Yes, you can bruise your bladder; the medical term for this injury is a bladder contusion. The bladder is a muscular sac located deep within the pelvis, and this protected position means injury to the organ is not common. A contusion is the least severe form of bladder trauma, involving bleeding within the bladder wall from a forceful impact without tearing the tissue. This trauma can range from a minor injury to a severe impact that may lead to a full bladder rupture.
How Bladder Injuries Happen
The bladder is resilient when empty because it collapses behind the pubic bone, shielding it from outside force. The risk of injury increases dramatically when the bladder is full, as it rises above the protective pelvic rim and becomes vulnerable to blunt force trauma. A full bladder is essentially a fluid-filled balloon that can burst under sudden impact.
High-energy blunt trauma, such as a motor vehicle collision, is the most frequent cause of significant bladder injury. Deceleration injuries in car accidents can cause rupture, especially if a seatbelt was improperly positioned over the lower abdomen. Falls or direct, forceful blows to the lower abdomen during sports or an assault can also cause a contusion or tear.
Pelvic fractures present a different mechanism of injury, occurring in fewer than 10% of blunt abdominal trauma cases. When the pelvic bones break, sharp fragments can pierce the bladder wall, leading to a tear or rupture. These injuries allow urine to leak into the surrounding tissues.
Identifying the Warning Signs
The most common and immediate sign of a bladder injury, including a simple contusion, is hematuria, or blood in the urine. This blood may be visible, appearing pink, red, or cola-colored, and indicates damage to the urinary tract lining. Even a minor bladder contusion typically causes gross hematuria, prompting medical attention.
Another significant symptom is lower abdominal or suprapubic pain, concentrated above the pubic bone. A person with a bladder injury may also experience difficulty or an inability to pass urine (dysuria or retention). This inability to urinate is concerning, as it can signal a major tear or rupture allowing urine to leak into the abdominal cavity.
If a bladder rupture is severe, a person may develop abdominal swelling or distension. Furthermore, signs of internal bleeding or shock, such as a rapid heart rate, pale skin, or decreased alertness, signal a life-threatening emergency. These systemic symptoms require immediate transport to a hospital.
Diagnosis and Medical Care
Medical evaluation for a suspected bladder injury begins with a physical examination and a urinalysis to confirm blood in the urine. To determine the extent of the damage, doctors rely on specialized imaging, most commonly a cystogram. This test involves inserting a catheter and filling the bladder with a radiopaque contrast dye before taking X-rays or a Computed Tomography (CT) scan.
The cystogram visualizes any leakage of the contrast dye outside the bladder wall, confirming a tear or rupture. A simple contusion is a diagnosis of exclusion, meaning the imaging shows no contrast leakage, or only a slight distortion due to swelling. These advanced imaging techniques are highly accurate.
For a simple bladder contusion, treatment is conservative, requiring observation, rest, and pain management until the blood in the urine resolves. A temporary catheter may be placed to keep the bladder empty and allow the wall to heal, which usually takes a few days to a week. However, a full bladder rupture often requires surgical intervention to repair the tear, especially if it leaks into the abdominal cavity.