The Effects and Outcomes of a Bladder Injury An injury to the bladder during a C-section can have a wide range of health complications, including: Bladder puncture or laceration. Pain or discomfort. Loss of bladder control.
There are numerous signs and symptoms, including hematuria, oliguria, lower abdominal pain, ileus, ascites, peritonitis, sepsis, fistula, and an increase in the blood urea nitrogen/creatinine ratio, which might appear in the early post-operative period and are symptomatic of bladder injury.
Complications of cuts or injury to a bladder include:
The first probable outcome is that urine seeps through the perforation and into the abdominal cavity, producing peritonitis. This causes symptoms such as fever, vomiting, diarrhoea, and, if not treated promptly, sepsis.
Complex injuries of this type should be repaired with surgery. But often it can be treated by simply placing a wide catheter into the bladder to keep it empty. The urine and blood drain into a collection bag. It usually takes at least 10 days for the bladder to heal.
Bladder injury is an uncommon complication of cesarean delivery (CD) with an incidence ranging from 0.0016% to 0.94%. The risk factors are emergency CDs, subsequent CDs, trial of normal delivery after CD and whether adhesions are present or not.
The bladder is classically repaired in two layers with running absorbable suture. Watertight closure is ensured with irrigation by filling the bladder in a retrograde fashion through a urinary catheter. The bladder can also be filled in a retrograde fashion with methylene blue to identify leaks.
Approximately 85% of such injuries will heal within 7 to 10 days, at which point the catheter can be removed and a trial of voiding completed. Overall, nearly all extraperitoneal bladder injuries heal within 3 weeks.
Long-term indwelling urethral catheters are associated with many risks, including urinary tract infection, catheter shedding, difficult extubation, urethral stricture and bladder mucosal damage, among others.
Bladder damage.
If the bladder becomes stretched too far or for long periods, the muscles may be permanently damaged and lose their ability to contract.
Women who have a caesarean can also develop bladder problems. Having a caesarean can reduce the risk of severe incontinence from 10% to 5% for the first baby, but after the third caesarean women are just as likely to develop bladder problems as women who give birth vaginally.
Adhesions formed from previous Cesarean section (C-section) are a significant risk factor for bladder injury.
In most cases, patients with bladder rupture have gross hematuria (77% to 100%). Other symptoms of bladder rupture include pelvic pain, lower abdominal pain, and difficulty voiding. It is important to note that trauma to the urinary tract is frequently associated with other traumatic injuries.
Cesarean birth is associated with a higher rate of injury to abdominal organs (bladder, bowel, blood vessels), infections (wound, uterus, urinary tract), and thromboembolic (blood clotting) complications than vaginal birth. Cesarean surgery can interfere with mother-baby interaction in the birthing room.
Overall, continence rates were 37.3% 48 hours after catheter removal, 54.4% 1 week, 77.5% 4 weeks, 92.1% 12 weeks, and 97.9% 24 weeks after catheter removal (Figure 1). The median time to regain continence was 1 week.
Increase the time between toilet visits by 15 minutes each week, to a maximum of 4 hours. Standing very still or if possible sitting on a hard chair. Distracting yourself, eg, counting backwards from 100. Squeezing with your pelvic floor muscles.
Your bladder and urethra may be irritated for 24 to 48 hours after the catheter has been removed. Your first attempt to urinate should be about 2 ½ to 3 hours after your catheter was removed. o This could overfill your bladder before it has had a chance to recover, making urination more difficult.
The most common symptoms of urethral injuries include blood at the tip of the penis in men or the urethral opening in women, blood in the urine, an inability to urinate, and pain during urination. Bruising may be visible between the legs or in the genitals. Other symptoms may arise when complications develop.
Bruised bladders generally do not require any interventions and will heal on their own. Rare cases may require a foley catheter to be placed if there are large blood clots that may not be able to be passed. This catheter may stay in place for a few days to a week depending on the extent of the injury.
[19] It can be repaired by simple running stitches of both layers - first layer consists of mucosa & muscularis and second layer consists of serosa. The first layer is sutured with 3-0 and second layer with 2-0 polyglycolic acid suture.
Extraperitoneal bladder rupture
The most common type of bladder injury, accounts for ~85% (range 80-90%) of cases. It is usually the result of pelvic fractures or penetrating trauma.
Although bladder contusion is a common injury that may be treated non-operatively, full thickness bladder rupture should be considered in the differential diagnosis as a potential surgical emergency.