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A puppy's bottom sticking out, has been described by dog owners often as a raised donut or a piece of pink tissue hanging out of the puppy's rectum. 

Some creative dog owners describe it as a "pink ball sticking out" others describe it as a case of "puppy hemorrhoids. "

 In any case, despite the colorful descriptions, most dog owners are describing the same thing: a case of rectal prolapse in their puppies.

 Veterinarian Dr.Ivana discusses rectal prolapse in puppies, underlying causes and treatment options. 

Rectal Prolapse in Puppies 

Rectal prolapse is defined as a protrusion of the rectal portion of the intestines through the anus. Based on how many layers of the intestinal wall are protruded, there can be partial and complete prolapse.

The condition can be congenital (from birth) or acquired.

 If acquired, the most common cause is excessive straining. It can occur in dogs of all ages, but it is most common among young puppies after having bouts of severe diarrhea and female dogs soon after giving birth. 

 Other causes of rectal prolapse include intestinal blockage, bladder obstruction, and birth.

Rectal prolapse is most frequently reported in puppies less than four months of age and in small dogs suffering from chronic, severe diarrhea.

In young puppies rectal prolapse is often due to local irritation and diarrhea, but in older dogs it can have other causes. 

Causes of Rectal Prolapse in Puppies 

Rectal prolapse in puppies and dogs often occurs alongside the following conditions. Worthy of mentioning that it is normal for a puppy's bottom to stick out slightly before having a bowel movement. 

Anal Sac Disease

Anal sac disease is the most common health problem in the dog's anal area. It occurs when the secretion from the anal glands, instead of being expelled, starts to accumulate inside the sacs. 

Over time, secretion becomes infected and causes anal sac disease. Anal sac disease occurs in all dogs but is more common among small breed dogs.

Perineal Hernia

A perineal hernia is a peritoneum-lined sac that protrudes through weakened muscles on either side of the anus. It is prevalent in un-neutered males between the age of 6 and 8. Certain breeds like Collies, Kelpies, Dachshunds, Boxers, Boston Terriers, Pekingese Dogs, and Welsh Corgis are at higher risk of developing a perineal hernia.

Perianal Fistula

Perianal fistula is a condition that manifests with chronic bleeding, ulcerating and infected wounds in the anal area. The condition's origin is unknown, and it is widespread in dogs over seven years old. German Shepherds, Retrievers, and Setters have a higher than average risk to develop perianal fistulas.

Perianal Tumors

Benign tumors in the perianal region are common among Samoyeds, Beagles, and Cocker Spaniels. The tumors are three to ten times more likely to occur in males than females. Un-neutered older males have the highest risk of developing perianal tumors.

Rarely, dogs can develop a malignant type of perianal tumor known as perianal adenocarcinoma. These tumors are prone to rupturing and, if they rupture, are quite painful and can quickly get infected. 

Rectal and Anorectal Strictures

A stricture is defined as narrowing due to excessive scar tissue formation. Rectal and anorectal strictures develop due to trauma caused by foreign objects and inflammations. These strictures are particularly common in German Shepherds, Poodles, and Beagles.

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There are two forms of rectal prolapse: partial and complete.

There are two forms of rectal prolapse: partial and complete.

Types of Rectal Prolapse in Puppies

There are two forms of rectal prolapse: partial and complete. Let's take a closer look at both of them. 

· Partial (mucosal) rectal prolapse – this takes place when only the lining (mucosa) of the rectum prolapses. There will be a swollen, doughnut-shaped, red ring of tissue protruding from the anus in such cases. Dog parents frequently mistake this tissue for hemorrhoids.

· Complete rectal prolapse – this takes place if all layers of the rectum wall prolapse. There will be a small or big sausage-shaped piece of red tissue extending from the anus in such cases.

It goes without saying that a partial (mucosal) prolapse is less severe than a complete prolapse.

Diagnosing Rectal Prolapse in Dogs

The vet can conclusively set the diagnosis based on physical examination. To determine the extent of the damage and the exact organ involvement, the vet may insert a probe.

Basically, setting the rectal prolapse diagnosis is straightforward. However, determining the underlying cause can be more complicated, and usually requires different diagnostic procedures such as blood work, ultrasound, and radiography.

Treating Puppies With Rectal Prolapse

The treatment for rectal prolapse in puppies depends on whether the prolapse is partial or complete.

In partial prolapse cases, the key strategy is to determine the underlying cause and adequately address it. The vet will apply a local anesthetic and a lubricant to solve the prolapse itself and try to replace the prolapsed intestine manually. 

The anesthetic role is crucial because if the patient strains due to pain, it will be hard for the vet to reposition the prolapsed rectum. Not to mention how inhumane it would be to perform such a procedure without considering the dog's pain. The vet will then advise using stool softeners and a low-residue diet for several days.

In cases of complete prolapse, the repositioning is significantly more demanding. Once again, it goes without saying that the underlying cause must be identified and managed. Meanwhile, the vet will use either local anesthetic or epidural anesthesia to numb the place and ensure safe and pain-free working conditions. 

Once the prolapsed part is repositioned, the vet will insert a temporary purse-string suture to hold the rectum back in its normal position. The suture usually stays for a couple of days, and then it is removed. 

Meanwhile, the vet will recommend using stool softeners, a low-reside diet, and avoiding vigorous physical activity or anything that may cause straining (including excitement, jumping, stress, anxiety).

Potential Complications

Sometimes, if the intestines' prolapsed part has been sticking out for an extended period, the tissue will dry and start dying. This is because this tissue was meant for staying in rather than sticking out. 

 In such cases, before the repositioning, the vet will have to remove the dead tissue surgically. The presence of dead (necrotic) tissue is considered a severe complication.

Cost of Dog Rectal Prolapse Treatment

The cost of treating a dog's prolapsed rectum varies from  location to location. In general it can cost anywhere between $500 to $2000 or more. The average cost though is estimated to be around 700 to 1,000.

 However, the exact price depends on the severity of the case, the presence of complications  (like dead tissue to remove), the actual underlying cause, and the area where you live.

Prognosis for Dogs with Rectal Prolapse

For dogs that received prompt treatment, the prognosis is good. However, it should be noted that, as a condition, rectal prolapse has recurring nature and usually requires surgical correction. However, with proper management, the short-term prognosis is good to excellent.

The prognosis is guarded for dogs with complications and depends on the amount of necrotic tissue that has to be removed.  Finally, the prognosis also depends on the nature of the underlying cause. 

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