TREATMENT OF VIGINAL PROLAPSE IN BITCHES
What is Vaginal Prolapse?
In the bitch, true vaginal prolapse or uterine prolapse is a rare condition, which mainly occurs during or shortly after parturition (Schaefers-Okkens, 2001) due to the decline of serum progesterone and the increase of serum estrogen (Johnston et al., 2001; Konig et al., 2004; Rani et al., 2004). Brachycephalic breeds appear predisposed to vaginal prolapse and may possess a hereditary weakness of the perivaginal tissue (Wykes, 1986). It has been recommended that affected bitches should not be rebred (Trager, 1970). Markandeya et al. (2004) reported that excess antepartum relaxation of pelvic tissues and increased intra-abdominal pressure may be the etiology of pre-partum prolapse. Chronic prolapse during pregnancy in the bitch has been reported (Alan et al., 2007) that was treated by hysteropexy, and subsequent cesarean followed by ovariohysterectomy. Furthermore, ovariectomy or ovariohysterectomy is strongly recommended in order to reduce the incidence of recurrence (Wykes, 1986), as the recurrence rate in affected bitches is high.
True Vaginal prolapse is very rare condition in bitch when compared to other vaginal pathologies like vaginal tumors or urethral tumors which protrude into vagina and obstruct the canal (Manothaiudom and Johnston, 1991). Vaginal prolapse usually occur in young bitch preferably less than 2 to 3 years age. It occurs majorly near parturition, as the serum progesterone concentration declines and the serum estrogen concentration increases (Konig et al., 2004; Rani et al., 2004). An amplification of this high serum estrogenic response can lead to disproportionate mucosal folding of the vaginal floor just cranial to the opening of urethra, which ultimately results in protrusion of vaginal mucosa from the vulva.
Discovering a large mass of tissue protruding from a dog’s vulva is alarming. For those unaware of vaginal prolapse, the mass may appear to be a fast-developing tumor, or an in-process miscarriage. As unsightly as it may be, the condition of vaginal prolapse commonly occurs in female dogs that have not been spayed. Due to the action of the female hormone estrogen, the tissue of the internal vaginal walls swells and protrudes through the vulva; the external female genital organ. The mass is usually accompanied by vaginal discharge.
In vaginal prolapse, the swollen, protruding vaginal tissue resembles what’s often described as a “donut-shaped” mass. While the primary cause of vaginal prolapse is estrogen stimulation, other causes include vaginal hyperplasia (a proliferation of the vaginal mucosa) and genetic predisposition. Other causes of prolapse are prolonged straining resulting from a difficult labor and delivery or a urinary tract infection, or an interruption during coitus before mating can occur. Reluctance to breed may be a symptom of vaginal prolapse.
While the condition affects a range of dogs, breeds most commonly affected include the Labrador and Chesapeake Bay retriever, English Bulldog, German Shepherd, St. Bernard, Mastiff, Springer Spaniel and Weimaraner. Predominance in certain breeds suggests that genetics plays a key role in the development of canine vaginal prolapse.
When serious, vaginal prolapse may prevent urination. The condition is almost always diagnosed just before or during estrus (heat). While the outcome is positive for most animals, the chance of the condition recurring throughout pregnancy, or at delivery is quite possible. Because breeding may place the dog at further risk for the condition, spaying the animal may be recommended.
Vaginal prolapse, a condition caused by the action of the female hormone, estrogen, occurs in young, unspayed female dogs.
Symptoms of Vaginal Prolapse in Dogs
- Protrusion of pink or red inflamed tissue from the vulva
- Excessive licking of the affected area
- Difficult or painful urination
- Resistance to mating, even during heat cycle
Types
- Type 1 occurs when there is a slight protrusion, even though it does not exit the vulva itself
- Type 2 is when the vaginal tissue protrudes through the vulvar opening
- Type 3 hyperplasia refers to the donut-shaped mass, which can be seen externally
Causes of Vaginal Prolapse in Dogs
- Genetics
- Breed affiliation
- Estrogen stimulation
- Vaginal hypoplasia
Diagnosis of Vaginal Prolapse in Dogs
A veterinary consultation will be required for diagnosis of vaginal prolapse. The timing of the problem (during pre-estrus or estrus), and the typical appearance of the mass upon physical examination, will usually be sufficient for diagnosis. In an older female dog, a tissue sample is often taken to differentiate the condition from a cancerous growth.
Aside from the physical examination, your veterinarian may choose to perform blood tests and urinalysis to rule out the presence of other underlying conditions or infection that may be present.
Treatment of Vaginal Prolapse in Dogs
If your dog is experiencing prolapse but can urinate normally, the veterinarian may prescribe hormonal therapy. The prolapse may correct itself as this type of therapy can initiate ovulation. Topical creams will be prescribed if your pet is uncomfortable. With these therapies, vaginal prolapse is highly treatable and in many cases, can be reversed.
Unless the vaginal prolapse is blocking the urethra completely so that your pet cannot urinate, the condition is not a medical emergency. If your companion is unable to pass urine, she will likely require hospitalization, surgery to suture the tissue back in and enable an assessment of the prolapsed tissue, and if required, a urinary catheter will be utilized. Spaying is often suggested.
LINE OF TREATMENT
Prolapsed mass is washed with 1% KMnO 4 solution. The mass is reduced by dipping the drape in cold water. Lignocaine jelly is applied to desensitize the mass and Cetrimide, an antiseptic cream is applied liberally for lubrication. By applying cold water to the mass, the edema is reduced. By application of bilateral pressure with the fingers from the ventral floor and lateral sides, the mass was reposed into the body. Modified Buhner suture are applied on the external labia keeping an opening of one finger diameter for the urination. Bitches are kept on Inj. Ceftriaxone @ 15 mg/kg i/v, Inj.neurokind 2ml i/m, Syp. Immunolpet 10 ml p/o for five days and Inj. Human chorionic gonadotropin (hCG) 500 I.U i/m for 4 days to induce premature ovulation. Sutures are removed after two weeks and the bitches generally recovered eventually. Vaginal prolapse occur mainly during proestrus or early estrus stages of the cycle (Johnston, 1989) and during or shortly after parturition (Schaefers-Okkens, 2001). Reports suggest that this condition may have some hereditary predisposition and is seen in pure bred dogs (Johnston, 1989). Regression of the protruded mass begins in late estrus to early diestrus, as serum estrogen returns to the normal basal level.
The owner is then advised to use Elizabethan collar, in order to prevent the bitch from licking the vaginal area.
Recovery of Vaginal Prolapse in Dogs
During recovery, you must keep the prolapsed area clean and dry. If tolerated, an Elizabethan collar may stop your dog from licking, chewing or biting the affected area; many dogs benefit from wearing a canine diaper to protect the area and make it less accessible.
The veterinarian will prescribe moisturizing ointments that will help prevent tissue damage. As a pet owner, you must be vigilant so that the prolapsed tissue is not aggravated or damaged by surfaces or other animals.
Compiled & Shared by- This paper is a compilation of groupwork provided by the Team, LITD (Livestock Institute of Training & Development)
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