A day of beer and boating went sour for one young man in Maine, who ended up bursting his bladder when he dove into a lake.
The injury tore a hole in the 24-year-old's bladder wall, allowing urine to leak into his abdomen, according to a new report of the man's case.
Hitting the water with a full bladder was "the equivalent of throwing a water balloon on the sidewalk," said Dr. Bradley Gill, a resident in urology at the Cleveland Clinic who was not involved in treating the patient.
The young man's alcohol consumption likely contributed to the injury, Gill told Live Science.
"When you drink alcohol, it causes the body to produce more urine than usual, so that can potentially contribute to the bladder being full," Gill said. But drunk people don't always realize they have to pee. [7 Ways Alcohol Affects Your Health]
A full bladder, "accompanied by an inebriated individual being less aware of this fullness, can be a setup for traumatic bladder rupture," Gill said.
A jump in the lake
The man's injury came to the attention in doctors at an emergency room in Maine, where he arrived complaining of severe pain after a day at the lake. The pain had started immediately after a leap into the water, he told doctors. His abdomen was swollen and tender when doctors examined him.
The man couldn't make himself pee, and a catheter inserted into his bladder revealed urine filled with blood, doctors Matthew Opacic, Janessa Leger and George L. Higgins III, all of the Maine Medical Center in Portland, wrote in their report, published online Aug. 13 in the journal Visual Diagnosis of Emergency Medicine.
A computed tomography (CT) scan soon made the cause of the pain and blood clear: The normally smooth bladder surface looked ragged — there was a rupture in the curved top, or dome, of the organ. Surgeons operated on the patient's abdomen, found the tear and stitched it up.
The bladder is a muscular sack, guarded at its opening by an internal sphincter and capable of holding between 10 and 20 fluid ounces (300 to 600 milliliters) of pee. When full, the bladder wall is under pressure, and the organ is vulnerable to outside forces that further raise that pressure, Gill said.
"If you imagine holding a water balloon between your two hands and squeezing it, the part that pushes out between your two hands is going to eventually bubble out and burst," he said.
Most bladder ruptures occur when the organ is penetrated by something hard and unforgiving. A broken pelvis, for example, can send bone shards into the bladder. But Opacic and his colleagues reported that 35 to 40 percent of bladder ruptures are "intraperitoneal," meaning they happen when there is too much pressure on the bladder wall.
Alcohol consumption can raise the risk of this type of injury, Gill said, but so can other circumstances that lead to a full bladder and a rapid increase in pressure. One common situation, he said, involves kids and soccer. A small child playing on the field may resist taking bathroom breaks. When the bladder gets too full, an errant ball to the abdomen can cause the organ to burst.
Fortunately for these patients, when a burst bladder is the only injury, surgery is usually very successful, Gill said. Patients have to use a catheter for several weeks during recovery so the bladder can rest, but after that, they can resume normal urination.
"The bladder's a remarkable organ," Gill said. "It has a pretty substantial capacity to recover from injury."
The leakage of pee into the abdomen, as the man in Maine experienced, isn't harmful in the long term either, as long as it's identified and treated, Gill said. The body reabsorbs the lost urine, and the wastes are removed as the blood is refiltered and disposed of as soon as the bladder can expel urine again.
Avoiding bladder rupture isn't the only reason to make regular bathroom breaks a habit. Consistently "holding it" can overdistend the bladder and cause it to go "floppy," like an overstretched rubber band, Gill said. Once this happens, the bladder might not empty efficiently, leading to infections and sometimes even bladder stones.
But a single long car ride with no rest stop in sight isn't going to cause the bladder to overdistend, Gill said — this is a condition that occurs only over a long period of time. The people who are most commonly afflicted by this condition are children who have serious potty-training problems and older men whose enlarged prostates make urinating difficult.