Definition and Overview

Urethrocele is a condition in which the urethra shifts from its original position and starts pressing against the vagina. It is one of the different types of prolapse that affects the female organ, along with cystoceles, enteroceles, and rectoceles. This condition is mainly triggered by the weakening of the tissues and muscle fibers that are responsible for holding the urethra in place, which is usually caused by pelvic damage due to childbirth or injury, but it can also be congenital in some rare cases. Urethrocele can sometimes be asymptomatic, allowing patients to live normally without needing treatment. However, it can also cause troublesome symptoms, such as incontinence, in which case it can be treated with continuous exercise or surgery.

Cause of Condition

The urethrocele is held in place by a thick layer of muscle fibers and soft tissue, called the pelvic floor. However, certain situations may cause the pelvic floor muscles and tissues to lose their natural strength, causing them to stretch and become unable to hold the urethra (other structures of the female organ) in their original place. Once this occurs, the urethra, which is shaped like a tube, will widen and form a curve, until it starts to press into the vaginal wall.

There are many risk factors that may increase a woman’s likelihood of developing a urethral prolapse, such as:

  • Pregnancy and childbirth - The most common reasons for the weakening of the pelvic muscles are pregnancy and childbirth. The strain of holding the heavy womb combined with the strain of labor and the passing of the baby may damage the pelvic floor.

  • Age - Age also plays a role in this process, as the muscles also naturally weaken as a woman ages.

  • Congenital defects - There are some rare cases in which young women who have never had any children suffer from this weakening of the pelvic muscles, as well as some cases wherein a urethral prolapse may already be present even at birth. Both cases are caused by congenital defects in the pelvic floor.

  • Obesity

  • Repetitive activities causing pressure to the pelvic floor, such as lifting heavy objects frequently

  • Health conditions that cause repetitive strain on the pelvic muscles, such as chronic cough or chronic constipation

  • Hysterectomy (surgery to remove the uterus)

Key Symptoms

Although asymptomatic cases are possible, most women with urethrocele will suffer from the following symptoms:

  • Incontinence – This refers to the inability to hold urine in, causing the patients to leak urine especially when they laugh, jump, sneeze, lift objects, or cough.

  • Cystitis – A woman with urethrocele faces a higher risk of getting a bladder infection, resulting in difficulty in emptying the bladder completely.

  • Dyspareunia – This refers to feeling some pain during sexual intercourse.

  • Increased frequency of urinating

  • Frequent and recurrent urinary tract infections

  • Heavy feeling or pressure in the lower abdominal area

It is also common for women to have urethrocele and a cystocele, or a prolapse of the bladder at the same time, in which case her condition becomes identified as a cystourethrocele.

Also, like other prolapse conditions affecting the female organ, urethrocele can occur on different grade levels depending on how much pressure there is on the vagina.

  • 1st degree – The urethra presses against the upper vagina
  • 2nd degree – The urethra presses up to the introitus
  • 3rd degree – The urethra protrudes from the vaginal opening

A woman showing signs of urethrocele will be diagnosed using a physical exam and with the help of some tests, such as a urinalysis and a urinary stress test. X-ray scans, as well as urine culture, may also be done to check for infection.

Who to See And Types of Treatment Available

Women suffering from urethrocele or experiencing incontinence may consult her general physician or obstetrician-gynecologist. Both are capable of making recommendations based on the state of the patient’s health.

In symptomatic cases, treatment primarily involves:

  • Kegel exercises – Doing Kegel exercises is an effective way to strengthen the pelvic floor muscles, and this can help improve the patient’s condition and reduce symptoms. To do Kegel exercises, simply contract and release the pelvic muscles repeatedly. These are the same muscles that control the flow of urine.

  • Surgery – In some severe cases, urethrocele may be treated with surgery, in which the supporting structure surrounding the urethra is repaired.
    References:

  • Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: diagnosis and management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 20.

  • Winters JC, Togamai JM, Chermansky CJ. Vaginal and Abdominal Reconstructive Surgery for Pelvic Organ Prolapse. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 72.

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