Traumatic injury of the bladder and urethra involves damage caused by external force.

Injuries to the bladder can be divided into blunt trauma (such as a blow to the body) or penetrating wounds (such as bullet or stab wounds). The nature of the injury to the bladder depends on the fullness of the bladder at the time of injury as well as the mechanism of the injury.

Traumatic injury to the bladder is uncommon. Only about 8-10% of pelvic fractures are associated with bladder injury. Because the bladder is located within the bony structures of the pelvis, it is protected from most external forces. Injury may occur if there is a blow to the pelvis that is severe enough to break the bones and cause bone fragments to penetrate the bladder wall.

Other causes of bladder injury include surgeries of the pelvis or groin, including hernia repair and abdominal hysterectomy. Injury to the urethra (the tube that carries urine out of the body) is slightly more common, especially in men. It is rare in women. Injury to the urethra includes cuts, tears, bruises, and similar injuries.

Injury to the bladder or urethra may cause urine to leak into the abdomen, leading to infection (peritonitis). This type of injury is more common if the bladder is full.

There may be severe bleeding and loss of fluids. Scarring (stricture) or obstruction of the bladder or urethra from swelling may develop.

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

• Difficulty beginning to urinate or inability to empty the bladder
• Small, weak urine stream
• Blood in the urine or at the urethral meatus
• Abdominal pain, lower
• Pelvic pain
• Painful urination

Emergency symptoms indicating shock or hemorrhage:

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

Note: Symptoms follow a history of injury.

Examination of the genitals may reveal injury to the urethra. If injury is suspected, a retrograde urethrogram should be done to show the structure of the lower urinary tract.

Palpation (examination by touch) over the bladder may show tenderness and bladder fullness,  caused by retention of urine. Examination of the abdomen or rectum may show a bladder injury or swollen (distended) bladder. If the bladder lining has been disturbed, urine may escape from the bladder into abdominal cavity, and the patient may only complain of vague abdominal pain or discomfort associated with inability to empty their bladder.

Other signs of pelvic injury must be considered. These include brusing over the penis, scrotum, and perineum. The person may have tender and unstable pelvic bones.

There may be signs of hemorrhage or shock, including decreased blood pressure -- especially in cases of pelvic fracture.

A Foley catheter (a tube that drains urine from the body) may be inserted.