Bladder Tamponade - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

A thrombus is a clot that forms when blood turns from a liquid to a solid. An embolus is a blood clot that breaks and travels from one place in the body to another. A blood clot or embolus can partially or completely block blood flow in a blood vessel or organ. A blockage in an artery can prevent oxygen from reaching the tissues in that area. This is called ischemia. Ischemia can lead to tissue damage or death if not treated promptly. Tamponade is a blockage of blood flow out of the heart, and in the case of the bladder, it is a blockage of urine out of the bladder due to a blood clot stopping the flow.

What Is Bladder Tamponade?

The term tamponade means obstruction, specifically hemostasis. Tamponade is a very effective method of hemostasis. In urology, bladder tamponade is an emergency in which the bladder fills with large blood clots. This thrombus (blood clot) formation is most commonly caused by bladder cancer.

What Are the Causes of Bladder Tamponade?

There are various causes of bladder tamponade. Common causes of bladder tamponade include-

• Bladder tamponade can occur secondary to bladder cancer.

• Bladder cancer causes profuse bleeding that fills the bladder cavity, leading to obstruction (tamping) of urine flow.

• Bladder padding is also seen in pregnant patients with placenta previa (In pregnancy, the placenta covers the opening of the uterus).

People on the following medication are more prone to bladder tamponade:

• Penicillin.

• Aspirin.

• Blood thinners, such as Heparin or Warfarin.

• Cyclophosphamide, a drug used to treat certain types of cancer.

The less common causes of bladder tamponade include -

• Rare blood disorders such as sickle cell anemia, Alport syndrome, and hemophilia.

• Heavy exercise or a blow to the kidneys can also cause blood to appear in the urine.

What Are the Risk Factors for Bladder Tamponade?

Factors that increase the likelihood of bladder tamponade include

• Age: Occasionally, men over 50 experience hematuria (blood in urine) due to an enlarged prostate.

• Recent Infections: Kidney inflammation after viral or bacterial infection (post-infectious glomerulonephritis) is a major cause of visible blood clots in the urine of children.

• Family History: If a family history of kidney disease or kidney stones is present, a person may be prone to bleeding in the urine and are likely to get clots in the bladder.

• Medications: Certain drugs, such as Aspirin, non-steroidal anti-inflammatory analgesics (NSAIDs), and antibiotics, like penicillin, are known to increase the risk of bladder clots.

• Strenuous Exercise: Long-distance runners are particularly prone to exercise-induced urinary bleeding and clots. The condition is sometimes called joggers hematuria. But anyone who runs excessively hard may develop a bladder clot.

What Are the Symptoms of Bladder Tamponade?

The signs and symptoms of bladder tamponade include

• Pain: Bladder tamponade is very painful. The pain is usually sharp, spasmodic, intense, and found above the pubic bone.

• Soft Solid Mass: The bladder is easily palpable above the pubic bone. Its consistency ranges from soft to hard.

• Lack of Urine: Pain during urination- A person is unable to urinate for several hours. There is the presence of severe colic with a strong urge to urinate. The passed urine is red due to the presence of blood.

• Anemia: There is a lot of blood loss. The affected individual may appear pale and anemic.

• Tachycardia: Increased heart rate.

• Hypotension: Low blood pressure.

What Are the Possible Complications of Bladder Tamponade?

Some causes of blood clots in the urine are serious, so a physician should be contacted in case symptoms of bladder tamponade are noticed. If the symptoms are due to cancer, ignoring it can cause the tumor to progress to a level that is difficult to treat. Untreated infections can eventually lead to kidney failure.

Suppose bladder tamponade is being caused by medications, such as blood thinners; ignoring it can lead to painful urination or reduced urine output and infection of the bladder.

Bladder tamponade causes urinary retention and rapid enlargement of bladder volume, resulting in obvious damage to bladder muscle fibers. Any external force can cause bladder injury more easily.

When to Get Help for Bladder Tamponade?

Because some causes of bladder tamponade are serious, people should see a doctor when they first develop hematuria (presence of blood in urine). Even a tiny amount of blood in the urine should not be ignored.

Also, even if blood is absent in the urine, a physician's visit is advised in the presence of the following symptoms -

• Frequent urination.

• Difficulty urinating.

• Painful urination.

• Abdominal pain.

• Pain in the lower back.

Emergency help should be sought if one is not able to urinate, blood clots are seen in urine, or there is the presence of blood in the urine, and if the following symptoms are noticed:

• Nausea.

• Vomiting.

• Feeling hot or cold.

• Pain in the side, back, or abdomen.

How Is Bladder Tamponade Diagnosed?

On the clinical examination following things are checked:

• Lack of urine or reduced quantity of urine output.

• Hematuria- Presence of blood in the urine.

• Anemia- Reduced hemoglobin in the blood.

• Tachycardia- Heart rate of more than 100 beats per minute.

• Low blood pressure- Blood pressure less than 90/60 millimeters of mercury.

• Suprapubic (above the pubic bone) - Presence of a hard and palpable mass.

In Some Laboratory Tests, the Following Is Seen:

Urinalysis

• Hematuria- Presence of blood in the urine.

• Reduced urine output.

Blood Test

• Hemoglobin test - There are low levels of hemoglobin in the blood.

• Red blood cell count test – The red blood cell count in the blood is low..

Cystoscopy

Cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope. A cystoscope is inserted into the urethra to view the blood clot.

Ultrasound Examination

An ultrasound examination reveals a blood clot within the bladder.

CT Scan (Computed tomography scan)

• A CT scan shows clots and blood.

Magnetic Resonance Imaging (MRI)

• An MRI shows clots and blood.

How Is Bladder Tamponade Treated?

The treatment of bladder tamponade may include the following:

Intravenous fluids are given to treat the following:

• Low blood pressure.

• Treat tachycardia.

Blood transfusion is given to meet the following parameters:

• To treat low hemoglobin levels.

• To treat severe blood loss.

Cystoscopy is done to achieve the following:

• To expel blood clots.

• To flush the bladder with saline.

• To stop the bleeding with a laser or cautery.

Suprapubic endoscopy:

• Cystoscopy is introduced through a skin incision above the pubic symphysis.

• The clots are removed using irrigation or instruments. Manual bladder irrigation using a Foley catheter along with a syringe is the most widely used method of removing clots from the bladder. Another thrombectomy (clot removal) method is modified lavage devices or changes in lavage fluid components. Bleeding is stopped with cautery or a laser.

What Are the Tips to Prevent Bladder Tamponade?

Preventing bladder tamponade means preventing the underlying cause:

• To Prevent Infection: Urinate immediately after intercourse and practice good hygiene.

• To Prevent Stone Formation: Drink plenty of water. Avoid certain foods such as spinach and rhubarb and minimize salt intake.

• To Prevent Bladder Cancer: Quit smoking and limit exposure to chemicals.

Conclusion:

Bladder tamponade is a health condition in which numerous blood clots form in the bladder, which can lead to serious complications. Immediate emergency medical care can prevent permanent damage to the kidneys and improve the outcomes of this condition. A delay in the treatment of this condition may result in fatality. This condition requires immediate surgical intervention, and therefore the outcome is dependent on the expertise of the medical caregiver.