Urethral prolapse (urethrocele) occurs when the urethra pushes into the vaginal canal. It also can happen when the urethra protrudes out of the urethral opening.
The urethra is a tube that carries urine from the bladder to the outside of the body. Typically, the urethra is held in place by a series of ligaments, muscles, and tissue. However, those supporting elements can give away for various reasons. When the urethra slips from its normal position, it can push into the vagina, slip out of the urethral opening, or both.
In many cases, bladder prolapse (cystocele) also occurs with urethral prolapse. This combination of conditions is called cystourethrocele.
People with mild or minor prolapse may not feel any symptoms. As the prolapse becomes more severe, symptoms may include:
- vaginal or vulvar irritation
- a feeling of fullness or pressure in the pelvic and vaginal area
- aching discomfort in the pelvic area
- urinary problems, such as stress incontinence, being unable to empty the bladder, and frequent urination
- painful sex
- organs bulging out of the vaginal or urethral opening
Urethral prolapse is classified by the severity of the protrusion:
- First-degree prolapse means the urethra is mildly pushing against the vaginal walls or slightly dropped toward the urethral opening.
- Second-degree prolapse typically means the urethra extends to the vaginal or urethral opening, or the vaginal walls have collapsed somewhat.
- Third-degree prolapse means the organs bulge outside of the vaginal or urethral opening.
Urethral prolapse occurs when the muscles, tissues, and ligaments inside the body are weakened. Fascia, a thin sheath of tissue, typically holds internal organs in place. When it fails, the other tissue may not be strong enough to maintain the normal position.
It’s unclear why urethral prolapse occurs, but some people seem more likely to develop it than others.
These risk factors, events, or conditions may increase the odds you’ll develop urethral prolapse.
Postmenopausal people are more likely to develop urethral prolapse. Estrogen is vital to muscle strength. When the level of this hormone begins to drop as a person nears menopause, the muscles may start to weaken too. Likewise, pelvic floor muscles grow weaker with natural aging.
Pregnancy and childbirth
Those who’ve been pregnant and given vaginal birth are more likely to experience this condition. The extra weight, pressure, and force of delivering a baby can weaken pelvic floor muscles. It can also stretch or tear those important muscles and tissues.
For some, the damage caused by pregnancy and childbirth may not show up until later, many years after the pregnancy.
Genetic muscle weakness
Some people are born with weak pelvic floor muscles. This makes prolapse more likely in people who are younger or haven’t been pregnant.
Increased pressure on the abdomen
Unnecessary pressure on the pelvic floor muscles can lead to weakening. Conditions that increase pressure include:
- lifting heavy objects routinely
- chronic coughing
- frequent straining, such as during a bowel movement
- presence of pelvic masses, including fibroids or polyps
Previous pelvic surgery
If you’ve had an earlier surgery for urethral prolapse or another pelvic organ prolapse, you’re at an increased risk for other prolapses.
Minor prolapse may not require treatment. In fact, you may not even know about the protruding urethra until it becomes more advanced. That’s because early stage urethral prolapse doesn’t always cause symptoms.
Treatment may be necessary for advanced prolapse. Your options will depend on the severity of the prolapse, the state of your health, and possibly your plans for a future pregnancy.
- Pessaries. These silicone devices sit in the vaginal canal and help maintain its structure. Pessaries come in many sizes and shapes. Your doctor will place it in your vaginal canal. It’s an easy, noninvasive option, so doctors often recommend trying a pessary before other treatments.
- Topical hormones. Estrogen creams can supply some of the missing hormone to the weakened tissues to help bolster their strength.
- Pelvic floor exercises. Pelvic floor exercises, also called Kegel exercises, help you tone the organs in your pelvis. Imagine you’re trying to hold an object in place with your vaginal canal, and tightly contract for 1 to 2 seconds. Then relax for 10 seconds. Repeat this 10 times, and do this several times a day.
- Lifestyle changes. Obesity can weaken muscles, so losing weight is a good way to help reduce pressure. Likewise, treating any underlying medical conditions that might be impacting your pelvic floor muscles will help eliminate stress. Try to avoid lifting heavy objects too. The strain can cause organs to prolapse.
If nonsurgical treatments aren’t effective or aren’t an option, your doctor may recommend surgery, such as anterior vaginal wall repair, to strengthen the supporting structures.
Several types of surgery can be used to treat urethral prolapse. What’s right for you will depend on the severity of the prolapse, your overall health, and any other organs that may be prolapsed.
While mild urethral prolapse usually doesn’t cause any symptoms, it can become quite uncomfortable as the condition progresses.
There are many treatment options for urethral prolapse, so make an appointment with your doctor to figure out the best next steps. Even people with severe urethral prolapse can find long-term relief.