A bladder rupture or pale rupture is usually caused by a strong external force. In most cases, surgical treatment is performed.
What is a bladder rupture?
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. Bladder rupture (bladder tear) is a tear of the urinary bladder. In most cases, bladder rupture is accompanied by pain. As another symptom of a bladder rupture, red blood cells (visible under a microscope) or small amounts of blood (visible to the naked eye) are often found in the urine. Above the pubic bone, a bulge also frequently appears in a bladder rupture; such a bulge is caused either by urine or by a hematoma (a bruise) that has developed. In addition to a strong urge to urinate, a bladder rupture can also cause irritation of the peritoneum. In medicine, a distinction is made between so-called extraperitoneal (outside the abdominal cavity) bladder rupture, intraperitoneal (inside the abdominal cavity) and spontaneous rupture. Extraperitoneal bladder rupture is the most common of these.
Causes
The most common cause of bladder rupture is fractures (breaks) of the pelvic ring. Such pelvic fractures are usually the result of strong forces and can occur, for example, in traffic accidents or falls from very great heights. Bone fragments of the pelvis can injure the bladder wall after a pelvic fracture, causing a rupture of the bladder. A sudden, external pressure on the abdomen can also cause a bladder rupture. Such pressure can be exerted, for example, by seat belts. In the rare cases in which a bladder rupture occurs spontaneously, there was usually a long-term stress on the bladder in the past. So-called open bladder ruptures are usually the result of gunshot or stab wounds.
Symptoms, complaints, and signs
Bladder rupture is primarily manifested by abdominal pain and pain during urination, which increase in intensity and duration as the condition progresses. Urinary behavior is disturbed, and the affected person urinates more frequently or less frequently than before (urinary retention). Nevertheless, there is a constant urge to urinate, which is associated with the characteristic feeling of pressure in the area of the bladder. In the further course, a bladder rupture causes bleeding, which manifests itself as blood in the urine. Occasionally, hematomas also form, which in turn can be associated with pain and pressure in the lower abdomen or in the area of the urethra. If necessary, peritonitis occurs, which is accompanied by nausea and abdominal pain, loss of appetite and fever. Some sufferers experience palpitations and dizziness. There is also a general weakness that manifests itself in the form of fatigue, exhaustion and an overall reduced physical and mental performance. External symptoms of a ruptured bladder include pallor, increased sweating, and occasionally swelling in the lower abdomen. The physician can clearly diagnose the injury based on the above symptoms and discomfort. Ultrasound examination may reveal other abnormalities such as the rupture itself, as well as urinary retention and internal hematomas.
Diagnosis and course
A suspected diagnosis of bladder rupture is often possible for an attending physician based on the presenting symptoms and a patient’s account of his or her past medical history. If a patient’s symptoms occur immediately after an accident, the accident history may provide further evidence of a present bladder rupture. In order to confirm the suspected diagnosis of a bladder rupture, a sonography (i.e. ultrasound examination) is often performed in a next step. With this examination procedure, the tissue structure of the urinary bladder can be visualized. In order to rule out concomitant injuries of a bladder rupture after severe accidents and/or pelvic fractures, for example, computed tomography (CT; another imaging procedure) can be used. The course of a bladder rupture varies between individuals and depends on the causes and the timeliness of medical treatment. If treatment is started early, the course of a bladder rupture is positive in most cases and the injury to the bladder wall can be healed.
Complications
As always when disease or organ damage has occurred, the first priority is to avoid further complications. In the case of bladder rupture (rupture of the urinary bladder wall due to mostly external factors), this is no different. This diagnosis can mean that if treatment is delayed or omitted, peritonitis (inflammation of the peritoneum), disruption of intestinal passage (paralytic ileus) or blood poisoning (urosepsis) may occur. These complications can occur because the contents of the bladder empty either intraperitoneally (into the abdominal cavity) or extraperitoneally (into the surrounding tissue). How do the complications manifest themselves
The complication in the form of peritonitis is noticeable by severe abdominal pain and an increasing defensive tension of the entire abdominal musculature up to a board-hard abdominal wall. Urosepsis without shock can have a lethality (fatal course) of 13 percent, with shock of 28 percent, and with shock after sepsis of 43 percent. Thus, the complications should not be ignored at all. Immediate consultation with a specialist (urologist) is strongly recommended to prevent the complications described here from occurring or even developing.
When should you see a doctor?
A ruptured bladder often goes undetected because the causes are usually due to other conditions or accidents. Most often, an injury to the pelvis, especially a fracture of the pelvic ring, causes a bladder tear because the bladder wall is injured by bone fragments. Although patients in such a situation always receive medical attention anyway, it is not uncommon for the doctor to focus on the more serious injuries and overlook the bladder rupture. Patients should therefore point out the possibility of a bladder rupture on their own initiative if this exists and if they also experience symptoms that are typical of this type of injury. The possibility of a bladder rupture is always present when there has been force or strong pressure on the bladder. The risk of injury is particularly high when the organ is bulging with urine. In the case of emergency braking, even the seat belt in the car can trigger a ruptured bladder. The attending physician should definitely be made aware of such occurrences. This is especially true if additional symptoms such as a strong urge to urinate and pain during urination occur. Then it should be clarified in any case by means of an ultrasound examination whether the bladder has been injured by an accident.
Treatment and therapy
Appropriate therapy for sustained bladder rupture depends on the form of the rupture and also on any concomitant injuries sustained. If a bladder rupture is accompanied by other physical injuries, these also require appropriate treatment. In most cases, an intraperitoneal bladder rupture is treated with the help of surgical procedures. For this purpose, the ruptured urinary bladder is first exposed so that the tear that has occurred can be sutured. As a rule, a patient treated in this way is then fitted with a permanent catheter (a catheter that has to be worn for a longer period of time) that runs through the urethra. Such an indwelling catheter after a bladder rupture serves to ensure continuous emptying of the bladder. If a patient has an extraperitoneal bladder rupture, the extent of the rupture usually determines the further medical procedure; in the case of a very minor bladder rupture, it may occasionally be possible to dispense with surgical procedures and limit therapy to the placement of an indwelling catheter. If a bladder rupture was caused by a pelvic fracture, this concomitant fracture can be addressed, for example, with the help of a procedure called osteosynthesis; this is a surgical procedure that restores the functionality of the injured pelvic bone.
Outlook and prognosis
The prognosis of a bladder rupture depends on the severity of the condition, the earliest possible start of treatment, and the patient’s state of health. There is a good chance of recovery as soon as there are no preexisting conditions and if the affected person receives early medical care. The larger the rupture of the bladder, the higher the probability of organ failure. In severe cases, blood poisoning may occur or other serious complications may occur.A fatal course of the disease would then be possible. Without treatment, recovery is only possible in the case of a mild bladder rupture. The existing self-healing powers could then be sufficient for the patient’s recovery. This step is not recommended, as the healing process is significantly prolonged and there is a risk that the bladder rupture will worsen. In addition, various complications can occur that pose a threat to health. Most patients can be discharged as cured after a few weeks of treatment. A surgical procedure is performed to correct the rupture so that the bladder can be fully functional again afterwards. The operation is associated with the usual risks and side effects. Despite a cure, bladder rupture may recur later in life. Therefore, to prevent recurrence, the causes of the occurrence should be clarified and treated.
Prevention
Because accidents and other sudden forces as the cause of bladder rupture usually occur unexpectedly, it is difficult to prevent the injury. A spontaneous bladder rupture can be counteracted to a limited extent by visiting a doctor at an early stage if symptoms affecting the urinary bladder occur; in this way, a longer-term health burden on the urinary bladder can often be prevented.
Follow-up care
Bladder rupture is difficult to treat because of the location of the trauma, and the wound may reopen. This makes comprehensive follow-up care all the more important. Follow-up care includes regular examinations in the hospital during the first ten to twelve weeks. These include blood pressure measurements, urine tests and, depending on the situation, imaging checks. If there is any suspicion that kidney function has not been fully restored or other complications arise, a so-called scintigraphy must also be performed at intervals, during which the kidney is checked using modern methods. Accompanying the medical measures, the affected person must continue to take care of himself. Physical exertion, especially endurance sports or bodybuilding, must be avoided. Swimming and light exercises from physiotherapy or yoga may be permitted. The patient should discuss with the doctor which measures in detail are reasonable and do not endanger the bladder. If unusual complaints occur, it is best to inform the attending physician. He or she can perform a further examination and, if necessary, arrange for a new operation. If follow-up care is performed according to the physician’s instructions, no major complications usually occur and the rupture heals completely within three to six months.
Here’s what you can do yourself
With a rupture of the bladder should definitely go to a doctor. Accompanying the medical treatment, the symptoms of a rupture can be relieved by various home remedies and tips. For example, willow bark tea, an extract of calendula or a cure with the extracts of devil’s claw help against the pain during urination. Typical medicinal herbs and plants such as verbena root, gentian or elderberry, which can also be used in the form of teas or extracts, have also proven effective. An irritated bladder can be treated with hot-moist compresses. Similarly effective are hot water bottles, cherry pit cushions or a hot shower. The latter should be done with a pH-neutral washing lotion or a special intimate washing lotion for bladder diseases. Increased intimate hygiene is generally recommended for bladder rupture. For minor ruptures, wearing an adult diaper may be appropriate. In addition, low-irritation undergarments should be worn to avoid further irritation of the intimate area and especially the bladder. In general, other bladder conditions such as cystitis or urethritis should be avoided. This and early medical clarification can prevent a severe course and further complications in the event of a bladder rupture.
