Uterine and Vaginal Prolapse

1. VAGINAL PROLAPSE
BVSc & A.H, 9th semester
Exam Roll no:35
Exam Roll no :36

2. Introduction
■ Also known as Red bag or throwing the rose.
■ Typically looks like a pink mass of tissue about size of
large grapefruit or volleyball.
■ A part or whole of vaginal wall displaced in such a
way that its mucosa is visible at vulvar lips.
■ Involve a prolapse of the floor, lateral wall and roof of
the vagina through vulva with cervix and uterus
moving caudal.
■ Frequency : Buffaloes (highest) Cattle, Sheep

3. Occurrence
■ All over the world
■ Seen in mature females in last trimester of pregnancy
■ Young , non pregnant fatty heifers
■ Common in stabled than pastured animals
■ More common in pluriparous animals

4. Etiology
■ Hereditary predisposition
■ Increase in intra-abdominal pressure
■ ↑ size of pregnant uterus
■ Intra abdominal fat
■ Rumen distention
■ Old age

5. Contd.
■ Endocrine imbalance (estrogen)
■ Cystic ovarian degeneration
■ Sheep confined on lush pasture and carrying twins.
■ Deficiency of Ca & disturbed Ca :P ratio
■ Constipation with difficult bowel movements
■ Urinary infection, vaginal injuries
■ Deposition of fat in peri vaginal space
■ Close confinement ; in which cow’s rear quarter projects over
the gut.

6. Clinical signs
■ Depends on degree & duration of prolapse
■ Tenesmus : continuous or intermittent
■ Attempts at frequent urination & defecation
■ Anorexia
■ Varying degrees of prolapse according to:
i. Size of prolapse
ii. Involvement of organs other than vagina
iii. Length of time for which prolapse has been present

7. Classification
■ • Simple : vaginal mucosa protrudes from vulva when cow is
recumbent but disappears when cow stands
■ • Moderate : protruding vaginal mucosa remains visible even
when cow stands; cervix not visible
■ • Severe : vagina protrudes & cervix is visible

8. Simple prolapse
■ Part of vaginal wall at vulvar lips in the form of a large reddish
swelling
■ Uterus & bladder not displaced
■ Superficial erythema & erosion of vaginal wall
■ Appears pale pink, moist, smooth, glistening
■ Prolapse appear and disappear as animal lies down and stands up
respectively.

9. Moderate prolapse
■ Bladder or intestine become involved in prolapse & get trapped
in pelvis.
■ Vaginal prolapse is so great & vesico - genital pouch is greatly
increased in size allowing viscera to enter it.
■ Rubbing with tail, ground, feces, urine
↓
severe irritation
↓
more painful, expulsive efforts
↓

10. Complications
■ Trapping of intestine → signs of intestinal obstruction
develops → strangulation ensues.
■ Bladder within prolapsed vagina → occlusion of urethra →
becomes filled & enlarged → rupture
■ Exposed vaginal mucosa becomes severely ulcerated and dried.
■ Blood stasis, disturbance in venous return & edema
■ pale pink→ deep red → blue → black (severe case)
■ Perforate with necrosis leading to peritonitis or to rapidly fatal
hemorrhage.

11. Severe prolapse
■ Third and most severe stage
■ Uterus & cervix pushed so far caudally that cervix appears at
vulvar lips
■ Bacterial liquefaction of cervical seal (If pregnant)
■ Establishment of infection inside the uterus
■ Fetal death & abortion occur several days after correction
■ Fetus invariably becomes emphysematous

12. Treatment
■ Reduction and Replacement
■ Retention
a. Replacement
■ First caudal epidural anesthesia
■ Thorough cleaning of prolapsed mass with cold water/ N.S./
mild antiseptic solution like acriflavine.
■ Raising prolapsed mass to level of labia thereby reliving
pressure on urinary meatus & immediate evacuation of bladder.

13. Contd.
■ Application of hygroscopic substances to reduce size such as
cold alum solutions
50% dextrose
Magnesium sulphate
■ Lubrication with non irritant liquid or jellies. Glycerin
(provides lubrication, reduces congestion & edema by osmotic
action)
■ Anesthetic jellies
■ Mass replaced back with fist or fingers held together.
(Replaced organ requires to be straighten completely as
slightest invagination tends to immediate recurrence)

14. Contd.
■ Vulvar truss is of practical value
■ Pessaries are popular in Europe but not in USA.
■ Vulvar tape retention sutures.
■ Buried or "hidden" purse string type suture, Buhner's method
Permanent retention technique
■ Minchev's method:
– Surgically fastening the cranial portion of the vaginal wall through the lesser sciatic foramen to
the dorso-lateral wall of the sacrosciatic ligament, muscles and skin of the croup.
■ Winkler's method:
– fixation of the cervix to the prepubic tendon.

15. Vulvular tape retention suture
■ Clean and thoroughly disinfect the anus, vulva, prolapsed parts, perineal
skin and the tail.
■ Return the prolapsed part to its proper position.
■ Locate the vulvar hairline on one side (located at least 2-3 inches lateral
to the vulvar lips) and swiftly pass the needle subcutaneously from the
dorsal commissure parallel through the entire vulvar lip out of the ventral
commissure.
■ This affords a much tougher and thicker skin for the suture, which does
not tear out as readily nor cause as much irritation as one in the vulvar
lips.
■ Place one hand in the vagina for proper orientation of the needle and to
maintain it at a depth of about 5-6 cm until the eye of the needle emerges
through the ventral commissure.

16. Contd.

17. Buhner’s method
■ The purse string suture around the vulva is tightened
sufficiently to allow 4 fingers in the vulva, and the knot is tied
and buried beneath the skin of the upper incision by suturing
the skin over the heavy purse string suture leaving it buried
within the vulvar tissues until parturition when it is removed.

18. Button technique
■ Horizontal mattress sutures placed through the holes in the
button on each side of the lips of vulva.

19. Flessa sutures
■ Commonly used in field
conditions to retain prolapsed
organ.
■ Possibility of vulvar tears if not
placed sufficiently deep/ when
tenesmus is present.

20. Rope truss

21. Post operative care
■ Balanced ration avoiding too much dry & green fodder
■ Proper Ca, P supplementation
■ Administration of calcium borogluconate every third day till animal
is normal
■ Bed of animal soft/not have slope & hind quarters be elevated

22. Differential diagnosis
Uterine prolapse:
A vaginal prolapse is a small pink or red colored ball of tissue ranging from
the size of a grapefruit to a soccer ball. It is expelled from the animal
BEFORE calving whereas a uterine prolapse takes place AFTER calving.
Vaginal prolapse occurs when there is an increase in pressure in the
abdominal cavity during the late stages of parturition. It is more common
than a uterine prolapse and can also be passed by genetics.
It is quite common for a vaginal prolapse to occur in the same animal each
time they calve but a uterine prolapse is not reoccurring.
Rectal prolapse:
It protrudes from the anus (and may occur concurrently).

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