Bladder Trauma Clinical Presentation

Updated: Mar 26, 2019
  • Author: Bradley C Gill, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Aside from iatrogenic injuries, patients with signs and symptoms of bladder injury will likely relay a history typical for pelvic trauma. This is fairly straightforward, and generally includes motor vehicle collisions, deceleration injuries, or assaults to the lower abdomen. If the patient is unconscious, family members or emergency services personnel may be able to provide the history.

Typical histories in patients with bladder trauma include the following:

  • Bladder injury from a motor vehicle collision may occur from direct impact with the car or indirectly from the steering wheel or seatbelt

  • Deceleration injuries of the urinary bladder usually result from falling a great distance and landing on unyielding ground

  • Assault to the lower abdomen by a sharp kick or blow may result in a bladder perforation

  • Penetrating injuries to the bladder usually result from high-velocity gunshots or sharp stab wounds to the suprapubic area [18]

Clinical signs of bladder injury are relatively nonspecific. Patients often present with the triad of gross hematuria, suprapubic pain or tenderness, and difficulty urinating or inability to void.

Hematuria invariably accompanies bladder injury. Gross hematuria is the hallmark of bladder rupture but is not unique to the injury. Almost every (98%) bladder rupture is accompanied by hematuria. Gross hematuria does not always occur, however; in approximately 10% of cases, the hematuria is microscopic.

Most patients with bladder rupture complain of suprapubic or abdominal pain but many can still void. The ability to urinate does not exclude bladder injury or perforation, however.


Physical Examination

An abdominal examination may reveal distention, guarding, or rebound tenderness. Absent bowel sounds and signs of peritoneal irritation indicate possible intraperitoneal bladder rupture. A rectal examination should be performed to exclude rectal injury, and in males, to evaluate prostate location. If the prostate is "high riding" or elevated, proximal urethral disruption should be suspected. In the setting of motor vehicle collision or crush injury, bilateral palpation of the bony pelvis may reveal abnormal laxity or mobility, indicating an open-book fracture or disruption of the pelvic girdle.

If blood is present at the urethral meatus, suspect a urethral injury. Perform retrograde urethrography to assess the integrity of the urethra. It is crucial that urethral integrity be confirmed before attempting to blindly pass a urethral catheter.