Uterine Prolapse
Ronald M. Bright, DVM, MS, DACVS
BASIC INFORMATION
Description
Uterine prolapse is movement of a portion of the uterus through a
dilated cervix and the vagina until it becomes visible at the vulva
(opening of the vagina). Uterine prolapse can occur in cats after
only one pregnancy, but in dogs it usually occurs after the animal
has given birth to multiple litters of puppies.
Causes
The condition usually results from prolonged straining during the
birth of kittens or puppies. It may also arise with forceful extraction of the fetus during a difficult delivery or with excessive traction on retained fetal membranes after the puppy or kitty has passed.
Occasionally, uterine prolapse develops in association with a uterine
infection. In cats it can occur without any predisposing conditions.
Clinical Signs
An animal with a prolapsed uterus usually has one or two tubular
masses bulging from the vulva. Sometimes a mass is not visible
but can be felt when the veterinarian performs a vaginal examination. In these latter cases, the animal often has some abdominal
pain or restlessness, vaginal discharge, excessive licking of the
vulva, or a swollen area near the vulva. The animal may strain as
if trying to pass a fetus.
If uterine tissue is visible, it often has “doughnut” shape and
can be swollen, very red in color, or encrusted with hair, feces,
placental tissue, or kitty litter (cats). Occasionally, an animal may
develop shock from rupture of a large uterine artery.
Diagnostic Tests
A prolapse that bulges through the vulva must be examined closely
to determine whether the vagina or the uterus is prolapsed. A partial or hidden uterine prolapse may require digital examination
(with a finger) or vaginoscopy (examination of the vagina with a
special scope) to confirm the diagnosis. Laboratory tests, x-rays,
and/or an ultrasound may be recommended to rule out infections,
retained fetuses, and other conditions such as vaginal tumors or
twisting of the uterus.
TREATMENT AND FOLLOW UP
Treatment Options
If the animal is in shock, aggressive therapy with intravenous
fluids and other medications is needed to correct the condition.
Antibiotics are recommended in many cases.
Manual reduction of the prolapse (gently pushing the exposed
tissue back into the abdomen) can be attempted if the animal is in
good physical condition and the uterus appears healthy. General
or epidural anesthesia is often necessary for the procedure, and
sometimes the opening of the vulva must be surgically enlarged
(episiotomy). The uterus is gently cleaned and coated with sterile
lubricating jelly prior to replacement. Although replacement may
be possible, recurrence is common, so the animal is often spayed
after the uterus is back in the abdomen.
If only partial replacement is achieved and the owner wants to
use the animal for future breeding, abdominal surgery is required
to further return the uterus to its normal position. If the exposed
uterine tissue is unhealthy and dying, then spaying (ovariohysterectomy) may be recommended once the uterus is back in the
abdomen.
On rare occasions, the damage to the uterus is so severe that it
must be amputated. Amputation is followed by abdominal surgery
to remove the ovaries and any other associated tissues.
Follow-up Care
After manual replacement or surgery, watch the animal for any
bleeding, weakness, problems urinating, failure to pass urine,
or signs of infection (fever, vaginal discharge, lethargy, poor
appetite). After manual replacement only, watch for the prolapsed tissue to reappear. Recheck visits and additional monitoring or testing depend on what procedure was used to correct the
problem.
Prognosis
In most cases of simple, manual replacement there is a risk of
recurrence. Prognosis is good following surgical removal of the
uterus.
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Copyright © 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved.