Urethral Prolapse: Causes, Symptoms, and Treatment

Urethral prolapse is a relatively rare condition that occurs when the urethra, the tube that carries urine from the bladder out of the body, becomes inverted or everted.

While not life-threatening, urethral prolapse can significantly impact a person's quality of life if left untreated. The prevalence of urethral prolapse is higher in women, especially young girls and postmenopausal women.

This condition can affect kidney function in several ways, including filtration of waste and excess fluids, regulation of blood pressure, production of hormones like erythropoietin, and maintenance of electrolyte balance.

Untreated urethral prolapse can lead to complications such as recurrent urinary tract infections, urinary retention, and in severe cases, kidney damage.

It is important to note that urethral prolapse is often asymptomatic in its early stages, highlighting the need for regular screenings and early detection to prevent long-term health risks.

Causes of Urethral Prolapse

Urethral prolapse can have various causes, both primary and secondary, that contribute to its development. Primary causes include factors that directly affect the urethra and surrounding structures, leading to prolapse over time.

• Pregnancy and Childbirth: The physical stress of pregnancy and vaginal childbirth can weaken the pelvic floor muscles, which support the urethra, bladder, and other pelvic organs. This weakening can result in urethral prolapse and impact kidney function by increasing the risk of urinary incontinence and pelvic organ prolapse.
• Chronic Cough or Straining: Conditions like chronic bronchitis, asthma, or habitual straining during bowel movements can create increased intra-abdominal pressure. This pressure can push down on the pelvic organs, including the urethra, leading to prolapse and affecting kidney function by disrupting normal urine flow.
• Connective Tissue Disorders: In some cases, underlying connective tissue disorders like Ehlers-Danlos syndrome or Marfan syndrome can weaken the supportive tissues around the urethra, making it more susceptible to prolapse. These conditions may increase the risk of urethral prolapse and impact kidney function through structural abnormalities.
• Age and Hormonal Changes: As women age, hormonal changes, especially during menopause, can contribute to the weakening of pelvic floor muscles and tissues. Additionally, decreased estrogen levels can affect the elasticity and strength of the urethral tissues, potentially leading to urethral prolapse. Factors such as obesity, smoking, and a history of pelvic surgeries can also increase the likelihood of developing urethral prolapse.

Secondary risk factors or lifestyle contributors can further exacerbate the risk of urethral prolapse. These factors may not directly cause prolapse but can worsen existing conditions or weaken pelvic support structures.

• Obesity: Excess weight can put additional pressure on the pelvic floor muscles and organs, increasing the risk of urethral prolapse and affecting kidney function by compromising urine flow and retention.
• Heavy Lifting: Engaging in activities that involve heavy lifting or straining can strain the pelvic floor muscles and lead to urethral prolapse. This can impact kidney function by disrupting the normal anatomy and function of the urinary tract.
• Chronic Constipation: Persistent constipation can cause frequent straining during bowel movements, which can weaken the pelvic floor muscles and contribute to urethral prolapse. This can affect kidney function by increasing the risk of urinary retention and infections.

Symptoms of Urethral Prolapse

Recognizing the symptoms of urethral prolapse is crucial for timely diagnosis and management. Symptoms can vary depending on the stage of prolapse, with early-stage symptoms often being subtle and easily overlooked.

Early Symptoms:

• Vaginal Bleeding: One common early symptom of urethral prolapse is vaginal bleeding, which may occur during urination or independently. This can impact daily activities due to discomfort and may be mistaken for menstrual bleeding, leading to delayed diagnosis.
• Urinary Frequency: Increased urinary frequency, especially during the night, can be an early sign of urethral prolapse. This symptom may be misunderstood as a normal part of aging or attributed to other causes, delaying proper diagnosis and treatment.

Advanced Symptoms:

• Urinary Incontinence: As urethral prolapse progresses, it can lead to urinary incontinence, where a person may experience leakage of urine during activities like coughing, sneezing, or exercising. This can have a significant physical and emotional impact on daily life, affecting self-esteem and quality of life.
• Pelvic Pressure: Advanced stages of urethral prolapse may cause pelvic pressure or a feeling of something bulging in the vagina. This physical sensation can be distressing and may indicate a more severe prolapse that requires medical intervention.

Diagnosis of Urethral Prolapse

Diagnosing urethral prolapse typically involves a series of tests and examinations to accurately assess the condition and determine the appropriate treatment approach.

• Pelvic Exam: A thorough pelvic examination allows healthcare providers to assess the position of the urethra and surrounding structures.