The cloaca, or vent, in reptiles is the slit opening under the tail. The digestive tract, the reproductive system and the bladder all empty out the same cloacal opening.
Reptiles will sometimes prolapse (slip out of place) tissues out through this opening. Cloacal prolapse refers to any condition involving tissue protruding from the reptile’s vent, where feces come out. Prolapsed tissues from the cloaca can have a variety of origins, including the gastrointestinal tract (colon, large and small intestines), urinary bladder, phallus (alligator, crocodiles, turtles, tortoises), hemipenis (snakes and lizards), and the oviduct (the organ where eggs and young are held). In rare cases the kidneys have been known to prolapse from the vent.
Any species of reptile can have a cloacal prolapse.
Cloacal prolapses are generally caused by an excessive amount of straining from a variety of causes:
- Inappropriate humidity levels and lack of water for drinking that lead to dehydration and constipation
- Improper husbandry such as lighting, cage size, and temperature gradients
- Metabolic bone disease and lack of calcium leading to improper function of the GI tract
- Tumors or infections that lead to straining
- The phallus (in male turtles and tortoises) and hemipenis (in lizards and snakes) from impacted or infected scent glands (very similar to scent glands in dogs and cats) or from smegma plugs (a waxy, sperm filled secretion that builds up in the hemipene and looks like a wax cast of the hemipene – no one is sure why this happens)
- Trauma from sex determination (probing)
- Oviductal prolapses in females are usually caused by failure to give birth or lay eggs (dystocia, egg binding)
- Prolapses of the colon, large intestine and small intestines usually result from infections with parasites, bacteria or constipation
- Urinary bladder prolapses usually are caused by a bladder stone.
Cloacal prolapses occur in any age reptile of any species and of any sex. They are commonly seen in high-producing, egg-laying species. Risk factors include collections or individuals with husbandry deficiencies, especially low-calcium and low-mineral diets.
On physical examination, it is usually easy to determine that a reptile has a prolapse; there will be tissue protruding from the cloacal opening. The difficulty is determining what tissue is prolapsed and why. These are important questions that your veterinarian will try and answer so the proper treatment and prevention can be accomplished. Other abnormal findings that may be found on exam are dehydration, poor-body condition and weakness.
Your veterinarian will take a detailed diet and husbandry history and perform a physical exam. In many cases, the type of tissue that is prolapsed will be identified on sight. However, your veterinarian may want to do some additional testing to determine the prolapse has occurred. The tests suggested may include a fecal exam to look for parasites; X-rays to check for metabolic bone disease, tumors or bladder stones; and a blood panel to look for sign of infection. In some cases, your veterinarian may suggest some advanced testing such as an endoscopy, during which the veterinarian puts a small camera into the cloaca to see what is going on), an MRI or CT scans.
Prolapses are generally treated as emergencies. Treatment should begin as soon as possible. Your veterinarian will likely instruct you to “protect” the protruding tissue by wrapping it is a soft, moist cloth such as a towel while on your way into the clinic.
Once the type of tissue that is protruding is identified, your veterinarian will attempt to replace the tissue back into its normal location and position. The tissue will be cleaned and lubricated and gently massaged back into the cloaca, often using a cotton tipped applicator. If the tissue is swollen, your veterinarian may use a concentrated sugar solution or gentle pressure to help reduce the size of tissue before replacing it into the cloaca. It is common for the tissue of the phallus or hemipenes to be necrotic, and if this is the case your veterinarian may want to amputate these organs. Reptiles only use the phallus and hemipenes for reproduction, and not for urination, so you can remove it and it the animal can still live a healthy life.
To prevent the tissue from prolapsing again, the veterinarian will often suture each side of the vent to make the opening smaller. This allows the reptile to defecate but prevents the tissue from re-prolapsing. These sutures may be left in place for three to four weeks.
Depending on what your veterinarian finds might be the cause of the prolapse, a nonsteroidal anti-inflammatory drug (NSAID) may be prescribed to help with the swollen tissue. Other treatments that your veterinarian may discuss based on the type of tissue that prolapsed and the cause may include husbandry changes (diet, lighting and temperatures), surgery to prevent future prolapses (bladder stone removal, spaying mass or tumor removal), and antibiotics for infections. It is critical to give all medications just as prescribed by your veterinarian and to return for all re-check exams scheduled.
There is a good chance of a complete recovery if the prolapse is recent, and a cause can be identified and corrected. Phallus, hemipenis, bladder and oviduct prolapses generally are more easily corrected and treated. The chance for a cure is reduced if the prolapse has been going on for more than 24 hours and if there is damage to the prolapsed organ or tissue. The most difficult to treat, and thus the ones with the least chance for a cure, are prolapses that involve the colon or the large intestine.
There are many reasons that cloacal prolapses can occur but the most common are from husbandry problems. A detailed review and discussion with your veterinarian is a great start. Any husbandry problems identified should be corrected so that future prolapses are minimized. Unfortunately, once a prolapse has occurred there is a greater risk for another prolapse in the future.