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Anal / Rectal Problems in Dogs
Anal Gland expression - can it be done to frequently
Straining after bowel movement
Perianal fistulas
Perianal Fisula treatment options
Anal sac tumor
Rectal bleeding
Infected Anal Glands
Anal Sacs
Anal sac expression
Perianal fistulas
Loss of bowel control
Scooting or dragging rearalso see Allergies
also see Digestive system
also see Diarrhea
also see Parasites
Anal Gland expression - can it be done to frequentlyQuestion: Dear Dr. Richards
I have a question regarding the anal glands. When is it appropriate to bring your pet in to the vet to clean out the glands. If it is done too much is it a problem for your pet? Is it a sign that they need to be cleaned out when a dog scoots their butt on the ground?
Many thanks,
LaurenAnswer: Lauren-
I am not aware of any problems associated with expressing the anal sacs frequently. We have had one patient in the past who seemed to need his anal sacs expressed every 2 weeks or so and we have one currently who probably needs this done about once every 3 weeks or so. Some dogs never need to have their anal sacs expressed in their entire lifetime.
The difficulty really is in figuring out whether the sacs need to be expressed at any time. Symptoms that indicate that they should be expressed include scooting the rear end on the ground, licking or chewing at the area around the rectum or any other sign of discomfort in this region. Some of my clients seem to be able to tell by odor when their dog's anal sacs need to be expressed, apparently because the dog expresses small amounts of the anal sac exudate but can't fully express the sac on their own by scooting or during bowel movements. Anytime that you see signs that the anal sacs are irritated it is a good idea to have them checked out.
If anal sacs aren't expressed and the dog can't express them on its own they may rupture. When this happens there is usually a draining tract about 2 inches below the rectum and about 1 inch from away from the rectum on whichever side the anal sac ruptured on.
Lots of dogs can express their anal sacs by scooting their rear end on the ground. If they do this once or twice and then the behavior stops it may be that they have successfully emptied the sac. If the behavior goes on longer than that it is probably a good idea to have your vet check things out.
Many of my clients have learned to express the anal sacs themselves but until you have a good idea when it is necessary it is best to have your vet check your dog to be sure that is the problem.
Mike Richards, DVM
1/4/2005
Straining after bowel movement
Question: Dr. Doctor Richards,
My dog, Sooki is 13 yrs. old. In great health. Recently, she
has started to... after a very normal bowel movement...
walk around for a few minutes and squat and try to push
again. Her stool is normal so I don't think she's
constipated.
She just continues to have the sensation of needing to squat
and push.What could this be?
Thank you, Cheyanne
Answer: Cheyanne-
There are several possible things that come to mind with what you are
seeing.Dogs get rectal polyps at times and these can produce straining.
Hair that is long enough to get matted across the rectum, or from the
lower part of the tail to the area around the rectum, can lead to straining
excessively. This is one of the more common causes of straining and
constipation we see. It is easy to detect by looking for matted hair,
especially matted hair with stool caught in it.Anal sac inflammation or infection can make the area around the rectum
sore and produce straining in some cases.A perianal hernia is possible. When these are present it is often
possible to see a bulge on one side of the rectum or the other. This might not
be too noticeable if both sides are herniated, though.Dogs with tumors in the colon will sometimes exhibit straining
behavior. The tumors seem to make them uncomfortable and they strain due to this,
not due to a real need to have a bowel movement. The tumor can be located
anywhere in the colon, not necessarily just near the rectal end.Perianal adenomas are small tumors around the rectum that sometimes
cause straining but are usually visible just by looking in this area.Your vet can help you sort through these possibilities. Perianal
hernias are often detectable just by feeling for them and this is true of anal
sac problems, as well. Rectal polyps can sometimes be detected by exploring
the rectum with a gloved finger and can be seen in other cases using an
anoscope (or even an otoscope) to view the rectum.Constipation can occur that is hard to detect because stool hangs up
prior to reaching the rectal area. This is usually detectable with X-rays and
often by rectal examination as well.Diseases that produce colitis, such as giardiasis, coccidiosis,
eosinophilic colitis, whipworms, among other things, can lead to
straining after bowel movements. Usually there is diarrhea with these problems,
though.Some forms of colon cancer show up pretty well on X-rays and other
forms are hard to see and may have to be detected through the use of barium
enemas, ultrasound examination, endoscopic examination or even
exploratory surgery.Bladder infections, bladder stones and bladder cancer can cause
straining that some clients confuse with straining to have a bowel movement,
especially when there isn't much urine flow due to frequent straining
and voiding of very small amounts of urine.These are the things that I can think of that might be causing this
Mike Richards, DVM
sort of behavior. Your vet can help you sort through them. Hopefully, this will
be one of the minor problems.
9/12/2001
Perianal fistulasQuestion: Hi - I am a subscriber. My 5 1/2 year old GSD intact bitch, Anna, was
diagnosed last week with perianal fistulas. Not to disagree with the vet
who made the diagnosis, but after reading up on this and listening to what
others have to say on the situation, many people to whom I am describing
Anna's anal area to are saying that they don't believe this is what her
problem is. There are no pinholes or gaping sores with any fluid coming out
of them, and she does not have a strong odor similar to anal gland fluid.
Anna has never had any IBS symptoms, and other than being very constipated
at times, has no other bowel problems. Her anal area appears to have red,
raw skin around it, going in strips from the center of the rectum outward,
in several directions around the anus. I initially noticed a small strip of
anal skin going from the center outward after she had had a very difficult
BM. I figured this was perhaps a hemrhoid or other problem related to this
difficult BM and assumed it would heal. This was probably 6 weeks ago -
initially it DID get much better, to the point where it looked normal. Then
last week, she had another very difficult BM (she was trying to pass a paper
towel she had eaten along with some ham scraps that I forgot to throw away)
and afterward was licking her anal area. At the time, I thought perhaps she
was coming into season again, and looked to see if her vulva was swollen.
IT wasn't, but her bare area surrounding her rectal area was probably about
2 inches across (my other dogs' anal areas are about the size of a quarter,
if that) and she had very red, abrasive-type looking sores. I took her to
the vet, and upon a visual she said it was pf - she also did a
digital-rectal exam with Anna awake, and pronounced that she did not feel
anything inside of Anna and that everything internally felt smooth. She did
not do any blood tests, skin scrapings, or anything to further her
diagnosis, although she did call in the other vet, who also looked and upon
visual inspection conferred with her diagnosis. Another thing that concerns
me is that neither of these vets has seen pf for 3 years - their last case
of pf was a GSD canine officer, who was 8 years old and had a severe case -
this was 3 years ago.My questions to you are these: if Anna has pf, why does she not have any
open pinhole sores or any other sores other than the abraded skin I see?
From what I am reading, a pf dog also has some type of IBS - Anna does not -
isn't this unusual? And, she has no odor - is this not unusual as well?Any help you can give me on this would be greatly appreciated!! Thank you -
oh, you will be happy to learn that Greta, my older bitch that I wrote to
you about who had thrombocytopenia, is doing very well - her platelet count
was at 320,000 within a day after her diagnosis, and now at 4 months later,
she is at 310,000 and continues to be her old self again!Gail
Answer: Gail-
When I read your note, the thought that kept recurring in my mind was that
you were describing exactly what perianal fistulas look like when most of
the cases we have seen are brought to the office. There is a time in some
dogs (maybe most of them) when there are small infectious tracts leading to
small holes in the areas around the rectum. But most dog owners don't
notice the disease at this stage. I have had one owner find a couple of
small tracts and I have noticed these on one or two dogs in the exam room
during routine physical exams. It is great when the disease is identified
this early, as it is easier to treat, but most of the time it doesn't
bother the dog enough to show clinical signs until there are ulcerated
areas around the rectum and fissure development.We do see a small number of dogs that have lax rectal muscles and crypts
forming in the mucosa of the rectum, which I guess would qualify it as
proctitis rather than perianal fistulas but the end result is usually the
same, eventually these become infected and then more severe disease develops.There are also some dogs that develop sores where the haired skin meets the
more specialized skin surround the rectum. These can be associated with
immune mediated diseases such as lupus erythematosus. It sounds to me like
Anna's sores are within the perianal tissue itself, though.Most dogs with perianal fistulas do not have another disorder, such as
inflammatory bowel disease, as a precursor to the problem, based on our
experience in practice. We might have been less observant than some folks
who are reporting that these problems occur together but I don't find
mention of these link in my veterinary textbooks, either. However,
perianal fistulas are most common in German shepherds, who often also
commonly have other bowel disorders, it makes sense that some would have
both conditions. We have seen perianal fistulas in a Lab, two or three
Chesapeake Bay retrievers and one malamute, along with several German
shepherds. It is supposed to occur in Irish setters more frequently than
other breeds (except shepherds) but I don't recall seeing one with perianal
fistulas.Perianal fistulas seem to occur due to inflammation of the glands around
the rectum and may have an immune mediated component, because the newest
treatment for this condition, cyclosporin administration, works by
suppressing the immune system. Many dogs have no clinical signs prior to
the time that severe inflammation sets in. This condition is almost always
painful and that can help in identifying the problem, too. We have seen
some patients who had noticeable odors and others with almost no odor. I
think that may vary some based on the presence or absence of secondary
infections or on which secondary invaders are present.It is best to do a rectal examination because some dogs have scarring from
the disease that can lead to strictures in the rectum and some dogs
probably get similar looking conditions from foreign bodies that are caught
in the rectum or from cancers that might be more identifiable by rectal
examination. The degree of anal sac involvement in the disorder can also be
better determined by rectal exam.There are no other tests for this condition. Blood work is almost always
normal, unless there is severe infection. X-rays are not useful and since
the lesions are visible without special imaging techniques (like endoscopy)
there isn't much else to do but identify the problem visually. If there is
any worry about the immune mediated diseases, especially if there are
lesions on the face or feet that resemble those around the rectum, biopsy
would help to identify and rule out these conditions.Prior to a few years ago, surgery was the only option for effectively
treating perianal fistulas. Medical treatment now works pretty well, with
the use of cyclosporin (Sandimmune Rx) at 2 to 3mg/kg every 12 hours. This
has to be continued for several months and is pretty expensive. About 40%
of dogs have relapses after therapy is stopped. Most will respond to
additional medical therapy or surgery at this point and it is often
possible to limit the amount of surgery necessary by using cyclosporin
first and then doing surgery if there is a recurrence, catching the new
problem as early as possible.Hope this helps some.
Mike Richards, DVM
1/23/2001
Perianal fistula treatment options
Question: DR.Richards, thanks for taking my question.
I would like to know your feelings on surgical verses cyclosporin
treatment for perianal fistula.
The long and short effects, and what to look for.
My 11 year german shepard is on the treatment now.I started with an
internal medicine group, but now i am with my regular vet, who has seen only two cases including
mine. We have been on cyclosporine since march of this year, with two
weeks off.most weeks 4-100mgs per day
some weeks 2-100 per day. one reason we have been on the drug so long,
there was a relapse.
thanks jereAnswer: Jere-
I am under the impression that is necessary in most dogs to continue
cyclosporin continuously in order to treat perianal fistulas and prevent
recurrences, so it doesn't seem surprising to me that you would find that
withdrawal of the medication resulted in a return of the problem. Since
this is expensive, veterinarians have begun to use ketaconazole and
cyclosporin combinations, because ketaconazole enhances the effect of
cyclosporin, allowing much lower dosages to be used in some dogs (as little
as a third of the original dosage of cyclosporin may be effective when the
combination is used). It is still best to test for cyclosporin levels in
the blood stream when using ketaconazole, as a method of establishing the
effective dosages, because cyclosporin is variably absorbed in dogs.Alternative medications are other immunosuppressive agents, including
prednisone and azathioprine, also usually used in combination.Surgery can be helpful but its drawback has been that the fistulas recur
after surgery, which still makes it a reasonable choice when dealing with
initial fistulas that aren't responding well to medical therapy. However,
if medication does control the problem and it just recurs when you stop the
medications, I think I'd avoid surgery, personally.There may be some value in using the new hypoallergenic diets (Hill's z/d
tm, Purina's HA tm), for this condition. That hasn't been proven, though.Mike Richards, DVM
12/4/2000
Anal sac tumor in Jack Russell
Q: I wonder if you could help me or put me in touch with someone that
can.our Jack Russell has been prescribed as having a tumor near his annal
passage. We are of course trying to give our dog the best quality
of life and so do not want him to have an operation unless it is
absolutely necessary. I would welcome your import and look forward to
receiving a reply. thanking you in anticipation.Kevin
A: Kevin-If this tumor is an tumor of the anal sac (an anal sac carcinoma) it is
important to remove it surgically as these are highly malignant. If the
tumor is a perianal adenoma or other tumor it may not be as important. Your
vet, who has examined these tumors, is your best source of information on
the type of tumor and the best method of dealing with it.Mike Richards, DVM
Rectal bleeding in Mini Schnauzer
Q: I have an 8 y/o neutered mini schnauzer that has a variety of health problems. He has been diagnosed with SARDS (he is totally blind), he has pancreatitis, and has had a herniated disc.
The problem that concerns me now is that he randomly bleeds from the rectum after having a bowel movement. There is no blood in his stool, and it just happens every so often. It seems to come in stages. He will bleed almost every day, and then quit bleeding for several weeks. Our vet doesn't know what could be causing it, and he doesn't seem too concerned about it; however, I am quite concerned that something is seriously wrong with him. Do you all have any ideas?
Please e-mail me at your earliest convenience with any suggestions. I would really appreciate it. He just doesn't ever seem to feel good, and I am so afraid that he will die anyday, and we will never know why. Thanks so much!! Dorothy
A: Dorothy- The rectal bleeding may be the result of a number of problems. Probably the most common causes of this are mild constipation leading to hard, irritating stools, colitis and proctitis. Dogs get rectal polyps which can lead to intermittent bleeding. Tumors can occur around the anus or in the colon. Rectal fissures and anal sacculitis can lead to intermittent rectal bleeding. Most of these things your vet has probably ruled out be examination. The constipation/colitis problem can sometimes require a bit of a workup and rectal polyps can be pretty frustrating to find without an endoscope. Dogs have rectal bleeding at times for no apparent reason. Most dogs with occasional rectal bleeding do not have serious problems as a result of it and many vets do tend assume that most owners are not interested in spending a lot of money to figure out what the cause is, due to this. Just let your vet know that you do wish to figure it out, if possible, if that is the case.
Mike Richards, DVM
Infected anal glands in German Shepherd
Q: I am really upset about my 1 year old German Shepherd. He's has infected anal glands. The vet first drained them and put him on Penicllin. That didn't work so we brought him back and he said only 1 gland was infected and put him on a broad spectrum antibiotic, Bactim. After 10 days we brought him back and he put him on Amoxcillin 500 mg 3 X a day. He said if that didn't work, he would have to operate. I called the breeder whose husband is a vet, and she said that antibiotics alone wouldn't alleviate the problem. The anal glands would have to be flushed out while he was under anesthesia and given antibiotics also. She said the last resort would be to remove his anal glands, because he might not have control of his bowel movements. What should I do??? I, myself, am going for surgery next Tuesday, and I don't know what to do. Please help. I haven't got much time. Is it a serious operation?? Thanks for any input. Sandy
A: Sandy- Anal sacs can be frustrating to treat when they become infected. It can take long term use of antibiotics as well as local treatment of the anal sacs through flushing with antiseptics or antibiotic preparations. In some cases it is necessary to remove the anal sacs due to difficulty in clearing an infection. There is a very small chance of surgical complications, including incontinence. I have never actually seen this complication occur in the time I have been in practice, though. If surgery is necessary the odds are very good that it will work out well. It might be a good idea to ask your vet about doing a culture and sensitivity test to determine what bacteria in involved in the infection and to make sure that an antibiotic is being used that will kill that particular bacteria, as long as the situation is under control enough that the time involved in testing is not a critical factor.
Mike Richards, DVM
Q: Hi Dr. Mike, I have an eight year old American Cocker spayed girl, who is a Service Dog. Today Mandy seemed to scoot frequently on her bottom. This evening I gently massaged her bottom, and brown/gray liquid came out on the tissue. It had a strong odor but wasn't pus or bloody. Is this what is meant by "expressing anal sacs"? Is this a frequent problem? Mandy's eight and has never had any similar problem. She appears to be in no distress. Is a vet visit warranted? Is this something that is common? Should I be checking this on her regular once-over health checks?
"To Do Is To Be" Socrates; "To Be Is To Do" Plato; "Do Be Do Be Do" Sinatra
A: It sure sounds like Mandy expressed her anal sacs (or that you caused them to express). If you can still feel enlargement of one or both sacs at about the 4 o'clock or 8 o'clock position relative to the rectum, it might be a good idea to have your vet show you how to fully express them, or to express them for you. It is not unusual for dogs to develop anal sac impaction later in life. Some dogs do this once or twice in their whole lifetime and others develop chronic problems. Hopefully, Mandy will be in the former category.
Mike Richards, DVM
Q: G'day Dr Mike, Could you kindly describe how I may express my 6yr old female spayed Rotweiler mix buddy of mine. The Vet did it about a month ago, and hurt her, because she yelped and put up an immense fight... I believe I can do it without hurting her... I shall not be going back to that Vet again . I read in your FAQ section, some person massaged his dogs' anal area, and that caused expression of the anal sac contents... not so with my 4-legged friend .Any advice greatly appreciated, Thank you, Peter
A: Peter- Most dogs are not too concerned about having their anal sacs expressed but we do have some that resent it -- even though they are trying hard to express them on their own by scooting and rubbing on the rug or ground. It probably is uncomfortable for the pet to express these sacs when they are very full or difficult to express.
If you want to try this at home it is often possible to do so. The anal sacs are located at about the 4 o'clock and 8 o'clock positions if you imagine the area around the rectum to be a clock face. It is usually possible to feel them under the skin at these points when they are full. In some dogs the sacs can be pretty far to the side of the rectum but most are about 1/4th to 1/2 inch to the side. If the glands are pressed against each other by pinching the rectal area together they will usually express. It is hard to get them as empty as the vet can by doing this rectally but most pets tolerate it better so it can be done more frequently. Don't push so hard that you rupture an anal sac, though. That leads to significant problems.
If you succeed, you should see an exudate exuding from the ducts. It can vary from liquid to a thick paste and may be gray, tan, brown or black and be normal. Blood or other colored exudates may indicate a problem.
If this is a persistent problem it may be best to remove the sacs, especially in a dog that resents having them expressed.
Mike Richards, DVM
Michal response: It's usually a really good idea to have a paper towel in hand or very close - projectile matter is not that uncommon :)
Q: Mike, Thank you for your reply. I have a 2 yr. GSD who gets in a possition which looks like he's rubbing or squeezing his butt. Sometimes after this he'll look at the spot where he was squatting as if he was looking for something. He also licks his butt or lower part of his tail. Had his oil sack checked, thinking this was the problem, and checked for worms. Oil sack OK and no worms. The Vet said he thought it was a behavior problem. He put him on Amori (I think ) what ever it was it didn't help. Contacted the Vet and was told to double the dosage which I did for the remainder of the perscription and still no change. The Vet said he had no ideal what it could be. To me, it seems likes something is irritating him. This happens quite often. Should I take him to someone else? Lost and concerned. Thank you.
A: German shepherds are one of the breeds which develop perianal fistulas. These are deep fissures around the edges of the rectal mucosa (pink inner portion of the rectum) that eventually lead to small abscessed tracts around the rectum. Your dog would be a little young for the problem based on our experiences with it but I don't think this problem could be ruled out. Sometimes it takes a very careful examination of the rectum, perhaps even under anesthesia, to find these.
Allergies can cause pretty severe itching in some dogs and it is possible to confuse the symptoms with problems like anal sac irritation.
Tapeworms can cause itching and irritation around the rectal area and they are difficult to find in a stool sample. It is necessary to look for the segments in the stool or around the rectum. They often look like rice granules stuck in the hair if they are present.
If your vet can not find a cause for this problem, it might be a good idea to ask about referral to a veterinary dermatologist or internal medicine specialist. There may be someone close in your area. The specialists tend to see the weird cases and they sometimes see patterns in them that general practitioners like myself just don't recognize since we see fewer of the odd cases.
Good luck with this.
Mike Richards, DVM
Q: My 12 1/2 year old Malamute recently has trouble controling his bowel movements. He has loose stools but seems to strain to evacuate all the stool. He will sqaut while walking around the yard while dropping small amounts of stool. He also has begun to have "accidents" in the house. Also once or twice he has lost control of his bowel upon standing up and stretching. Any suggestions would be appreciated. TSS-
A: I would be very suspicious of a problem with perianal fistulas in an older Malamute with this set of symptoms. This could also be a problem with fecal incontinence or a problem like rectal polyps. Please let your vet examine your dog to sort through these possibilities. It could make a big difference in comfort level.
Mike Richards, DVM
"Scooting" or dragging the bottom
Q: My neighor's older black lab is scraping his bottom HARD on a blacktop road. I say it might be worms. She says let it go because there are sacs that she is breaking open. What to do?
A: We see three common causes of "scooting" or dragging the bottom along rough surfaces.
The first is impacted anal sacs. While many dogs can express their anal sacs by dragging their rectum along the ground it is quicker to express them manually. Many vets will show owners how to do this if asked.
The second is tapeworm infestation. Tapeworms release muscular segments that exit the rectum and move around spreading tapeworm eggs into the environment. These appear to cause pretty severe itching in some dogs. They can usually be seen in the stool or haircoat when they first exit the rectum as small (1/2 to 3/4th inch) moving objects. If they are missed in the active stage, they dry up and look like rice granules stuck in the hair around the rectum.
The last is allergic disease -- flea allergy being the most common allergy leading to itching around the base of the tail and rectal region.
If my dog was dragging his butt on a surface as rough as a paved road, I think I'd want to provide some relief immediately. Therefore, I think your friend should consider at trip to her dog's vet for a diagnosis and for treatment of this problem.
Mike Richards, DVM
Last edited 06/28/05