Bladder tamponade is a condition caused by bladder cancer and sometimes pregnancy or traumatic injury. In addition to bladder cancer, it can less commonly indicate placenta previa as well as other medical conditions. It is a severe and life-threatening medical emergency.
Definition & Facts
Bladder tamponade is a term that literally translates to mean "bladder blockade." The blockage is caused by large amounts of blood clots in the urinary bladder, which obstruct the flow of urine. Bladder tamponade is not considered a common medical condition, except in the case of individuals diagnosed with cancer of the bladder or placenta previa.
Symptoms & Complaints
- Severe pain in the abdominal and bladder areas, and especially right over the pubic bone area.
- The pain often comes in spasms and is severe
- Blood loss causes pale skin and anemia.
- Increased heart rate (tachycardia) and low blood pressure (hypotension).
- Inability to produce urine for several hours at a time (oliguria)
- If urine passes, it is bloody (hematuria).
- Colic (severe flank pain or side pain).
- Sometimes there is a bladder rupture.
Bladder tamponade can be caused by a number of factors. However, there are certain factors that are most commonly associated with this condition.
- Cystitis. Bladder infection and inflammation.
- Placenta previa. This condition occurs during pregnancy when the placenta is unusually low inside the uterus. This low placement can cause the cervix to be partially or fully covered.
- Often tamponade happens post-delivery due to bleeding from a caesarean section.
- Bladder cancer. The bleeding caused by the cancer can lead to tamponade.
- Binge drinking. In some cases, bladder rupture which leads to tamponade has been caused by binge drinking followed by the individual passing out and not realizing there is a need to urinate. The buildup of fluid in the bladder is what causes the rupture and production of blood clots in this case.
Diagnosis & Tests
A number of diagnostic tests are available for identifying bladder tamponade as well as determining its underlying causes. The first step the doctor typically does is to take a thorough individual medical history and family history followed by a physical examination.
The doctor will inquire about the patient's symptoms while the physical examination will involve the palpation of the abdomen and bladder above the pubic bone as well as an assessment of skin color, heart rate, blood pressure, and other symptoms.
If needed, a number of diagnostic tests can be ordered. The most common diagnostic tests to determine if the symptoms are caused by bladder tamponade include these:
- Urinalysis. Analysis of the urine can detect the presence of blood.
- CBC (blood work). Blood work will look for low red blood cell count and hemoglobin levels.
- Cystoscopy. A cystoscopy inserts a camera into the bladder to detect the presence of blood clots.
- Ultrasound. An ultrasound can also detect the presence of blood clots.
- Computed tomography (CT) scan (computerized tomography). This is another test to look for the presence of blood clotting in the bladder as well as tumors or other masses.
- Magnetic resonance imaging (MRI). An MRI can also be used to detect blood clots in the bladder and masses or tumors.
Treatment & Therapy
Treating bladder tamponade is an urgent need since the internal bleeding can have severe health consequences. Usually the patient is hospitalized immediately and surgery is often required to completely resolve the risk of bladder rupture, heart attack, and heart failure. Treatment methods that are most commonly ordered include these:
- Administration of intravenous fluids. This is done to rehydrate the individual and improve blood pressure.
- Blood transfusion. This is done to restore hemoglobin and red blood cell count levels.
- Cystoscopy. If this procedure was not done during the diagnostic phase, it is often ordered during the treatment phase. Cystoscopy permits saline irrigation of the bladder to remove the blood clots and stop the bleeding via either a laser or cauterization.
- Suprapubic endoscopy. This procedure involves the insertion of a catheter which removes the blood clots in the bladder area via irrigation.
If bladder cancer is deemed to be the underlying cause of bladder tamponade, treatment may involve chemotherapy, radiation therapy, and transurethral resection. Removal of tumors may be possible during cystoscopy.
Prevention & Prophylaxis
Bed rest may be necessary if one has placenta previa. Avoiding exercise may also be necessary in preventing complications of placenta previa. Sexual activity should be considered off limits if one has placenta previa.
There is a possibility of prevention for cases that arise from binge drinking if the individual chooses to address alcohol use disorder which often causes binge drinking. Joining a support group such as a twelve step program like Alcoholics Anonymous and seeking psychotherapy (cognitive behavioral therapy is one type) are treatment options for alcoholism.
Certain rare cases have been reported where bladder perforation and tamponade have been caused by errors during surgery, and these hold the possibility for prevention.
Ultimately, at present the best options involve lowering the risk of bladder tamponade through careful monitoring of health conditions known to lead to tamponade. In this way, tamponade cases can be caught earlier before the risks become severe.