“Doc, looks like my cow’s got a giant hemorrhoid on her back end.”
Some variation of this description clues a livestock veterinarian in that their patient is dealing with a prolapse of some variety. Prolapses are not uncommon in cattle, sheep and goats. They can be rectal, vaginal or uterine. Knowing which type it is, the duration of the prolapse and the reproductive status of the individual will impact how the issue is addressed.
Uterine Prolapse
A uterine prolapse is a true medical emergency, and among the most time-sensitive we deal with. Uterine prolapses can be distinguished from vaginal prolapses by appearance. A prolapsed uterus is large (often hanging down to the hocks) and red. It is covered by caruncles or meatball-shaped masses covering the inside of the uterus which were former attachment sites for the placenta. The uterus can only prolapse postpartum, usually immediately, but almost always within 24 hours. This is an emergency due to a high risk of life-threatening internal bleeding when this massive organ is hanging outside of the body. Uterine prolapses can be caused by a very large calf, difficult delivery or low blood calcium.
While waiting for veterinary assistance, it is critical to keep the patient calm and still. If on pasture where restraint is not possible, slowly move the cow towards a working facility. If the cow is laying, the uterus can be wrapped in a towel or pillow case to protect it from additional trauma. Gather the following supplies to have on hand for your veterinarian:
Towels and water are useful for cleaning the uterus. Large towels can also be used as a sling to support the uterus during replacement.
Have at least two able-bodied people present to assist if possible. Replacement of the uterus often involves repositioning the patient. “Frog-legging” down cows eases pressure on the uterus. Also, it is virtually impossible to replace a uterus if the cow is pointed uphill. In small ruminant patients, lifting the hind quarters or propping rear limbs up on a square bale can aid in reduction.
Sugar is helpful for pulling fluid out of the uterus to reduce its size prior to replacement.
In cattle, a wiffle ball bat or empty wine bottle can be helpful to ensure the very end of the uterus has inverted after replacement of the uterus.
The veterinarian will typically administer an epidural prior to cleaning the uterus. Then, the uterus is placed back into the body while attempting to minimize hemorrhage and additional trauma. This procedure is often followed with stitches to keep the uterus in place as it closes down, as well as administration of medication to aid in the involution of the uterus.
Unfortunately, even once the uterus is successfully replaced, it is not uncommon for internal hemorrhage to continue. It is not possible to diagnose or treat this internal hemorrhage. It is not uncommon for some patients to be found dead due to hemorrhage even after successful replacement. Patients that are up and well after 24 hours generally heal with no issue. Uterine prolapses are not considered to be heritable. Therefore, those that recover can be rebred without concern for recurrence in the future.
Vaginal Prolapse
Unlike uterine prolapses, vaginal prolapses are not urgent medical emergencies. Though not life-threatening, earlier intervention does minimize tissue damage and makes replacement easier. Additionally, in near-term individuals, the prolapse must be corrected to allow unassisted delivery. Vaginal prolapses are most common pre-partum although they can occur at any stage of gestation or even in open cows. A vaginal prolapse can be distinguished from a uterine prolapse because the surface of the prolapse will be smooth and pink, unlike the red and bumpy uterus.
A vaginal prolapse can be cleaned and replaced like a uterine prolapse. The veterinarian will select the most appropriate stitch to hold the vagina in place in cattle. In small ruminants, a prolapse retainer is often used to hold the vagina in position. The trickier part of the vaginal prolapse is not replacement, but assessing stage of gestation and how to best manage the individual until delivery. In a near-term pregnancy, especially with a known due date, induction is often the best option so that the prolapse does not recur. If the pregnancy is not far enough along to allow induction, a serious discussion must be had on the best welfare decision for the patient as it can be difficult to keep the prolapse in place for a prolonged period and there is a high likelihood of delivery complication.
Vaginal prolapses are considered to be heritable. Therefore, individuals with a vaginal prolapse should not be bred back. Occasionally, you may observe a partial or intermittent prolapse. These are often visible when a heavily pregnant or obese animal is laying down, but return to normal when standing. Intervention is not needed as long as the prolapse does not come out and stay out. These individuals should also not be allowed to breed back as intervention is very likely to be needed in subsequent pregnancies.
Rectal Prolapse
Rectal prolapses can occur in any age or sex of animal. It can be associated with short tail-docking in sheep; scours or pneumonia; excessive riding behavior; secondary to vaginal prolapse or any condition that causes straining; and just plain bad luck. Like vaginal prolapses, they are not a life-threatening emergency. However, earlier intervention makes reduction easier. Any predisposing causes should be addressed at the time of correction.
Identifying the type of prolapse and preparing a work space and supplies for your veterinarian can maximize the chance of a positive outcome for all types of prolapses. Reduction of a prolapse can be attempted by experienced producers without veterinary assistance, but an epidural and sutures are often needed to complete the job.