptoms, like numbness or swelling. This may be a sign that you have secondary leg cramps caused by an underlying condition.

In this case, you may need further tests, like blood tests and urine tests, to rule out other conditions.


Medication is usually only needed in persistent cases where cramping does not respond to exercise.

If you have secondary leg cramps, treating the underlying cause may help relieve your symptoms.

Leg cramps that occur during pregnancy should pass after the baby is born.

Treating cramps that occur as a result of serious liver disease can be more difficult. Your treatment plan may include using medications like muscle relaxants.

Medication

Certain medications have been known to cause leg cramps in a small number of people. If you develop leg cramps after starting a new medication, speak to your pharmacist.

Never stop taking a prescribed medication unless your GP or healthcare professional advises you to do so.

Preventions

If you often get leg cramps, regularly stretching the muscles in your lower legs may help prevent the cramps or reduce their frequency.

You might find it useful to stretch your calves before you go to bed each night.

If you lie on your back, make sure that your toes point upwards. Placing a pillow on its side at the end of your bed, with the soles of your feet propped up against it may help keep your feet in the right position.

If you lie on your front, hang your feet over the end of the bed. This will keep your feet in a relaxed position. It’ll help stop the muscles in your calves from contracting and tensing.

Keep your sheets and blankets loose.

Lichen planus
of skin hair and nails

Lichen planus is a non-infectious, itchy rash that can affect many areas of the body.

Affected areas can include the:

arms, legs and trunk  mouth (oral lichen planus) nails and scalp vulva, vagina and penis

The exact cause of lichen planus is unknown. However, the condition isn’t infectious and doesn’t usually run in families. It can’t be passed on to other people, including sexual partners.

A GP can usually diagnose lichen planus by examining the rash and asking about your symptoms. Oral lichen planus is often diagnosed by a dentist during routine dental check-ups.

Lichen planus is an itchy rash that can occur anywhere on the body.Source: https://dermnetnz.org/

Who’s affected by lichen planus

Lichen planus is thought to affect 1-2% of the worldwide population. It’s more common in adults over the age of 40.

Lichen planus of the skin affects men and women equally. However, oral lichen planus is more common in women. The mouth is affected in around 50% of all cases of lichen planus (oral lichen planus).

Symptoms

The symptoms of lichen planus vary, depending on which area of the body is affected.

Areas of the body most commonly affected by the condition include the:

skin mouth penis vulva (external female sex organs) and vagina

Lichen planus causes symptoms like itchy skin and red, slightly raised, bumps.Source: https://dermnetnz.org/

Causes

The cause of lichen planus is unknown.

It’s thought to be related to the immune system, or an abnormal response of the immune system to certain medicines.

Lichen planus isn’t infectious, doesn’t usually run in families and can’t be passed on to others.

Diagnoses

Lichen planus is often diagnosed by a GP or dentist examining the affected area.

Treatments

There’s no single treatment that can cure lichen planus completely. However, treatments are available to help manage the symptoms and make living with it easier. For example, steroid creams or ointments are often used to help relieve the itch and control the rash.

Most cases of lichen planus of the skin clear up on their own within 6 to 9 months. The rash rarely lasts longer than 18 months. However, oral lichen planus and lichen planus that affects the genital area may be more persistent.

Read more about how lichen planus is treated.


There’s no cure for lichen planus, so treatments aim to ease the symptoms and clear the rash. Mild lichen planus doesn’t require treatment.


If corticosteroids are not effective in treating your symptoms, you may be prescribed a medication that suppresses your immune system to try to limit the autoimmune reaction that’s thought to cause lichen planus.

These types of treatments are known as immunomodulating agents. Depending on which area of your body is affected by lichen planus, treatments that may be recommended for you can include: treatments such as tacrolimus 

topical immunomodulating agents (used to treat lichen planus of the skin) – treatments such as tacrolimus ointment and pimecrolimus cream are rubbed directly onto the skin immunomodulating agents (used to treat lichen planus of the mouth) – these are usually available in the form of tablets or capsules, and can be used to treat severe cases of oral lichen planus

These treatments can cause a number of different side effects, which your specialist can discuss with you.

You’ll also need to have regular blood tests while taking immunomodulating agents, particularly in the early stages of treatment.

Complications

Complications of lichen planus may include discoloured skin and, in some cases, erosive lichen planus may develop into certain types of cancer.

Liver cancer
of cancer, cancer types in adults

Primary liver cancer is an uncommon but serious type of cancer that begins in the liver.

This is a separate condition from secondary liver cancer, which occurs when cancer that first develops in another part of the body spreads to the liver.

The rest of this article refers to primary liver cancer only. The Macmillan Cancer Support website has more information about secondary liver cancer.

Symptoms

Symptoms of liver cancer are often vague and don’t appear until the cancer is at an advanced stage. They can include:

unexplained weight loss loss of appetite feeling very full after eating, even if the meal was small feeling sick and vomiting pain or swelling in your abdomen (tummy) jaundice (yellowing of your skin and the whites of your eyes) itchy skin feeling very tired and weak

Speak to your GP if you notice any of these symptoms. Although they are more likely to be the result of a more common condition, such as an infection, it’s best to have them checked.

You should also contact your GP if you have previously been diagnosed with a condition known to affect the liver, such as cirrhosis or a hepatitis C infection, and your health suddenly deteriorates.

Causes

The exact cause of liver cancer is unknown, but most cases are associated with damage and scarring of the liver known as cirrhosis.

Cirrhosis can have a number of different causes, including drinking excessive amounts of alcohol over many years and having a long-term hepatitis B or hepatitis C viral infection.

It is also believed obesity and an unhealthy diet can increase the risk of liver cancer because this can lead to non-alcoholic fatty liver disease.

By avoiding or cutting down on alcohol, eating healthily and exercising regularly, and taking steps to reduce your risk of becoming infected with hepatitis B and C, you may be able to significantly reduce your chances of developing liver cancer.

Read more about the causes of liver cancer.


The exact cause of liver cancer is unknown, but many cases are linked to a problem with the liver called cirrhosis. This is where the tissue of the liver has become scarred and cannot perform many of its usual functions.

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably, producing a lump of tissue known as a tumour.

In cases of liver cancer, it is uncertain why and how the cells of the liver are affected, but it appears that cirrhosis can increase a person’s chances of developing the condition.

However, most cases of cirrhosis do not lead to liver cancer, and people without cirrhosis can also develop liver cancer.


Heavy and harmful drinking

The liver is a tough and resilient organ. It can endure a high level of damage that would destroy other organs and is capable of regenerating itself. But despite the liver’s resilience, excessive alcohol intake over many years can damage it.

Every time you drink alcohol, your liver filters out the poisonous alcohol from your blood and some of the liver cells die. The liver can regenerate new cells, but if you drink heavily for many years, your liver will lose the ability to do this and it can become damaged and scarred over time.

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease occurs when small deposits of fat build up inside the tissue of the liver. It’s a common condition and causes no noticeable symptoms in most people.

However, in some people, high levels of fat can make the liver inflamed. Over time, the inflammation can scar the liver.

The exact cause of non-alcoholic fatty liver disease is unclear, but it is associated with obesity and type 2 diabetes.

Hepatitis C

A long-term infection of hepatitis C can cause inflammation and scarring of the liver. 

Hepatitis C is spread by blood contact. The most common ways this happens worldwide include poor medical practice with the use of contaminated needles, or injected drug use, where any item of injecting equipment (not just needles) is shared.

If you smoke or regularly drink alcohol and have hepatitis C, your risk of developing liver cancer further increases.

Early treatment of long-term hepatitis C with antiviral medication can prevent the liver from becoming scarred.


Hepatitis B

Hepatitis B is a virus that can be spread through contaminated blood and other types of bodily fluids, such as saliva, semen and vaginal fluids.

Like hepatitis C, hepatitis B is spread through blood contact. It is most commonly spread from mother to child at birth or from child to child in early life (usually in areas outside the UK where the infection is very common), and very rarely sexually or through injecting drugs.

It affects about 1 in every 200 people in the UK. Most of those infected were born in parts of the world where the hepatitis B virus is very common.

As with hepatitis C, hepatitis B can also cause inflammation and scarring of the liver over time.

If you smoke or drink and have hepatitis B, your risk of developing liver cancer further increases.

Early treatment of long-term hepatitis B with antiviral medication is not always needed, but can substantially reduce the risk of the liver becoming scarred.

Haemochromatosis

Haemochromatosis is a genetic condition where the body stores too much iron from food.

The excess levels of iron have a poisonous effect on the liver and cause scarring over time, although treatment can reduce the risk of the condition leading to liver cancer.

Primary biliary cirrhosis

Primary biliary cirrhosis is a rare and poorly understood liver condition.

One of the main functions of the liver is to create a fluid called bile, used by the body to help break down fat. The bile is transported to the digestive system via a series of tubes called bile ducts.

For reasons that are unclear, in cases of primary biliary cirrhosis, the bile ducts gradually become damaged. This eventually leads to a build-up of bile inside the liver, which damages the liver and causes cirrhosis.

Diagnoses

Liver cancer is usually diagnosed after a consultation with a GP and a referral to a hospital specialist for further tests, such as scans of your liver.

However, regular check-ups for liver cancer (known as surveillance) are often recommended for people known to have a high risk of developing the condition, such as those with cirrhosis.

Having regular check-ups helps ensure the condition is diagnosed early. The earlier liver cancer is diagnosed, the more effective treatment is likely to be.

Read more about diagnosing liver cancer.


For many people, the first stage of diagnosing liver cancer is a consultation with a GP, although people at risk are usually tested regularly for the condition.

If you visit your GP, they will ask about your symptoms, when they started, and when they are noticeable. They will also examine you.

If they feel you need further tests, they will refer you to a hospital specialist. 


The tests above can also be used to look for liver cancer in people who are not being routinely screened.

If these initial tests suggest there is a chance you could have liver cancer, one or multiple tests will usually be recommended to confirm the diagnosis.

The further tests include:

computerised tomography (CT) scans – a series of X-rays of your liver are taken to give a more detailed three-dimensional image magnetic resonance imaging (MRI) scans – uses a strong magnetic field and radio waves to build up a picture of the inside of your liver biopsy – a needle is inserted into your abdomen (tummy) to remove a small sample of liver tissue, which is then tested in a laboratory for cancerous cells laparoscopy – a small incision is made in your abdomen under general anaesthetic (where you are asleep) and a flexible camera called an endoscope is used to examine your liver

After these tests have been carried out, it will usually be possible to confirm a diagnosis of liver cancer and determine the condition’s stage.

Treatments

Treatment for liver cancer depends on the stage the condition is at. If diagnosed early, it may be possible to remove the cancer completely.

Treatment options in the early stages of liver cancer include:

surgical resection – surgery to remove a section of liver liver transplant – where the liver is replaced with a donor’s liver microwave or radiofrequency ablation – where microwaves or radio waves are used to destroy the cancerous cells

However, only a small proportion of liver cancers are diagnosed at a stage where these treatments are suitable. Most people are diagnosed when the cancer has spread too far to be removed or completely destroyed.

In these cases, treatments such as chemotherapy will be used to slow down the spread of the cancer and relieve symptoms such as pain and discomfort.

Read more about treating liver cancer.


The treatment for liver cancer depends on the stage of the condition. Treatment can include surgery and medication.


Most hospitals use multidisciplinary teams (MDTs) to treat liver cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment.

Deciding which treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.


Your recommended treatment plan will depend on the stage your liver cancer is at.

If your cancer is at stage A when diagnosed, a complete cure may be possible. The 3 main ways this can be achieved are:

removing the affected section of liver – known as a resection having a liver transplant – an operation to remove the liver and replace it with a healthy one using heat to kill cancerous cells – known as microwave or radiofrequency ablation (RFA)

If your cancer is at stage B or C, a cure is not usually possible. However, chemotherapy can slow the progression of the cancer, relieve symptoms, and prolong life for months or, in some cases, years. There is also a medication called sorafenib that can help prolong life.

If your cancer is at stage D when diagnosed, it is usually too late to slow down the spread of the cancer. Instead, treatment focuses on relieving any symptoms of pain and discomfort you may have.