Rectal prolapses occur when the pressure gradient between the pelvic and abdominal cavities is increased causing the rectal mucosa to bulge and protrude through its sphincter.
There are four categories of prolapses described:
1) Mucosal prolapse
2) Complete prolapse
3) Complete prolapse with invagination of colon
4) Intussusception of rectum or colon through the anus
Predisposing factors are any that cause tenesmus or diarrhoea, such as enteritis, colitis, parasitism, dystocia, obesity, urethral obstruction or cystitis/urolithiasis, respiratory disease causing prolonged coughing and also increased abdominal fill in high fecundity ewes or cases of bloat.
This condition also occurs in cattle.
Animals present with an elongated, cylindrical, fluctuant mass protruding from the rectum, often straining and in significant discomfort.
Ulceration, inflammation and congestion of the mucosa is also common and necrosis may occur, producing a dark and dry appearing mucosa if left for prolonged periods without treatment. Secondary infections are also common and may require treatment.
Clinical examination is usually sufficient to diagnose and stage a rectal prolapse.
A prolapse must be differentiated from an ileocolic intussusception by passing a probe, blunt instrument or finger between the prolapsed mass and the rectal wall. The fornix of the rectal wall in a prolapse would prevent insertion beyond a couple of centimetres.
An epidural should be administered and the prolapse cleaned with warm water and soap and then evaluated for viability and necrosis. Any necrotic areas should be surgically debrided/amputated using the appropriate procedure and wounds sutured closed. It should then be replaced manually with plenty of lubricant. Circumferential purse string sutures can be placed to prevent recurrence although care must be taken not to occlude faecal passage. These are removed in 3-4 days.
The predisposing factors should be identified and rectified to prevent further cases.
As is always the case, the animal’s value and productivity should be considered when discussing treatment viability.
Broad spectrum antibiotic cover and analgesia should also be provided.
Prevention of predisposing factors is difficult but may be valuable in problem flocks.
Recurrent individuals should not be bred from due to the possibility of a congenital element.
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Haskell, S (2008) Blackwell’s Five-Minute Veterinary Consult:Ruminant. Wiley-Blackwell, Oxford, pp758-759.
Merck Veterinary Manual, Rectal prolapse, accessed online 24/07/2011 at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/20609.htm&word=rectal%2cprolapse
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