Medicine has quite a history of crazy, outdated medical practices. Bloodletting, animal dung ointments and sleeping with human skulls were once considered “modern medicine”. Yikes.
Not far behind these practices is female urethra stretching (also known as urethral dilation). What’s scarier about female urethra stretching compared to bloodletting and animal poop ointments, is the fact that there are still doctors offering this therapy.
At Pazona MD Urology we want you to get the care you deserve. This includes avoiding unnecessary and potentially dangerous therapies.
What is female urethra stretching?
The female urethra is a short muscular tube where urine passes through during urination. It starts at the bladder opening, is surrounded by a muscular sphincter, and leads to an opening (meatus) just above the vaginal opening and below the clitoris. The female urethra is responsible for holding urine in during coughing, laughing and sneezing.
Female urethra stretching is a dilation or widening of the urethra. Typically performed in an office setting, a series of metal dilators (that look like medieval torture devices) are placed into the opening of the urethra. These progressively larger rods “stretch” the urethra to treat “narrowing” (we’ll soon find out why this is bogus).
Why is female urethra stretching performed?
Mankind has been placing objects into the urethra, with apparent good intentions, for almost 3000 years. In modern times the practice of female urethra stretching was popularized in the 1960’s for treatment of recurrent bladder and urethral infections. Urethral dilations were also used in young girls with “potty problems.”
Today, urologists and urogynecologists perform female urethra stretching for:
- Urethral strictures (narrowing)
- Recurrent bladder infections
- Urethral pain
- Poor bladder emptying
- Frequent urination
- Bladder leakage
Well that sounds reasonable. So what’s the problem? A review article by a leading expert in urology states:
“Modern studies have demonstrated that urethral dilation is of NO VALUE in treating symptoms of urgency/frequency in females in the absence of true urethral stricture”
It’s not often that leading medical experts use the term “no value” to describe a therapy. When in doubt they tend to say “may or may not help but further studies are necessary.” In other words, when we hear the words “no value” then we should listen.
You might be asking yourself:
“But maybe a lot of women need female urethral stretching for a urethral stricture or narrowing?”
The problem with that logic is that true female urethral strictures are RARE. VERY RARE. A review of the literature reveals that other than a few case reports (single patient reports), there are “no more than 40” reported cases of female urethral strictures since 1965! Logic should dictate then that female urethral dilation should be very rare as well. Unfortunately this is not the case.
Why is female urethral dilation still being performed?
There are several reasons why urologists and urogynecologists are still performing female urethral stretching:
- Outdated medical practice beliefs
- Financial benefits
- Patient requests
I wish we could state that all doctors practice up-to-date medicine like our Pazona MD providers. Unfortunately this is not the case. Many physicians do not change their medical practices and are performing the same procedures they were trained on 30 years ago. In medicine we have a rule that states 50% of what we know today will be wrong in 10 years . . . we just don’t know which 50% is wrong.
Unless your doctor is forward thinking and takes the time to consume high-quality continuing medical education material (CME), then you might be subjecting yourself to outdated therapies like female urethral dilation.
If you haven’t noticed, the U.S. healthcare system is a fee-for-service model. Doctors get paid to do “more stuff” to patients. It’s perverse, we know. This is slowly changing to a value-based component of payment (doctor’s being paid for providing “high-value” medical care). Until then just be mindful of the financial incentives in medicine.
Lastly, some women have been having their urethras dilated for YEARS. It’s a bit of a ritual that some women feel is necessary to continue to help their “bladder symptoms.” Rather than argue with these women, doctors often continue the dilations.
Re-educating patients with current medical guidelines can be hard work. But, we believe it’s crucial. The more you know as a patient, the more engaged in your medical care you will become, the better the outcomes you will receive.
Can female urethra dilation help my symptoms?
Despite all that you have just learned about the negatives of female urethral stretching, some women do report relief of their symptoms. Slow stream, frequent urination and urethral pain can sometimes improve with urethral dilation. How much of this is psychological relief vs. physiologic relief, we don’t know.
There are plenty of traditional and non-traditional therapies that we as healthcare professionals don’t understand. It’s not due to lack of caring or incompetence either. The human body is very complex. Sometimes a treatment will help and we cannot explain why.
However, make certain you are well informed of possible long-term risks.
What are the dangers of female urethra stretching?
There are several risks to female urethral stretching. The first being the short-term recovery. Pain and bleeding with urination is common for several days. Blood dripping from the urethra may also be seen. A urinary tract infection can occur with any procedure of the urinary tract.
The long-term complications of female urethral dilation are not well known. If female urethral stretching is extreme then conceivably damage can occur to external urethral sphincter. This is the muscle surrounding the female urethra which is partially responsible for urine control.
Repeated dilation or enlargement of the sphincter muscle can cause urinary incontinence. This is commonly seen in women with chronic urinary catheters in their bladder. The urethra gets bigger and bigger the longer catheters in place. Eventually the urethral opening is so dilated, that urine leaks out without warning.
The worst known danger of female urethra stretching is that it delays getting the care you deserve! Urethral dilation does not truly help most female urology issues. The good news is that the right doctor and therapy is closer than you think!
What are treatment alternatives to female urethra stretching?
The best treatment alternative to female urethral dilation depends on your symptoms or condition. Let’s take a look at the most common reasons a woman will have her urethra stretched and identify some better approaches to these issues:
Recurrent bladder infections
Urinary tract infections (UTI) are rarely due to a “narrowed urethra”. Evaluation by a board-certified urologist can identify and treat risk factors for recurrent bladder infections such as:
- Infrequent urination due to low fluid intake or prolonged holding of urine.
- Constipation
- Poor bladder emptying
- Low estrogen levels
- Abnormality of the urinary tract (e.g. stones, blockages)
- Genetics
UTI prevention is possible with treatment of the above conditions and use of medications such as:
- High-quality cranberry and D-mannose extracts
- Daily, low-dose antibiotics (don’t worry the correct antibiotic is actually safe)
- Hormone replacement therapy
Overactive bladder (OAB) symptoms
An overactive bladder causes urinary frequency, urgency, excessive nighttime urination and bladder leakage. It is caused by an abnormality in the signaling pathway between the brain and the bladder. Urethral stretching makes absolutely zero sense for treating this condition but sadly it is still performed by some doctors.
As an alternative, if you have overactive bladder symptoms, then you should instead consider:
- A bladder friendly diet (low acid/caffeine/sugar)
- Treating constipation
- An evaluation for obstructive sleep apnea (OSA)
- A trial of an overactive bladder medication
- Consultation with a urology specialist to discuss bladder botox injections or sacral neuromodulation (bladder pacemaker)
Pelvic pain (urethritis, interstitial cystitis)
Let me get this straight. You’re having pain in the urethra or bladder and the recommended treatment is placing LARGE METAL RODS IN YOUR URETHRA! I’m confused . . . and scared.
Now there’s no doubt that healthcare professionals often do a poor job of treating chronic pain. Pelvic pain and interstitial cystitis (IC) are no exception. If for some reason you’ve tried everything else and urethral dilation helps your pain, then no judgment here.
On the other hand, may we kindly suggest the following for your pelvic pain:
- Bladder friendly diet (eliminate caffeine, sugar and acid)
- Pelvic physical therapy
- High-intensity interval training (HIIT exercises) several days a week
- A low carb diet with intermittent fasting
- Stress reduction including meditation
- A 2nd opinion via telemedicine
Poor bladder emptying
Women have difficulty emptying their bladder much less commonly than men. Nonetheless, urinary retention or incomplete bladder emptying can be caused by:
- Weakened bladder muscle (atonic bladder)
- Neurogenic bladder (e.g. multiple sclerosis, spinal cord injury)
- Pelvic prolapse (blockage of bladder opening due to a severe “fallen bladder”)
- Primary bladder neck obstruction or urethral stricture (rare)
If you cannot empty your bladder as a woman this is typically a complex issue. If you have a female urology specialist in your area then a visit is recommended. Otherwise a telemedicine evaluation with a board-certified urologist is a great place to start.
Female Urethral Stretching - Closing Thoughts
Hopefully we’ve given you enough data to steer you clear of having your urethra stretched. Female urethral dilation is an outdated medical practice that can be harmful and delays the correct treatment for your issue.
Do you still have a question? Maybe a telemedicine consultation with a urology expert is the way to go. From the comfort of your home you’ll receive a thorough, up-to-date evaluation.
And don’t worry, we haven’t recommended animal dung ointment or a night sleeping with a human skull in a really long time.
