There are several steps to take in controlling the problem of rectalprolapse and if any step is missed or if an incorrect conclusion is drawnat any stage in the process it can encourage relapse.

The first step is to carefully consider the problem. Is it a rectalprolapse, an anal prolapse or a prolapse of the colon through the rectum(colonic intussusception)? These are very different situations and thetreatment is different, as well. Anal prolapses are small protrusions ofthe red mucosal tissue lining the rectum that usually occur right aftera bowel movement. Rectal prolapse looks like a tube of tissue protrudingfrom the anus. Colonic intussusception looks identical to rectal prolapsebut the tube of tissue is actually the colon passing through the rectumin a "telescoped" manner. I am not sure of the overall incidence of theseproblems but anal prolapse is probably the most common and in our practicerectal prolapse and colonic intussusception appear to occur about equally.

Anal prolapse is more of an irritating problem for the cat and the ownerthan it is a life threatening condition. We look for problems that causeirritation in the anal area and try to resolve any that we can find. Tapeworminfestation, other intestinal parasites, anal sac irritation, allergies,fleas, an inability to groom in obese cats, hair entrapment in long hairedcats and persistent diarrhea or straining for any reason can lead to analprolapse. Sometimes local treatment with topical cortisone ointments oreven Preparation H (tm) can be helpful. Elimination of any and all causesof irritation in the anal area usually will resolve the problem if it canbe accomplished.

Rectal prolapse is more life threatening. In this case, the inner rectaltissue is protruding from the anus, sometimes for several inches. If therectal tissue is not returned to its proper place in the body it will die,which usually results in the death of the pet. Rectal prolapse can be differentiatedfrom colonic intussusception by your vet using a well lubricated probe.If a probe can pass between the edge of the rectum and the tissue, theproblem is usually an intussusception. If not, a rectal prolapse is morelikely. Rectal prolapses occur because of chronic irritation in the rectaltissues. It is important to look for and find the cause of the irritationto have long term success in treatment of this condition. Possible problemsthat contribute to rectal prolapse include intestinal parasites, enteritisfrom bacterial or viral causes, cancer, foreign body ingestion (burrs andbones cause the most problems in our practice), straining associated withdelivering kittens, straining associated with bladder infections or felinelower urinary tract disease, congenital rectal problems, and inflammatorybowel disease. It is usually necessary to reduce the prolapse (return thetissue to its normal position inside the body) and then to place suturesaround the rectum to hold it in place while treating whatever underlyingproblem can be identified at the same time. The sutures are usually leftin place 24 hours but can be left in place 48 hours when necessary. Lotsof times this is sufficient to control the problem. Other times, it keepscoming back.

When rectal prolapse recurs there are two options. The first is a surgeryknown as colopexy. In this case, an incision is made into the abdomen similarto the incision made for spay surgery. The colon is identified and thenretracted along one side of the muscular body wall. Sutures are placedthrough the colon wall and into the muscle layer to secure the colon tothe body wall. Doing this prevents the rectum from prolapsing because itis attached to the colon and kept inside the body by the fixation of thecolon. This works pretty well. It is sometimes necessary to repeat thissurgery because of insufficient fixation to the body wall or because therectum persists in stretching and attempting to prolapse again becausethe underlying cause of the problem has not been identified or can notbe controlled. If the rectal tissue is damaged too severely to do a colopexyit is sometimes necessary to amputate the diseased portion of the rectum.This works better than it sounds like it would work but it does sometimeslead to blockages of the rectum by scarring or incontinence due to insufficientfunction of the remaining rectal tissue. If the cat's life is threatenedby the prolapse it may be the best choice, though.

Colonic or ileocolic (colon and ileum - the last part of the small intestine)intussesception looks almost exactly like a rectal prolapse and the underlyingcauses are much the same. Intussusception will sometimes occur for no apparentreason, though. The tissue must be retracted by making an abdominal incisionand pulling it back into place. This allows the surgeon to examine thetissue and make sure it is all still viable, too. We always do a colopexywhen we repair an intussusception and have only had this problem recuronce that I can remember. It is still very necessary to look for underylingcauses and to treat any that are found.

If your cat is having  these problems it is important to do reviewthe steps. Is this an anal prolapse? If so, look for the underlying causeand treat the inflammation. You may have to live with some degree of analprolapse long-term, though. If this is a rectal prolapse and colopexy hasnot been attempted, that may help. Another careful review of possible underlyingcauses is always a good idea. If the problem is an intussusception andthere is no cause of continuing straining or diarrhea it may just be badluck - once in a while a patient is just prone to intussusception. I can'trecall this happening more than two times in a cat patient but have fixedthree intussusceptions in one dog patient.

I have not seen any information to suggest that this is or is not aninherited trait. I think that most of the time there is an underlying causeother than genetics - but some of those causes are genetic problems!