Bladder Injuries

A bladder injury often occurs when the pelvis is injured, as may occur in a high-speed motor vehicle accident or a fall. Penetrating wounds, usually from gunshots, also can injure the bladder. In addition, a bladder injury may occur unintentionally during diagnostic tests or surgery involving the pelvis or lower abdomen.

Symptoms and Diagnosis

The most common symptoms of a bladder injury are blood in the urine and difficulty in urinating. If the lowermost portion of the bladder (where the muscle that helps to control urination is located) has been injured, the person may experience frequent urination or an uncontrollable loss of urine (urinary incontinence). Changes in urination and fever may develop if the injury leads to infection.

If bladder injuries are not treated, complications, such as frequent and urgent urination, infection, and incontinence, may develop.

The diagnosis of a bladder injury is best established by cystography, a procedure in which a radiopaque dye, which is visible on x-rays, is injected into the bladder and x-rays are taken to look for leakage.

Treatment

Minor bladder injuries, either bruises or tears (lacerations), may be treated by inserting a catheter into the urethra for 5 to 10 days while the bladder heals. For more extensive bladder injuries or any injury resulting in leakage of urine into the abdominal cavity, surgery should be performed to determine the extent of the injury and to repair all tears. The urine can then be more effectively drained from the bladder using two catheters, one inserted through the urethra (a transurethral catheter) and one inserted directly into the bladder through the skin over the lower abdomen (a suprapubic catheter). These catheters are removed in 7 to 10 days or once the bladder has healed satisfactorily. If complications develop, they must be treated.