What Is Urethral Prolapse?

The urethra is a thin tube that carries urine from the bladder to the outside of the body. Urethral prolapse (urethrocele) is when part of this tube's inner lining turns inside out and sticks out through the external opening of the urethra. The inner lining creates a circular or doughnut-shaped bulge in the urethral opening.

Urethral prolapse is a type of pelvic organ prolapse. It is relatively uncommon, with most cases seen in girls before they reach puberty. Women who are postmenopausal (time after menopause, when menstrual periods have stopped for 12 straight months) may also develop urethral prolapse.

Read on to learn more about the signs, causes, and treatment options of urethral prolapse.

Symptoms

The most common signs of urethral prolapse are a visible circular bulge protruding from the external opening of the urethra, as well as vaginal bleeding. The bleeding may cause spotting or blood in underwear or diapers.

Less often, urethral prolapse causes frequent urination or pain with urination or sexual intercourse.

Sometimes urethral prolapse occurs without noticeable symptoms, especially in young girls.

In postmenopausal women, urethral prolapse is usually accompanied by additional symptoms, particularly pain with urination, frequent urination, and an increased need to urinate at night. Postmenopausal women with urethral prolapse are also more likely to have blood in their urine.

Diagnosis

The presence of a circular or donut-shaped bulge protruding from the external opening of the urethra indicates a likely urethral prolapse. Release of urine from the central opening within the mass, either by natural voiding or catheterization, confirms the diagnosis.

In adults, the cystourethroscopy (inserting a tube with an attached camera into the urethra) is sometimes used to confirm the diagnosis.

Causes

The causes of urethral prolapse are not fully understood. Activities or life events like lifting heavy objects or childbirth may raise the risk for prolapse because they increase abdominal pressure. This can weaken or strain the pelvic muscles and supporting tissue.

Genetic and Congenital Causes

Some people may have a genetic predisposition to weak pelvic floor muscles or tissues. These tissues normally support the urethra, so people with naturally weaker tissues may have an inherent susceptibility to urethral prolapse.

Age

Pelvic organ prolapse is most common among post-menopausal women. Aging leads to a loss of muscle strength, including strength in the pelvic floor muscles that support the urethra.

Hormone Levels

Estrogen is a hormone found in higher levels in women than men. Because estrogen increases muscle strength, it is thought to help prevent pelvic organ prolapse. Estrogen levels decline during menopause, which can reduce muscle strength in the pelvic region. Estrogen therapy in postmenopausal women appears to lower their risk of urethral prolapse.

Low levels of estrogen may also help explain prepubescent girls' relatively high risk for urethral prolapse.

Pregnancy and Childbirth

Women who have been pregnant and who have had one or more vaginal deliveries have an elevated risk for urethral prolapse.

Pregnancy and giving birth places pressure and strain on the abdomen and pelvic region. This pressure and strain can stretch, tear, or damage the pelvic floor muscles and other tissues that help support the urethra.

For some women, the damage to the supportive tissues is not immediately apparent after giving birth and only noticed years later.

Other Sources of Abdominal Pressure

Other sources of strain and pressure on the pelvic region and abdomen can also raise the risk of urethral prolapse. Potential sources of strain and pressure include:

• Obesity
• Heavy lifting
• Chronic constipation and straining during bowel movements
• Frequent coughing
• Uterine fibroids (noncancerous tumors of the uterus) or polyps (overgrowth of cells that attach to the uterus)
  

Previous Pelvic Surgery

Prior pelvic surgeries, especially for a previous urethral prolapse or other pelvic organ prolapse, can increase your risk for urethral prolapse.

Complications

The most severe complication is strangulated urethral prolapse. Strangulated urethral prolapse occurs when the prolapse tissue obstructs blood flow.

The blocked flow of blood causes clotting and prevents the normal return of blood from the tissue. The protruding tissue begins to die and turns a bluish or purplish color.

Strangulated urethral prolapse can cause severe pain upon urination, bleeding, difficulty urinating, and pain the radiates through the pubic region.

Treatment

Many cases of urethral prolapse are mild and go away with minimal or no treatment. More severe cases, such as those involving strangulated urethral prolapse, may require surgery.

Nonsurgical Treatments

Mild cases of urethral prolapse typically require no or only minimal treatment. They can often can be managed with warm, shallow-water sitz baths, keeping the area clean, and applying petroleum jelly to help alleviate tenderness or sensitivity.

Your healthcare provider may also prescribe a topical estrogen cream to help strengthen the tissues supporting the urethra. This cream is applied in small, pea-sized amounts two or three times a day for two weeks. Children receiving estrogen cream should be monitored for side effects such as breast budding and the development of pubic hair.

In postmenopausal women, estrogen creams often resolve mild symptoms. These creams can improve the strength of the tissues supporting the urethra and prevent recurrence. Lifestyle adjustments, such as weight loss and avoiding heavy lifting, may also reduce the risk of a recurrence.

In children, treating constipation and preventing straining while passing bowel movements generally help the prolapsed tissue heal and prevent recurrence.

If an infection is present, your healthcare provider may prescribe antibiotics.

Surgical Treatment

Your doctor may recommend surgery for more severe cases of urethral prolapse, such as those involving an infection, a blockage of the urethra, or a strangulated urethral prolapse.

During a surgical repair, the surgeon will typically cut away the protruding tissue and then sew the lining back together. Most patients require catheterization for a brief period after surgery, and then make a full recovery. Estrogen creams after surgery can help prevent a recurrence.

A Word From Verywell

Many cases of urethral prolapse cause no symptoms. If you notice tissue protruding from the urethral opening, be sure to bring it up to your healthcare provider. Prompt treatment can prevent infections and other complications and help you avoid surgery.