Injury - bladder and urethra; Bruised bladder; Urethral injury; Bladder injury; Pelvic fracture; Urethral disruption

• Abdominal pain, lower
• Blood in the urine or at the urethral opening
• Difficulty beginning to urinate or inability to empty the bladder
• Loss of fluids
• Painful urination
• Pelvic pain
• Severe bleeding
• Small, weak urine stream

Emergency symptoms indicating shock or hemorrhage:

• Decreased alertness
  • Coma
  • Drowsiness, lethargy
• Increased heart rate
• Pale skin
• Sweating
• Skin cool to touch

Note: Symptoms follow a history of injury.

Scarring (stricture) or obstruction of the bladder or urethra from swelling may develop.

If urine retention occurs, there may be an increased risk of urinary tract infections (UTI).

An examination of the genitals may show injury to the urethra. If the health care provider suspects an injury, an x-ray of the urethra using dye (retrograde urethrogram) should be done to show the structure of the lower urinary tract.

Examination may also show:

• Bladder injury or swollen (distended) bladder
• If the bladder lining has been disturbed, urine may escape from the bladder into the abdominal cavity.
• Other signs of pelvic injury, such as brusing over the penis, scrotum, and perineum
• Signs of hemorrhage or shock, including decreased blood pressure -- especially in cases of pelvic fracture
• Tenderness and bladder fullness when touched (caused by urine retention)
• Tender and unstable pelvic bones

A catheter (a tube that drains urine from the body) may be inserted once an injury has been ruled out. An x-ray of the bladder using dye to highlight any damage can then be done.

Images

Female urinary tract

Bladder catheterization, male

Bladder catheterization, female

Male urinary tract

Review Date: 06/21/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)