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 and what caused the injury.
Traumatic injury to the bladder is uncommon. The bladder is located within the bony structures 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 penetrate 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 (including hernia repair and hysterectomy)
- Tears, cuts, bruises, and other injuries to the urethra (the tube that carries urine out of the body) -- most common in men.
- 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.
- Abdominal pain, lower
- 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
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 successfully 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 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 - 6 months.
Traumatic injury of the bladder and urethra can be minor or life threatening. Short- or long-term serious complications can occur.
- Acute bilateral obstructive uropathy
- Bleeding, hemorrhage, shock
- Chronic bilateral obstructive uropathy
- Scar formation, blockage of the urethra
- Urinary retention
When to Contact a Medical Professional
Go to the emergency room or call the local emergency number if you have symptoms of traumatic bladder or urethra injury -- especially if you have been injured in those areas.
Call your health care 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 steps:
- Do not insert objects into the urethra.
- If you need self-catheterization, follow the instructions of your health care provider.
- Use safety equipment during work and play.
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: Mosby Elsevier; 2013:chap 47.
Morey AF, Dugi III DD. Genital and lower urinary tract trauma. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 88.