Urethral Prolapse

The urethra is the tube that drains urine from the bladder to the outside of the body. Urethral prolapse occurs when the inner lining of the urethra sticks out. When this happens, the opening of the urethra looks like a small pink donut and seems larger than normal.

Children with urethral prolapse may not have any symptoms at all. Urethral prolapse occurs most commonly in young girls before puberty. Children may have blood spots on their underwear or diapers. Some children may complain of tenderness when wiping themselves after going to the bathroom.

The exact cause of urethral prolapse is not known. It may happen if the tissues around the urethra are weak. It often happens before puberty starts, when girls have low levels of the estrogen hormone. African American and Hispanic girls are more at risk for getting urethral prolapse. It is also more likely to happen to girls who have a history of heavy coughing, constipation, urinary tract infections, trauma or who are obese. All of these conditions can increase pressure inside the belly, which may lead to urethral prolapse.

Often, urethral prolapse is an incidental finding during routine examination. Upon examination, round doughnut-shaped tissue is observed protruding from the urethral opening.

Since some girls have no symptoms, no treatment may be an option. If there are symptoms, we will discuss your options for treatment with you and your family. These treatments may include:

• Estrogen cream: A hormone cream called Premarin® may be prescribed for a short time. Premarin® is an estrogen cream. It is important that when the cream is applied you watch for known side effects (development of pubic hair, breast budding, general irritation). Once the cream is stopped the side effects may go away.
• Vaseline: Another option is to simply apply Vaseline®. The Vaseline will act as a barrier to help alleviate any sensitivity associated with the prolapsed urethra.
• Sitz baths: A warm, shallow sitz bath twice a day for 15 to 20 minutes will help the urethral prolapse area heal and keep the area clean.
• Surgery: Sometimes, medical treatment does not resolve the urethral prolapse. If your child continues to have symptoms, surgery may be needed.

Reviewed by: Division of Urology
Date: August 2011