About two percent of cases carried out abdominal operations is given to the ruptures of the bladder. This organ is rarely damaged due to the protection of the pelvic bones.
The bladder is a hollow organ in which urine accumulates after the blood is cleaned by the kidneys. Bladder emptying occurs by creating pressure by the muscles of the bladder walls. At the same time, the urinary canal opens, through which the urine is excreted.
The pelvic bones protect the empty organ from damage, but in case of overflow, the top of the bladder protrudes beyond the border of the pelvis. This place is vulnerable and may rupture if injured.
Causes of damage
Bladder rupture most often occurs as a result of injury. This phenomenon can be observed in penetrating wounds with cold or firearms, as well as in severe pelvic fractures, when there is a high probability of damage to the bladder with bone fragments. Such situations are observed as a result of an accident, when falling on the stomach.
Bladder rupture may occur with medical interventions. For example, catheterization, cystoscopy, endoscopy can lead to rupture. Sometimes a bladder rupture occurs during delivery.
The reason for the rupture can be an infection that leads to a violation of the outflow of urine. Most often, this variant of the development of the disease is observed in men with prostatitis, when the inflamed prostate gland squeezes the urinary duct and urine accumulates in the bladder, causing stretching, and then rupture of its walls.
Symptoms of bladder rupture are divided into closed and open. The first type is manifested:
- urine builds up in the abdomen,
- pain in the lower abdomen, which after a few hours disperses throughout the abdomen,
- blood in the urine
- urination in small portions,
- after some time, symptoms of peritonitis appear.
When extraperitoneal rupture of the bladder observed hematuria, pain in the pubic zone, the urge to urinate.
With an open type of bladder injury, pain is observed throughout the abdomen. Due to the onset of pain, patients note the tension of the abdominal muscles, complain of urinary retention. When you try to go to the toilet, there is pain, and the urine portion is stained with blood.
When a bubble ruptures, the patient feels shock. When injured by splinters, hemorrhage into the fiber of the pelvis may occur. With such an injury, the doctor conducts the removal of all fragments, and drainage is established for the outflow of blood and urine that has entered the cavity.
When extraperitoneal ruptures over the pubis may be observed infiltration. A few days later, purulent inflammation appears on the skin, involving the tissues of the perineum, thighs, scrotum, and lower abdomen in the pathological process. With the development of the disease there is an increase in symptoms of intoxication. The patient has a fever, tachycardia.
When examining a patient, if there are no injuries, a history is taken. From it, the doctor may suggest an organ injury. For example, a man who has a history of chronic prostatitis or who has had complaints of pain during urination may refer to a doctor. This suggests prostatitis, which can lead to bladder injury.
At the reception, the doctor must specify when and what symptoms the pathology began. This may be a violation of urination, severe or mild pain. It is necessary to specify what medical procedures and when were performed. Sometimes the cause of a rupture is an improper bladder catheterization, some types of diagnostics.
Mandatory assignment of urine analysis. If there is blood, a preliminary diagnosis can be made. Finally, the rupture of the bladder is detected after instrumental methods of examination.
To make a diagnosis, the doctor relies not only on complaints and clinical manifestations, but also on data from cytoscopy, cytography and other examination methods. To determine the rupture of the bubble, a contrast agent is injected. A few minutes after its use, an x-ray is taken.
If prescribed, a patient may have a computed tomography scan. It allows you to get a three-dimensional image of the body, and also to see exactly where the damage is located, to establish the length of the gap.
Types of breaks
Diagnosis allows you to determine the type of gap. This may be intraperitoneal, extraperitoneal, penetrating or combined extraperitoneal and intraperitoneal damage.
In case of an intraperitoneal rupture of the bladder, urine can lead to peritonitis. This is due to the fact that the urine enters the abdominal cavity, which causes a complication. To remove it, an emergency operation is assigned. The doctor makes an incision on the anterior wall of the peritoneum, through which the gap is sutured, and all urine trapped in the cavity is removed. After surgery, the patient walks with a catheter, through which the outflow of urine from the damaged organ occurs. This is necessary so that all places of damage have time to heal.
For extraperitoneal damage, the gap is observed on the side or at the bottom of the organ. Signs of bladder rupture - the appearance of blood in the urine. Usually, this type of injury occurs when the catheter is not properly selected.
Sometimes a penetrating injury that requires surgery leads to injury. In this form, usually located nearby tissue, organs.
The effects of a bladder rupture are similar in different cases. Most often, trauma leads to peritonitis and osteomyelitis. Fistulas are less often observed, abscesses are formed, the integuments are broken.
When rupture occurs internal bleeding. It can lead to a decrease in pressure, increased heart rate. If not treated in a timely manner, the pathology can be fatal.
Damage to the bladder leads to the penetration of microorganisms into the tissues and organs located near the bladder. Due to the development of pathogenic microflora, symptoms of pelvic bone inflammation, peritonitis, fistula appear, anemia increases. With timely treatment to the doctor can hope for a positive result of treatment.
Treatment of bladder rupture is of two types: operative and non-operative. Conservative treatment is prescribed for light bruises, bumps.
The operative method is prescribed in the event that another method of treatment does not give the desired result. Surgery is accompanied by a cut in the abdominal wall through which the injury site is stitched. A drainage is installed next to the affected organ, along which urine and blood flow away.
Treatment of rupture requires nutritional adjustment. The patient is forbidden to eat fatty, fried, spicy, salty foods. You also can not eat foods that cause increased excretion of urine from the body. Alcohol, sweets, flour dishes are completely excluded from the diet. Preference is given to light products, best of all plant origin.
Failure to follow the diet can cause pain, seam divergence, and suppuration. To avoid this, it is necessary to strictly monitor nutrition during rehabilitation.
After a rupture of the bladder, the healing process lasts about ten days. At this time, the patient put a catheter, providing a normal outflow of urine. After the bladder heals, the patient can return to his normal lifestyle. Usually in a month, people can gradually introduce their favorite foods into the diet, drink drinks. Two months from the gap will not remain a trace. In a year, the surgical site on the surface of the abdomen will be invisible.
In the structure of general injury, mechanical damage to the bladder ranges from 0.4 to 15% (in Russia, from 1 to 7%). In recent years, there has been more frequent injury to the body, which is associated with an increase in the intensity of transport links, depreciation of the fleet, an increase in the number of severe man-made disasters and local military conflicts. The peak of trauma is observed at 21-50 years of age, about 75% of the victims are men. A special feature of injuries is the predominantly combined nature of the lesion (in 100% of open wounds and in 85% of blunt injuries, besides the bladder, the bones of the pelvis, the spine, and other organs are damaged). The urgency of timely diagnosis and emergency treatment measures is due to an unfavorable prognosis - in accordance with the estimated scales, 31.4% of victims are categorized as severe, 49.2% are extremely serious patients, the mortality rate exceeds 25%.
Causes of Bladder Injury
In most patients, traumatic damage to the bladder is associated with exposure to its wall by external mechanical factors of various origins. In rare cases, the injury is caused by the influence of aggressive chemicals installed in the bladder, or the presence of diseases that prevent urination. Causes of injury are:
- Traffic accidents. In more than a quarter of cases, the bladder is injured during an accident. Damage occurs when a direct blow to the projection of the body, a strong pressure in the vehicle, injury by shrapnel of the pelvic bones, structural elements of the car, objects of the environment.
- Iatrogenic factors. 22-23% of patients are injured during medical procedures. The wall of the organ can be damaged during its catheterization, the narrowing of the urethra, the performance of operations - transurethral interventions, cesarean section, hysterectomy, myomectomy, adenomectomy, colon resection, etc.
- Household and occupational injuries. In 10% of cases, damage occurs due to falling from a height onto a solid object. If there are prerequisites (urine overflow, cicatricial changes, etc.), the organ may rupture due to a sharp jolt of the body when jumping. In 4.2% of injured injuries occur under the influence of production factors.
- Violent actions. The integrity of the bladder can be broken with blunt bumps in the stomach, wound with a knife or other sharp objects in fights, with criminal abortions. In wartime, the number of gunshot injuries and open wounds of the body by fragments of explosive ordnance increases by 3-4 times.
- Urological diseases. Extremely rare spontaneous rupture of the bladder is observed in patients who suffer from diseases that violate urination, adenoma and prostate cancer, stenosis of the urethral neck, urethral strictures. More often, urological pathology plays the role of a predisposing factor, increasing the stretching of the organ.
The risk of the most severe injuries - partial or complete ruptures - depends not only on the strength of the traumatic impact, but also on the place of its application, direction, surprise. The likelihood of injury significantly increases with alcohol intoxication, which contributes to the overflow of the bladder due to blunting the urge to urinate and provokes traumatic behavior. Anticipating factors are also tumor lesions, fibrous changes in the wall of the organ after surgery, radiation therapy, inflammatory diseases.
The mechanism of bladder injury depends on the type of factors that caused the damage. With a blunt blow to the suprapubic region, the counter-impact of the sacrum, compression, the intravesical pressure rises sharply, the load on the urinary wall increases. The appearance of the hydrodynamic effect contributes to the intraperitoneal rupture of the organ in the area of the least developed muscles (usually along the back wall of the bladder near its apex). The wound is usually torn, with jagged edges. With a lower mechanical force, the impact causes closed injuries (bruises, hemorrhages into the wall). Similar pathogenesis is characteristic in the presence of urological diseases with impaired passage of urine.
A significant displacement of the bladder in case of mechanical injuries leads to a sharp tension of the supporting lateral and vesicular-prostatic ligaments with extraperitoneal rupture of the soft-elastic wall of the organ. A strong blow can cause a rupture of the ligaments, pulmonary blood vessels, tearing of the neck. With closed and open injuries of the vesicular membranes with sharp objects, tools, bone fragments, superficial, deep incision or through dissection of the wall occurs. The wound is usually linear. The combination with hydrodynamic impact with gunshot and comminuted injuries leads to additional radial tears of the round wound hole.
Criteria for the systematization of traumatic injuries are the severity, possible communication with the environment, the location of the gap in relation to the peritoneum, the combination with injuries of other organs. This approach allows us to predict the course of the pathological process and possible complications, to choose the optimal patient management tactics. Depending on the severity of damage to the urinary wall, injuries may be deaf (bruised, superficial wound of the outer membrane, tearing of the mucous membrane) or end-to-end (complete rupture, tearing of the neck). In turn, end-to-end damage is divided into three groups:
- Intraperitoneal breaks. Observed in more than 60% of victims. Usually due to direct blows to the overflowing bladder. Due to the flow of urine into the abdominal cavity, they are quickly complicated by peritonitis.
- Extraperitoneal breaks. Occur in 28% of cases. More often provoked by excessive tension of the supporting ligament apparatus. The injured bladder does not communicate with the abdominal cavity, urine expires in the pelvis.
- Combined breaks. Observed in 10% of victims. Multiple damage to the wall of the body is usually combined with fractures of the pelvic bones. The communication between the bladder, abdominal and pelvic cavities causes a particular severity of the pathology.
Up to 90% of peacetime injuries are closed, due to the preservation of the integrity of the skin, the damaged bladder does not communicate with the external environment. During the war period, during violent actions with the use of cold arms and firearms, the frequency of open injuries increases, in which the integrity of the skin is disrupted, a message arises between the membranes or cavity of the organ and the environment. According to the observations of specialists in the fields of traumatology and urology, the combined damage prevails over the isolated ones. In 40–42% of patients fractures of the pelvic bones are detected, in 4–10% of intestinal breaks, in 8–10% of injuries of other internal organs.
Symptoms of bladder injury
An important clinical feature of this damage is the frequent predominance of the general symptoms over the local one. Signs of hemodynamic disturbances increase in patients with severe pain and bleeding, traumatic shock is observed in 20.3%: blood pressure decreases, heart rate rises, skin becomes pale, sticky cold sweat, weakness, dizziness, stunnedness, confusion and then loss of consciousness. Due to irritation of the peritoneum with urine, patients with intraperitoneal ruptures experience intense pain in the nadlone area, in the lower part of the abdominal cavity, which subsequently spreads to the entire abdomen, accompanied by nausea, vomiting, gas and stool retention, and abdominal muscular tension.
The specific symptoms of the urinary wall injury are pain and local changes in the area of damage, dysuria. With open wounds on the front wall of the abdomen, less often - in the perineal zone, a gaping wound is revealed, from which urine can flow. For closed extraperitoneal injuries is characterized by the formation of painful swelling over the pubis, in the groin, bluish color of the skin due to their soaking with blood. Victims experience frequent false urge to urinate with a significant decrease or complete absence of diuresis, the release of drops of blood from the urethra. When urine is retained in patients with mucosal tears, the urine is stained with blood.
Mortality in traumatic injuries of the bladder, especially open and combined, reaches 25% or more. The causes of death are usually neglected forms of peritonitis, pain, infectious-toxic, hemorrhagic shock, sepsis. Traumatic injuries of the bladder wall are quickly complicated by the involvement of other organs in the process. The anatomical features of the paravesical, retroperitoneal tissue, fascial spaces contribute to urinary infiltration, the dissemination of streaks, and the formation of urohematoma. When intraperitoneal rupture occurs uroascitis. Secondary infection leads to the formation of abscesses, phlegmon. In 28.3% of patients, urinary peritonitis develops, in 8.1% - urosepsis. The upward spread of the infection provokes the onset of acute pyelonephritis. In 30% of cases with a combination of bladder injury with damage to other organs, DIC is observed. In the long-term period, urinary fistulas are sometimes formed in patients, urinary incontinence is observed.
Bladder injury treatment
Пострадавшего срочно госпитализируют в травматологическое или урологическое отделение, переводят на строгий постельный режим. Conservative management in the form of catheterization (usually for 3-5 days before cessation of gross hematuria) is possible only with bladder contusion, tears of the mucous membrane during rough medical manipulations, small extraperitoneal ruptures with a preserved lesion of the neck. The remaining victims are shown emergency reconstructive surgery with drainage of the abdominal or pelvic cavities. At the preoperative preparation stage, hemostatic, antibacterial, anti-inflammatory, analgesic drugs, and hemodynamic stabilization agents are prescribed.
The volume of the operation depends on the features of the damage. When intraperitoneal ruptures, the bladder extraperitonizes before stopping a wound to stop urine leakage and conduct a full audit, after reconstruction of the damaged organ, the abdominal cavity is sanitized without fail. Extraperitoneal injuries are sutured without extraperitonealization. Regardless of the type of injury after the restoration of the integrity of the wall, the men are given an epicystoma, the women are placed on a urethral catheter. The abdominal or pelvic cavity is drained. After surgery, continue the introduction of antibiotics, analgesics, anti-shock infusion therapy.
Prognosis and prevention
Violations of the integrity of the bladder walls are justifiably considered as severe, prognostically unfavorable injuries. Compliance with the algorithm of surgical treatment of patients provides a significant reduction in the frequency of complications, even with severe injuries. Prevention is aimed at creating a safe working environment, adhering to the rules of the road, meeting safety requirements when practicing traumatic hobbies and sports, avoiding alcohol abuse. To reduce the prerequisites for injury to patients with diagnosed diseases of the prostate, urethra, bladder, regular monitoring and treatment by a urologist is recommended.
Extraperitoneal and intraperitoneal injury
There are various bladder injuries. They are classified by location, size of injury, and mechanism of origin. Basically bladder injuries are divided into two types:
- In relation to the peritoneum. The area in which the internal abdominal organs are located is called the abdominal cavity. Damage to the bladder relative to the peritoneum are divided into:
- Extraperitoneal rupture. Such a breakthrough is a consequence of damage to the pelvic bones. Most often, extraperitoneal bladder rupture occurs in the anterior or lateral wall, which is not covered by the peritoneum. The bladder as a result of a breakthrough, completely emptied or in it remains a small part of the urine. Urine does not flow into the peritoneum, but into the soft tissues surrounding the injured organ.
- Intraperitoneal rupture. A direct impact on the abdominal area causes injury to the upper-posterior organ septum, in which muscle layers are weakly expressed. It is in this gap that the organ is connected with a thin wall lining the space of the peritoneum, in which the liver, spleen, and intestines are concentrated. As a result of the injury, the peritoneal membrane also breaks, and an intraperitoneal wall rupture appears.
- Combined gap. Mixed bladder rupture occurs in case of severe pelvic bones injuries. Urinary is at the time of injury in a crowded state. The rupture of the walls is observed in several places where there is a close connection with the peritoneal region and the pelvic region. Urine gets not only into the peritoneal cavity, but also into the pelvic area.
Partial and full gap
By severity. Any bladder injury is characterized by varying severity levels. The specialist needs to assess the degree of damage in order to calculate the possibility of complications. There are the following types:
- Only a specialist can assess the extent of organ damage.
Bruised organ. One type of closed injury. As a rule, when bruised, the integrity of the shell is not violated and there is no great danger to human health. A hematoma appears, so there is a need to remove the clots with a catheter with a large lumen. As soon as the urine color is normal and the doctor confirms that the catheter is optional, it will be removed.
In addition, damage may affect other internal organs. In relation to the organs of injury are divided:
- isolated (only bladder is injured),
- combined (injury is accompanied with injury to other organs).
Causes and damage mechanisms
As already known, most often damage to the bladder occurs as a result of injuries. Being in the deepening of the pelvic region, the body is reliably protected from all sides. If it is filled with urine, it is easily damaged, but if the “reservoir” is empty, a sufficiently strong force or through wound of the bladder will be required that violates the surface of the membrane. Factors affecting damage to the bladder, are different, but among them are the most common:
- Unfavorable jump, due to which damage to the bladder can be obtained with its fullness.
- When falling from a height down (especially on a hard plane), it is not only the organ of the excretory system that is broken, many internal systems are damaged.
- Intentionally causing a wound with a firearm or knife leads to injury directly to the area of the organ.
- A simple blow, pressure or kick in the abdomen can damage the integrity of the shell.
- Damage during medical procedures:
- installation of a catheter for removal of urine,
- widening of the urination channel,
- surgery on the pelvic organs.
- Untimely emptying under the influence of alcohol.
- Pathological conditions in the body that provoke damage:
- neoplasms of the pelvic organs or organs closely adjacent to them,
- the growth of prostate tissue,
- compression of the urethra.
Gap, its consequences
The situation in which the doctor deals with a ruptured body requires high professionalism. What happens if the bladder bursts? The further development of events is affected by the complexity of the injury, but the likelihood of complications is high:
- Severe bleeding, shock, low pressure, rapid pulse. The result of this condition may be death.
- The development of infection as a result of the penetration of toxins and microorganisms into the blood after the shell has burst.
- The inflammatory process in the area of damage and blood.
- If during a long process of inflammation an abscess has torn, the integrity of the skin is broken. There is a channel through which environmental microorganisms have access to internal organs.
- Inflammation of the membrane and internal organs of the abdominal cavity.
- Infectious inflammatory process of the pelvic bone tissue.
The main task in case of urinary trauma is to deliver the victim as soon as possible to the hospital, where there is a surgical hospital. First aid for bladder injury is to carry out anti-shock measures that stop bleeding. They are, according to the following procedure:
- Treat the area with antiseptic agents and make a bandage.
- Lay the victim on his back, legs in the "frog" position with a roller placed under his knees, his head raised. If the victim is in a strong shock condition, the body should be placed at a 45 degree angle, raising the legs and pelvis above the head.
- Apply to the stomach cold.
- Cover the body of the patient with a blanket.
- If possible, enter a medicine that provides blood clotting.
In the closed form of the injury should not be given anesthetic drugs.
Conducted with minor injuries: injury, minor extraperitoneal sheath breakthrough. For therapy use:
- Urethral catheter. It is installed in the urinary for several days.
- Strict adherence to bed rest.
- Prescribed medication:
- inhibit the growth of pathogenic microorganisms,
- stopping the blood,
- relieve inflammation,
Any traumatic rupture requires surgery, which either prevents the body from bursting completely with a minor defect or requires its complete removal. Operations are performed through cut skin or by the laporoscopic method, when instruments and a camera are inserted into a neat little incision:
- stitching gap,
- installation of drainage (tubule), which improves the flow of urine and blood,
- cytostomy, used in the treatment of men and is to install a rubber tube through the urine-excreting duct directly into the urinary.
There are no effective prophylactic methods that help avoid injury to the urinary organ, due to factors beyond human control that cause injury. But each person is able to take care of the prevention of dangerous situations and take care of personal safety measures:
- Health monitoring and timely access to a doctor. Men - control of the prostate, for women - a constant examination by a gynecologist and observation after childbirth.
- Avoiding traumatic situations.
- The elimination of alcoholic beverages.
- Regular follow-up with a specialist after injury for 3 years.
It is important to keep track of the prostate specific substance. A special antigen is a protein that tracks the work of the prostate gland. Abnormalities found in the analyzes indicate problems with work or the possible development of a neoplasm. Early diagnosis and treatment gives a favorable result for health.
Features of the structure of the body
The bladder is an unpaired hollow organ. Its size varies quite noticeably, but on average it can hold from 500 to 1000 ml of liquid. Its function is to collect the urine produced by the kidneys and bring it out through the urethra. The structure of the body in men and women is the same.
The process of collecting and excreting urine is carried out due to the tension and relaxation of the walls of the urea. When the muscles of the body are relaxed, the walls are stretched and the bladder increases in order to collect and hold a certain amount of urine. During urination, the muscles contract, pressure builds up in the bladder, due to which the output of urine occurs. The shape and size of the body is constantly changing as it is filled.
The urea is a very elastic organ, so it withstands quite a lot of pressure. In addition, anatomically, it is located very well: located in front of the pelvis behind the pubic bones.
Behind the bladder in men and women are different organs: in men - the sex glands, in women - the uterus and vagina. Since the uterus is noticeably larger than the seminal vesicles, the organ of a woman has a smaller size and cannot stretch so much and hold such a large volume as a man.
Due to the elasticity of the organ, its ruptures are unlikely, however, with strong fullness, when the walls of the organ are overstretched, the probability of such an injury increases markedly. As a rule, it is provoked by some kind of additional mechanical action. In addition, damage can be caused by injury - a fall from a great height, a gunshot or knife wound.
The ICD disease code is N32.4, the bladder rupture is not traumatic, and S37.2 is bladder injury.
Pictured bladder rupture
Bladder rupture forms
There are several types of urea injury. They are classified according to the mechanism, the magnitude of the lesion and so on.
The organ is located in the abdominal cavity.
Urea injuries to the peritoneum are distinguished as follows:
- Extraperitoneal rupture - the cause is the destruction of the pelvic bones. In this case, the gap occurs on the wall that is not covered by the peritoneum. As a result, the urea is completely emptied. Urine gets into the soft tissue around, and not into the peritoneum. Partially fluid may remain in the bladder. An intra-abdominal rupture is possible with incomplete filling.
- An intraperitoneal rupture is normal for a fully filled bladder, because at that moment it protrudes above the bones of the pelvis. When the abdomen is exposed to the abdomen, the upper-back septum of the organ is injured - here the muscle layer is most thin, as it is connected with the wall lining the abdominal space in which the liver, intestine and spleen are located. Urine while going into the peritoneum.
Both ruptures are equally life threatening and require immediate surgical intervention.
However, intraperitoneal rupture is heavier. Combined - it is registered extremely rarely, as it implies simultaneous rupture of the membrane in several places. In this case, urine enters the peritoneum and the tissues around the organ. The most common cause is a fall from a height, when the urea not only bursts due to excessive pressure on impact, but also gets injured by shrapnel bones.
In the photo the form of bladder rupture
According to severity, there are 3 types of damage:
- traumatic injury - the actual violation of the shell does not imply. A hematoma is formed, severe pain appears, blood is detected in the urine. The treatment basically comes down to the withdrawal of blood clots with a catheter. Urination while maintaining normal
- partial rupture - damage to the membrane is observed, but urine does not flow out of the bladder. Urination becomes frequent and painful, sometimes there is an acute delay,
- full - while the shell is broken, and the urine is in the peritoneum or in soft tissues. With frequent and painful impulses, independent urination is impracticable. Incomplete rupture may turn into complete with inflammation and necrotic processes in wounds, as well as due to overflow of the urea.
There are closed and isolated breaks.
Here the difference is the presence or absence of other injuries and damages:
- closed - urea injury is combined with injuries of other organs. Accordingly, the typical symptoms for rupture - hematuria, abdominal pain, urinary disorders combined with symptoms of other injuries,
- isolated - there are only ruptures of the bladder and only its inherent symptoms appear. To diagnose the disease in this case is much easier.
Depending on the severity of the injury and the area of the gap, the clinical picture is quite different. This often causes serious complications due to late visit to a doctor with isolated and injuries and incomplete sheath rupture.
- Contusion - urine for contusions does not enter the peritoneum. Urination remains normal, although it may be painful. Hematuria is weak or absent. In fact, the only sign indicating damage is lower abdominal pain, aggravated by the filling of the organ, and more frequent urination. In the lower abdomen, as a rule, hematoma is observed.
The risk of injury is not so much the damage itself as the threat of attaching a secondary infection and inflammation of the membrane and organs of the peritoneum.
- Incomplete rupture of the membrane - the ability to urinate is usually preserved, but the process becomes painful, sore. There are cases and acute delay urine. Hematuria is short-term or even completely absent, which gives the victim false hopes. The pain, however, is quite severe, changing as the urea is filled or emptied. Shock and blood loss are very rare.
An incomplete break does not cure itself. Moreover, it is very easily transformed into a full one, since even with a slight pressure of the urine the wall can not withstand and the damaged shell will break completely.
- Complete rupture is accompanied by severe acute pain, due to which the patient assumes a forced sitting position. Urine with a full break enters the peritoneum or surrounding tissue and strongly irritates the nerve endings. The stomach is swollen, usually in the area above the pubis, hematomas form on the skin surface. Urination is not possible against the background of strong, frequent and painful urges. Sometimes the output of urine is possible, but in small portions. Blood is observed in the urine.
The nature of the injury affects the manifestation of symptoms very much. From where and how the urine falls and the severity of symptoms, and the development of the disease.
- Symptoms of an intra-abdominal rupture are growing slowly over a period of 2–3 days. Such damage, unless it is a closed injury, rarely leads to shock. First there are pains in the pubic area, then the boundaries of the zone expand, painful sensations appear both in the groin and in the perineum. Observed bloating, possible intestinal paresis and delayed stools and gas. After an enema, the intestines, as a rule, begin to work. Although the pain in the abdomen is observed, it is mild and is recorded as weak on palpation.
However, after a day, the condition worsens dramatically. Urine, getting into the peritoneum, causes intoxication: there is a sticky cold sweat, severe nausea, lethargy, and leukocytosis develops. При этом симптомы непроходимости кишечника оказываются более выраженными, чем признаки перитонита.If there is no trauma data, the gap is mistaken for poisoning.
- In the case of extraperitoneal rupture, hematuria is recorded, which decreases after a few hours. This increases the frequency and pain of the urge. A swelling is formed above the pubis and in the groin. Pain syndrome is pronounced. The patient's condition worsens over time: intoxication leads to fever, leukocytosis, hypochromic anemia. During the first 24 hours, a rupture may result in phlegmon and abscesses.
Diagnosis of the disease is difficult: in 50-80% of cases, patients are in a state of shock, and this greatly changes the clinical picture. An urgent examination is needed in order to establish the cause of the symptoms as soon as possible and proceed to treatment.
Repairing damage with closed injuries is much more difficult. As a rule, the correct diagnosis for ruptures is established in 20-25% of cases. The rest need additional diagnostics. The situation is even worse with intraperitoneal ruptures, when, against the background of severe blood loss and shock, all clinical signs - bloating, rapid pulse, and urinary disturbance are either not recorded or can be explained for a variety of other reasons.
In general, the diagnostic scheme looks like this:
- examination - abrasions, bruises, subcutaneous injuries on the anterior abdominal wall are indications of a uretic lesion,
- hematuria - 82%, and soreness of the abdomen when probing - 62%, are the most characteristic signs. Other symptoms - difficulty or inability to urinate, hypotension, spasm of the abdominal wall are less characteristic and may be absent with relatively light lesions. When intoxicated, the signs are not fixed at all,
- blood test is required. The level of red blood cells, hematocrit establish the severity of blood loss,
- diagnostic clustering is the easiest and most affordable way. Used during the procedure soft catheter. At the same time, an insignificant amount of urine is established, or, conversely, a volume exceeding the bladder capacity, blood is detected in urine, high protein content. The volume of injected and outgoing fluid does not match,
- Ultrasound of the peritoneum - allows you to register free fluid in the abdominal cavity. This is not the most informative method for such cases.
- puncture of the abdominal cavity - a catheter is inserted - into the iliac regions, into the pelvic cavity, in the hypochondrium, and the liquid is taken with a syringe. If urine, blood, impurities of bile, intestinal contents are obtained, damage to the organs of the peritoneum is performed and a laparotomy is performed. If the fluid does not flow through the device, saline is first injected, then sucked off and examined for blood, urine and diastase. If they are not detected, the operation is not performed,
- retrograde cystography - x-ray examination using a contrast agent. The latter is inserted into the bladder with a catheter, and then a snapshot is taken. Thus, it is possible to accurately assess the condition of the bladder and make differential diagnostics. Today it is the most affordable and effective way to survey
- CT scan is performed in combination with retrograde contrasting, since CT is not informative when the bladder is full: urine cannot be distinguished from transudate,
- angiography - is prescribed for suspected additional foci of latent bleeding,
- MRI - usually used for combined injuries.
Intraperitoneal bladder rupture on ultrasound:
Features of bladder injury
By bladder injury is understood as any violation of the integrity of its walls. This occurs as a result of external influence. Such damage is severely tolerated by the injured and may have critical consequences. Therefore, when detecting the first symptoms, you should immediately seek help from specialists.
This organ is not protected by anything, so even a small force blow to the stomach can lead to its damage. Recovery will take a long time. The treatment will be carried out in a hospital.
How does the disease manifest?
In order to correctly determine the method of treatment, it is necessary to pay attention to the symptoms that accompany the problem. Among them are:
- Pain in the lower abdomen.
- Loss of urination.
- Detection of blood in the urine.
- Frequent urging to the toilet, but urination does not occur. There may be a small amount of blood.
- There are signs of internal bleeding, such as a drop in blood pressure, skin blanching, and rapid heartbeat.
- Manifesting signs of developing peritonitis. This phenomenon occurs when urine enters the abdominal cavity. These symptoms include: pain, which subside only in the half-sitting position, increased body temperature, increased muscle tone of the abdominal cavity, bouts of vomiting and nausea, bloating.
- If the injury is of the non-abdominal type, then a swelling may appear in the lower part of the abdomen, as well as blueing of the skin in this area.
If you experience these symptoms, you should be examined as soon as possible and begin treatment. Delay in such a situation faces grave consequences.
The main causes of injury
You can get bladder injury in the following situations:
- When falling from a height on any object.
- During a knife strike or a gunshot wound.
- With too sharp a jump. This often happens if the bladder was full during the jump.
- When the blow came in the lower abdomen.
- During the procedure, catheterization of the bladder. With the introduction of the tube into the body to ensure full flow of urine, possible damage to the walls of the bladder.
- During the dilation of the urethra. This procedure involves the expansion of the channel by introducing metal pins into it.
- Surgery for fractures of the pelvic bones.
- The following injuries can also occur: prostate adenoma, narrowing of the urethra, prostate cancer.
Often, injuries occur while intoxicated. At the same time, the urge to urinate is dulled.
Basic diagnostic techniques
To make an accurate diagnosis, the specialist conducts several diagnostic measures. These include:
- Examination of the patient and collection of anamnesis. The doctor interrogates the victim for complaints, receiving such injuries earlier, the use of any drugs.
- General blood analysis. Allows you to determine the presence of bleeding, is determined by the level of hemoglobin and red blood cells.
- Analysis of urine. The study revealed the presence of red blood cells in the sample.
- Ultrasound. Not only the bladder, but also the kidneys are being examined. This allows you to assess the size and structure of the body, to identify the presence of blood clots, a violation of the passage of urine. In addition, an abdominal ultrasound scan can be performed. It helps to detect hemorrhages in the abdominal cavity.
- Retrograde cystography. In the bladder injects a special substance, which is clearly manifested in the radiographic image. The pictures will clearly show the features of damage and the condition of the pelvic bones.
- Urography The victim is administered a drug that enters the kidneys. After that, a radiographic examination is carried out. This method allows to determine the localization of injuries, as well as the degree of its severity.
- MRI This method has a high accuracy. It allows you to examine the bladder in various projections. Thanks to this, it is possible to ascertain the nature of the damage, the degree of severity, and also the trauma of nearby organs.
- Laparoscopy. Small cuts are made in the lower abdomen. A probe with a camera is inserted through them. This examination allows to determine the presence of bleeding and its intensity, the location of the wound and the presence of associated injuries.
- CT scan. This is a radiographic method of research, which allows to obtain a three-dimensional image. With it, you can accurately determine the nature of the damage, severity, intensity of bleeding.
The choice of a specific technique is carried out on the basis of the equipment available in a medical institution, the characteristics of the patient.
Modern medicine offers the following therapeutic techniques:
- Drug treatment. The use of drugs is permissible only for minor injuries: bruising or slight tearing of the bladder wall. Prescribe hemostatic and anti-inflammatory drugs, antibiotics. In the presence of strong pain prescribe painkillers. In this case, the patient must adhere to bed rest.
- Closure of the bladder by laparoscopic or through an incision.
- Cystostomy. This procedure is applied for men. A small rubber tube is inserted into the bladder to allow urine flow.
With the spreading of urine into the abdominal cavity, drainage will be required. The specific treatment method is selected based on the severity of the injury.
What complications can cause injury?
In severe cases, complications of the disease may develop. Among them are:
- Urosepsis. An open wound can become infected with microorganisms. As a result, the inflammatory process starts.
- Shock condition due to heavy blood loss. This is manifested in loss of consciousness, rapid heartbeat, shallow breathing, falling blood pressure.
- Purulent process in the bladder.
- Osteomyelitis. This is an inflammation of the pelvic bones.
- Fistula formation. Blood and urine suppuration occurs next to the bladder. This provokes the destruction of part of the wall of the body. The result is a channel through which urine can flow into the abdominal cavity.
- Peritonitis. Appears when urine enters the abdominal cavity.
If such effects occur, an additional complex of therapeutic measures will be required. The program is developed by the attending specialist based on the characteristics of the disease.
How to prevent injury?
In order to avoid serious health consequences, the following recommendations should be followed:
- Determine and treat prostate diseases in a timely manner.
- Try to avoid traumatic situations.
- To give up bad habits, especially the use of alcoholic beverages.
- Regularly monitor the level of prostate-specific antigen. Its concentration increases with prostate diseases.
If the injury did occur, then for three months after the end of treatment, it is necessary to be observed by a urologist.
Timely diagnosis and proper injury therapy will help avoid serious health consequences. At the first warning signs, contact your doctor.
Intraperitoneal bladder rupture
Access: lower median laparotomy. Layers dissect the abdominal wall, open the abdominal cavity.
Remove exudate, bloody urine. Detect the place of the gap. Depending on the degree of rupture, the defect of the bubble is stitched. The gap in the wall of the bladder is sutured with absorbable threads of two-three-row suture, not capturing the mucous membrane.
Completion of the operation. With reliable closure of the defect of the bladder, the abdominal cavity is sewn up tightly. If there are doubts about the reliability of the seams in the pre-vesicle space, a tampon and tube are left. A catheter is inserted into the bladder through the urethra to remove urine.
The wound of the abdominal wall is sutured in layers tightly or before drains.
Extraperitoneal bladder rupture
Technique of operation. They stop bleeding, remove blood clots and foreign bodies. SUBSTANCE: wound stitching of the bladder wall is performed with a double-row suture with absorbable threads. Put the third row of stitches on the paravesical tissue. Drainage tubes are usually inserted into the wound and left open or sewn up to the drains with seaming stitches. In the absence of inflammation, the drains tighten and are removed after a few days. With appropriate indications on the 6-8th day impose secondary seams on the wound of the abdominal wall.
B. D. Ivanova, A.V. Kolsanov, S.S. Chaplygin, P.P. Yunusov, A.A. Dubinin, I.A. Bardovsky, C. N. Larionova
Puncture of the bladder is made when it is full and it is impossible to empty it naturally or by catheterization.
Varicocele surgery is the creation of artificial venous outflow paths from the testicle and the treatment of renal venous hypertension.
Phimosis - the impossibility of displacement of the foreskin for the glans penis. Paraphimosis - strangulation of the glans penis, is often a complication of phimosis, resulting from the forced displacement of the narrowed foreskin behind the glans penis.
Consequences of a bladder rupture
A bladder rupture, if left untreated, can have negative and irreversible consequences for a person. How the injury is diagnosed correctly, what symptoms and signs will occur when an intraperitoneal organ is damaged, you can find out more in detail below.
Signs of a bladder rupture
Bladder rupture refers to those types of injuries that require immediate treatment in a hospital.
Elimination of traditional methods in this case is not suitable, since such a severe degree of the disease is subject only to surgical treatment.
Symptoms of bladder rupture will help not only to overcome further consequences, but also be able to warn the victim when you need to contact the medical institution immediately. Symptoms and signs of damage to the bladder include:
- Lower abdominal pain. (To find out all about the causes of pain in the lower abdomen, follow the link)
- Frequent urge to urinate or, conversely, delay urine emission.
- Blood urination support. Signs of blood inside the body: pale skin, rapid pulse, low pressure.
If a person has a complication of rupture of the organ in the form of peritonitis - intraperitoneal damage, which is accompanied by damage to the joint cavity of the bladder with the abdominal cavity. Symptoms and signs may occur such as:
- Severe pain in the supine state.
- Rare chair.
If the rupture of the internal organ is extraperitoneal, the consequences will be as follows:
- Swelling in the groin area.
- Over the pubis will be the skin of a blue tint.
It is noted that the damage occurs due to injury, stroke, overcrowded organ, fracture and other factors that affect the integrity of the bladder. The type of damage is:
- Combined, due to which a pelvic bone fracture is formed.
The consequences of late treatment and diagnosis of the damaged place in the human body may have a high degree of complication in the future. When detecting minimal signs, it is recommended to consult a doctor. All about bladder symptoms and treatment
Bladder rupture treatment
Treatment of tearing of the wall of the organ or urethra can occur as a conservative non-surgical, and with the implementation of the operation. The first type of treatment can occur in frivolous cases when functional impairment of the urethra is insignificant: a bruise and not a serious blow.
Surgery for bladder rupture can occur when it is not possible to eliminate the cause in any other way. Surgical intervention is accompanied by a cut of the abdominal skin. Due to this, the introduction of instruments with a video camera, the elimination of the gap, the installation of tubes next to the affected organ, through which blood and urine expire, take place.
If you do not eliminate the signs of any disease, in particular the urinary organ in time - the consequences are irreversible.
If the bladder still managed to burst, the person may have heavy bleeding with possible shock and loss of consciousness, low blood pressure, rapid pulse rhythm.
Such signs can be fatal if you do not seek help for a fairly quick time.
Damage can lead to the accumulation of a huge number of microbes and the formation of inflammation of the pelvic bones and walls of the abdominal organs. If the problem is not solved, you can rarely hope for a positive result.
Diet after bladder rupture
Diet is based on a variety of failures in food. It is often recommended to eat light food without adding a large amount of salt and spices. Preference should be given to products of plant, rather than animal origin. It is mandatory to exclude alcohol. Flour, sweet, fried and fat in the first days of postoperative treatment should be excluded.
One misbehaving misconduct in non-compliance with the diet can play a cruel joke with the patient. You should treat your health with full responsibility, closely monitor the symptoms and signs that may occur after the intervention of the surgeon.
Symptoms of a bladder rupture
The most characteristic sign of damage to the bladder is urinary disorder. Along with the pain syndrome, victims complain of constant urge to urinate and inability to empty the bladder. At the external opening of the urethra drops are detected or blood clots.
If, during intraperitoneal rupture of the bladder, all urine enters the abdominal cavity, urination may be absent.
Subsequently, due to an increase in the phenomena of urinary peritonitis, a forced position of the patient on the back is noted, nausea, vomiting, dry tongue, abdominal distention, pain and muscle tension of the anterior abdominal wall, symptoms of peritoneal irritation, dullness of percussion sound in unstable abdomen, tachycardia. When the finger study of the rectum is detected overhanging its front wall.
When extraperitoneal rupture of the bladder in combination with a fracture of the pelvic bones, severe shock is observed, significant bleeding into the tissue of the pelvis from the bone tissue and from the vessels of the soft tissues, urinary infiltration of the paravesical cellulose.
These injuries are accompanied by pain and muscle tension in the lower sections of the anterior abdominal wall. Above the bosom are determined stupidity as a consequence of urohematoma and urinary infiltration.
The latter is often found with a finger examination of the rectum.
Combined (extra- and intraperitoneal) damage, and especially the combination of a gap with damage to internal organs and pelvic bones, are the most difficult and difficult to recognize. Expectant tactics for suspected bladder rupture is unacceptable. The success of treatment depends entirely on early diagnosis and timely surgery.
When emergency catheterization detect a small amount of urine or its complete absence, an admixture of blood. There may be a lot of urine, if all of it is drained into the abdominal cavity, where the catheter came out through a wound in the bladder wall. In this case, a diagnostic error is possible.
The decisive role in the diagnosis of closed bladder injuries belongs to contrast vesicography, which makes it possible to detect the leakage of a contrast agent into the free abdominal cavity or outside the contour of the bladder.
A completely safe and informative method of investigation is excretory urography.
Symptoms and first signs of bladder rupture
Bladder rupture is quite rare, as this organ has good pelvic bones protection. Vulnerable, it becomes when it is filled, as it increases, and its tip is in the abdomen. In addition, it may be damaged due to injury. The rupture of the walls of this organ can lead to serious consequences.
Types of damage
Damage to this organ is divided into extraperitoneal and intraperitoneal rupture of the organ. Damage, called intraperitoneal, is quite dangerous. It occurs when the organ is full.
The walls of the bubble in its upper part are the thinnest, namely, it is at risk. The danger is that in this case, urine is poured directly into the abdominal cavity, spreading to the tissues of the spleen, liver, and intestines.
All this is fraught with inflammation, which may be complicated by peritonitis.
Extraperitoneal rupture occurs usually in injuries, when bone fragments damage the mucous membrane and muscle layer. Urine in this case penetrates the surrounding tissue. Consequences - flow of urine in the perineal region, pubis, development of phlegmon, hemorrhages in the retina of the eye are possible.
Symptoms and manifestations
Symptoms of bladder rupture occur very quickly. First of all, it is pain, which can be of different intensity. With extraperitoneal damage, pain will accompany urination.
It is often localized above the pubis, in the perineum, and there may be pain in the lower abdomen. A person has difficulty urinating, the amount of urine is less.
In almost all cases of trauma to the bladder, hematuria, that is, blood in the urine, is present, which is caused by rupture of the bladder tissue. Painful symptoms of intra-abdominal rupture manifest paroxysmal. The pain is felt in the perineum, in the pubic area, and soon in the entire abdomen.
- Puffiness in the pubis and perineum.
- Increased abdomen.
- Pallor of the skin.
- Cold sweat.
- Slow breathing.
If the rupture occurred due to a bone fracture or another serious injury, then the patient's blood pressure drops sharply, and heart palpitations appear.
Perhaps the development of a state of life-threatening shock.
Catheterization is carried out with extraperitoneal injuries. After installing the catheter, the urine freely exits the bladder without accumulating in it. This allows the tissues to not experience stress and allows them to heal. If scarring does not occur, then resort to surgery. It is also necessary if an intraperitoneal rupture of the walls of the bladder occurs.
During the operation, an incision is made in the peritoneum to gain access to the organ. Next, its walls are stitched together. Installing a catheter is required. This is required to give the body peace and opportunity to recover. This is necessary for the entire period of rehabilitation after surgery.
In case of injuries as a result of injuries, the operation is necessary, because the probability of damage to other organs is also high. Since the consequences can be very dangerous, even fatal, it is impossible to delay the adoption of measures. These cases require emergency medical care.
Causes of bladder rupture - how to avoid the development of the disease
The bladder is a hollow intramuscular sac. It is located in the small pelvis of the human skeleton. Its walls are very elastic, can strongly stretch. An adult can fit about a liter of urine into the bladder. Long and often urge to urinate is a bad practice. The bubble is strongly stretched, the muscles of its walls are overloaded.
At best, an uncontrolled, spontaneous urine output will occur. Not the most pleasant thing that can happen to a person in society. But in the worst case, the walls of the body will not withstand a strong load and tension, and can simply burst. The result is a rupture of the bladder. Such damage can be of two types:
- Extraperitoneal. Such a gap occurs, as a rule, if the bubble is empty or not completely filled. When damaged, its contents enter the soft tissues around the bladder and do not enter the peritoneum.
- Intraperitoneal. Here the situation is more complicated. There is such a gap always with a full bladder, when its upper part rests against the wall of the abdominal cavity. And since the thinnest muscles are on this tip, then with an external influence the gap occurs exactly there. The contents of the bladder goes into the peritoneum. This increases the risk of inflammation of other abdominal organs.
The photo shows extraperitoneal (left) and intraperitoneal (right) bladder ruptures.
The causes of bladder rupture are few. These are, for the most part, injuries and fractures observed in road accidents, falls from a height or severe injuries to the lower abdomen.
Moreover, the type of damage (extraperitoneal or intraperitoneal) will depend on how much the organ was filled in when it was struck or dropped. It should also be mentioned that breaks can also occur from a penetrating injury: a gunshot or knife.
Any intraperitoneal ruptures of the bladder, as a rule, are also accompanied by damage to other internal organs.
To minimize the effects of damage and injuries of the bladder can only provide medical assistance in time. Because the vast majority of cases of violation of the integrity of the muscular wall of this organ requires surgical methods of treatment.
The torn wall can only be sewn up, it does not grow together, in simple terms. Only a small percentage of extraperitoneal single and very small area ruptures are able to prolong themselves.
But this is possible only under the condition of serious medical and inpatient treatment. That is why it is important to quickly and accurately understand that this disease is in front of you.
To do this, you need to know what characterizes this type of disease in order to get rid of the problem as soon as possible.
We list the reasons for the presence of which should immediately contact the medical facility. So, the main symptoms include the following:
- Lower abdominal pain. They can be both strong and dimly pronounced, dull and aching.
- Serious urination disorders. A person cannot urinate on his own, the urge to do so is either too frequent or not at all.
- The main symptom of all types of bladder ruptures is the presence of blood in the urine that is visible to the eye. In this case - do not hesitate a minute. The situation is more than serious.
- The body temperature may increase, severe back pain may occur.
- Sometimes there may be some swelling in the suprapubic area or in the perineum. This is especially true for the extraperitoneal rupture.
Learn about the details of the functioning and prevention of diseases of the bladder can be from the following popular science video:
How to cure a disease
The final diagnosis confirming the rupture of the bladder, of course, will be put by a qualified doctor. First, he visually examines the patient, probes the problem organ. Not superfluous and conducting ultrasound diagnosis of the pelvic organs and internal organs of the abdominal cavity.
Further, it is imperative to conduct special types of research, such as cystography or urography. A special substance called “contrast” will be injected into the bubble. Then an x-ray of the damage area will be made from several angles.
And it will be seen where the contrast agent "flows" out of the bladder.
Thus, the gap will be confirmed and the place of its localization will be accurately determined. And only when the diagnosis is fully confirmed, does the preparation and carrying out of the operation to restore the integrity of the bladder begin.
It takes several weeks to fully restore the normal functioning of the organ after surgery or catheterization. It will be necessary to observe, take tests and periodically undergo examinations in a medical institution for several months.
This is the only way to avoid complications and surprises in the post-hospital period. Remember, only a qualified specialist can prescribe treatment, and you should not look for a solution to the problem in various forums, as well as with the help of advice from friends.
Recovery period after illness
It takes a long recovery if the bladder ruptures repeatedly. This concerns the functional performance of the bladder, it will take a lot of time and effort.
First, it will be necessary to restore the liver and kidneys “loaded” during intensive treatment. Do not do without the restoration of intestinal microflora, put under attack by antibiotic therapy.
What can we say about the bubble itself, it will have to take care of and rehabilitate. Do not avoid a diet that excludes fatty, salty, smoked.
Needless to say, alcohol and smoking are also prohibited. All that irritates the mucous membrane of the urogenital system.
For the entire period of rehabilitation, excessive exercise and sports are excluded. It is impossible to supercool and overheat. All - in moderation.
Hypothermia entails inflammatory diseases, and overheating prevents full healing.
If you are overtaken by the symptoms described, you should immediately inform your doctor.
Prevention of this disease
The only adequate prevention of bladder rupture will be its timely emptying. Do not forget to go to the toilet before a long trip or a long hike. Do not tolerate a feeling of fullness in the bladder.
Do not force its walls to thin and overly stretch. After all, even a trivial fall from a bicycle with an overflowing bladder can end very sadly.
Even a weak blow to the area of the abdomen, in the case of filling the bubble can lead to its rupture.
A healthy adult should empty his bladder five to seven times a day. This is a good habit, do not ignore it. It is also useful for strengthening the walls and healing the mucous membrane of the kidneys and bladder to use for drinking decoctions of herbs and medicinal plants, renal herbal tea and fees. Thus, rupture of the bladder does not threaten you.
What is a bladder?
Bladder is a hollow, spherical organ that is located in the pelvic cavity.
The bladder is a reservoir for urine (liquid waste products of the body that are produced by the kidneys during the blood purification process).
Muscle tissue in the wall Bladder allow you to create enough pressure to release urine through urethra.
How does bladder rupture occur?
When bladder empty, it is protected from damage by the bones of the pelvis, located in the lower abdomen. As far as filling upper bladder more into the abdominal cavity, making it more vulnerable.
In children, pelvic bones do not reach their full development, so the bladder is more easily injured than in adults. If the impact force is large enough to come fracture of the pelvic bones, the bladder can be injured, even if it is empty.
A bullet or knife can also damage the bladder, regardless of the presence of fluid in it.
Symptoms of a bladder rupture
In almost all cases bladder rupture, blood will be present in the urine. There may be pain below the navel, but often the pain at the rupture of the bladder is not very pronounced.
When the bladder ruptures, anuria may occur (complete absence of urine). This happens when bladder rupture a large defect forms in its wall, and all urine enters the abdominal cavity.
In women, with extensive damage, a rupture of the vagina can occur along with the bladder. If this happens, in this case, blood may flow from the bladder through the vagina.
Other symptoms may include: difficulty urinating at the beginning, a weak stream when urinating, painful urination, fever and severe back pain.
How to diagnose a bladder rupture
Your doctor can make a diagnosis. bladder rupture based on his cystoscopy and cystography.
Cystography is performed with a liquid contrast agent, which is injected slowly, heated to body temperature and in not too large quantities (150 ml), and an x-ray image is taken after 1-2 minutes to fill the bubble.
Contrast agent injected with a urinary catheter inserted through the urethra.
What types of bladder traumatic injury exist and how to treat them?
Injury: In most cases, the walls of the bladder are not broken, and bladder injury occurs.
If this occurs, it is necessary to catheterize the bladder with a large lumen catheter in order to allow the clots to exit.
As soon as the urine becomes clear, and your doctor decides that there is no need for the further presence of a catheter in the bladder, your doctor will remove your urethral catheter.
Intraperitoneal bladder rupture: If a rupture occurred at the top of the bladder, then a message is possible with the abdominal cavity, which contains all the vital organs (liver, spleen and intestines). This damage must be surgically repaired.
Urine poured into the abdominal cavity is a serious problem. In this case, make a cut on the anterior abdominal wall and sew up the gap of the bladder.
In the postoperative period, the catheter remains in the bladder for several days in order to allow the damaged tissues to restore their structure.
Extraperitoneal bladder rupture: If there is a gap at the bottom or on the side walls of the bladder, urine does not enter the abdominal cavity, but into the soft tissues around the bladder.
Most urologists believe that such damage requires surgical treatment, but in some cases, bladder catheterization with a large-diameter urethral catheter is necessary to allow the bladder to drain from urine and blood into the urinal trap.
If the catheter is not properly emptied, then surgery is necessary. Restoration of bladder function occurs for at least 10 days, and the catheter is removed after a control radiography of the bladder.
Penetrating bladder injuries: Patients with penetrating wounds of the bladder are operated on with surgery. As a rule, with a penetrating injury, the neighboring organs are also damaged, which also require surgical treatment. The catheter remains in the bladder for emptying urine and blood, as described above.
The postoperative period with bladder rupture
Remove urinary catheter a few weeks after normal urination. In order to prevent infectious complications, antibiotic therapy is carried out.
Some patients may develop overactive bladder (involuntary loss of urine in combination with an urgent urge) for several weeks or months.
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V.A. Shaderkina - urologist, oncologist, scientific editor at Uroweb.ru. Chairman of the Association of Medical Journalists.
Burst bladder: symptoms and treatment
Bladder rupture is not a frequent occurrence. The body is very elastic and can accumulate urine for a long time, “disturbing” a person only with active urge to urinate.
But in a crowded state, the bubble becomes vulnerable: this is facilitated by the thinning of the stretched walls. As a result, any mechanical effect can provoke a gap.
By what signs can we understand that the bladder burst? What to do in this case?
The symptoms of bladder rupture manifest themselves very clearly, and it is unlikely that the patient will be able to remain in the illusion that everything is in order with the body. The main features of a bursting organ include:
- Soreness in the lower abdomen (under the navel and near the pubis). Her character is different - from light aching to acute.
- A bulge or puffiness localized in the groin or above the pubis.
- Fever, fever, chills, general discomfort.
- Hematuria - the appearance of blood in the urine.
- Problems with urination - urges are felt, but urine is not removed from the body. In some cases, the desire to urinate does not occur at all.
- Sometimes - severe back pain.
It is necessary to understand one feature of the bladder: it does not burst without a reason. Even a prolonged enduring of desires in a small way will not be a reason for a break: the organ is designed for a serious “burden,” in the worst case, the person is simply writing.
Another thing is if the filled bubble is subjected to mechanical stress. Since, due to the accumulated urine, the walls of the organ are stretched, and its size is increased in comparison with the norm, the "urea" slightly stands behind the area of its usual location and loses the protection of the pelvic bones. In this state, extremely dangerous:
- the fall,
- shaking in transport,
- push in the stomach.
Each of these "events" can be a decisive factor that will lead to a rupture. We should not forget about the more obvious injuries - a gunshot or knife wound, as well as injuries resulting from an accident.
If the above symptoms occur after an incident that is “stressful” from the point of view of a full bladder, then it is necessary to consult a doctor immediately. Without the help of a specialist in this case can not do.
Signs of a bubble rupture can be detailed: for each type of injury, the symptoms are somewhat different.