# Rectal Prolapse in Dogs: Causes and Treatment Rectal prolapse in dogs is a condition in which the rectum, the final section of the large intestine, telescopes outward through the anus and remains visible as a tube of pink to red tissue protruding from the rear. It is a true emergency. The exposed tissue dries, swells, and can become necrotic within hours, and the underlying cause is often a serious gastrointestinal, urinary, or rectal disease that will not resolve on its own. If you see a tubular mass coming out of your dog's anus, keep the tissue moist with a cool damp cloth, prevent your dog from licking or sitting on it, and go to a veterinarian immediately. Do not attempt to push it back in yourself. This article covers the causes veterinarians rule out, how rectal prolapse is distinguished from ileocolic intussusception and prolapsed ileum, the step-by-step reduction technique, when surgery such as colopexy is indicated, and how to recognize the emergency in the first place. **This article is educational and is not a substitute for veterinary diagnosis or treatment.** ## At a Glance: Rectal Prolapse Versus Other Protrusions The single most important clinical question is whether the protruding tissue is rectal mucosa, prolapsed ileum, or an intussusception. The answer changes the surgery entirely. | Feature | Rectal Prolapse | Prolapsed Ileum / Ileocolic Intussusception | |--|--|--| | Tissue appearance | Concentric rings of rectal mucosa radiating from the anal opening | Velvety intestinal mucosa with a central slit or dimple | | Palpation | A finger can be passed between the mass and the anal wall | The mass is continuous with deeper tissue and cannot be separated from the anal wall | | Digital rectal exam | Rectum is present cranial to the mass | A tubular structure can be felt extending cranially into the abdomen | | Typical patient | Any age, often with chronic diarrhea or tenesmus | Often young dogs with a history of diarrhea and vomiting | | Definitive diagnosis | Visual and digital exam | Abdominal ultrasound, contrast radiography, or exploratory laparotomy | | Treatment | Manual reduction, purse-string suture, colopexy if recurrent | Abdominal surgery to resect the intussusception | The distinguishing feature is the mucosal pattern. A prolapsed rectum shows radial folds of rectal mucosa. A prolapsed ileum or intussusception shows a mucosal slit where the ileum enters the colon, and the tissue has a different, more intestinal appearance. A veterinarian confirms the diagnosis by palpation and, when needed, imaging. ## What Is a Rectal Prolapse? A rectal prolapse occurs when the rectal wall loses its normal attachment and telescopes through the anal sphincter. The Merck Veterinary Manual describes rectal prolapse as a protrusion of the rectal mucosa, and in more severe cases the full thickness of the rectal wall, through the anus [1]. The condition is distinct from a perineal hernia, in which abdominal organs bulge through a defect in the pelvic diaphragm, and from a prolapsed bladder, which can occur after pelvic trauma [2]. The rectum is the terminal portion of the colon. It sits within the pelvic canal and is anchored by supporting ligaments and by its connection to surrounding structures. When those attachments weaken or when the dog strains repeatedly, the rectum can intussuscept and push outward. The exposed tissue is not designed to survive outside the body. It loses moisture, becomes edematous, and can progress to necrosis if not treated promptly. Rectal prolapse in dogs can be partial or complete. Partial prolapse involves only the mucosal layer. Complete prolapse involves the full thickness of the rectal wall. Complete prolapse carries a higher risk of necrosis and usually requires more aggressive treatment. ## Causes and Underlying Conditions to Rule Out A rectal prolapse is a sign, not a diagnosis. The veterinarian's job is to find and treat the reason the dog is straining. Treating only the prolapse without addressing the cause leads to recurrence. ### Severe or Chronic Diarrhea Persistent diarrhea causes repeated tenesmus, the painful urge to defecate. That straining pressure pushes the rectum outward. Any condition that produces chronic diarrhea can predispose a dog to rectal prolapse, including inflammatory bowel disease, infectious colitis, and dietary intolerance. A 12-week-old golden retriever with recurrent diarrhea and rectal prolapse was ultimately diagnosed with an intussusception associated with a congenital mesenteric lymphatic malformation, showing how a primary intestinal lesion can drive both the diarrhea and the prolapse [3]. ### Intestinal Parasitism Heavy parasite burdens, particularly whipworms and other colonic parasites, cause tenesmus and diarrhea. The Companion Animal Parasite Council recommends routine fecal testing and deworming, and a fecal examination is a standard part of the workup for any dog with rectal prolapse. Parasitism is one of the most treatable causes and should always be ruled out. ### Foreign Body or Intussusception A foreign body in the intestinal tract can cause partial obstruction, leading to straining and prolapse. Intussusception, in which one segment of intestine telescopes into another, is a critical differential diagnosis. A 12-week-old golden retriever with recurrent diarrhea and rectal prolapse was found to have a jejuno-ileo-cecal-colic intussusception at exploratory laparotomy [3]. Intussusception requires abdominal surgery, not manual reduction of the prolapse. ### Perineal Hernia Perineal hernia is a common cause of tenesmus in older male dogs. In this condition, the pelvic diaphragm weakens and abdominal organs, including the rectum, bulge into the perineal region. The rectum can become sacculated and trap feces, causing chronic straining. A 6-kg castrated male mixed-breed dog with a chronic recurrent perineal hernia and rectal sacculation developed a rectal prolapse after herniorrhaphy [4]. Another report described transient rectal prolapse in two dogs with bilateral perineal hernias after repair with a fascia lata graft [5]. Perineal hernia and rectal prolapse are closely linked, and both must be addressed. ### Prostatic Disease An enlarged or diseased prostate, common in older intact male dogs, can press on the rectum and cause tenesmus. Prostatic disease is a standard consideration in any older male dog with straining to defecate. A rectal examination and imaging of the prostate are part of the diagnostic workup. ### Rectal Neoplasia Tumors of the rectum can cause tenesmus, bleeding, and prolapse. A dog with a lymphocytic lymphosarcoma of the rectum presented with bloody stools and rectal prolapse [6]. Primary rectal tumors including adenocarcinoma, carcinoma, plasmacytoma, adenoma, leiomyoma, and papilloma have all been excised surgically in dogs [7]. Rectal masses can be removed through an anal approach after the rectum is prolapsed, and a stapling technique has been described for distal rectal masses [8]. Any dog with a rectal prolapse should have a digital rectal examination to check for a mass. ### Other Predisposing Conditions A 4-month-old mixed-breed dog with an anogenital cleft and recurrent rectal prolapse illustrates how congenital anatomic abnormalities can predispose to prolapse [9]. A 2-year-old Central Asian Shepherd dog developed a true vaginal prolapse with bladder incarceration and a secondary irreducible rectal prolapse, with extreme tenesmus from constipation as the likely trigger [10]. Cystocele, a displacement of the urinary bladder, has also been reported alongside rectal prolapse in a young female dog [11]. These cases show that rectal prolapse can be part of a broader pelvic or perineal problem. ## Risk Factors Several factors increase the risk of rectal prolapse in dogs. - **Age**: Both young dogs with congenital or infectious causes and older dogs with perineal hernia or prostatic disease are affected. - **Sex**: Intact male dogs are at higher risk because of prostatic disease and perineal hernia. - **Breed**: Small-breed dogs such as Maltese and Yorkshire Terriers appear in multiple case reports [12][13]. Shar Pei cross-bred dogs have been reported with colonic duplication causing recurrent prolapse [14]. - **Chronic straining**: Any condition that causes repeated tenesmus, including diarrhea, constipation, foreign body, and perineal hernia, increases risk. - **Anatomic abnormalities**: Congenital defects such as anogenital cleft or colonic duplication can predispose to prolapse [9][14]. ## How Veterinarians Diagnose Rectal Prolapse Diagnosis begins with a thorough physical examination. The veterinarian inspects the protruding tissue, assesses its color and viability, and performs a digital rectal examination. The key steps are: 1. **Visual inspection**: Note the color, moisture, and presence of necrosis. Bright pink tissue is viable. Dark, dry, or black tissue is necrotic and requires resection. 2. **Digital rectal examination**: Pass a lubricated finger around the mass. In a rectal prolapse, the finger can be inserted between the mass and the anal wall. In an intussusception or prolapsed ileum, the mass is continuous with deeper tissue and cannot be separated. 3. **Abdominal palpation**: Feel for a tubular structure in the abdomen, which suggests intussusception. 4. **Abdominal ultrasound**: Confirms intussusception and evaluates the prostate, bladder, and other organs. In one case, ultrasound confirmed a suspected intussusception in a young dog [3]. 5. **Contrast radiography**: A barium enema can identify colonic duplication, as in the Shar Pei cross-bred dog with recurrent prolapse [14]. 6. **Fecal examination**: Rules out parasitism. 7. **Blood work and urinalysis**: Assesses overall health and identifies concurrent conditions such as urinary tract infection [9]. The veterinarian also evaluates for perineal hernia, prostatic disease, and rectal masses. In one report, a digital rectal examination after reduction identified a feces-filled sac within the ventral rectal wall, leading to a diagnosis of colonic duplication [14]. ## Step-by-Step Reduction of a Rectal Prolapse Manual reduction is the first-line treatment for a viable, non-necrotic rectal prolapse. The goal is to return the tissue to its normal position without damaging it. The following steps reflect standard veterinary practice. ### Step 1: Assess Viability Before attempting reduction, the veterinarian assesses the tissue. Viable tissue is pink, moist, and intact. Necrotic tissue is dark, dry, friable, or black. Necrotic prolapse requires surgical resection, not manual reduction. ### Step 2: Lubricate the Tissue Apply a generous amount of water-based lubricant to the prolapsed tissue and the anal opening. This reduces friction and minimizes trauma during reduction. ### Step 3: Reduce Edema Edematous tissue is swollen and difficult to reduce. Two methods are commonly used: - **Sugar**: Granulated sugar is applied to the prolapsed tissue and left for several minutes. The sugar draws fluid out of the tissue by osmosis, reducing swelling. - **Hypertonic dextrose**: A hypertonic dextrose solution can be applied to the tissue for the same purpose. Both methods shrink the tissue enough to allow gentle reduction. ### Step 4: Apply Gentle Digital Pressure Using a lubricated gloved finger or thumb, apply steady, gentle pressure to the center of the prolapse. Push the tissue back through the anal opening. Do not use force. If the tissue will not reduce, stop and reassess. Forced reduction can damage the rectum. ### Step 5: Confirm Reduction After reduction, perform a digital rectal examination to confirm the rectum is in its normal position and to check for any remaining mass, intussusception, or foreign body. ### Step 6: Place a Purse-String Suture A purse-string suture is placed around the anus to prevent immediate recurrence. The suture is tightened enough to narrow the anal opening but loose enough to allow the dog to pass stool. The veterinarian will adjust the tension and may leave a small gap. The purse-string suture is typically left in place for several days while the underlying cause is treated. ### Step 7: Treat the Underlying Cause Reduction alone does not address the cause. The veterinarian treats diarrhea, deworms for parasites, manages prostatic disease, or addresses perineal hernia as needed. Without treating the cause, recurrence is likely. ## Why Recurrence Is Common After Manual Reduction Manual reduction and purse-string sutures are temporizing measures. They do not fix the underlying problem. A 2.5-kg Maltese dog had two previous episodes of rectal prolapse within four months, both managed with manual reduction and purse-string sutures, before the prolapse recurred and required laparoscopic colopexy [12]. A Shar Pei cross-bred dog had recurrent rectal prolapse over seven months despite repeated reduction, purse-string sutures, and even an incisional colopexy, until a colonic duplication was found and removed [14]. Recurrence happens because the forces that caused the prolapse are still present. Chronic diarrhea, tenesmus, perineal hernia, and anatomic abnormalities do not resolve with a purse-string suture. When the suture is removed, the prolapse can return. ## When Surgery Is Needed Surgery is indicated when manual reduction fails, when the tissue is necrotic, or when the prolapse recurs despite conservative management. ### Colopexy Colopexy is the surgical fixation of the colon to the abdominal wall. It prevents the rectum from telescoping outward by anchoring the distal colon in place. A retrospective study of 14 animals (eight dogs and six cats) found that colopexy, using either a simple suture technique or an incisional technique, prevented recurrence in all 14 animals at follow-up [15]. Incisional dehiscence occurred in two animals, and infection at the colopexy site is a potential complication [15]. Colopexy can be performed through an open abdominal approach or laparoscopically. A 2.5-kg Maltese dog with recurrent rectal prolapse was treated with laparoscopic colopexy using three ports. The distal colon was retracted cranially and attached to the abdominal wall with three simple interrupted sutures. The dog recovered uneventfully and was in good condition at 12 months [12]. Another dog with a chronic recurrent perineal hernia developed a rectal prolapse after herniorrhaphy and was successfully treated with laparoscopic colopexy, remaining in good condition at 27 months [4]. Colopexy is also used in combination with other procedures. A 9-year-old Yorkshire Terrier with dysuria and rectal prolapse after bilateral perineal herniorrhaphy was treated with combined cystopexy and colopexy [13]. A young female dog with cystocele and rectal prolapse was treated with cystopexy, colposuspension, and colopexy concurrently, with no recurrence after three months [11]. ### Resection and Anastomosis When the prolapsed tissue is necrotic, it must be removed. Resection and anastomosis involves cutting away the dead tissue and reconnecting the healthy ends of the rectum. A 2-year-old Central Asian Shepherd dog with an irreducible rectal prolapse required rectal resection and anastomosis, with no recurrence after surgery [10]. ### Colonic Duplication Excision When a colonic duplication is the cause, the duplicated segment must be removed. A Shar Pei cross-bred dog with a ventral communicating tubular colonic duplication was treated with surgical excision of the duplicated tube via a caudal ventral midline laparotomy. At 20 weeks post-operation, there was no recurrence [14]. ### Tumor Excision When a rectal tumor is the cause, it must be removed. Surgical excision of tumors of the caudal rectum can be accomplished through the anus after rectal prolapse [7]. A stapling technique has been described for distal rectal masses, with no recurrence in seven dogs at a mean follow-up of 564 days [8]. ## Triage to Surgery Decision Table | Clinical Scenario | Recommended Action | |--|--| | Viable prolapse, first episode, no necrosis | Manual reduction, lubricant, sugar or hypertonic dextrose, purse-string suture, treat underlying cause | | Viable prolapse, recurrent despite reduction and purse-string | Colopexy (open or laparoscopic) | | Necrotic prolapse | Resection and anastomosis | | Prolapse with intussusception or prolapsed ileum | Abdominal surgery to resect the intussusception | | Prolapse with perineal hernia | Herniorrhaphy plus colopexy | | Prolapse with rectal mass | Tumor excision, possibly through an anal approach after prolapse | | Prolapse with colonic duplication | Surgical excision of the duplicated segment | | Prolapse with prostatic disease | Treat prostatic disease, consider colopexy if recurrent | ## The Main Decision Path The following flowchart summarizes the clinical decision path from presentation to treatment. ```mermaid flowchart TD A[Prolapsed tissue at anus] --> B[Assess tissue viability] B --> C{Tissue viable} C -->|Yes| D[Reduce with lubricant and sugar or dextrose] C -->|No| E[Resection and anastomosis] D --> F[Place purse string suture] F --> G[Identify underlying cause] G --> H{Cause found} H -->|Yes| I[Treat cause] H -->|No| J[Monitor for recurrence] I --> K{Recurrence} J --> K K -->|Yes| L[Colopexy] K -->|No| M[Continue management] ``` ## Differential Diagnosis: Rectal Prolapse Versus Ileocolic Intussusception The distinction between rectal prolapse and ileocolic intussusception is critical because the treatments are completely different. A rectal prolapse is treated by manual reduction and, if recurrent, colopexy. An ileocolic intussusception is treated by abdominal surgery to resect the affected bowel. The key clinical signs are: - **Rectal prolapse**: The protruding tissue shows concentric rings of rectal mucosa. A finger can be passed between the mass and the anal wall. The dog may have a history of diarrhea or tenesmus. - **Ileocolic intussusception**: The protruding tissue shows a mucosal slit or dimple where the ileum enters the colon. The mass is continuous with deeper tissue and cannot be separated from the anal wall. The dog often has a history of vomiting and diarrhea, and may be systemically ill. A 12-week-old golden retriever with recurrent diarrhea and rectal prolapse was suspected of having an intussusception, which was confirmed by abdominal ultrasound and exploratory laparotomy [3]. This case shows why imaging is essential when the diagnosis is unclear. ## Unsafe Home Remedies and What Not to Do Owners should never attempt to treat a rectal prolapse at home. The following actions are dangerous: - **Do not push the tissue back in yourself.** You can damage the rectum, introduce infection, or miss an intussusception. - **Do not apply sugar or dextrose at home.** These are veterinary techniques that require proper assessment of tissue viability first. - **Do not tie a string or suture around the anus.** A purse-string suture must be placed by a veterinarian with the correct tension to allow stool to pass. - **Do not wait to see if it resolves.** Necrosis can occur within hours. Early treatment improves the outcome. - **Do not use human hemorrhoid creams or medications.** These are not formulated for dogs and can be toxic. ## Prevention Preventing rectal prolapse means preventing the conditions that cause straining. Key steps include: - **Routine deworming and fecal testing**: Follow the Companion Animal Parasite Council guidelines for parasite control. - **Prompt treatment of diarrhea**: Chronic diarrhea causes tenesmus and predisposes to prolapse. - **Management of perineal hernia**: If your dog has a perineal hernia, discuss surgical repair with your veterinarian. - **Prostate health**: Have intact male dogs examined regularly for prostatic disease. - **Regular veterinary checkups**: Early detection of rectal masses, prostatic disease, and other conditions can prevent prolapse. ## Prognosis The prognosis for rectal prolapse in dogs depends on the underlying cause and the viability of the tissue. When the prolapse is viable and the cause is treatable, the prognosis is good. Colopexy prevented recurrence in all 14 animals in one retrospective study [15]. Laparoscopic colopexy has been successful in small-breed dogs with recurrent prolapse [12][4]. When the tissue is necrotic, resection and anastomosis can still result in a good outcome [10]. When the cause is a colonic duplication, surgical excision can resolve the problem [14]. When the cause is a rectal tumor, the prognosis depends on the tumor type and completeness of excision [7][8]. The most important prognostic factor is early treatment. A prolapse that is reduced before necrosis has a better outcome than one that is left untreated for hours. ## Limitations and When to Contact a Veterinarian This article is educational and is not a substitute for veterinary diagnosis or treatment. Individual cases vary, and only a veterinarian who examines your dog can determine the correct diagnosis and treatment. Contact a veterinarian immediately if: - You see tissue protruding from your dog's anus. - The tissue is dark, dry, or black. - Your dog is straining repeatedly and cannot pass stool. - Your dog is vomiting or has bloody diarrhea. - Your dog has a history of perineal hernia or prostatic disease and is straining. - The prolapse has recurred after a previous reduction. - Your dog is in pain or distress. Do not wait. Rectal prolapse is a time-sensitive condition. ## Frequently Asked Questions ### What does a rectal prolapse look like in a dog? A rectal prolapse looks like a tube of pink to red tissue protruding from the anus. The tissue shows concentric rings of rectal mucosa. If the tissue is dark or black, it may be necrotic and requires emergency surgery. ### How do I tell a rectal prolapse from an intussusception? A rectal prolapse shows radial folds of rectal mucosa and a finger can be passed between the mass and the anal wall. An intussusception shows a mucosal slit and the mass is continuous with deeper tissue. A veterinarian confirms the diagnosis with a digital rectal examination and imaging. ### Can a rectal prolapse go away on its own? No. A rectal prolapse will not resolve without treatment. The exposed tissue can become necrotic within hours. Manual reduction by a veterinarian is required, and the underlying cause must be treated to prevent recurrence. ### What causes rectal prolapse in dogs? Common causes include severe diarrhea, intestinal parasitism, foreign body, intussusception, perineal hernia, prostatic disease, rectal tumors, and congenital abnormalities such as colonic duplication or anogenital cleft. ### Is surgery always needed for rectal prolapse? No. A viable, first-time prolapse can often be reduced manually with lubrication and sugar or hypertonic dextrose, followed by a purse-string suture. Surgery is needed when the tissue is necrotic, when reduction fails, or when the prolapse recurs. ### What is colopexy? Colopexy is a surgical procedure that attaches the colon to the abdominal wall to prevent the rectum from prolapsing again. It can be performed through an open abdominal approach or laparoscopically. ### How long does it take for a dog to recover from rectal prolapse surgery? Recovery time varies. In one case, a dog treated with laparoscopic colopexy recovered uneventfully and was in good condition at 12 months [12]. Another dog was in good condition at 27 months after laparoscopic colopexy [4]. Your veterinarian will provide specific recovery instructions. ### Can rectal prolapse recur after treatment? Yes. Recurrence is common after manual reduction alone because the underlying cause is still present. Colopexy is effective at preventing recurrence in most cases [15]. Treating the underlying cause is essential. ## Related Articles - [Urethral Prolapse in Bulldogs: Diagnosis, Treatment and Prevention](/knowledge/veterinary-medicine/urology-nephrology/urethral-prolapse-in-bulldogs-diagnosis-treatment-and-prevention) - [Reptile Cloacal Prolapse: Emergency Stabilization, Reduction, and Cause Investigation](/knowledge/veterinary-medicine/reptile-care/reptile-cloacal-prolapse-emergency-stabilization-reduction-cause-investigation) - [How To Express Dog's Rectal Glands](/knowledge/veterinary-medicine/clinical-methods/how-to-express-dog-s-rectal-glands) - [Equine Digestive Physiology: Cecum and Colon Fermentation](/knowledge/veterinary-medicine/veterinary-anatomy-physiology/equine-digestive-physiology-cecum-colon-fermentation) - [Cat Ear Hematoma: Causes and Treatment](/knowledge/veterinary-medicine/skin-allergy-and-ear-care/cat-ear-hematoma) - [Hamster Abscesses: Causes, Treatment, and Prevention](/knowledge/veterinary-medicine/small-mammal-care/hamster-abscesses-causes-treatment-prevention) - [Equine Sarcoid: Types, Causes, and Treatment Options](/knowledge/veterinary-medicine/skin-allergy-and-ear-care/equine-sarcoid-types-causes-and-treatment-options) ## Sources 1. 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