This article will focus on only vaginal prolapses. The act of replacing these is the visible part but there are many other aspects veterinarians consider when working on these conditions. The cause, method of replacement, long-term care and expected force of straining afterwards must all be considered when vaginal prolapses are being corrected. As an experienced veterinarian there are times when I must use my complete bag of tricks to help the producer arrive at a favourable outcome.
The number of classic vaginal prolapses that occur before calving where a soccer ball or bigger mass protrudes from the vagina have been greatly reduced by culling these cows in subsequent years. Once we discovered that it is highly heritable, producers began eliminating susceptible animals from the gene pool along with their heifers so the occurrence from that cause has declined remarkably.
Today the prolapses we see have many different causes and these must be differentiated in order to properly serve the client. To my mind it isn’t enough to simply freeze with an epidural, reduce the prolapse, suture and leave.
A more extensive physical exam may identify the cause of the straining that caused the prolapse. It may be due to kidney and/or bladder infection, low-grade peritonitis, a uterus full of infection or a large full-term calf or twins. 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 have manure stick to it. 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 the cause as well as the prolapse once these medical causes are diagnosed.
In the case of a heavily pregnant cow that has prolapsed, your veterinarian may need some idea of when she is due to calve. In some situations we can induce the cow to calve if she is close enough to term. If she has a time to go you will improve the chance of survival by being available when she calves, especially if you have to cut the vaginal suture.
Inducing is only advisable if the cow is within 10 days of her calving date. In emergency situations the size of the fetus, udder fill, looseness of the vulval lips and even when she calved last year provide clues for your veterinarian to assess as to whether she is close enough to induce. You want to maximize the chances of a viable calf whenever you induce.
I have found if the colostrum looks very normal, thick and creamy the cow may be close enough to induce. This is a decision made by you and your veterinarian. When inducing early there may be retained placentas and potentially premature calves you will need to contend with.
There are three main ways we reduce prolapses depending on the circumstances. One is 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.
Another technique your vet may use is tying rubber tubing across the suture ends. Large knot balls are left at the loose ends of the suture ends pulled tight and the rubber tubing is knotted over the ends. The advantage of this technique is if you are not present to cut the suture the straining of the cow forces the calf’s legs out, breaking or separating the tubing so the vaginal lips fall out of the way and the calf is delivered naturally. Most times after calving the prolapse will not reoccur until, of course, next year with the hereditary ones.
One must always be careful if the suture is to be left in on prolapsed vaginas done after calving that enough room is left in case a bull breeds the cow. The last thing we want is a bull injured by 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. This of course is true but for prolapses caused by condtions such as a kidney infection or peritonitis cured with medication. My rule is most prolapsed vaginas may crop up again. For instance, kidneys are strained close to calving from filtering the calf’s blood as well as the cow’s so low grade infections tend to reappear. Your veterinarian can give guidance on whether sutures should be removed and when, or left in till shipping.
The last technique involves reducing the prolapse and with a good epidural using a device that holds the vagina in and pins it to the musculature in the pelvis. Then 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 past this pin but the whole apparatus must be removed after a week or so. 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 and remove the apparatus.
It is not uncommon when we palpate cows close to calving to find either a large calf or twins. The pressure from these calves together with a full rumen can push her vagina out the back end, hence the problem. If it goes back in when the cow runs around don’t panic. Best to leave it and hope she calves ending your problem. If it stays out it must be repaired as the cow cannot pass a calf by this large mass. Older cows may have the condition worsen year by year starting with a small bubble that protrudes a little bit when lying down.
Work with your veterinarian to reduce the incidence of these cases in the future and remember the initial cause is what we need to determine. 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!