Traumatic injury of the bladder and urethra
Traumatic injury of the bladder and urethra involves damage caused by an outside force.
Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption
Types of bladder injuries include:
- Blunt trauma (such as a blow to the body)
- Penetrating wounds (such as bullet or stab wounds)
The amount of injury to the bladder depends on:
- How full the bladder was at the time of injury
- What caused the injury
Traumatic injury to the bladder is not very common. The bladder is located within the bones of the pelvis. This protects it from most outside forces. Injury may occur if there is a blow to the pelvis severe enough to break the bones. In this case, bone fragments may pierce the bladder wall. Less than 1 in 10 pelvic fractures lead to bladder injury.
Other causes of bladder or urethra injury include:
- Surgeries of the pelvis or groin (such as hernia repair and removal of the uterus)
- Tears, cuts, bruises, and other injuries to the urethra. Urethra is the tube that carries urine out of the body. This is most common in men.
- Straddle injuries. This injury may occur if there is direct force that injures the area behind the scrotum
- Deceleration injury. This injury may occur during a motor vehicle accident. Your bladder can get injured if it is full and you are wearing a seatbelt
Injury to the bladder or urethra may cause urine to leak into the abdomen. This may lead to infection.
Some common symptoms are:
- Lower abdominal pain
- Blood in the urine
- Bloody discharge
- Difficulty beginning to urinate or inability to empty the bladder
- Loss of fluids
- Painful urination
- Pelvic pain
- Severe bleeding
- Small, weak urine stream
- Abdominal distention or bloating
Shock or internal bleeding may occur after a bladder injury. This is a medical emergency. Symptoms include:
- Decreased alertness, drowsiness, coma
- Increased heart rate
- Pale skin
- Skin that is cool to the touch
If there is no or little urine released, there may be an increased risk of urinary tract infections (UTI).
Exams and Tests
An exam of the genitals may show injury to the urethra. An x-ray of the urethra using dye (retrograde urethrogram) should be done if the health care provider suspects an injury.
The exam 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
A catheter (tube that drains urine from the body) may be inserted once an injury of the urethra has been ruled out. An x-ray of the bladder using dye to highlight any damage can then be done.
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
You may need emergency surgery to repair the injury and drain the urine from the abdominal cavity in the case of peritonitis (inflammation of the abdominal cavity).
The injury can be repaired with surgery in most cases. The bladder may be drained by a catheter through the urethra or the abdominal wall over a period of days to weeks. This will prevent urine from building up in the bladder. It will also allow the injured bladder or urethra to heal and prevent swelling in the urethra from blocking urine flow.
If the urethra has been cut, a urological specialist can try to put a catheter in place. If this cannot be done, a tube will be inserted through the abdominal wall directly into the bladder. This is called a suprapubic tube. It will be left in place until the swelling goes away and the urethra can be repaired with surgery. This takes 3 to 6 months.
Traumatic injury of the bladder and urethra can be minor or life threatening. Short- or long-term serious complications can occur.
Some of the possible complications of injury of the bladder and urethra are:
- Bleeding, shock.
- Blockage to the flow of urine. This causes the urine to back up and injure one or both kidneys.
- Scarring leading to blockage of the urethra.
- Problems emptying the bladder completely.
When to Contact a Medical Professional
Call the local emergency number (911) or go to the emergency room if you have a traumatic bladder or urethra injury.
Call your provider if symptoms get worse or new symptoms develop, including:
- Decrease in urine production
- Severe abdominal pain
- Severe flank or back pain
- Shock or hemorrhage
Prevent outside injury to the bladder and urethra by following these safety tips:
- Do not insert objects into the urethra.
- If you need self-catheterization, follow the instructions of your provider.
- Use safety equipment during work and play.
Morey AF, Zhao LC. Genital and lower urinary tract trauma. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 101.
Runyon MS. Genitourinary system. In Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 47.