ConditionKidneys & urinary tract
Urethral Prolapse
Urethral prolapse is when the inner lining of the urethra, the tube that carries urine out of the body, slips out through the urethral opening, forming a red or purple, donut-shaped swelling. It mainly affects school-age girls, particularly Black girls, and women after menopause. It often causes painless spotting or blood on underwear, and is sometimes mistaken for vaginal bleeding. Most cases improve with estrogen cream and sitz baths; surgery is needed if it does not resolve or the tissue becomes damaged.
Also called: Urethral mucosal prolapse, prolapsed urethra, urethral eversion
At a glance
- What it is
- Protrusion of the urethral lining through the urethral opening.
- Who gets it
- Prepubertal girls (most often Black girls aged 5 to 10) and postmenopausal women.
- Symptoms
- Spotting or blood on underwear, a red or purple ring of tissue at the urethral opening; sometimes pain or difficulty urinating.
- Causes
- Low estrogen, straining from constipation or coughing, weak tissue attachments.
- Diagnosis
- Examination showing a ring of tissue with a central opening.
- Treatment
- Topical estrogen cream and sitz baths; surgical removal for persistent or damaged tissue.
When to get help
See a doctor within a day or two
- Dark purple or black tissue at the urethral opening, severe pain or inability to urinate (possible strangulated prolapse)
- Genital bleeding in a girl without an obvious cause, to rule out injury, foreign body or abuse
- Any vaginal or urethral bleeding after menopause
Book a routine appointment
- A red, swollen ring or lump at the opening where urine comes out
- Spotting on underwear, with or without discomfort
- Burning or frequent urination with a visible swelling
Usually safe to manage at home
- A known, mild urethral prolapse already assessed by a doctor, while using prescribed cream and sitz baths
What happens in urethral prolapse
The urethra is lined by a soft mucous membrane held in place by muscle layers. When the attachment between these layers weakens, raised pressure in the abdomen can push the lining out through the opening (meatus). The everted tissue swells, becomes congested and can bleed easily. If blood supply is compromised, it can become very swollen and dark (strangulated).
Who gets it and why
Children
- most common in prepubertal girls, especially Black girls
- low estrogen levels before puberty make the tissue thin and weakly attached
- triggers include straining from constipation, coughing, crying or heavy lifting
Women after menopause
- low estrogen after menopause thins the tissues of the urethra and vagina (see atrophic vaginitis)
- triggered by chronic cough, constipation or obesity
- may coexist with pelvic organ prolapse
Symptoms
- bright red or brown spotting on underwear or diapers, often painless
- a red, pink or purple doughnut-shaped swelling at the urethral opening
- pain, burning or frequent urination in some cases
- difficulty urinating if the prolapse is large
In girls, it is often found when parents notice blood and fear vaginal bleeding or injury.
Diagnosis
A doctor examines the genital area. A urethral prolapse appears as a circular ring of tissue with a central opening (the urethra). Placing a small catheter through the center, or watching urine pass through it, confirms the diagnosis. Other conditions to consider:
| Condition | Clues |
|---|---|
| Urethral caruncle | Small, fleshy growth on one side of the opening, usually in older women |
| Urethral diverticulum | Lump under the urethra, discharge, recurrent infections |
| Vaginal bleeding sources | Bleeding from inside the vagina rather than the urethra |
| Injury, foreign body or abuse | Must be considered in children with genital bleeding |
| Tumors | Rare; firm, irregular mass |
Treatment
Conservative treatment
- topical estrogen cream applied to the prolapsed tissue for a few weeks, which strengthens the tissue and reduces swelling
- sitz baths: sitting in warm water several times a day
- treating constipation and cough to reduce straining
- antibiotics if a urinary tract infection or urethritis is present
- pain relief as needed
Most children respond within weeks.
Surgery
Surgical removal of the prolapsed tissue (excision) with stitching of the remaining lining is used when:
- conservative treatment fails or the prolapse recurs
- the tissue is strangulated or necrotic
- urination is blocked
Results are generally excellent.
Outlook
Urethral prolapse is benign. Most cases resolve with estrogen cream and sitz baths, and surgery is curative when needed. Preventing constipation and treating chronic cough reduce recurrence. Any bleeding after menopause should still be investigated to exclude other causes.
Frequently asked questions
What is urethral prolapse?
Urethral prolapse is when the inner lining of the urethra pushes out through the urethral opening, forming a red or purple ring of tissue. It mainly occurs in young girls before puberty and in women after menopause.
What does urethral prolapse look like?
It looks like a small red, pink or purple doughnut-shaped swelling at the opening where urine comes out, with a hole in the center. It may bleed slightly, leaving spots on underwear.
How is urethral prolapse treated?
Most cases are treated with estrogen cream applied to the area, warm sitz baths and avoiding straining. Surgery to remove the prolapsed tissue is needed if it does not improve, keeps coming back, or the tissue becomes dark and damaged.
Why is my daughter bleeding from her private area?
In young girls, causes include urethral prolapse, skin irritation, constipation-related fissures, foreign bodies, infections, injury and, importantly, possible abuse. Any genital bleeding in a child should be checked promptly by a doctor.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Pediatrics: Pediatric and adolescent gynecology resources on genital bleeding
- North American Society for Pediatric and Adolescent Gynecology: Urethral prolapse patient information
- MedlinePlus: Urethral disorders
- Cleveland Clinic: Urethral Prolapse
- StatPearls (NCBI Bookshelf): Urethral Prolapse