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How to Palpate the Kidneys, Ureters, and Bladder For Osteopathic Professionals

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In this article, I share a method of isolating the kidneys, ureters, and bladders for osteopathic professionals to evaluate and release them. This can be useful in cases of low back pain, pelvic issues, issues specific to these organs, and more. The final decision on whether applying treatment to these areas must be made by the professional. I recommend proceeding with nothing but the upmost respect for these organs and any other organs that are in the vicinity.

Evaluation

I always like to have something to check before and after practicing any technique that is beyond the direct structure being treated. The reason for this is that it teaches me the effects the  structure I’m treating is having on the whole organism. It helps me to learn and get insights on how different parts of the body are related.

  • Kidneys:

A good place to check for kidney issues is the thoracolumbar junction and lumbar region. The kidneys are retroperitoneal organs that sit on top of the psoas major muscle. The side with the most pronounced tissue texture changes will also have the biggest tissue texture changes with associated kidney if the kidney is involved in that back pain. I like to assess by motion testing and gliding my fingers back and forth perpendicular to muscle fibers to elicit a pain reflex and gain a deeper sense for the tissue texture changes. Sensory innervation also shows up at T10-11 and that can also be a great place to evaluate.

  • Ureters: 

Apart from evaluating the ureters themselves along their path and the area around them, I don’t have a more specific method of other places to look. I have observed in people with kidney stones that as the stone moves down along the ureter, the tissue texture changes along the spine, including marked heat, also moves down the spine. However, I would not recommend treating the ureters directly during an active kidney stone.

  • Bladder:

A good place to evaluate the effect the bladder is having on the pelvis is at the pubic bones. Intraosseous strains at the pubic bones may be a result of a somatic dysfunction in the bladder. Making sure the patient has an empty bladder, I recommend checking the suprapubic region for tension. This can be done by palpating and moving your fingers back and forth over the region feeling for areas of increased tissue texture changes. Often one side will feel more restricted than the other. You may also then palpate the pubic bones by getting a hold of them and motion testing them. The bones may feel too dense with restricted motion. You may find that the side with the greater bladder dysfunction will also correspond to greater pubic bone dysfunction.

Palpation

To isolate the kidneys, we’re going to place a flat, relaxed hand on the abdomen where the kidney should lie on the side you want to isolate. The kidneys lie under the rib cage following the path of the psoas major muscle. The right kidney will be lower than the left due to the liver. The other flat, relaxed hand will be placed in the suprapubic region over where the bladder lies. The ureters come off the medial aspect of the kidneys so be sure to have a part of your hand covering that region.

Once your hands are in place, move your hand side to side gently to “wiggle” the kidney and ureter side to side. The hand that is over the bladder is feeling for motion where the ureter inserts into it. To be certain you are on the kidney, you can move your hand off of the kidney and ureter and move it side to side as well. There should be no motion palpated over the bladder where the ureter inserts.

Another way of checking to see if indeed you are palpating the kidney keep your hand over what you feel is the kidney. Then ask the patient to imagine that they are urinating. As soon as they do that, the kidney will reflexively contract. No other organ should contract in the region. So if you feel a contraction, that can give you more confirmation that you are on the kidney. Then you can move on and isolate the other kidney and ureter where it inserts into the bladder being mindful of any tensions and other tissue texture changes that may take place there.

By doing this exercise, you’re also palpating into the bladder. Once you have felt it and isolated it where the ureters insert into it, then you can start to assess it for dysfunction. Using a pincher grasp, it is possible to move the bladder in different directions to assess for dysfunction. It can also be helpful to place your other free hand over the pubic bones to asses how they change as you are evaluating the bladder.

I hope you have found this exercise helpful. Please feel free to comment on how they have worked for you. Sign up below on the “Osteopathic Professionals” section to get future updates like this.

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Daniel Lopez, D.O.

Author Daniel Lopez, D.O.

Daniel Lopez, D.O. grew up with a lot of pain trying many things that did not help. Realizing that if he could not help himself, he would be unable to help others effectively, he dedicated himself to finding real answers. Since that time, Dr. Lopez has found a unique but powerful style where he has patients from around the country and the world that travel to see him for headaches, TMJ issues, eye issues, neck pain, back pain, and more. Daniel Lopez, D.O. is an osteopathic physician with Osteopathic Integrative Medicine. Prior to that he had a private practice in NYC for 6 years. He is the author of the Amazon best seller "Unwinding the Body and Decoding the Messages of Pain: An In-Depth Look into the World of Osteopathic Physicians and How They 'Magically' Use Their Hands for Healing." He lives in Aurora, CO with his wife and daughters.

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