Nutcracker Syndrome

The nutcracker syndrome is a venous compression of the left renal vein, which is usually accompanied by pain symptoms and blood or protein in the urine. Treatment often takes the form of a stent procedure. The prognosis is excellent.

Nutcracker Syndrome

What is Nutcracker Syndrome?

The venous compression group of diseases includes various diseases that are symptomatically related to compressed veins. One such condition is Nutcracker Syndrome. The nutcracker phenomenon is the most common vascular compression of all. The exact prevalence of the symptom complex is not known. See aviationopedia for Hypersalivation Explanations.

All symptoms of the syndrome are due to a blockage in the left renal vein. In most cases, the vein gets stuck between the abdominal aorta and the superior mesenteric artery. As a result, the pressure gradient between the inferior vena cava and the LRV increases to about three times the normal value. The thin venous septa rupture and hematuria occurs.

Three different types of the syndrome are distinguished: in addition to an anterior phenomenon, medicine knows a posterior and a combined nutcracker phenomenon. Most of the cases described so far have occurred in the Far East. The disease often manifests itself between the third and fourth decades of life. Females are more commonly affected by the syndrome than males.


The nutcracker syndrome is favored by the human anatomy and thus goes back to a general disposition of the human race. Genetic dispositions or familial accumulations do not seem to exist. From an anatomical point of view, a jamming of the left renal vein between the abdominal aorta and the superior mesenteric artery is a risk for everyone.

Science assumes that this risk is due to human evolution. For example, walking upright in humans has produced a lordosis, or characteristic curvature, of the lumbar spine. This curvature is now accepted as the actual cause of nutcracker syndrome. The disease does not appear to be related to size or related parameters. In most cases, patients are asthenic and of normal build, of average height.

Symptoms, Ailments & Signs

The nutcracker syndrome usually manifests itself in urological or gynecological symptoms. Left-sided lumbar pain is a possible urological symptom. Macroscopically or microscopically created hematuria or proteinuria can also develop on the left side. Varicoceles or varicose veins often form in the lower extremities.

The gynecological manifestations of the syndrome are associated with the concept of pelvic congestion syndrome. They may manifest as abdominal pain, dysmenorrhea, aversion to coitus, dysuria, or varicose veins in the pelvis, vulva, or thighs. Emotional disorders are also conceivable.

In addition to abdominal pain, left-sided flank pain and left-convex lordosis in the lumbar region, women with nutcracker syndrome can experience left-sided ovarian pain, severe pain and pain during sexual intercourse.

Both women and men with the syndrome also often complain of severe back pain, headaches or pain in the genital area. Hemorrhoids can also be an accompanying symptom of the phenomenon, as they are characterized by an increase in blood flow. Sperm production may be reduced in men.

Diagnosis & course of disease

The diagnosis of the nutcracker syndrome can be clearly made by functional color Doppler sonography. Other diagnostic tools can be computed tomography or magnetic resonance imaging. A suspected diagnosis is often confirmed by imaging the renal vein with a contrast agent, which is also known as phlebography.

A pressure measurement in the renal vein or the inferior vena cava can also show diagnostic qualities. The prognosis for people with nutcracker syndrome is relatively good. Numerous therapeutic steps are available to relieve symptoms. Patients in the growth phase are often only observed and not treated.

Your physical development can favor a spontaneous remission of all symptoms. Overall, the prognosis for all patients is excellent. Those affected with pronounced symptoms such as severe pain or severe hematuria are dependent on active surgical intervention, with the prognostic predictions after the intervention being excellent.


In most cases, the symptoms and compilations of Nutcracker Syndrome can be avoided and limited relatively well. The course of the disease is always positive. Those affected suffer from severe pain due to nutcracker syndrome. Bloody urine can also occur.

Pain in the stomach or abdomen can also lead to a significantly reduced quality of life due to the nutcracker syndrome. Severe abdominal pain and flank pain also occur, which can lead to a reluctance to have sex. This pain often spreads to the head or back and can lead to irritability in the affected person.

The refusal of sexual intercourse can, among other things, also lead to disturbances in a relationship. As a rule, an operation is carried out in the case of nutcracker syndrome, which is intended to alleviate the symptoms. The installation of a stent can also reduce the symptoms. Usually there are no complications. However, in most cases, the patient’s resilience is reduced as a result of the procedure.

When should you go to the doctor?

The nutcracker syndrome does not always cause symptoms and therefore does not necessarily have to be treated. Medical advice is required when the typical symptoms occur. Anyone who notices blood in the urine, pain in the flanks or testicles and impaired sperm formation should definitely consult a doctor. Pain in the pelvis or in the area of ​​the ovaries also requires a medical evaluation. The doctor will physically examine the patient and then make a diagnosis. If the diagnosis is made early, complications such as functional disorders of the testicles and ovaries can usually be avoided.

People who already suffer from nerve disorders should speak to their doctor immediately if they experience the above symptoms. People with arterial problems or malformations in the genital area also belong to the risk groups and should always see a doctor with the symptoms mentioned. This is particularly necessary if the symptoms become more severe or cannot be relieved by stretching exercises and bed rest. Then a doctor must determine the cause and initiate therapy. In addition to the family doctor, the urologist or gynecologist and a neurologist are the right places to go. In addition, physiotherapists should be involved in the treatment.

Treatment & Therapy

Therapy of nutcracker syndrome is not indicated in all cases. As with people going through puberty, monitoring for symptoms is more appropriate in patients with only mild symptoms and minimal hematuria. Even in the case of painless and intermittent hematuria with a normal blood count, monitoring of therapy is preferable for the time being. In all other cases, vascular transpositions are indicated.

In the past, kidney autotransplantations were often considered as treatment measures. These are open surgical procedures that show good results. However, since these interventions are associated with significant morbidity, they are now rarely used. Nowadays, nutcracker syndrome is more likely to be treated with extravascular stents. In this procedure, a transplant, which usually consists of PTFE, is placed around the left renal vein from the opening into the inferior vena cava to the opening into the left gonadal adrenal vein.

The stents can be placed openly or as part of a laparoscopic procedure. An intravascular and self-expanding stent made of metal is the most common choice. This stent migrates to the area of ​​the left renal vein under local anesthesia and under the guidance of a digital subtraction angiography. The medial end of the stent is placed in the inferior vena cava.

Outlook & Forecast

Nutcracker syndrome has a favorable prognosis. The course of the disease is mostly described as positive in the literature. As soon as pain, circulatory disorders or restricted mobility occur, cooperation with a doctor should be sought. This ensures a quick diagnosis and leads to the initiation of necessary medical interventions. Within a short time, there is a significant reduction in symptoms. Recovery is achieved after the wound has healed in almost all of those affected.

If no medical help is sought, an increase in complaints and health irregularities can be expected. The same applies if an improvement in the overall situation is to be achieved through naturopathic treatments or other alternative healing methods. The possibilities of these therapeutic approaches are not sufficient to achieve a cure for this syndrome. Rather, complications are to be expected and coping with everyday life is becoming increasingly difficult.

For some patients, the installation of a stent is recommended for long-term freedom from symptoms. This should prevent a recurrence of the disease and guarantee lifelong stable vascular activity. Nevertheless, it is advisable to have check-ups carried out at regular intervals so that possible complications or changes in the organism can be reacted to immediately. Especially after falls or accidents, the clarification of the functional activity is recommended.


Promising preventive measures for nutcracker syndrome do not exist, since the symptom complex is favored by the natural curvature of the lumbar spine. However, targeted exercises to reduce lordosis may reduce the risk of the syndrome.


In most cases, the person affected with nutcracker syndrome has no special measures or options for aftercare, although these are not always necessary. If the treatment is correct and, above all, timely, there will be no further complications or further complaints. Therefore, ideally, the person affected should consult a doctor at the first signs and symptoms of the disease in order to prevent further deterioration of the symptoms.

Self-healing is usually not possible with nutcracker syndrome. After the procedure, which can completely alleviate the symptoms of nutcracker syndrome, the person concerned should have regular check-ups by a urologist. This allows the condition of the kidneys to be continuously monitored in order to identify further problems at an early stage. In some cases, physical therapy is also necessary.

The person concerned can carry out many therapy exercises at home in order to speed up the treatment. Further aftercare measures are usually no longer necessary. The nutcracker syndrome does not reduce the life expectancy of those affected. However, the sooner a doctor is consulted for this disease, the better the further course of the disease.

You can do that yourself

The Nutcracker Syndrome is a nervous disorder that can be treated well nowadays. Medical treatment can be supported primarily by moderate movement and special stretching exercises. The doctor will describe appropriate stretching and stretching exercises, which on the one hand alleviate any nerve problems and on the other hand prevent a nerve from being pinched again.

In addition, patients should determine the cause of Nutcracker Syndrome. There are many different triggers that can vary greatly. It is therefore advisable to keep a complaints diary and to note any possible causes in it. This is particularly recommended shortly after the therapy, since a connection between the syndrome and possible triggers can usually still be established here. Drug treatment can be supplemented with natural painkillers. Teas, ointments and lotions that can be applied externally to the affected area have proven effective.

If an unhealthy lifestyle is the cause of Nutcracker Syndrome, a nutritionist needs to be consulted. The expert can name further treatment measures and thus help to ensure that the painful nerve ailment does not occur again. The patient should also go to regular medical check-ups to reduce the risk of complications.