Urethral Prolapse - Stages, Causes, Symptoms, Diagnosis, and Treatment

What Is Urethral Prolapse?

Urethral prolapse occurs when the urethra protrudes into the vagina, and the opening of the urethra looks like a tiny pink donut-shaped bulge that appears more prominent than usual. Urethral prolapse is rare and mostly seen in girls before puberty. However, postmenopausal women (postmenopause is the period after menopause when menstruation has stopped for 12 straight months) may also develop urethral prolapse. It is a benign condition.

What Are the Stages of Urethral Prolapse?

The staging of urethral prolapse depends on the extent and gravity of the protrusion.

• First-degree prolapse means that the urethra pushes slightly against the vaginal walls or lowers towards the urethral aperture.

• In second-degree prolapse, the urethra extends to the vaginal or urethral opening, or the vaginal walls have collapsed slightly.

• Organs bulge outside the vaginal or urethral opening but not farther than 0.79 inches in third-degree prolapse.

• Fourth-degree prolapse exhibits maximal possible descent, and eversion of the lower genital tract is complete.

What Causes Urethral Prolapse?

The causes of urethral prolapse are unclear. However, it is believed that urethral prolapse occurs when muscles, tissues, and ligaments become weak. The fascia, a thin sheathing, usually keeps internal organs in place. Failure of this tissue to hold other tissues may cause prolapse.

Activities or health events such as lifting heavy objects or giving birth may increase the risk of prolapse because it increases abdominal pressure and weakens or compresses the pelvic and supporting muscles.

Who Is Likely to Get Urethral Prolapse?

The majority of postmenopausal and prepubescent individuals who were assigned female at birth (AFAB) experience urethral prolapse. In individuals who are assigned male at birth (AMAB), the syndrome is extremely uncommon.

What Are the Symptoms of Urethral Prolapse?

In the case of mild prolapse, no symptoms are felt. However, occasionally, urethral prolapse occurs without significant symptoms, especially in adolescent girls. The most common symptoms of urethral prolapse are visible swelling that extends from the outer opening of the urethra and bleeding from the vagina. Bleeding may cause stains or blood on the underwear or diapers. More severe symptoms may include:

• Irritation of the vagina.

• Painful sex.

• Aches in the pelvic area.

• Urinary incontinence (not able to hold urine).

In postmenopausal women, urethral prolapse is often accompanied by additional symptoms, especially painful urination, frequent urination, and a growing need for nighttime urination; they are likely to have blood in their urine.

How to Diagnose Urethral Prolapse?

• Pelvic Examination- A circular or donut-shaped bulge extending beyond the outer opening of the urethra indicates a probable urethral prolapse.

• Catheterization- Breakdown of urine from the center of urethral prolapse mass by making a void or catheterization confirms the diagnosis of urethral prolapse.

• Cystourethroscopy- This procedure confirms urethral prolapse in some adults where a urethroscope (small thin tube with a camera) is inserted to look for prolapse.

Is Urethral Prolapse Serious?

Urethral prolapse is typically moderate, and the symptoms disappear on their own without treatment. However, in extreme cases, the prolapse may not receive adequate blood flow, which could cause tremendous pain. Because of this, people should get medical attention for urethral prolapse promptly as soon as they realize there is a problem.

How Could the Risk of Urethral Prolapse Be Decreased?

Even with effective therapy, urethral prolapse might recur or reappear. By keeping the pelvic region from experiencing further pressure, one can lower the likelihood of a recurrence. To carry out this:

• Sustain a healthy weight.

• Steer clear of hard lifting.

• Exercise the pelvic floor by using Kegels.

What Are the Risk Factors of Urethral Prolapse?

• Genetic Factors- Some people show a genetic predisposition to weakened pelvic muscles. These tissues support the urethra, so people with naturally weakened tissue may be at increased risk for urethral enlargement.

• Hormone Levels- Estrogen hormone generally increases muscle strength, and it is thought to help prevent pelvic organ rupture. Estrogen levels decrease during menopause, reducing muscle strength in the pelvic area. Estrogen treatment in postmenopausal women appears to reduce the risk of urethral prolapse.

• Previous Pelvic Surgery- Previous surgery for the existing urethral prolapse or any other surgery to the pelvis may increase the risk of urethral prolapse.

• Aging- Pelvic organ prolapse is more common in postmenopausal women because aging leads to a loss of muscle strength, including the strength of the lower pelvic muscles that support the urethra.

• Pregnancy and Childbirth- Those who have been pregnant and gave birth through the vagina are more likely to have this condition. Because excess weight, pressure, and labor can weaken the pelvic floor muscles. It can also stretch or tear those vital muscles and tissues.

• Pressure on Abdomen- Increased pressure on the abdomen eventually causes the pelvic floor muscles to weaken.

What Are the Treatment Options for Urethral Prolapse?

Many occurrences of urethral prolapse are minor and require little or no therapy to resolve. However, strangulated urethral prolapse may require surgery.

A. Non-surgical Methods:

• Sitz Baths - A warm, shallow sitz bath twice a day for 15 to 20 minutes will aid in the healing and cleaning of the urethral prolapse area.

• Changes in the Way of Life - With obesity, muscles are weakened, and decreasing weight is an effective strategy to lower blood pressure. Similarly, treating any underlying medical issues that may be affecting the pelvic floor muscles would aid in stress reduction. Lifting heavy objects should also be avoided. Pelvic organs may prolapse as a result of the stress.

• Exercises - The pelvic floor exercises, commonly known as Kegel exercises, help tone the pelvic muscles.

• Pessaries - These silicone devices are placed in the vaginal canal to help maintain its structure.

• Topical Hormonal Therapy - To strengthen the tissues that support the urethra, the use of estrogen-containing creams is advised. Apply a pea-sized dollop of this cream two or three times a day for two weeks. It is recommended to look for side effects like irritation, pubic hair growth, and breast budding in children using estrogen cream. Consultation with a healthcare provider is essential before using this cream.

B. Surgical Procedure:

More severe occurrences of urethral prolapses, such as those involving an infection, urethral obstruction, or a strangulated urethral prolapse, may require surgery. Typically, the surgeon will cut away the projecting tissue and then sew the lining back together during a surgical repair. Most patients require catheterization for a short time after surgery for better recovery. After surgery, estrogen creams can help prevent a recurrence.

What Is the Prognosis for Urethral Prolapse?

Although minor urethral prolapse typically has no symptoms, when the condition worsens, it can be extremely bothersome. Schedule an appointment with a physician to determine the best course of action, as there are numerous treatment options available for urethral prolapse. It is possible to have long-term relief even for those with severe urethral prolapse.

Conclusion:

Many cases of urethral prolapse usually show mild or no symptoms. Still, they can eventually develop discomfort as it progresses. While nonsurgical treatments are typically used to treat urethral prolapse, severe cases may necessitate surgery. A doctor can assist in identifying the reason for the urethra prolapse and suggest a course of treatment.