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A prolapse is not just a prolapse

There are many factors that can contribute to a vaginal prolapse

The act of replacing a vaginal prolapse is really just the visible part. There are many other aspects veterinarians consider when they are working on these. The cause, method of replacement, long-term care and expected force of straining afterwards must all be considered when they are corrected. As an experienced veterinarian, there are times when I must use my complete bag of tricks to help the producer arrive at a favorable outcome.

The instances of a classic vaginal prolapse, which occurs before calving with a soccer-ball size or bigger mass protruded from the vagina, have been greatly reduced in subsequent years by culling these cows.

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Once recognized as highly heritable weakness in the animal, producers eliminated them from the gene pool and didn’t keep any of their heifer offspring as replacements — the occurrences declined remarkably.

Different causes

Now we see many different causes for vaginal prolapses and these must be differentiated in order to provide service to our clients. In my view, it isn’t enough to simply freeze with an epidural, reduce the prolapse, suture and leave. A further physical exam may identify the cause of the straining.

The prolapse is simply the end result of the animal straining. Kidney and/or bladder infection, low-grade peritonitis, a uterus full of infection, or a large full-term calf or twins are some of the reasons cows start straining. Really, there are many causes too numerous to mention — I have even seen prolapses in overweight, out of shape show cows.

Once the vagina protrudes through the vaginal lips it can dry out and get covered with manure. This in itself is irritating and results in further straining plus the prolapse gets bigger from edema or a fuller bladder kinked off underneath it.

To me it’s absolutely critical for the veterinarian to treat any of the medical reasons that may have contributed to the prolapse.

With heavily pregnant cows, after the prolapse is reduced, it’s again important for your veterinarian to give some idea of what stage of pregnancy the cow is at, when to watch for imminent calving, and in some cases induce calving if the cow is close enough.

In cases where sutures need to be removed, if the producer has a good idea of when to observe calving there is a good chance of survival. Inducing labour is only advisable if the cow is within 10 days of her calving date. Otherwise the producer and veterinarian may need to closely watch for imminent calving clues such as the size of the fetus, udder fill with colostrum, looseness of the vulval lips and even when she calved last year. You want to maximize the chances of delivering a viable calf anytime a cow is induced. I have found if the colostrum looks very normal thick and creamy the cow may be close enough to induce. This is a decision to be made by the producer and veterinarian. Inducing too early can result in retained placentas and potentially premature calves.

It is not uncommon if cows are palpated close to calving to find either a large calf or twins. This pressure from the calves along with a full rumen can push her vagina out the back end hence the problem. If the prolapse goes back in when the cow moves around I don’t panic as these are better left hoping she calves and the problem is over. If they stay out they must be repaired, as the cow cannot have a calf with this large mass in the way. Older cows may have the condition worsen each year starting with a small bubble, which just protrudes a little bit when lying down.

Three procedures

There are three main ways to reduce prolapses, depending on the circumstances.:

  1. Using the standard purse string suture, which acts as drawstring to pull the vaginal lips together. I only use this technique in cows severely straining or non-pregnant cows.
  2. Your vet may tie rubber tubing across the suture ends. Large knot balls, pulled tight, are left at the loose ends of the suture ends. The rubber tubing is knotted over the ends. The advantage of this technique is if you are not present to cut the sutures as the cow begins to calve, the calf’s legs will break or separate the tubing allowing the vaginal lips to fall out of the way so the calf is delivered naturally. Most times after calving the prolapse will not reoccur until of course next year with the hereditary ones.Always be careful, if the suture is left in on prolapsed vagina after calving, that enough room is left in case a bull breeds the cow. The last thing we want is an injured bull from a vaginal suture catching his penis at breeding. If at all possible keep the cow separate, don’t breed her, and ship her when the calf is weaned. My rule is most prolapsed vaginas will recur. Shipping cows prone to prolapse related to hereditary factors is recommended, however, other causes of prolapsing such as a kidney infection or peritonitis are cured with medication. Close to calving, kidneys are strained from filtering the calf’s blood as well as the cow’s, so low grade infections tend to reappear then. Your veterinarian can give guidance if and when the suture is to be removed. Sometimes they can be left in until the cow is shipped.
  3. The last technique involves administering a good epidural and reducing the prolapse with a device that holds the vagina in and pins it through the musculature in the pelvis. Once the pin is in place, a plastic washer is placed over this pin. I only use this if cows are close to calving and not overly straining. Cows will calve with the device in place, but the whole apparatus must be removed a week or so after calving. Some veterinarians will use this on both sides of the pelvis — a double repair so to speak. The cow should calve normally with little risk of any complications, but again make sure to remove the apparatus.

Work with your veterinarian to reduce the incidence of these in the future and remember the initial cause is what we also need to know. It’s not enough to simply reduce and suture in all cases. Often an explanation can be found if one looks for it. Remember a prolapse is not just a prolapse.

About the author

Columnist

Roy Lewis is an Alberta-based veterinarian specializing in large-animal practice. He is also a part-time technical services vet for Merck Animal Health.

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