Rectal prolapse in dogs – symptoms and treatment

Overview

A prolapse may appear suddenly, recur intermittently or become a persistent problem. In a partial prolapse, only the bowel lining turns outwards.

A complete prolapse includes all layers of the bowel wall. The typical finding is elongated, tube-like tissue visible through the anus.

In a mild case, the lining may sometimes return on its own when the dog stops straining. Prolapse is often a consequence of another intestinal, anal or urinary condition.

It is different from a haemorrhoid, in which a blood vessel enlarges. Intussusception can also look similar from the outside.

Causes

Prolonged straining pushes the bowel outwards

Persistent straining to defecate, called tenesmus, can push rectal tissue through the anus. Severe intestinal inflammation and the resulting diarrhoea are possible underlying causes.

Internal parasites can sustain intestinal irritation and straining. Persistent constipation can also cause repeated, forceful straining.

A foreign body, injury or dilation of the bowel wall may make defecation difficult. A tumour in the rectum or end of the colon may underlie the straining.

Urethral obstruction and an enlarged prostate can cause straining to urinate. In a bitch, a difficult birth may lead to prolonged straining and prolapse.

Support from the pelvic floor and sphincter can fail

In a perineal hernia, wasting of the pelvic diaphragm muscles weakens support for the rectum. The rectum may then deviate or dilate into the perineal region around the anus.

Nerve damage affecting the external anal sphincter can also predispose to prolapse. After hernia repair, pain, bowel disease or nerve damage may sustain straining.

Risk factors

Young dogs are a common patient group, particularly when they have severe diarrhoea. However, the condition can develop in dogs of any age, breed or sex.

An internal parasite infection in a puppy increases risk, particularly if it causes marked diarrhoea and straining. Disease causing difficulty urinating can make the protrusion a consequence of a urinary problem too.

A bilateral perineal hernia with rectal dilation may particularly predispose to prolapse. Surgery around the anus and perineum is another possible predisposing situation, so previous surgical history forms part of risk assessment.

Typical symptoms

The most obvious sign is reddish tissue coming out of the anus, either continuously or during defecation.

• Your dog repeatedly squats and strains to pass faeces.

• Defecation looks painful or is accompanied by restlessness.

• Diarrhoea and dehydration may occur at the same time.

• Appetite declines and your dog is more tired than usual.

• Your dog may have abdominal pain or lose weight.

• Protruding tissue swells, its surface becomes irritated and ulcers may develop.

Your dog may lick or bite the sore protrusion or drag its bottom along the ground, which can cause bleeding. Severe straining may appear as an arched back and repeated defecation posture without passing any faeces.

Initially, the visible bowel segment may be short and free of ulcers. Later, darkening and hardening of the surface suggest tissue damage.

Complications and consequences

Tissue left outside can dry out and lose its viability. Untreated damage can lead to severe infection and sepsis, a life-threatening systemic condition.

After repair surgery, a stricture may develop in the bowel and make later defecation difficult. A complete prolapse may entirely prevent faeces from passing.

Dead bowel may need removal, even though healthier tissue could have been replaced without resection. Possible postoperative problems include bleeding, wound infection, impaired continence and another prolapse.

Complete recovery is possible when the underlying cause is also treated. In one dog with a severe perineal hernia, neither the hernia nor the prolapse recurred during 27 months of follow-up after corrective operations.

Scarring at the surgical site may make the bowel stiff and narrow, restarting constipation and straining. Straining caused by a stricture may sustain a cycle in which another prolapse further damages the previously operated area.

Diagnosis at the vet

Protruding tissue and the underlying cause are assessed separately

The vet examines the anus, protruding tissue and rectum by palpation. The examination assesses whether tissue is viable or too damaged to replace safely.

A faecal sample is tested for parasites if they are suspected of causing diarrhoea. Radiographs or ultrasound may identify a bowel obstruction or tumour.

Imaging can also investigate urinary stones and thickening of the bladder wall. In males, prostate size is assessed if necessary.

A bitch that has given birth may be checked for a retained foetus in the uterus. An increased white blood cell count may support suspicion of inflammation or widespread infection.

Rectal examination also looks for other findings, such as a lodged object, full anal sacs or a tumour. Urinalysis may complement the investigation if the straining is associated with urination.

Recurrent prolapse may require colonoscopy, in which a camera examines the bowel's inner surface. The vet also checks whether an instrument can pass between the protruding part and the rectal wall, as this helps distinguish intussusception.

Before anaesthesia, the dog's general condition and anaesthetic safety are also assessed.

Treatment

Viable tissue is replaced and held in position

Your vet prescribes treatment according to tissue condition, the underlying disease and your dog's health. A small or partial prolapse can often be replaced manually under general anaesthesia.

The tissue is rinsed with warm saline and lubricated with water-soluble gel before replacement. At the veterinary practice, topical sugar solution may reduce swelling before the tissue is replaced.

A loose purse-string suture may be placed around the anus, usually for 5–7 days. Another possible removal interval is 3–7 days, depending on the dog's situation and the surgeon's plan.

The suture must leave enough room for faeces to pass while preventing another protrusion. Local anaesthesia may be used during the procedure to reduce straining.

Parasite infection, foreign-body obstruction and urethral obstruction each require their own treatment.

Resection and colopexy address different problems

Dead or severely damaged bowel is removed and the remaining healthy ends are joined. Recurrent prolapse may be treated by colopexy, attaching the colon to the abdominal wall.

This creates a permanent tissue connection between the descending colon and the left abdominal wall. Colopexy can be performed through open surgery or laparoscopically.

Sutures penetrating the bowel's full thickness are avoided because they can predispose to infection and peritonitis. In one repair of a dog's postoperative stricture, scar tissue was released and the bowel widened using a balloon catheter.

That dog's straining gradually eased within 3 days of the corrective procedure. No further prolapse or other complications were identified during 1 year of follow-up in the same dog.

During recovery, defecation should be possible without severe straining

Pain relief may be prescribed at home to improve postoperative comfort and reduce straining. A stool-softening medicine such as lactulose may be used after the procedure if needed.

A low-residue diet produces less faecal bulk, which may make defecation easier after the procedure. Persistent diarrhoea may need additional treatment even after the repair.

The surgical wound is usually allowed 10–14 days to heal, which differs from the period for the temporary anal suture. An Elizabethan collar prevents licking and protects the wound from infection and opening.

Exercise is typically restricted for the first 10 days according to the surgeon's instructions. Quiet lead walks for defecation and urination replace running, jumping and swimming during recovery.

A dog recovering from anaesthesia is kept in a quiet, confined area at home, separate from other animals and children. Do not wet the surgical wound in a bath or take the dog for grooming before the recovery period ends.

Any removable skin stitches are often removed after 10–14 days, separately from the short-term anal retention suture. Monitor the wound for increasing redness, swelling, discharge and separation of its edges, particularly early in recovery.

Do not give human painkillers on your own initiative, as some are poisonous to dogs.

Prevention

Prevention relies on identifying and treating conditions that cause straining. Persistent diarrhoea, constipation or difficulty urinating should not repeatedly be left without follow-up.

Parasite infection is treated according to test findings so parasites do not continue irritating the intestine. Keep rubbish and swallowable objects out of reach to prevent foreign-body obstruction.

Feed a balanced complete diet and avoid treats that give your dog diarrhoea. Rectal examination in an older uncastrated male may help identify perineal hernia changes early.

Repairing a prolapse does not remove the need to treat the underlying cause of straining.

Important for dog owners

Note when tissue first became visible, whether it also appears at rest and whether diarrhoea, constipation or difficulty urinating preceded it. Bring details of previous surgery, parasite tests and medicines. Even if the tissue retracts before the appointment, explain what happened.

At discharge, agree clearly on follow-up and removal of the temporary anal suture. Stitches in an abdominal surgical wound may have a different removal date. Record ease of defecation, stool consistency, urination and appetite. Contact the veterinary practice immediately if tissue protrudes again or your dog strains without producing anything.

Keep the protective collar on for the instructed period and inspect the wound calmly without unnecessary handling. Give only medicines prescribed for this dog, following the instructions. Do not remove stitches yourself or try enemas without veterinary guidance.

Frequently asked questions

Can a prolapse go back by itself?

A small protrusion of the lining may disappear when straining stops. It still needs prompt examination because the cause must be found. A complete prolapse does not usually return in this way. Bowel remaining outside can dry out and become damaged while waiting for treatment.

Can I push the bowel back at home?

Do not try to replace the tissue yourself, as replacement often requires general anaesthesia. During the journey, the priorities are preventing licking and protecting moist tissue from drying with saline solution. Keeping it moist is first aid for the journey, rather than a substitute for examination and treatment of damaged tissue.

Does every dog need major surgery?

A fresh, small prolapse with viable tissue can often be replaced without removing bowel. Dead tissue, however, must be removed. If prolapse recurs, surgery to attach the colon may be needed to prevent further episodes. After a minor repair, a temporary loose suture may support the anus during early healing.

How long does recovery take?

The temporary anal suture is often kept in place for 5–7 days. The surgical wound itself is generally allowed 10–14 days to heal. The underlying disease also needs its own treatment, so suture removal alone does not resolve every diarrhoea or defecation problem.

Can it happen again?

Recurrence is possible, and repeated prolapse may require colopexy. The condition sustaining straining must be treated alongside the repair. Protecting the wound from licking also reduces local problems during healing. A temporary retention suture supports the tissue in position during early healing before removal.