The bladder can be bruised, an injury medically termed a bladder contusion. The bladder is a hollow, muscular organ in the lower abdomen, generally well-protected by the bony structure of the pelvis. However, severe blunt force trauma can cause damage. A contusion occurs when the bladder wall is damaged, leading to bleeding within the tissue without a complete tear.
The Bladder’s Susceptibility to Injury
The bladder’s position and condition primarily influence its vulnerability to injury. When empty, the bladder rests low within the pelvic cavity, shielded by the pubic bones, making it highly resistant to external impact. As the bladder fills with urine, its muscular walls stretch, causing the organ to ascend higher into the abdominal cavity, above the pelvis.
This distended state exposes the upper portion, known as the dome, to potential injury. Blunt force trauma, such as a severe blow or rapid deceleration, can cause a sudden, massive increase in internal pressure within a full bladder. This pressure surge can result in a contusion or, in more severe cases, a complete tear. Blunt trauma is the most common cause of bladder injuries, often occurring alongside pelvic fractures where bone fragments may perforate the organ.
Distinguishing Bladder Contusion from Rupture
Bladder injuries are categorized by severity, distinguishing a contusion from a rupture. A bladder contusion involves internal bleeding and bruising of the wall layers without a full-thickness tear. The damage is contained entirely within the organ, meaning no urine leaks out. The primary sign of a contusion is hematuria (blood in the urine), which is usually self-limiting as the bruise heals.
A bladder rupture, conversely, involves a tear through the entire wall, allowing urine to escape into surrounding tissues. Ruptures are classified based on the tear location. Extraperitoneal ruptures leak urine into the space around the bladder, while intraperitoneal ruptures leak urine into the abdominal cavity. Intraperitoneal rupture is concerning because leaked urine can cause peritonitis, a serious infection and inflammation of the abdominal lining. Contusions are often managed conservatively, but intraperitoneal ruptures almost always require immediate surgical repair.
Recognizing the Signs of Bladder Trauma
The most common sign following blunt trauma to the lower abdomen is hematuria (blood in the urine). This symptom is present in almost all cases of bladder contusion and rupture. The blood may be visible (gross hematuria) or only detectable through laboratory tests.
Patients experience pain in the lower abdomen, often localized just above the pubic bone. Another element is the inability to urinate or difficulty passing urine, even with the urge to do so. If a rupture has occurred and urine is leaking into the abdominal cavity, symptoms progress to include severe, worsening abdominal pain, tenderness, and distention. These signs suggest a more severe injury requiring urgent assessment.
When to Seek Medical Attention
Immediate medical evaluation is necessary following significant blunt trauma to the lower abdomen, especially if accompanied by blood in the urine or the inability to void. Healthcare providers use imaging techniques to confirm the injury’s presence and extent. The most definitive diagnostic procedure is retrograde cystography, which involves filling the bladder with a contrast dye and taking X-rays or a CT scan to check for leaks indicating a rupture.
Treatment depends on the injury’s classification and severity. For a simple bladder contusion, treatment is non-operative and involves placing a urinary catheter for continuous drainage. Keeping the bladder empty allows the walls to rest and heal, usually resolving the contusion within a few days. Uncomplicated extraperitoneal ruptures are also often treated with catheter drainage alone, but all intraperitoneal ruptures require surgical intervention to close the tear and prevent infection.