Urethral prolapse is a rare health problem in women in which pressure in the abdomen and groin causes the urethra to protrude from its opening in the vagina. The condition is usually seen in prepubertal girls and postmenopausal women, and rarely occurs in a person of reproductive age. A urethral prolapse can be painful, and women often experience vaginal bleeding and a frequent need to urinate. Treatment in the form of topical creams and careful hygiene are usually enough to relieve a prolapse, but surgery may be necessary if the condition is persistent and painful.
The female urethra is made up of two layers of smooth muscle tissue, vascular tissue, and a mucous membrane. Prolapse usually occurs when the two muscle layers separate from each other and can no longer hold the urethra in place under normal intra-abdominal pressure. When urethral prolapse occurs in postmenopausal women, the cause is usually a natural weakening of smooth muscle tissue. Any additional pressure from coughing or constipation can cause the urethra to bulge out.
Urethral prolapse in a prepubescent girl may be related to a birth defect of the urethra or vaginal opening. Inherited connective tissue disorders and malnutrition can also cause smooth muscle to be weaker than normal or not to attach properly. Trauma to the vagina rarely causes urethral problems, but prolapse has been seen after cases of sexual abuse. As with older women, conditions that increase intra-abdominal pressure in a girl make urethral bulge more likely.
Some cases of urethral prolapse cause no pain and may be barely noticeable to the naked eye. However, in most cases, women and girls can see a visible lump at the top of the vaginal opening. The damaged and inflamed tissue can cause vaginal bleeding, and blood may be seen in the urine. Women and girls often have frequent urges to urinate and have heavier streams.
It is essential to visit a doctor at the first signs of urethral prolapse to prevent potentially serious complications. If left untreated, the bulging tissue can become strangulated by the urethral opening, cutting off blood flow. Tissue can begin to die when its blood supply is robbed, a condition called necrosis. The risk of serious infections and disseminated necrosis is high when medical attention is not sought.
A urologist or pediatric specialist can diagnose a urethral prolapse by inspecting the lump and testing urine samples for the presence of blood. When a prolapse is discovered in its early stages, a patient can usually recover by taking pain relievers and applying a prescribed antibiotic ointment. Doctors also encourage good personal hygiene and suggest daily hot baths until symptoms subside. Very large persistent lumps can be removed surgically, but procedures are only considered when necrosis is likely or conservative treatments do not resolve symptoms after about a month.