Rectal Prolapse in Cats

What Is Rectal Prolapse in Cats?

Rectal prolapse occurs when some or all of the rectal tissue protrudes through your cat’s anus. Rectal issue is usually dark pink or dark red. The rectum is the part of the intestinal tract that connects the large intestine to the anus. 

There are two main types of rectal prolapse: 

• Incomplete: In this condition, the rectal tissue will protrude when your cat is straining to pee or poop, usually without producing much. After the cat is done straining, the rectal tissue will go back to its normal position and no longer be visible. This is a serious condition, however, because it can get worse and should be treated. 

• Complete: In a complete rectal prolapse, all layers of the rectum protrude through the anal opening. It will look like a tube, with the inner lining of the rectum visible on the outside (everted). A complete rectal prolapse requires immediate veterinary attention.

Symptoms of Rectal Prolapse in Cats

Cats with rectal prolapse will often act very uncomfortable and may not want to move around much. They may lick at their rectum and continue to posture and strain to poop, pee, or give birth, depending on the cause of the prolapse. 

The color of the exposed rectum is important. A recently prolapsed rectum will be dark pink but will quickly turn dark red as swelling and exposure progress. 

If the rectal prolapse is not treated quickly, the rectum may turn very dark red to black. Darker colors may be a sign of tissue death (e.g., necrosis). This is very serious and may result in long-term complications. The wall of the prolapsed rectum may also break (e.g., ulcerate) and swell.
 

Causes of Rectal Prolapse in Cats

Rectal prolapse can be caused by any medical condition that causes a cat to strain too hard while peeing or pooping. Straining weakens the tissue that supports the rectum. 

These conditions could cause rectal prolapse in cats: 

• Intestinal parasites 

• Diarrhea

• Constipation 

• Obstruction of the colon or rectum because of a foreign object

• Rectal or vaginal mass

• Urinary obstruction 

• Giving birth 

In kittens, diarrhea due to intestinal parasites is the most common cause of rectal prolapse. 

Certain breeds of cats, such as the Manx cat, or cats that have had tail amputations, may be more prone to rectal prolapse if the nerves to their rectum and anus were affected.

How Vets Diagnose Rectal Prolapse in Cats

Rectal prolapse in cats is diagnosed with a physical examination. By the time most cases are seen by a veterinarian, the prolapse is often complete, so the rectum is constantly exposed, rather than only being visible when a cat is pooping. 

A completely prolapsed rectum will look like a long, tubular mass protruding from the anus. Rectal masses may sometimes look like rectal prolapses. In general, if you see any type of tissue protruding from the anal opening, you should see your vet right away. 

Once the prolapse is diagnosed, your vet will try to determine if there’s an underlying cause. Treating the underlying cause can sometimes resolve the condition. Underlying causes of rectal prolapse include intestinal parasites, rectal masses, stenosis of the rectum (narrowing), or an enlarged prostate. All of these conditions can cause your cat to strain while pooping, which can lead to rectal prolapse. 

A stool sample should be checked to rule out intestinal parasites. Bloodwork and x-rays of the abdomen and may be recommended if the underlying cause of the prolapse is not obvious based on physical examination alone. 

Treatment for Rectal and Anal Prolapse in Cats

Your cat may have a simple rectal prolapse, or they may require rectal prolapse surgery, where part of the rectum must be surgically removed. You will also need to treat the underlying cause of the rectal prolapse.

Simple Rectal Prolapse

Treatment of rectal prolapse usually requires your cat to be anesthetized during the procedure. Reducing a prolapsed rectum can be painful, and a prolapsed cat will already be in pain and distress. 

After your cat is safely sleeping, the rectal tissue will be carefully and thoroughly cleaned. It there is swelling, your vet may use medications or hypertonic saline (a special type of saline solution with a higher salt concentration than regular saline solution) to help decrease swelling. A rectal exam should also be performed to rule out a rectal mass or other abnormality. 

If the rectal tissue is still healthy, your veterinarian can usually manually reduce the prolapse after flushing the rectum thoroughly with sterile saline. Once clean, the rectum will be lubricated and gently replaced inside the pelvic cavity.

Once the prolapse is reduced, a technique known as a purse-string suture is used to make the anal opening smaller so the rectum cannot prolapse again while your cat heals. 

Rectal Prolapse Surgery

If the rectum has been prolapsed long enough for the tissue to become necrotic (black and dying), the dying portion of the rectum must be surgically removed. Healthy rectal tissue is then surgically reattached to more healthy tissue. 

Depending on how much rectum must be removed, this can result in fecal incontinence (inability to control bowel movements) or other elimination issues. These may be temporary or long-term.

Colopexy

If a cat has a history of repeat rectal prolapses—or if surgery is required to remove dead tissue—a procedure called a colopexy may be performed. In a colopexy, the rectum is attached to the abdomen wall using an internal suture (stitch). This is an extensive abdominal surgery, but it can help prevent repeat prolapse events. 

Treating the Underlying Cause

To avoid recurrence of rectal prolapse, the underlying cause of the prolapse must also be treated. This treatment will depend on the underlying cause. 

If the prolapse is due to birthing kittens, your cat must be spayed so it won’t happen again. 

Intestinal parasites can be treated by deworming, while a urinary stone or obstruction will need its own treatment, and so on. 

Recovery and Management of Rectal Prolapse in Cats

If your cat has diarrhea during the healing period, contact your vet right away. Your cat will likely need additional treatment. Diarrhea increases the risk of another rectal prolapse. 

After surgery, most cats will be prescribed pain medication, stool softeners, and possibly antibiotics. Their medications depend on the health of their rectal tissue at the time of surgery. Epidurals are sometimes used to eliminate the urge to strain when your cat goes to the bathroom, and as a form of pain control. 

A cat who receives an epidural and/or who has a surgical repair of their rectal prolapse may require hospitalization for 1-3 days, depending on how they are doing. If your cat received a purse-string suture, they may be sent home the day of the procedure. 

The period of rest after a rectal prolapse repair depends somewhat on whether a purse-string was performed, or whether part of the rectum had to be surgically removed. The more serious the repair, the longer and stricter the rest period will be.

Recovery After a Simple Rectal Prolapse

Recovery from a simple rectal prolapse, where the rectal tissue was healthy and could be reduced without complication, requires that the purse-string suture remains in place for 5-7 days while your cat heals. 
During the recovery period, your cat must wear an E-collar to prevent licking, which can cause the suture to fall out early and increase the risk of infection. 

Soft foods and stool softeners will be prescribed to reduce pressure on the purse-string suture while your cat poops. After your cat is healed, the purse-string suture should be removed by a veterinarian, who will clear your cat for regular food. 

Recovery After Prolapse Surgery

Recovery after a prolapse repair that required surgical removal of part of the rectum will take a bit longer. After surgery, most cats will need to wear an E-collar and be on soft food and stool softeners for 10-14 days or longer. 

Potential complications for prolapse repair include a recurrence of the prolapse (meaning that the repair is unsuccessful), fecal incontinence, and infection. 

Recurrence of Prolapse

If your cat experiences another prolapse, it will look very similar to the first occurrence, with rectal tissue protruding from the anus. If it’s infected, the tissue will be red and swollen, and you may see discharge around your cat’s anus.

Fecal incontinence, or not being able to control pooping, is uncommon, but it is possible if part of the rectum had to be surgically removed.