Bladder Injury

Overview

The bladder is the muscular organ in the lower pelvis that stores urine. A bladder injury is damage to this organ, most often from significant trauma, a broken pelvis, or, less commonly, during surgery in the lower abdomen or pelvis. Injuries range from a simple bruise (contusion) of the bladder wall to a tear or rupture that allows urine to leak into the abdomen or surrounding tissues.

A full bladder is more vulnerable to injury because it sits higher and is more exposed. Bladder injuries are serious and need prompt evaluation, because untreated tears can cause infection and other complications. The good news is that, with appropriate treatment, the bladder usually heals well.

Symptoms

Symptoms of a bladder injury may include:

• Blood in the urine, which can range from a slight pink tinge to obvious blood.
• Lower abdominal or pelvic pain.
• Difficulty urinating or being unable to pass urine.
• Passing only small amounts of urine, or a strong urge with little output.
• Bruising or swelling in the lower abdomen, pelvis, or genital area.
• In significant injuries, signs of a more serious condition such as fever, abdominal swelling, or feeling very unwell, which can occur if urine leaks internally.

Because bladder injuries often accompany pelvic fractures and other trauma, they may be part of a broader set of injuries.

Causes

Bladder injuries usually result from force to the lower abdomen or pelvis. Common causes include:

• Pelvic fractures, a frequent cause, in which broken bones can tear the bladder.
• Blunt trauma from car crashes, falls, or a direct blow to a full bladder.
• Penetrating injuries, such as stab or gunshot wounds.
• Surgical injury during operations in the pelvis or lower abdomen, including some gynecologic, urologic, and bowel surgeries.
• Rarely, injury from instruments passed into the bladder during procedures.

Risk Factors

Factors that increase the risk of bladder injury include:

• Major trauma, especially events that cause pelvic fractures.
• Having a full bladder at the time of an impact.
• Undergoing surgery in the pelvis or lower abdomen.
• Previous pelvic surgery or radiation, which can create scar tissue.
• Activities or situations with a high risk of severe accidents.

Diagnosis

Diagnosis combines examination with imaging focused on the bladder:

• Examination and history, including the nature of the injury and signs such as blood in the urine and lower abdominal tenderness.
• Urine testing to check for blood.
• Imaging of the bladder, especially a special X-ray or CT study in which contrast dye is placed in the bladder to look for leaks. This is a key test for detecting a tear.
• CT scan to evaluate the pelvis and any associated injuries, such as fractures.

Identifying whether a tear leaks into the abdomen or into the surrounding pelvic tissue is important, because it affects treatment.

Treatment

Treatment depends on the type and location of the injury:

• Bruises and small tears that leak only into the surrounding pelvic tissue often heal on their own when the bladder is rested by draining it continuously with a catheter for a period of time.
• Surgical repair is usually needed for tears that leak into the abdominal cavity, for penetrating injuries, and for many injuries that occur during surgery.
• Catheter drainage after surgery to allow the repair to heal.
• Antibiotics to prevent or treat infection.
• Treatment of associated injuries, such as pelvic fractures.

With proper treatment, the bladder generally heals well, and follow-up imaging may be used to confirm healing before the catheter is removed.

Prevention

Most bladder injuries stem from accidents that are hard to predict, but general safety measures help reduce serious trauma:

• Wearing seatbelts and using proper restraints in vehicles.
• Taking steps to prevent falls, especially in older adults.
• Using protective equipment in high-risk activities.
• For surgical injuries, careful technique by the surgical team reduces the risk, and these injuries, when they occur, are often repaired during the same operation.

When to See a Doctor

Seek emergency care immediately after major trauma or a pelvic injury if you have blood in the urine, severe lower abdominal or pelvic pain, inability to urinate, or signs of serious injury. Bladder injuries often occur with other serious injuries and need prompt evaluation.

Also see a doctor promptly for blood in the urine, trouble urinating, or worsening lower abdominal pain after an accident or recent pelvic surgery. Fever, a swollen abdomen, or feeling very unwell after such an injury should be treated urgently, as these may indicate a urine leak or infection.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine.
2. American Urological Association.
3. Mayo Clinic.