What is Bladder Trauma?

Male Urinary Tract
Male urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

Female Urinary Tract
Female urinary tract
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

The bladder isnt injured often. The bones in the pelvis protect it from most outside forces. But the bladder can be injured by blows or piercing objects. Most often these are related to pelvic fracture. Timely evaluation and proper management are critical for the best outcomes.

What Happens under Normal Conditions?

The bladder is a balloon-shaped organ that stores urine. Its held in place by pelvic muscles in the lower part of your belly. When it isnt full, the bladder is relaxed. Muscles in the bladder wall allow it to expand as it fills with urine. Nerve signals in your brain let you know that your bladder is getting full. Then you feel the need to go to the bathroom. The brain tells the bladder muscles to squeeze (or "contract"). This forces the urine out of your body through your urethra.



What are Symptoms of Bladder Trauma?

The two basic types of damage to the bladder by trauma are bruises and tears.

Blunt injury (a bruise) is damage caused by blows to the bladder. Penetrating injury (a tear) is damage caused by something piercing through the bladder.

Almost everyone who has a blunt injury to the bladder will see blood in the urine. Those with penetrating injury may not actually see bleeding. There may be pain below the belly button, but many times the pain from other injuries makes the bladder pain hard to notice. If there’s a large hole in the bladder and all of the urine leaks into the abdomen, it’s impossible to pass urine. In women, if the injury is severe enough, the vagina may be torn open as well as the bladder. If this happens, urine may leak from the bladder through the vagina. Blood may also come out of the vagina in this case.

Other symptoms may include:

  • Hard to start urinating
  • Weak urine stream
  • Painful urination
  • Fever
  • Severe back pain


What Can Cause Bladder Trauma?

When the bladder is empty, the bones of the pelvis protect it from blows to the lower abdomen. As it fills, though, the top of the bladder rises into the abdomen where it’s less protected. In children, the pelvic bones aren’t fully developed, so it’s more easily injured than adults. If the pelvis is hit with a force great enough to break the pelvic bones, the bladder may be injured even if it’s empty.

The most common ways the bladder is injured are:

  • Car crashes
  • Falls from high places
  • Heavy object falling on the lower abdomen

You can prevent bladder trauma from a car crash by wearing a seat belt properly. The seat belt should be worn as a lap belt, and not across the belly. During a car crash, passengers with a full bladder wearing a seat belt around the belly may have the force of the crash focus on the full bladder.

The bladder can also be hurt by being pierced from the outside ("penetrating trauma"). Some causes of penetrating trauma are:

  • Bullets
  • Knives
  • Shrapnel
  • IEDs (improvised explosive devices)


How is Bladder Trauma Diagnosed?

A health care provider diagnoses bladder injury by placing a tube ("catheter") into the bladder and taking a series of X-rays. X-rays of the urethra may be taken before the catheter is put in, to see if it is damaged. Before the X-rays are taken, the bladder is filled with a liquid that will make it visible on the X-rays.



How is Bladder Trauma Treated?

The treatment for bladder trauma depends on the type of damage.

Blunt injury is damage caused by blows to the bladder. This bruises the bladder.

Penetrating injury is damage caused by something piercing through the bladder. This tears the bladder.

Contusion

Most of the time, the bladder wall doesn’t tear and is only bruised. The only sign will be bloody urine. Your health care provider may just leave a wide catheter in the bladder so clots can pass. Once the urine becomes clear, the catheter will be taken out if there aren’t any other reasons to leave it in.

Intraperitoneal Rupture

If the tear is on the top of the bladder, the hole will usually open to the part of the abdomen that holds the liver, spleen, and bowel. Urine leaking into the abdomen is a serious problem. This tear can be sewn closed with surgery. A catheter is left in the bladder for up to 2 weeks after surgery to allow the bladder to rest. The tube will either come out through the urethra or out through the skin below the belly button.

Extraperitoneal Rupture

If the tear is at the bottom or side of the bladder, the urine will leak into the tissues around the bladder instead of the abdominal cavity. Complex injuries of this type should be repaired with surgery. But often it can be treated by simply placing a wide catheter into the bladder to keep it empty. The urine and blood drain into a collection bag. It usually takes at least 10 days for the bladder to heal. The catheter is left in the bladder until an X-ray shows that the leak has sealed. If the catheter doesn’t drain properly, surgery is needed.

Penetrating Injuries

Injury to the bladder from a bullet or other penetrating object is usually fixed with surgery. Most of the time, other organs in the area will be injured and need repair as well. After surgery, a catheter is left in the bladder to drain the urine and blood until the bladder heals.



What Can I Expect after Treatment?

After the catheter is taken out, urination should return to normal in a few weeks. You'll usually take antibiotics for a few days to get rid of any infection in the bladder from the injury or the catheter. In some patients, the bladder may be "overactive" for many weeks or months from the irritation of the injury. With overactive bladder, you would feel the need to urinate often ("frequency") or suddenly ("urgency"). For this, you may be given drugs to help calm the bladder.