Bladder Rupture

Overview

The bladder is the muscular organ in the lower pelvis that stores urine. A bladder rupture is a tear or burst in its wall that allows urine to leak into the abdomen or the tissues around the bladder. This is a serious injury that usually requires urgent treatment, because leaked urine can cause infection, pain, and other complications.

Bladder ruptures most often happen with major trauma to the pelvis, such as a car crash, particularly when the bladder is full at the time of impact. They can also occur during certain surgeries or procedures. A bladder rupture is a medical emergency, and anyone with severe lower abdominal pain and trouble urinating after an injury should seek immediate care.

Symptoms

Symptoms appear after an injury or procedure and may include:

• Severe pain in the lower abdomen or pelvis
• Blood in the urine
• Difficulty or inability to pass urine
• Passing only small amounts of urine, or none at all
• Abdominal swelling, bloating, or tenderness
• Pain or burning when urinating
• Fever and feeling generally unwell if infection develops

Because bladder rupture often accompanies other pelvic injuries, there may also be signs of shock such as dizziness, pale skin, rapid heartbeat, or fainting. These require emergency care right away.

Causes

A bladder rupture happens when force or a sharp object damages the bladder wall. Common causes include:

• Blunt trauma: Car crashes, falls, or blows to the lower abdomen, especially with a full bladder or a pelvic fracture.
• Penetrating trauma: Stab or gunshot wounds to the lower abdomen.
• Surgical or procedural injury: The bladder can be injured during pelvic or abdominal operations or instrument-based procedures.
• Severe overdistension: Rarely, an extremely full bladder that cannot empty may tear.

Bladder injuries from blunt trauma frequently occur together with pelvic fractures.

Risk Factors

• High-energy trauma such as motor vehicle crashes
• Pelvic fracture
• A full bladder at the time of injury
• Pelvic or lower abdominal surgery
• Conditions that prevent the bladder from emptying
• Heavy alcohol use, which can mask a full bladder before injury

Diagnosis

Bladder rupture is diagnosed in the emergency setting using examination and imaging:

• CT cystogram: A special scan in which contrast dye is placed into the bladder to show whether and where it is leaking.
• Urinalysis: Checking for blood in the urine.
• CT or X-ray of the pelvis: To look for fractures and other injuries.
• Catheter placement: May be used both to drain urine and as part of the evaluation.

Doctors also determine whether the tear is inside the abdominal cavity or outside it, because this affects treatment.

Treatment

Treatment depends on the location and severity of the rupture and on any associated injuries.

• Catheter drainage: Many tears outside the abdominal cavity heal with a urinary catheter left in place for a period to keep the bladder empty while it mends.
• Surgery: Tears inside the abdominal cavity, or those caused by penetrating injury, usually need an operation to repair the bladder wall.
• Treating other injuries: Pelvic fractures, bleeding, and other organ damage are managed at the same time.
• Antibiotics: Used to prevent or treat infection from leaked urine.

With prompt treatment, the bladder generally heals well. A follow-up scan often confirms the repair before the catheter is removed.

Prevention

• Always wear a seatbelt while driving
• Use protective equipment in contact sports and at work
• Empty the bladder regularly and avoid extreme overfilling
• Treat conditions that block bladder emptying
• Seek prompt care after any significant lower abdominal injury

When to See a Doctor

A bladder rupture is a medical emergency. Call emergency services or go to an emergency department immediately after an injury if you have:

• Severe lower abdominal or pelvic pain
• Blood in the urine or inability to urinate
• Abdominal swelling or tenderness after trauma
• Dizziness, pale skin, rapid heartbeat, or fainting, which may signal shock

Do not wait to see if symptoms improve. Prompt diagnosis and treatment reduce the risk of infection and other serious complications.

Related Topics

Frequently Asked Questions

References

1. Urology Care Foundation, American Urological Association. Trauma and Bladder Injury.
2. Mayo Clinic. Pelvic trauma and urinary injuries.
3. MedlinePlus, U.S. National Library of Medicine. Bladder injury.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Urinary tract injuries.