Ruptured Bladder in Horses

A bladder rupture commonly occurs due to trauma of the bladder wall. This is most often a result of birth, which can compact the bladder, or prevent male foals from urinating, thus leading to a bladder rupture. Foals can also suffer from a tear in the urachus, a fetal structure that allows urine to be excreted. Other causes stem from urinary obstructions, trauma from accidents or falls, or any previous procedures that have weakened the bladder wall. Often, urinary procedures or problems encountered as a foal can predispose an adult to a rupture.

A rupture of the bladder, or cystorrhexis, is an uncommon occurrence that primarily affects foals, and very rarely affects adult horses. The rupture is a tear in the bladder wall that results in the leak and accumulation of urine inside the abdominal cavity, called uroperitoneum. Symptoms of abnormal urination, abnormal levels of urine, dullness, and colic in the foal can be a sign of a problem in the urinary tract. While bladder ruptures are not a common issue, they do need immediate attention for the health of the affected horse.

Many of the symptoms of a ruptured bladder stem from the accumulation of urine in the abdominal cavity, and the resultant metabolic imbalances. Signs in a foal can manifest within 1 to 5 days from birth. Symptoms include:

• Dullness 
• Depression
• Colic
• Abdominal distension
• Increased abdominal pressure
• Dribbling urine 
• Unsteady stream of urine 
• Increased frequency of urination
• Decreased amount or lack of urine
• Painful urination
• Decreased fecal output
• Lack of appetite
• Congested mucous membranes 
• Metabolic imbalances
• Decrease in circulating blood volume
• Increased heart rate
• Cardiac arrhythmias 

Additional symptoms seen if squamous cell carcinomas are involved include:

• Fever
• Groaning
• Reluctance to walk
• Frequently lying down
• Abdominal muscle contraction 
• Dark pink mucous membranes 
• Increased breathing rate
• Preputial swelling in male
• Foreskin of male cannot extend

Foals and adult horses can both be susceptible to bladder ruptures due to trauma, most often from childbirth. Causes of a bladder rupture include:

• Urethral obstruction, such as from bladder stones or neoplasia
• Parturition, or birth 
• Trauma, such as from anesthesia, car accidents, or falls 
• Neonatal infection 
• Previous bladder surgery
• Weak scar tissue on bladder
• Tears to the bladder wall 
• Previous urachal infection

Diagnosis often begins with a complete physical examination and presence of symptoms which can lead your veterinarian to suspect a compromised urinary tract. Blood and serum tests are then performed. Abdominal ultrasonography, sometimes aided with injected saline, can help to identify the site of the rupture, or show the presence of a tumor.  An abdominocentesis is used to collect internal fluids for examination. 

Cystoscopy in adult horses uses an endoscope to assess the bladder condition, and is also used in follow up exams to monitor healing. If squamous cell carcinomas are suspected, a further rectal exam may be needed.

Treatment for a ruptured bladder and the subsequent uroperitoneum involves drainage and surgical repair of the bladder. Before any surgery requiring anesthesia takes place, any metabolic imbalances need to be addressed. Urine is removed from the bladder with a catheter and an abdominal drain, and then intravenous fluid therapy is administered. 

Most patients will require surgery to repair the wall of the bladder. This involves entering in the abdominal area, finding the tear, and then suturing it closed. Surgical repair in mares can involve a vaginal entry while standing. If the urachus in a foal is torn, it is removed. In foals, your veterinarian may use a non-surgical approach by draining and decompressing the bladder with a catheter, thus encouraging the tear to heal itself. Antibiotics and nonsteroidal anti-inflammatories may be prescribed.

Treatment of squamous cell carcinoma depends wholly on the location and severity of tumors, and can include chemotherapy, cryotherapy, phallectomy, radiotherapy, and an en bloc penile resection. While lesions can be treated successfully if caught early, metastatic spread may still occur to organs, lungs, and lymph nodes.

After any surgeries, you may need to administer antibiotics and anti-inflammatories to your horse, and any other supplementary care needed. Recovery is good for an early diagnosis and prompt treatment, with an 80% to 90% survival rate. Foals with other reasons for urinary issues may have a lower rate of recovery. It is important to be aware of the signs and seek immediate treatment to ensure the recovery of your horse.