A urethral caruncle is a normally benign, red, soft lump found on the posterior of the urethra. Women who have already gone through menopause are more likely to develop these lumps than younger women. Some patients will experience vaginal pain, pain with sex or bleeding from a urethral caruncle, in which case surgery may have to be performed.
Lack of estrogen production and excessive abdominal pressure are two common causes of a urethral caruncle. Some women seem to develop these growths for no apparent reason. It is possible that some patients develop this lump from trauma to the area or from inflammation resulting from back-to-back urinary tract infections.
Some women may develop a urethral caruncle and never know it. Sometimes the caruncle will cause no pain and disappear on its own as mysteriously as it came. Other patients may be in excruciating pain from it. This pain can occur during urination, while sitting or during sexual intercourse. Women experiencing chronic or abnormal urethral pain should make an appointment to see a urologist or gynecologist.
It is important for a doctor to take a look at the urethra of a woman with pain in the area. There are other causes for urethral pain aside from urethral caruncles, including interstitial cystitis, a chronic bladder disease and several sexually transmitted diseases. If a doctor determines that a urethral caruncle is responsible for a woman's pain, then there are several courses of treatment that may work to ease the symptoms. Anti-inflammatory medications or estrogen creams can help to reduce the pain and swelling in the urethra area. The at-home treatment of taking a sitz bath also is typically recommended for patients experiencing discomfort.
Rare cases may occur when a urethral caruncle does not heal on its own. In this scenario, a patient may have to undergo surgery to remove the fleshy lump. The surgery can be done under general or local anesthesia and is normally performed in a hospital rather than a urologist's office. A doctor may prescribe temporary narcotic pain medication while a patient is recovering.
There is always a low possibility that any mass found in the urethral area can cancerous. If a urologist suspects anything unusual about the caruncle, he or she will perform a biopsy. Typically, however, caruncles are benign. Cysts and other hard masses found in the pelvic region are much more likely to be potentially cancerous.
Urethral Caruncle Treatment
Because urethral caruncles are typically benign, treatment is often optional. This is especially true if a patient does not experience any pain. The caruncle will often resolve itself without any medical intervention. Of course, this is not always the case, and there are some circumstances when treatment is necessary. In these instances, there are several options that a doctor may employ.
The first line of treatment is often a regimen of at-home self-care that may include the aforementioned sitz baths and topical anti-inflammatory medication. There is insufficient research to confirm the efficacy of these treatments, but many patients report that they provide relief from symptoms.
If these treatments do not provide relief, however, further intervention may be necessary. Other treatment options include hormone replacement therapy (HRT) to balance the patient’s estrogen levels. Alternately, the caruncle may be removed via one of several surgical methods, including laser vaporization, ligation, or cauterization. These removal methods may be used in combination with other treatment options.
Urethral Caruncle Appearance
Urethral caruncles may be located within the urethra, rendering them invisible to the naked eye. If this is the case, they may only be visible when detected on an ultrasound or other imaging device. If a urethral caruncle is located at the opening of the urethra, however, it may be visible, and it will typically appear as a fleshy mass hanging from the urethral opening.
These growths can reach up to two centimeters in size, though it’s more common to see growths around one centimeter. They typically feature a red or pink color. If a blood clot emerges within the growth, however, it may become a black or purple color. This may cause the growth to bleed, too, if it is left untreated.
The caruncle most often looks like a fleshy protrusion emerging from the urethral opening, and in some cases, it may appear to block the urethra entirely. Though they are extremely uncommon for men, there are rare cases of male urethral caruncles. Men who experience this will likely see a pink or red fleshy protrusion from the head of their penis.
Urethral Caruncle Causes
One of the most common causes of a urethral caruncle is an imbalance of estrogen that commonly affects post- and perimenopausal women. Estrogen is one of the most essential hormones for keeping the skin of the genitals — including the urinary tract — healthy. When there is a deficit of estrogen — as is often the case during and after menopause — it can make a woman vulnerable to dryness and irritation that causes urethral caruncles.
This problem is called urogenital atrophy, and it can lead to other symptoms, too. It can also be caused by a decline in the mucosal lining of the urethra. This is also linked to low estrogen, but there are other hormonal imbalances that may compromise the mucus membrane. It’s important to note that men may develop urethral caruncles as a result of a different cause, but in some cases, male hormonal imbalance may be to blame, too.