Urethral prolapse: causes, symptoms, and treatment options

Seeing unexpected tissue, swelling, or bleeding near the urethra can be alarming. While urethral prolapse looks concerning, it doesn’t mean your body is in danger. 

Urethral prolapse is a rare condition where the inner lining of the urethra — the tube that carries urine from the bladder out of the body — protrudes through the urethral opening. “If you have urethral prolapse, try not to panic,” says Renee Bullis, PT, DPT, a physical therapist at Hinge Health. “Symptoms can often be managed with simple at-home treatments,” she shares.

Urethral prolapse is uncommon, but when it does happen, it most often affects two groups: girls before puberty and postmenopausal women. The good news is that with the right diagnosis and treatment plan, most people recover well.

Here's what you need to know about urethral prolapse in females, including what causes it and how targeted exercises recommended by Hinge Health physical therapists can support both prevention and recovery.

What is urethral prolapse?

Urethral prolapse happens when the inner lining of the urethra slips outward through the urethral opening. “The inner lining of the urethra sticks out like a small pink or red doughnut-shaped ring,” explains Dr. Bullis.

This is different from other types of pelvic organ prolapse, where the bladder, uterus, or rectum bulges into the vaginal wall. Urethral prolapse also differs from a urethrocele, which is when the urethra bulges into the front vaginal wall.

“Urethral prolapse is not very common, so some healthcare providers may not see it often,” says Dr. Bullis. That’s why getting a proper diagnosis from a medical provider is so important. In some cases, this may mean seeing a specialist, such as a urogynecologist or a urologist, who regularly evaluates urethral and pelvic floor conditions.

Who gets urethral prolapse?

Urethral prolapse occurs in females and most often affects two groups:

• Prepubescent girls. Urethral prolapse is most common in girls between ages 2 and 10, before puberty begins. It’s more frequently reported in Black and Hispanic girls.

• Postmenopausal women. Urethral prolapse can also occur after menopause, when estrogen levels are lower.

For both groups, low estrogen is thought to play a role. Estrogen helps keep urethral and vaginal tissues strong and elastic. When estrogen levels are lower, these tissues may become thinner and less supported, making prolapse more likely. “We rarely see it in women of reproductive age because they typically have higher estrogen levels,” explains Dr. Bullis.

Causes of urethral prolapse

The exact cause of urethral prolapse isn’t always clear. “We do know it’s related to changes in the tissues and ligaments that support the urethra,” says Dr. Bullis. Possible contributors include:

• Low estrogen levels. Lower estrogen levels in prepubescent girls and postmenopausal women can contribute to tissue thinning and weakening, making urethral prolapse more likely.

• Increased abdominal pressure. Chronic constipation, frequent straining, chronic coughing, heavy lifting, or excess pressure on the pelvic area may contribute. “We see it in some women with chronic constipation because they regularly strain or push with their abdominal muscles to force bowel movements,” says Dr. Bullis.

• Tissue weakness. Some people naturally have weaker connective tissue around the urethra, which may make prolapse more likely, Dr. Bullis explains.

• Trauma to the area. If you’ve had pelvic surgery or an injury to the perineal area after childbirth, for example, these may contribute to urethral prolapse in some cases.

Signs and symptoms of urethral prolapse

Urethral prolapse symptoms can vary. Some people, especially children, may have little to no discomfort. Others may notice bleeding, irritation, or pain. Common symptoms include:

• A visible pink or red ring of tissue at the urethral opening

• Vaginal spotting or bleeding, which may show up as blood on underwear or a diaper

• Pain or discomfort when urinating

• Frequent urination or urgency

• Blood in the urine

• Difficulty with urinating, or urinary retention

• Genital discomfort or tenderness

• Painful sex in sexually active adults

• No symptoms, especially in young girls

If you or your child notices visible tissue, bleeding, or pain near the urethral opening, see a healthcare provider for a proper diagnosis. If symptoms include severe pain, a blue or black color change in the tissue, or trouble peeing, seek medical care right away, as these can signal impaired blood flow or a blockage.

Diagnosing urethral prolapse

Urethral prolapse is usually diagnosed during a physical exam. A correct diagnosis requires verifying that the urethral opening is directly in the center of the protruding tissue. This is often described as a doughnut-shaped mass.

Several conditions can look similar to urethral prolapse, including:

• Urethral polyp, a benign growth in the urethral lining

• Urethral caruncle, a small benign growth near the urethral opening

• Urethrocele, where the urethra bulges into the front vaginal wall

• Lichen sclerosus, a skin condition that can affect the vulvar area

• Urethral cancer, which is very rare but may need to be ruled out in unusual cases

Because these conditions require different treatment approaches, it’s best not to self-diagnose. That said, there are some things you can do to advocate for a clear diagnosis, including:

• Write down when your symptoms started, what they look and feel like, and whether you’ve noticed bleeding or changes in urination.

• If you feel comfortable, take clear photos of the tissue when symptoms are present so your provider can see what’s happening even if it isn’t visible during your appointment.

• Ask your provider to check whether the urethral opening is directly in the center of the protruding, doughnut-shaped ring of tissue — this is a key sign of urethral prolapse and helps distinguish it from other conditions.

• If you still have questions or your symptoms aren’t improving, ask for a referral to a urogynecologist or a urologist.

How movement can help prevent and support recovery from urethral prolapse

Urethral prolapse treatment is primarily medical and may include topical estrogen, sitz baths, and sometimes surgery. Pelvic floor exercises are not typically the first-line treatment for an active prolapse, but they can support long-term pelvic health, help prevent recurrence, and aid recovery after simple treatments or even surgery.

“It’s especially important for postmenopausal women to maintain pelvic floor strength and help support all pelvic structures,” says Dr. Bullis.

Movement can also help reduce some of the pressure that contributes to pelvic symptoms. For example, staying active can support healthy bowel function, which may reduce constipation and straining. Learning how to breathe during lifting and daily activities can also help manage pressure through your abdomen and pelvic floor.

These exercises support pelvic floor activation, core strength, and better pressure management. Diaphragmatic breathing helps reduce strain and improve coordination. Hooklying kegels and kegel squats strengthen the pelvic floor, while dead bug, donkey kicks, and abdominal bracing with bent knee fallout build core and hip support. These skills can make everyday movement feel more controlled and comfortable.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment for urethral prolapse

Urethral prolapse treatment depends on the severity of symptoms, as well as other factors like patient age. Here’s what Hinge Health physical therapists recommend:

Non-surgical treatments

Simple at-home treatments are often the first approach, especially when symptoms are mild and the tissue looks healthy. Your provider may recommend:

• Topical estrogen cream. This prescription cream is applied to the affected area to help strengthen and heal the tissue. It may be used in both postmenopausal women and young girls when prescribed and monitored by a healthcare provider.

• Warm sitz baths. Sitting in warm, shallow water for several minutes a few times a day can help reduce irritation and discomfort.

• Gentle hygiene. Keep the area clean and dry, but avoid harsh soaps, antiseptic wipes, or over-scrubbing. “Don’t overly clean it with harsh soaps or antiseptic wipes,” says Dr. Bullis. Lukewarm water and gentle patting are usually best.

• Cold therapy for comfort. “Another option is to fill a urinary pad with water, then put it in the freezer for a couple of hours before you apply it to the urethral area,” advises Dr. Bullis. “It can help ease pain and inflammation.”

• Antibiotics, if needed. If a urinary tract infection is present, your medical provider may prescribe antibiotics.

Many cases improve with simple at-home treatments like the ones above, especially when treatment starts early.

Surgical treatment

Surgery is not automatically necessary for urethral prolapse. It’s usually reserved for specific situations, such as:

• Symptoms that don’t improve after several weeks or months of conservative treatment

• Severe or persistent bleeding

• Prolapsed tissue that loses blood supply, called strangulation

During surgery, a provider removes the excess tissue and secures the urethral lining. Recovery often includes the same supportive measures used during simple at-home treatment, and pelvic floor physical therapy may help support strength, coordination, and recurrence prevention afterward.

Living with and preventing urethral prolapse

Whether you’re managing urethral prolapse or trying to prevent recurrence, several strategies can support long-term pelvic health. Follow your treatment plan. Use topical estrogen, sitz baths, or other treatments exactly as recommended by your provider. Consider these other holistic approaches as well:

• Manage constipation. Preventing straining can reduce pressure on pelvic tissues. Stay hydrated, eat fiber-rich foods, and stay active. Ask your provider whether a stool softener is appropriate if constipation is ongoing.

• Practice good bathroom habits. Try not to strain or rush when peeing or having a bowel movement. “We see a lot of what we call racehorse peeing, where women try to pee as fast as they can,” explains Dr. Bullis. “It puts unnecessary pressure on the urethra.”

• Maintain a healthy weight. This can help reduce pressure on the abdomen and pelvic floor.

• Use good lifting mechanics. Exhale as you lift heavy objects. Holding your breath during this motion can increase pressure on the pelvic floor.

• Stay active with appropriate exercises. “The stronger and more mobile your hips, the healthier your pelvic floor will be,” says Dr. Bullis.

• Work with a pelvic floor PT. This can be especially helpful for postmenopausal women, anyone who strains during bowel movements, or people recovering after treatment.

• Address chronic coughing. If allergies, asthma, smoking, or another issue causes frequent coughing, treating the underlying cause can help reduce repeated pressure on the pelvic floor.

Understanding recovery and outlook

Can urethral prolapse heal itself? Sometimes, especially in children, symptoms may improve as estrogen levels rise with puberty. But it’s still important to get a medical evaluation and follow your provider’s treatment plan, which can help speed healing and reduce discomfort.

In postmenopausal women, urethral prolapse usually needs treatment, often with topical estrogen or other simple treatments. Some people may need ongoing support to maintain tissue health and reduce the risk of recurrence.

Is urethral prolapse dangerous? In most cases, no. Urethral prolapse is generally benign and treatable. Serious complications, such as loss of blood supply to the tissue, are rare when the condition is diagnosed and managed appropriately.

“With the right treatment, people can usually expect symptoms to improve within about four to six weeks,” says Dr. Bullis.

When to see a doctor

Urethral prolapse often improves over time with simple at-home treatments recommended by your provider. But if you’re experiencing pain or it’s causing difficulty with daily activities, see a healthcare provider.

In rare cases, symptoms can suggest a more urgent problem with blood flow or a blockage. Get medical care right away — call your provider, go to urgent care, or go to the emergency room — if you or your child:

• Has severe pain in the prolapsed tissue

• Notices the tissue turning blue, purple, or black

• Can’t pee or is only passing very small amounts of urine

It’s also a good idea to get care if you or your child:

• Notices visible tissue at the urethral opening

• Has vaginal bleeding or spotting, especially in a child

• Has painful urination or blood in the urine

• Has symptoms that don’t improve with prescribed treatment

• Shows signs of infection, such as fever, increased redness, pus, or foul odor

PT tip: Breathe when you lift

If you need to lift something heavy, exhale as you pick it up. “We often instinctively hold our breath, but that puts more pressure on our pelvic floor and can stir up urethral prolapse symptoms,” says Dr. Bullis. Think of your breath as a pressure-release valve: exhaling during effort helps your core and pelvic floor work together more efficiently.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Vunda, A., Vandertuin, L., & Alain Gervaix. (2011). Urethral Prolapse: An Overlooked Diagnosis of Urogenital Bleeding in Pre-Menarcheal Girls. The Journal of Pediatrics, 158(4), 682–683. doi:10.1016/j.jpeds.2010.11.050

2. Chene, G., Nohuz, E., Cerruto, E., & Mellier, G. (2026). Surgical management of urethral prolapse in five steps: A technical note. Journal of Gynecology Obstetrics and Human Reproduction, 55(5), 103143. doi:10.1016/j.jogoh.2026.103143

3. Hidouri, S., Ammar, S. B., Mosbahi, S., Chaouch, M. A., Gafsi, B., & Mekki, M. (2024). A case report of urethral prolapse in young girls: Clinical manifestations and surgical management. International Journal of Surgery Case Reports, 120, 109879. doi:10.1016/j.ijscr.2024.109879

4. Silveira, F., Magalhães, R., Leandro, V., Viana, S., Alvim, M., & Seixas, J. A. (2025). Ischemic urethral prolapse in postmenopausal woman – case report. Maturitas, 199, 108502. doi:10.1016/j.maturitas.2025.108502

5. Ma Mayala, A. M., Ngwala, P. L., & Lubaki, J.-P. F. (2021). Diagnosis and management of a urethral prolapse in a 6-year-old girl: a case report. Pan African Medical Journal, 39. doi:10.11604/pamj.2021.39.284.30954

6. Benign (Not Cancerous) Urethral Lesions: Symptoms, Diagnosis & Treatment - Urology Care Foundation. (n.d.). Www.urologyhealth.org. https://www.urologyhealth.org/urology-a-z/b/benign-(not-cancerous)-urethral-lesions

7. Salah, Aloulou, M., Naoum, R., Moumeni, M., Abdallah Kaddour, & ElSheemy, M. S. (2021). Conservative approach for the treatment of urethral prolapse in children: case report and literature review of 278 pediatric cases. African Journal of Urology, 27(1). doi:10.1186/s12301-021-00256-5