Bladder rupture

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 27, 2016
StartDiseasesBladder rupture

A bladder rupture occurs when the bladder is torn open or pierced in some way that causes the bladder to open. This is typically the result of a traumatic injury rather than a disease process. The bladder is more likely to rupture when full as it is smaller and more relaxed when empty. A full bladder also extends above the bones of the pelvis and beyond the protected area behind the pelvic bones.

Contents

Definition & Facts

Bladder ruptures are usually categorized as intraperitoneal or extraperitoneal. An intraperitoneal rupture is one in which the top of the bladder is damaged, allowing urine to leak into the abdominal cavity. This type of rupture accounts for about 15 percent of all bladder ruptures.

Conversely, an exrtaperitoneal rupture is found on the bottom of the bladder and accounts for about 85 percent of bladder tears. In this type of rupture, urine may leak out of the bladder and into the surrounding area but will not enter the abdominal cavity.

Combined ruptures can also occur, causing both intraperitoneal and extraperitoneal ruptures. All bladder ruptures are potentially serious medical conditions that can result in internal bleeding and other secondary problems if left undiagnosed and untreated.

Symptoms & Complaints

A ruptured bladder can cause severe abdominal pain, pelvic pain, blood in urine and painful urination. Bleeding in the bladder after a rupture may also cause a blood clot. Depending on the clot's location, urination may be difficult or impossible due to blockage.

Patients may also experience a decreased urinary urgency (need to urinate) as urine leaks into the body rather than expanding the bladder and creating the urge to go to the bathroom. Internal bladder bleeding following a rupture also lowers the blood pressure (hypotension) while increasing the heart rate (tachycardia). Some patients with bladder rupture also suffer dehydration from the loss of fluid caused by the rupture.

Causes

Bladder ruptures are caused by a traumatic injury such as a car accident or a fall in 82% of cases. Both blunt force trauma, such as a punch or kick, and penetrating injuries such as gunshot wounds can cause a bladder rupture. The condition frequently appears as a secondary injury in those who suffer a bone fracture, as bone shards and broken pieces can easily rupture the bladder wall.

The bladder can also be ruptured during surgeries of the prostate, uterus, rectum, and colon. Caesarean sections and difficult vaginal deliveries may also result in a bladder rupture due to the large amounts of force and pressure in the pelvic area during these events.

In most cases of bladder rupture, there is an identifiable cause in most cases of bladder rupture. Spontaneous rupture can occur but only does so in about 2 percent of cases. Spontaneous rupture is rare but more likely in those who have had radiation therapy to treat bladder cancer or had their bladder removed and a new one surgically created from their intestines.

Recent studies have explored the connection between bladder rupture and binge drinking particularly among women. Binge drinking results in the bladder holding large amounts of urine as well as the reduction of the senses that alert a person to urinate. Over time, those with alcoholism can damage and thin the walls of their bladders, which can eventually result in rupture. While rare, this is a disturbing phenomenon.

Diagnosis & Tests

Several tests can be done to diagnose bladder rupture. One such test is a retrograde cystography. During this procedure, a catheter is inserted into the bladder where it inserts contrast material. This contrast material is visible on an X-ray and will leak out of the bladder if there is a rupture. Dye in inappropriate places can also be detected with a computed tomography (CT) scan or magnetic resonance imaging (MRI).

An ultrasound can also be used to diagnose bladder ruptures in some cases. Blood tests, too, can sometimes show signs of a bladder rupture. Blood tests won't show the rupture itself, but will make clear signs of internal bleeding and other possible rupture symptoms.

Doctors may also examine urine samples when suspecting bladder rupture, checking to see if blood is present in the urine. Lab testing can detect tiny amounts of blood in the urine, known as hematuria, even when the blood is so minimal that it can't be seen with the naked eye.

Treatment & Therapy

Treatment depends on the type of bladder rupture. Extraperitoneal ruptures are often treated by placing a catheter into the bladder to keep it drained and small while the tear heals itself. In the meantime, patients are given pain medication to ease any discomfort. Healing typically takes about three weeks. If the rupture fails to heal on its own, surgical intervention to close the breach in the bladder if necessary.

Intraperitoneal ruptures are a bit more complicated and always require corrective surgery. During the surgery, doctors use catheters to drain any urine that has leaked into the abdominal cavity. This is done to protect the abdominal organs from any bacteria that may be present in the urine.

Both types of rupture may require emergency surgery if they are accompanied by severe bleeding. Antibiotics may also be administered to prevent infection during healing of both natural and surgical bladder repairs. Both types of ruptures can be treated and fully healed with no lasting side effects or ongoing problems in most cases.

Because drug abuse and alcohol abuse both increase the odds of being involved in an accident that could cause bladder ruptures and other serious injuries, it is important to seek treatment. Support groups, psychotherapy, psychiatric medications, and drug detoxification are all components of treatment for substance abuse.

Prevention & Prophylaxis

Because bladder ruptures are often caused by traumatic injuries, caution is the best way to avoid them. Always follow safety regulations and guidelines when on the job and drive carefully and safely.

After having radiation treatment to the bladder or surgeries close to it, it is important for patients to carefully follow all of their doctor's instructions. It is, of course, also important for patients to see only qualified, licensed surgeons who are experienced at performing surgeries on and around the bladder.

The elderly and others prone to balance problems should be assessed for fall risk and treated accordingly to prevent blunt trauma to the bladder from falls in the home, especially since bladder ruptures caused by falls could go undiagnosed for a time if minor in nature.