Urethral Prolapse
The urethral lining bulging out through its opening
Quick Facts
- Type: Lower urinary tract condition
- Most affected: Young girls, postmenopausal women
- Main sign: A red, ring-like bulge at the opening
- Outlook: Usually treatable, often without surgery
Overview
Urethral prolapse occurs when the inner lining of the urethra, the tube that carries urine out of the body, turns outward and protrudes through the urethral opening. This creates a soft, doughnut-shaped or ring-like bulge of red or pink tissue at the opening, located just above the vaginal opening in women and girls.
The condition is most common in two groups: young girls before puberty and women after menopause. In both, lower levels of estrogen are thought to play a role by affecting the strength and support of the surrounding tissues. Urethral prolapse is usually not dangerous, but it can cause bleeding, discomfort, and worry. It often responds well to simple measures, and many cases improve with topical treatment, though some need a minor procedure.
Symptoms
Symptoms vary, and some cases are noticed only because of a visible bulge or spotting.
- A red or pink, ring-shaped bulge of tissue at the urethral opening
- Spotting of blood, often noticed on underwear or after wiping, sometimes mistaken for vaginal bleeding
- Discomfort, irritation, or soreness in the genital area
- Pain or burning with urination in some cases
- Difficulty starting urination or a feeling of pressure
In children, painless spotting may be the first sign that prompts a parent to seek care.
Causes
Urethral prolapse develops when the tissues that normally hold the urethral lining in place become weak or lax, allowing the lining to slip outward. The exact cause is not always clear, but several factors are associated with it.
- Low estrogen levels: Common in girls before puberty and women after menopause, which can affect tissue strength.
- Increased abdominal pressure: From straining, constipation, chronic coughing, or heavy lifting.
- Weak supporting tissue: Differences in the strength of the tissues around the urethra.
It is not caused by anything a person did wrong and is not contagious.
Risk Factors
- Being a prepubertal girl or a postmenopausal woman
- Low estrogen levels
- Chronic constipation or straining
- Long-standing cough or repeated heavy lifting
- Conditions that raise pressure in the abdomen
Diagnosis
Urethral prolapse is usually diagnosed by examining the area, because the bulging tissue has a characteristic appearance.
- Physical examination: A clinician can recognize the ring of tissue surrounding the urethral opening, which helps distinguish it from other causes of bleeding or a bulge.
- Urine testing: To check for infection if there are urinary symptoms.
- Further evaluation: Occasionally needed to rule out other causes of genital bleeding, especially to reassure that the bleeding is not coming from the vagina.
Treatment
Many cases improve with conservative measures, and treatment depends on symptoms and severity.
- Topical estrogen cream: Often the first treatment, applied to strengthen the tissue and help the prolapse resolve.
- Warm soaks (sitz baths): To soothe irritation and reduce swelling.
- Good hygiene and avoiding irritants: Gentle care of the area.
- Treating contributing factors: Such as relieving constipation or managing a chronic cough.
- Minor surgery: If the prolapse is severe, persistent, or the tissue becomes painful or its blood supply is compromised, a small procedure can remove the prolapsed tissue.
Prevention
Urethral prolapse cannot always be prevented, but reducing strain on the pelvic tissues may help.
- Prevent and treat constipation with adequate fiber and fluids
- Avoid prolonged straining when using the toilet
- Manage chronic cough and lift heavy objects carefully
- Seek evaluation early if bleeding or a bulge is noticed, especially in children
When to See a Doctor
See a doctor if you or your child notice spotting of blood, a bulge at the urethral opening, or genital discomfort, since these should always be evaluated. Seek prompt care if:
- The protruding tissue becomes very painful, dark, or swollen, which may mean its blood supply is reduced
- There is heavy or ongoing bleeding
- There is difficulty passing urine
- There are signs of infection such as fever or increasing redness
Frequently Asked Questions
What is urethral prolapse?
It is when the inner lining of the urethra turns outward and bulges through the opening, forming a red, ring-shaped piece of tissue. It is most common in young girls before puberty and in women after menopause.
Is urethral prolapse dangerous?
It is usually not dangerous and often improves with simple treatment. However, the protruding tissue should be evaluated, and if it becomes very painful, dark, or swollen, prompt care is needed because its blood supply may be reduced.
Why does urethral prolapse happen in girls and older women?
Both groups tend to have lower estrogen levels, which can weaken the tissues that support the urethral lining. Added strain from constipation, coughing, or heavy lifting can also contribute.
How is urethral prolapse treated?
Many cases improve with topical estrogen cream, warm soaks, and gentle hygiene, along with treating contributing factors like constipation. A minor surgical procedure may be needed if the prolapse is severe, persistent, or the tissue is compromised.
Could spotting in a young girl be urethral prolapse?
Yes. Painless spotting at the genital area in a prepubertal girl can be caused by urethral prolapse and is a common reason families seek care. Any genital bleeding in a child should be evaluated by a clinician to confirm the cause.
References
- MedlinePlus, U.S. National Library of Medicine. Urethral disorders.
- American Urological Association. Urethral prolapse.
- Office on Women's Health, U.S. Department of Health and Human Services.
- American Academy of Pediatrics.