Traumatic injury of the bladder and urethra involves damage caused by an outside force. These injuries can be categorized as:
- Blunt trauma (such as a blow to the body)
- Penetrating wounds (such as bullet or stab wounds)
The amount of injury to the bladder typically depends on how full the bladder was at the time of injury and what caused the injury.
Traumatic injury to the bladder is uncommon. Only about 8 – 10 percent of pelvic fractures lead to bladder injury. Because the bladder is located within the bony structures of the pelvis, it is protected from most outside forces. Injury may occur if there is a blow to the pelvis severe enough to break the bones and cause bone fragments to penetrate the bladder wall.
Other causes of bladder or urethra injury include:
- Surgeries of the pelvis or groin (including hernia repair and hysterectomy)
- Tears, cuts, bruises, and other injuries to the urethra (the tube that carries urine out of the body).
- Straddle injuries (direct force that injures the area behind the scrotum)
- Deceleration injury (for example, a motor vehicle accident that occurs when you have a full bladder and are wearing a seatbelt)
Injury to the bladder or urethra may cause urine to leak into the abdomen, leading to infection (peritonitis). This type of injury is more common if the bladder is full. The inability to empty the bladder can also lead to a Urinary Tract Infection.
Symptoms
- Pain in the lower abdomen
- Blood in the urine
- Difficulty beginning to urinate or an inability to empty the bladder
- Loss of fluids
- Painful urination
- Pelvic pain
- Severe bleeding
- Small, weak urine stream
Urologic Trauma can lead to a life-threatening condition called shock or hemorrhage. Seek immediate medical help if you notice these symptoms after experiencing an injury:
- Decreased alertness, including coma, drowsiness or lethargy
- Increased heart rate
- Pale skin
- Sweating
- Skin that is cool to the touch
Diagnosis
Your Ohio State urologist or an Emergency Department physician, will examine your genital area for signs of injury. An X-ray or other imaging may be done to better understand your injury.
An examination may also show:
- Bladder injury or swollen (distended) bladder
- Other signs of pelvic injury, such as bruising over the penis, scrotum, and perineum
- Signs of hemorrhage or shock, including decreased blood pressure, especially in cases of pelvic fracture
- Tenderness and bladder fullness when touched (caused by urine retention)
- Tender and unstable pelvic bones
- Urine in the abdominal cavity
Treatment
Treatment may include surgical repair of the injured area and antibiotics to prevent infection.
The goals of treatment are to:
- Control symptoms
- Repair the injury
- Prevent complications
Emergency treatment of bleeding or shock may include:
- Blood transfusions
- Intravenous (IV) fluids
- Monitoring in the hospital