What is urethral prolapse?
The inner lining of the urethra (the tube that carries urine out of the bladder) pushes out through its opening and forms a swollen ring around it. This is called urethral prolapse.
It is most common in girls before puberty. The exact cause is not known. Conditions that raise pressure inside the belly, such as a persistent cough or constipation, can make it more likely. Excess weight and injury to the genital area are also risk factors.
Symptoms
- small spots of blood on the underwear or diaper: this is how most parents first notice it,
- a red or purple, doughnut-shaped swelling around the opening of the urethra,
- usually no pain, but sometimes discomfort when she pees or when the area is wiped,
- rarely, difficulty peeing.
Diagnosis
An examination by a doctor is usually enough: the opening of the urethra is seen in the center of the ring-shaped swelling. Complex tests are usually not needed to make the diagnosis. Girls can have genital bleeding for other reasons, such as a foreign body in the vagina or vulvovaginitis. So if you see blood, do not try to diagnose it yourself; have your daughter seen by a doctor.
Why it should not be left untreated
Over time, the prolapsed lining can become trapped, lose its blood supply and develop sores. The tissue can then die (necrosis), pain gets worse and surgery becomes necessary. This is why urethral prolapse should be treated promptly.
Treatment
- Estrogen cream: a small, pea-sized amount is applied directly to the red area once or twice a day. The cream is used for a short time, until the prolapse heals; the doctor decides how long.
- Warm sitz baths: she sits in shallow, warm water for 15–20 minutes twice a day.
- Treating the trigger: constipation and a lingering cough are treated.
Antibiotics do not treat the prolapse and are prescribed only if there is also an infection.
When is surgery needed?
The cream and baths do not always work. Removing the prolapsed lining is considered when:
- the prolapse does not go away despite treatment,
- the prolapse comes back after it has healed,
- bleeding continues, pain is severe or peeing is difficult,
- the prolapsed tissue loses its blood supply (thrombosis, necrosis).
When to see a doctor
If you see blood on the underwear or diaper, have your daughter checked. If she cannot pee, the swelling is very painful or the bleeding gets heavier, seek urgent care without waiting for a scheduled appointment.
Urethral prolapse can come back even after treatment. Keep going to follow-up visits after the course has finished, and help prevent constipation.
When to seek urgent care
If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.
- Unable to pee or great difficulty peeing
- Severe pain in the swollen area
- Bleeding that does not stop or gets heavier
Call your local emergency number (112 in Europe, 911 in North America)
Note for pediatricians and family doctors
Urethral prolapse occurs mainly in prepubertal girls, with an average age at presentation of about 4 years. The most common complaint is genital bleeding; a hyperemic, doughnut-shaped mass with the urethral meatus at its center usually allows a clinical diagnosis. Factors that raise intra-abdominal pressure (chronic cough, constipation) should be treated. Conservative treatment consists of topical estrogen cream and sitz baths; in a review of 278 pediatric cases, medical treatment was successful in 19% of all patients (32.7% of those in whom it was tried first), and recurrence was reported up to 2 years after conservative treatment. Indications for surgical excision include failure of conservative treatment, recurrence, persistent bleeding, urinary retention and complicated prolapse (thrombosis, necrosis). The differential diagnosis includes a foreign body, vulvovaginitis, urethral caruncle, ectopic ureterocele and tumor; when abuse is suspected, a careful examination and a detailed interview with the parents are advised.
What happens at the visit?
- The external genitalia are gently examined, and the color and size of the swelling are assessed.
- We ask about constipation, a lingering cough and any problems with peeing.
- We explain how to use the cream and sitz baths and plan a follow-up visit.
Frequently asked questions
Is the blood coming from the urethra or the vagina?
Parents usually see the blood on underwear or a diaper, and it is hard to tell the source at home. In urethral prolapse, the bleeding comes from the swelling around the opening of the urethra. Girls can have genital bleeding for other reasons too, so always have your daughter seen by a doctor.
When is surgery needed?
When the cream and baths do not help, when the prolapse comes back after healing, or when bleeding continues, pain is severe or peeing is difficult.
Does she need antibiotics?
Antibiotics do not treat the prolapse itself. The doctor prescribes them only if there is also an infection.
Related topics
Sources
- Kacimi SEO et al. Conservative approach for the treatment of urethral prolapse in children: case report and literature review of 278 pediatric cases. Afr J Urol, 2021.
- Seck NF et al. Conservative management of urethral prolapse in African girls: a report of 15 cases. Afr J Urol, 2022.
- Gill BC. Urethral prolapse. Medscape, 2021.
- SickKids staff. Urethral prolapse. AboutKidsHealth, 2019.
- The Royal Children's Hospital Melbourne. Clinical Practice Guideline: Vulval and vaginal conditions.
This information is for educational purposes and does not replace medical advice. Decisions about your child’s treatment are made with the doctor after an examination.
Updated: