A urethral prolapse is an uncommon women's health problem in which pressure in the abdomen and groin causes the urethra to bulge out of its opening in the vagina. The condition is usually seen in prepubescent girls and postmenopausal women, and it only rarely happens to a person of reproductive age. A urethral prolapse can be painful and women often experience vaginal bleeding and frequent urges 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 comprised of two layers of smooth muscle tissue, vascular tissue, and a mucous membrane. Prolapse typically occurs when the two muscle layers separate from one another and can no longer hold the urethra in place under normal intra-abdominal pressure. When prolapse happens 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 outward.
Urethral prolapse in a prepubescent girl may be related to a congenital 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 attached together correctly. Trauma to the vagina rarely causes urethral problems, but prolapse has been noted after instances of sexual abuse. As with older women, conditions that raise intra-abdominal pressure in a young girl makes urethral bulging more likely.
Some cases of urethral prolapse do not cause pain and may be barely noticeable to the naked eye. In most instances, however, women and girls can see a visible bulge in the upper part of the vaginal opening. Damaged, inflamed tissue can cause vaginal bleeding, and blood may be visible in the urine. Women and girls often feel frequent urges to urinate and have heavier streams.
It is essential to visit a physician at the first signs of prolapse to prevent potentially serious complications. Left untreated, bulging tissue can become strangulated by the urethral opening, cutting off blood flow. The tissue can start to die when it is robbed of its blood supply, a condition called necrosis. The risk of serious infections and spreading necrosis are high when medical care is not sought.
A urologist or pediatric specialist can diagnose a urethral prolapse by inspecting the bulge 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 prescription antibiotic ointment. Doctors also encourage good personal hygiene and suggest taking daily warm baths until symptoms resolve. Very large, persistent bulges can be removed surgically, but procedures are only considered when necrosis is likely or conservative treatments do not resolve symptoms after about one month.