By Dr. Manoj Talwar , Urology
Urinary Bladder Rupture may occur as a result of a trauma to the lower abdomen or pelvis. Traumatic injury is often seen following domestic fall, work injury or automobile accident. Most severe bladder injury occurs when bladder is filled with urine.
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. 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
- Severe back pain
What Can Cause Bladder Trauma?
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.
The bladder can also be hurt by being pierced from the outside (“penetrating trauma”). Some causes of penetrating trauma are:
- IEDs (improvised explosive devices)
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. The doctor 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. 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.
- 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.