A rectal prolapse is a rare condition in which one or more of the inner layers of the rectum (the end portion of the large intestine that ends just inside the anus) lose their attachments within the body which allows it to telescope out of the body through the anal opening. It can be incomplete in which only the mucosal layer, or complete (or full thickness) in which all layers of the rectal wall are affected.
Cats of any age can develop a rectal prolapse, although it is most common in kittens under six months of age.
The root cause of rectal prolapse is straining, which eventually pushes part of the rectum out of the anal opening. Contributing factors which lead to straining include:
- Internal parasites (ringworm, tapeworm, hookworm are the most common intestinal parasites to affect cats)
- Foreign bodies
- Constipation or megacolon
- Disorders of the rectum due to foreign bodies, lacerations, formation of pockets in the lining of the large intestine (diverticula), or bulge in the rectum (sacculation), Manx syndrome
- Lower urinary tract disease
- Rectal tumours
- Dystocia (difficulty giving birth)
- Perineal hernia
The cause in kittens is usually due to parasites or gastroenteritis. While in middle-aged to senior cats causes include perineal hernia, tumours, and dystocia.
A rectal prolapse is extremely painful which needs urgent veterinary treatment as untreated, the exposed tissue will ulcerate and eventually die.
- Pink, elongated, cylindrical mass protruding out of the anal opening. Early on the tissue appears inflamed, later the surface becomes thickened and ulcerated before darkening and eventually dying.
- Absent defecation due to a bunching up of the rectum which creates a blockage
- Loss of appetite.
- Straining to defecate.
- Excessive licking of the genital area.
The prolapsed rectum will be painful and swollen, and there should be no attempt to re-insert it at home. Do not allow the cat to lick the area and keep the external portion of the rectum moist with a damp face cloth.
The veterinarian will perform a thorough physical examination of the cat at which time will carefully examine the prolapse. It is important to establish the underlying cause.
A rectal examination enables the veterinarian to evaluate for perineal herniation and differentiate between a rectal prolapse and an even more serious condition known as intussusception. The veterinarian will insert a probe or thermometer into the anus if the probe passes easily, intussusception is the cause, if it doesn’t pass far, rectal prolapse is the cause.
There are no specific laboratory tests to diagnose a rectal prolapse, however, the veterinarian may decide to run baseline tests such as complete blood count and biochemical profile to evaluate the overall health of the cat. This may be an elevated white blood cell count if an infection is present.
Fecal tests to look for signs of gastrointestinal parasites.
Abdominal ultrasound and/or x-ray to evaluate the gastrointestinal tract for obstructions,
The goal of treatment is to address the underlying cause as well as treat the prolapsed rectum. The choice of management for a rectal prolapse will depend on the severity of the prolapse, tissue viability as well as the number of recurrences.
- If the tissue is healthy, the veterinarian can try to manually move the tissue back through the anus. As edema (swelling due to excess water in the tissues) is common, a hypertonic solution (fluids which have a higher concentration of dissolved solutes, which pulls fluid out of the tissue) is used to reduce edema. Lubricants are then used and the tissue is gently pushed or massaged back through the anus. A purse string suture is placed around the anus for several days to prevent the prolapse recurring.
- If tissue damage or necrosis has occurred, the veterinarian will surgically remove damaged tissue (rectal resection) before moving the tissue back inside the anus.
- In some cases, a colopexy will be necessary. A vertical incision is made in the middle of the abdomen (midline laparotomy) and the veterinarian pulls the rectum back into place and attached to the abdominal wall.
A care sheet will be provided at the time of hospital discharge.
Antibiotics and analgesics post-surgery to prevent infection and relieve pain. Administer as instructed.
Stool softeners help to keep stools soft so they can easily pass and reduce pain. The veterinarian may recommend a soft diet during the recovery period.
Monitor incision sites and stitches for signs of infection which include redness, swelling, foul odour, and discharge.