Urethral prolapse is a condition where the inner lining of the urethra, the tube that carries urine from the bladder out of the body, protrudes through its opening. This can appear as a small, reddish mass. While the presence of this tissue might seem concerning, it is generally a benign condition that is treatable. Understanding the nature of urethral prolapse can help individuals recognize its signs and seek appropriate care.
What is Urethral Prolapse
Urethral prolapse occurs when the innermost layer of the urethra turns inside out and extends beyond its opening. It typically appears as a doughnut-shaped, pink or reddish mass at the external meatus, where urine exits the body. This condition differs from other pelvic organ prolapses, such as bladder or uterine prolapse, which involve different organs. Urethral prolapse specifically concerns the urethral lining. It is often observed in prepubertal girls and postmenopausal women.
Common Symptoms
Individuals with urethral prolapse may experience a range of symptoms, though some might have no noticeable signs. A visible mass protruding from the urethral opening is the most common indicator. This protrusion can sometimes be accompanied by discomfort or pain, especially when sitting or during urination.
Other symptoms include spotting or bleeding, which might be observed on underwear or diapers. Urinary issues, such as difficulty urinating, frequent urination, or a feeling of incomplete bladder emptying, can also occur. Some individuals report a feeling of pressure or fullness in the pelvic area.
Understanding the Causes
The precise cause of urethral prolapse is not always clear, but it is related to a weakening of the tissues that support the urethra. Increased pressure within the abdomen is a significant factor, pushing the urethral lining outwards. Activities contributing to this pressure include chronic coughing, straining during bowel movements due to constipation, and heavy lifting. Low estrogen levels also play a role, as they can lead to weakened tissues. Other contributing factors include trauma to the area, genetic predispositions to weaker connective tissues, and obesity.
Diagnosis and Treatment
Diagnosing urethral prolapse involves a physical examination. The appearance of a reddish, doughnut-shaped mass at the urethral opening is often sufficient for diagnosis. In some cases, additional tests like a cystourethroscopy might be performed, particularly in adults, to confirm the diagnosis and rule out other conditions.
Treatment approaches vary depending on the severity of the prolapse and symptoms, ranging from conservative measures to surgical intervention. For mild cases, conservative treatments are often effective. These include sitz baths, which involve sitting in warm water to soothe the area, and over-the-counter pain relievers for discomfort. Topical estrogen cream is frequently prescribed, as it helps strengthen the urethral tissues.
If conservative treatments do not resolve the condition or if the prolapse is severe, surgical intervention may be considered. Surgery aims to remove or reposition the prolapsed tissue and typically involves excising the everted lining and suturing the remaining urethral edges. After surgery, a brief period of catheterization may be necessary to facilitate healing. Lifestyle adjustments, such as managing constipation and avoiding activities that increase abdominal pressure, are also important to prevent recurrence.