Prolapse

Anal, rectal and colon prolapse -identification and control

There are several steps to take in controlling the problem of rectal prolapse and if any step is missed or if an incorrect conclusion is drawn at any stage in the process it can encourage relapse.

The first step is to carefully consider the problem. Is it a rectal prolapse, an anal prolapse or a prolapse of the colon through the rectum (colonic intussusception)? These are very different situations and the treatment is different, as well. Anal prolapses are small protrusions of the red mucosal tissue lining the rectum that usually occur right after a bowel movement. Rectal prolapse looks like a tube of tissue protruding from the anus. Colonic intussusception looks identical to rectal prolapse but the tube of tissue is actually the colon passing through the rectum in a "telescoped" manner. I am not sure of the overall incidence of these problems but anal prolapse is probably the most common and in our practice rectal prolapse and colonic intussusception appear to occur about equally.

Anal prolapse is more of an irritating problem for the cat and the owner than it is a life threatening condition. We look for problems that cause irritation in the anal area and try to resolve any that we can find. Tapeworm infestation, other intestinal parasites, anal sac irritation, allergies, fleas, an inability to groom in obese cats, hair entrapment in long haired cats and persistent diarrhea or straining for any reason can lead to anal prolapse. Sometimes local treatment with topical cortisone ointments or even Preparation H (tm) can be helpful. Elimination of any and all causes of irritation in the anal area usually will resolve the problem if it can be accomplished.

Rectal prolapse is more life threatening. In this case, the inner rectal tissue is protruding from the anus, sometimes for several inches. If the rectal tissue is not returned to its proper place in the body it will die, which usually results in the death of the pet. Rectal prolapse can be differentiated from colonic intussusception by your vet using a well lubricated probe. If a probe can pass between the edge of the rectum and the tissue, the problem is usually an intussusception. If not, a rectal prolapse is more likely. Rectal prolapses occur because of chronic irritation in the rectal tissues. It is important to look for and find the cause of the irritation to have long term success in treatment of this condition. Possible problems that contribute to rectal prolapse include intestinal parasites, enteritis from bacterial or viral causes, cancer, foreign body ingestion (burrs and bones cause the most problems in our practice), straining associated with delivering kittens, straining associated with bladder infections or feline lower urinary tract disease, congenital rectal problems, and inflammatory bowel disease. It is usually necessary to reduce the prolapse (return the tissue to its normal position inside the body) and then to place sutures around the rectum to hold it in place while treating whatever underlying problem can be identified at the same time. The sutures are usually left in place 24 hours but can be left in place 48 hours when necessary. Lots of times this is sufficient to control the problem. Other times, it keeps coming back.

When rectal prolapse recurs there are two options. The first is a surgery known as colopexy. In this case, an incision is made into the abdomen similar to the incision made for spay surgery. The colon is identified and then retracted along one side of the muscular body wall. Sutures are placed through the colon wall and into the muscle layer to secure the colon to the body wall. Doing this prevents the rectum from prolapsing because it is attached to the colon and kept inside the body by the fixation of the colon. This works pretty well. It is sometimes necessary to repeat this surgery because of insufficient fixation to the body wall or because the rectum persists in stretching and attempting to prolapse again because the underlying cause of the problem has not been identified or can not be controlled. If the rectal tissue is damaged too severely to do a colopexy it is sometimes necessary to amputate the diseased portion of the rectum. This works better than it sounds like it would work but it does sometimes lead to blockages of the rectum by scarring or incontinence due to insufficient function of the remaining rectal tissue. If the cat's life is threatened by the prolapse it may be the best choice, though.

Colonic or ileocolic (colon and ileum - the last part of the small intestine) intussesception looks almost exactly like a rectal prolapse and the underlying causes are much the same. Intussusception will sometimes occur for no apparent reason, though. The tissue must be retracted by making an abdominal incision and pulling it back into place. This allows the surgeon to examine the tissue and make sure it is all still viable, too. We always do a colopexy when we repair an intussusception and have only had this problem recur once that I can remember. It is still very necessary to look for underyling causes and to treat any that are found.

If your cat is having  these problems it is important to do review the steps. Is this an anal prolapse? If so, look for the underlying cause and treat the inflammation. You may have to live with some degree of anal prolapse long-term, though. If this is a rectal prolapse and colopexy has not been attempted, that may help. Another careful review of possible underlying causes is always a good idea. If the problem is an intussusception and there is no cause of continuing straining or diarrhea it may just be bad luck - once in a while a patient is just prone to intussusception. I can't recall this happening more than two times in a cat patient but have fixed three intussusceptions in one dog patient.

I have not seen any information to suggest that this is or is not an inherited trait. I think that most of the time there is an underlying cause other than genetics - but some of those causes are genetic problems!

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Last edited 01/13/08