Prolapsed Cattle - Before You call Your Vet

Originally Published in Gulf Coast Cattleman

Prolapses happen and when they do, it’s pretty easy to see something isn’t right. Next time you deal with a prolapse, consider noting a few things before you call your veterinarian. Simple notes like the appearance of the prolapse, the animal’s production stage, pregnancy status, and diet can give your veterinarian a better idea of how to prepare for or direct treatment. Some prolapses are emergencies, others can wait over night or may fix themselves.

Prolapses can be categorized as one of three classes: rectal, vaginal, and uterine based on origin and organ (or organs) affected. Robert Conley, DVM of Conley Veterinary Services, said prolapses are not a primary disease, but rather a symptom of a deeper issue. While the prolapse itself should be treated, the cause of the prolapse should also be determined and corrected if possible.

“A rectal prolapse is a prolapse of the very distal rectum,” Conley said. “While rectal prolapses do happen in the feedlot, for our purposes, I’ll focus on prolapses in the cow-calf operation. A rectal prolapse occurs from excessive straining. The animal is straining, and they push so hard that a portion of the rectum comes out. They could be straining to have a calf or to defecate. It’s possible for there to be something serious going on that causes them to strain. They could have a digestive blockage, an intestinal twist or torsion, or even Rabies causing them to strain. These aren’t common in cattle, but they are considered veterinary emergencies and shouldn’t be overlooked.”

Tyler Mackey, DVM of Houston County Veterinary Hospital, said rectal prolapses can be seen in calves as well as mature cattle.

“In calves, we can see rectal prolapses from severe parasitism and coughing in respiratory disease,” Mackey said. “They can build up so much abdominal pressure coughing that they have a rectal prolapse. Often a rectal prolapse will be associated with some level of diarrhea. We will want to establish the animal’s other symptoms and what type of feed they are on so we can determine the cause of the prolapse. We can fix the prolapse, but if we don’t fix the root problem, we’re going to have to fix the prolapse again.”

Conley said rectal prolapses can be identified as a “meaty mass protruding from the rectum” often starting out circular and becoming cylindrical over time. Rectal prolapses can happen in both males and females at any production stage.

“Rectal prolapses are best treated at the clinic,” Conley said. “If we can catch them early enough, we can sometimes put them back in and hold them in with retention sutures. However, many times, those are going to be surgical amputations which will best be performed in a clinic setting.”

The second class of prolapse is a vaginal prolapse which can be subcategorized into three types; vaginal prolapse, vagino-cervical prolapse and cervical prolapse. These prolapses are exclusive to pubertal and mature females.

“A vaginal prolapse is a defect in the integrity of the vaginal wall,” Conley said. “This defect allows subcutaneous tissue to come out, which can entrap the bladder and allow it to become trapped inside the prolapse making it more dangerous for the cow. I like to think of these as more of a hernia. Yes, it’s a prolapse, but it’s also a defect in the body wall allowing the prolapse to happen. It’s going to look like a fleshy ball protruding from the vulva. Often in the very early stages of a vaginal prolapse, you may see it come and go, especially when the cow or heifer lies down and gets back up.”

Vaginal prolapses happen under the influence of hormones, commonly occurring when cows come into heat or are close to calving. Hormones cause the vaginal tissue to relax and a vaginal prolapse occurs.

“I've done all kinds of things surgically to try to correct vaginal prolapses with very minimal success,” Conley said. “Putting them back can be very easy to do. Once the prolapse is replaced into the pelvic canal, the edematous tissue resolves and the prolapse appears to be treated; however, the next time the cow is in heat, or in some instances right before calving next year, they prolapse again. For that reason, I don't encourage producers to keep vaginal prolapse cows, unless the cow is of significant genetic value, and they're willing to put up with having to fix that year after year.”

The second subcategory of vaginal prolapses is the vagino-cervical prolapse.

“This is another prolapse due to the integrity of the vaginal wall, only this time the defect is big enough that it pulled the cervix out with it,” Conley said. “The vaginal-cervical prolapse is going to look a little different. Instead of just a round ball like a vaginal prolapse, it’s going to be an oddly shaped ball of tissue with a hole in it. That hole is the os of the cervix. It’s just the same as a vaginal prolapse, only bigger and more difficult to put back. Again, this issue will repeat itself and for a commercial cow, it’s not worth fixing that every year.”

A vaginal or vaginal-cervical prolapse should be fixed as soon as possible.

“The sooner we can get those prolapses repaired, the better,” Conley said. “Once they’re back inside, they’re no longer pooling edema and tissue can return to normal. If she prolapsed prior to calving this will allow her to calve without having to calve around the prolapse. However, she will need to be monitored closely leading up to calving. If the retaining sutures are still in place doing their job holding the prolapse within the pelvic canal, the cow can’t calve without assistance to untie the sutures or possibly doing extreme damage to herself.”

The third subcategory of a vaginal prolapse is the cervical prolapse.

“In a cervical prolapse, the integrity of the vaginal wall is fine, the walls of the vaginal vault are intact,” Conley said. “The cervix itself is all that prolapses, and it looks like a very large cylindrical shaped mass with an opening approximately in the center. Cervical prolapses in general are less of an emergency. They still need to be handled promptly, but they don’t need to be handled at midnight. They can be fixed the next morning.”

Conley said, in his practice cervical prolapses are more commonly seen in bos indicus and bos indicus influenced cattle as their cervix are longer and have more potential to come out.

“I’ve had cattle have a cervical prolapse one year, go on to calve normally and never prolapse again,” Conley said. “I’ve also had cows that do it every year. On a cervical prolapse I’m less inclined to advise culling, unless it’s the third time I’m fixing a cervical prolapse on the cow.”

Uterine prolapses are the final category of prolapse and are considered an emergency that needs to be handled immediately.

“A uterine prolapse needs to be dealt with as an emergency,” Conley said. “Uterine prolapses always happen immediately post-calving. It can happen with natural deliveries or assisted deliveries. Anytime you have a uterine prolapse, it’s a true emergency. The entire uterine horn that just held a big ol’ calf is outside of the cow and hanging down to her hocks. It’s bloody, there’s afterbirth stuck to it, and there’s visible cotyledons that look like big meatballs. In this situation the cow can rupture the uterine artery and bleed to death, she can severely lacerate the uterine body which can result in spilling of small intestines or bladder… It needs to be handled immediately. Now, sometimes, uterine prolapses that aren’t discovered for a few days can still be treated and the cow can still be saved. There are severe cases where the uterus has to be amputated if repair has been delayed or the uterus has been severely traumatized, but if they are treated properly the cow could avoid any further complications and be salvaged. The prognosis for a cow with a uterine prolapse is worse if the cow cannot get up following calving.  Sometimes we don’t know if she can get up until after the prolapse has been replaced; therefore, I try to replace them all even if they don’t all survive.”    

Conley and Mackey said they prefer to treat uterine prolapses at the ranch to avoid further complications that could arise when hauling the animal to the clinic.

“Think about how often a cow will turn around in a trailer,” Mackey said. “Especially if she's a big cow and she drags her uterus and tears or cuts it. With a uterine prolapse if you try to haul her in you may damage the uterus to the point she may not breed again or she could bleed out.”

Conley said anyone can be taught how to identify a prolapse and treat the animal under direction of their veterinarian.

“Fixing a prolapse is not something that requires an advanced degree in veterinary medicine,” Conley said. “Anyone can be shown and become very good at putting them back in if you have the proper training and tools. This is where your relationship with your veterinarian comes in. Build a strong relationship with your veterinarian and allow them to train you in how you handle these situations. You may also want to ask your veterinarian what tools to keep on hand in case of a prolapse.”

Conley said he recommends keeping the following on hand; a sterilizing agent like chlorhexidine or iodine, lidocaine for an epidural and pain relief (under the direction of your veterinarian), a Buhner needle, and umbilical tape or Buhner tape. The Buhner needle and umbilical tape will be used to put a Buhner stitch on either side of the vagina to pull it down where the prolapse won’t be pushed back out even if the patient continues to strain.

“There are a few things you want to make note of before you call your veterinarian,” Mackey said. “Are they up or down? Are they eating? What are they eating? Are they bred or open? If they’re bred, how bred are they? What does it look like? How long has it been like that? What is their temperature? Temperature is not always the most important thing with a prolapse, but it can often be overlooked.”

Dr. Mackey said it’s important to always consult your primary veterinarian before treating an animal and follow their direction for treatment. He also noted that while treating your own animal under the direction of your veterinarian is entirely legal, treating an animal you do not own is not legal. If the owner askes you to treat their animal you should still consult with the operation’s primary veterinarian before providing treatment.