What Is Bladder Trauma?
The bladder does not get injured often. This is because the bones in the pelvis protect the bladder from most of the outside forces. But it can get injured by blows or piercing objects. Most often, these injuries are related to pelvic fractures. So, timely evaluation and appropriate management are critical for the best outcomes.
How Does the Bladder Usually Function?
The bladder is an organ shaped like a balloon that stores urine, which is made in the kidneys. It is kept in place with the help of pelvic muscles in the lower part of the belly. When it is not full, the bladder is in a relaxed state. Muscles in the wall of the bladder, as it fills with urine, allow the bladder to expand. Nerve signals in the brain give the signal that the bladder is getting full. This signaling makes one feel the need to go to the bathroom. In addition, the brain signals the bladder muscles to squeeze (or "contract"). This forces the urine out of the body through the urethra.
What Are the Symptoms of Bladder Rupture?
The two common types of damage to the bladder due to trauma are bruises and tears.
- Blunt injury, or a bruise (damage to the bladder caused by blows).
- Penetrating injury or tear (damage to the bladder caused by something piercing through it).
Almost everyone who gets a blunt injury to the bladder will notice blood in the urine. Those with penetrating injuries may not actually notice any bleeding. There might be pain below the belly button, but most times, the pain caused by other injuries masks the bladder pain and makes it hard to notice. If there develops a large hole in the bladder, allowing all of the urine to leak into the abdomen, it becomes impossible to pass urine. In females, if the injury is serious enough, the vagina may be torn open along with the bladder. If this happens, urine may start to leak into the vagina through the bladder. In this case, blood may also come out of the vagina.
Other symptoms may include the following-
-
Hard to initiate urination.
-
Painful urination.
-
Weak urine stream.
-
Severe back pain.
What Are the Causes of Bladder Rupture?
When the bladder is empty, the pelvic bones protect it from sudden blows to the lower abdomen. But when it starts to fill with urine, the top portion of the bladder rises into the part of the abdomen, where it is less protected. However, the pelvic bones in children are not fully developed, so they are more easily prone to injuries than adults. If the pelvis is hit with force strong enough to cause breakage of the pelvic bones, the bladder may get injured even if it is empty.
The most common causes of bladder injury include the following-
-
Car crashes.
-
A heavy object falling on the lower abdomen.
-
Falls from high places.
Bladder trauma from a car crash can be prevented by wearing a seat belt properly. Instead of wearing it across the belly, the seat belt should be wrapped as a lap belt. This is because, during a car crash, passengers wearing the seat belt around the belly and having a full bladder may get the force of the crash to focus on the full bladder.
The bladder can also get injured from being pierced from the outside (penetrating trauma). Some causes of penetrating trauma may include the following:
-
Knives.
-
Shrapnel.
-
Bullets.
-
IEDs (improvised explosive devices).
How Is Bladder Rupture Diagnosed?
A healthcare provider diagnoses a bladder injury by inserting a tube, called a catheter, into the bladder and taking a series of X-rays. Before the catheter is put in, X-rays of the urethra may be taken to see if it is damaged. The bladder is filled with a liquid before the X-ray is taken. This liquid allows the visibility of the bladder on the X-rays.
What Is the Treatment for Bladder Rupture?
The treatment for bladder rupture depends on the type of trauma or damage.
1. Contusion: Most of the time, the wall of the bladder does not tear and only gets bruised. The only sign indicating this will be bloody urine. In this case, the healthcare provider may place a wide catheter and leave it there so clots can pass. After the urine gets free of blood and becomes clear, the catheter will be removed if there are no other reasons to leave it in.
2. Intraperitoneal Rupture: If the bladder gets a tear on the top part, the hole that develops will usually open to that part of the abdomen that holds the bowel, spleen, and liver. The leakage of urine into the abdomen is a serious problem. Surgery is required to sew and close this tear. A catheter is placed and left in the bladder for up to two weeks post-surgery to allow the bladder to rest.
3. Extraperitoneal Rupture: If the tear occurs at the bottom or side part of the bladder, there will be urine leakage into the tissues that surround the bladder instead of the abdominal cavity. Surgery is required to repair complex injuries of such type. But often, it can be treated by keeping the bladder empty by placing a wide catheter. The urine, along with the blood in the urine, gets drained into a collection bag. It usually takes at least ten days to ensure the healing of the bladder. In the bladder, the catheter is left until and unless an X-ray shows the leak has been sealed. If the catheter does not drain properly, surgery is needed.
4. Penetrating Injuries: Injury to the bladder from a penetrating object, such as a bullet or a knife, is usually fixed with surgery. However, most of the time, other organs in the area will also be injured and need repair. After surgery, a catheter is left in the bladder to allow the bladder to heal by draining the blood and urine.
Conclusion
Bladder rupture is not a common injury because it is often well-protected by the pelvic bones. However, in some instances, a blunt injury, such as a blow or a penetrating injury, may cause damage to the bladder, which may prove to be serious. The treatment involves catheter drainage, close clinical observation, and antibiotics. In severe cases, surgical exploration and bladder closure may be required.
