Urethral prolapse is a relatively uncommon condition affecting the female urinary tract that can cause significant concern and discomfort. It involves a portion of the urethra shifting from its normal position, leading to a visible protrusion. Understanding this condition requires clarity on its anatomical basis, symptoms, risk factors, and the range of available medical and surgical solutions.
Defining Urethral Prolapse
Urethral prolapse is defined as the circumferential protrusion of the inner lining (mucosa) of the distal urethra through the external urethral meatus, the body’s external urinary opening. The urethra is a tube that carries urine from the bladder to the outside of the body. This prolapse occurs when the internal tissue of this tube folds outward.
When the inner lining protrudes, it typically appears as a round, fleshy mass surrounding the external opening. This tissue often looks like a doughnut or a ring, which may be pink, bright red, or purplish, depending on the degree of congestion and inflammation. Observing the central opening for urine within the protruding tissue confirms the diagnosis. This anatomical confirmation helps distinguish the condition from other masses or lesions, such as a urethral caruncle.
Identifying Signs and Symptoms
The manifestations of urethral prolapse vary significantly; some individuals, particularly pre-pubescent girls, experience no symptoms at all. When symptoms occur, the most noticeable sign is a visible mass of tissue protruding from the urethral opening. This tissue may be painful or tender, and if severely congested, it may become ulcerated and bleed easily.
A common symptom is bleeding or spotting unrelated to menstruation, which can appear as blood on underwear or a diaper. Other urinary tract symptoms frequently accompany the prolapse, including dysuria (pain or discomfort during urination). Individuals may also report increased urinary frequency, urgency, or nocturia (the need to urinate more often at night).
Understanding Risk Factors
Urethral prolapse occurs most commonly in two distinct groups: pre-pubescent girls and postmenopausal women. This pattern suggests that low levels of estrogen play a significant role in weakening the surrounding tissues. In young girls, naturally low estrogen levels before puberty contribute to tissue weakness around the urethra.
In postmenopausal women, the natural decline in estrogen leads to atrophy and reduced strength of the pelvic and urogenital tissues. Beyond hormonal factors, any condition that chronically increases abdominal pressure can predispose a person to urethral prolapse. This includes persistent coughing, severe or chronic constipation that causes straining, and obesity. Genetic predisposition and pre-existing weakness in the pelvic floor muscles are also contributing factors.
Diagnosis and Treatment Options
The diagnosis of urethral prolapse is primarily clinical, relying on a visual inspection of the external genitalia. A healthcare provider observes the characteristic doughnut-shaped tissue mass surrounding the meatus. They verify the presence of the central urethral opening to differentiate the prolapse from other conditions, such as urethral caruncles or malignant tumors.
For mild cases, initial management begins with conservative, non-surgical methods. A primary treatment involves topical estrogen cream, applied directly to the prolapsed tissue, often two to three times daily for a couple of weeks. This therapy helps restore the strength and thickness of the atrophied urethral mucosa, particularly in postmenopausal women and pre-pubescent girls.
Sitz baths, which involve soaking the perineal area in warm water, are recommended to promote local hygiene, soothe inflammation, and reduce swelling. Managing underlying conditions such as chronic constipation or persistent coughing is also necessary, as these factors increase abdominal pressure and can prevent healing. If a coexisting urinary tract infection is present, antibiotics will be prescribed.
If conservative treatment fails or the tissue becomes severely compromised, surgical intervention is the appropriate next step. Surgery is also necessary if the prolapsed tissue is strangulated (meaning its blood supply is cut off), leading to necrosis or severe bleeding. The most common and definitive procedure is a simple excision, known as a prolapsectomy, where the redundant tissue is removed and the remaining urethral edges are sutured together.
This surgical correction has a high success rate and offers a quick resolution of symptoms. Following excision in postmenopausal women, long-term topical estrogen therapy is often recommended to maintain tissue robustness and reduce the risk of recurrence. For children, managing abdominal straining from constipation or dysfunctional voiding is a key part of the post-treatment plan to ensure lasting results.