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Prolapse

Prolapse is a medical condition in which an organ or tissue slips or falls out of its normal anatomical position, typically due to the weakening or stretching of the supporting muscles, ligaments, or connective tissues that hold it in place.^[1]^[2] Prolapse can occur in both humans and animals, with specific manifestations detailed in subsequent sections. This displacement can lead to protrusion of the affected structure, often causing discomfort, functional issues, or visible bulging, and it affects various parts of the body depending on the type.^[1] A common form is pelvic organ prolapse (POP), which occurs when pelvic floor muscles and tissues weaken, allowing organs such as the bladder, uterus, rectum, or small intestine to descend into or bulge through the vaginal wall in women.^[3]^[4] Specific subtypes of POP include cystocele (bladder prolapse into the anterior vaginal wall), rectocele (rectal prolapse into the posterior vaginal wall), uterine prolapse (descent of the uterus into the vagina), and enterocele (small intestine protrusion).^[5]^[6] Other significant types encompass rectal prolapse, where the rectum extends through the anus, often linked to chronic straining or aging; mitral valve prolapse, a cardiovascular issue where one or both leaflets of the heart's mitral valve bulge into the left atrium during systole; and lumbar disc prolapse (also known as herniated disc), involving the rupture of the outer fibrous ring of an intervertebral disc in the lower spine, allowing the inner gel-like material to protrude and potentially compress nerves.^[7]^[2]^[1] Risk factors for prolapse generally include advanced age, which contributes to tissue degeneration; pregnancy and vaginal childbirth, which stretch pelvic supports; obesity, increasing intra-abdominal pressure; chronic cough or constipation leading to repeated straining; and conditions like connective tissue disorders or prior pelvic surgery.^[4]^[2] Symptoms vary by location but commonly feature a sensation of pelvic heaviness or pressure, lower back pain, urinary incontinence or retention, bowel dysfunction, and pain during intercourse; some cases remain asymptomatic until advanced stages.^[3]^[1] Diagnosis typically involves physical examination, imaging such as ultrasound or MRI for spinal cases, and specialized tests like defecography for rectal prolapse. Treatment strategies emphasize conservative approaches first, including Kegel exercises to strengthen pelvic muscles, lifestyle modifications like weight management and high-fiber diets to reduce straining, and pessaries (supportive devices) for pelvic prolapses; severe or symptomatic cases often require surgical repair, such as mesh reinforcement for POP or valve repair/replacement for mitral prolapse, with outcomes generally favorable when addressed promptly.^[8]^[2]

Overview

Definition

Prolapse is a medical condition characterized by the abnormal displacement, slipping, or protrusion of an organ or tissue from its normal anatomical position, typically due to weakening or stretching of the supporting ligaments, muscles, or fascia.^[9] This descent often occurs within a body cavity or through an adjacent opening, leading to potential functional impairment depending on the affected structure.^[10] The term originates from the Latin prolāpsus, the past participle of prolabī, meaning "to slide forward" or "to fall forward," reflecting the directional nature of the displacement.^[11] Prolapse differs from a hernia, which specifically involves the protrusion of an organ or tissue through a defect or weakness in the enclosing wall, such as the abdominal fascia, often creating a visible bulge external to the cavity.^[12] In contrast, prolapse generally arises from generalized laxity in supportive tissues rather than a localized tear or aperture, though the two can overlap in certain contexts like pelvic floor disorders.^[13] Prolapse is also distinct from ptosis, a term denoting mere drooping or sagging of a body part due to loss of tone or support, without significant protrusion or herniation beyond its normal confines.^[14] For instance, eyelid ptosis involves the upper lid falling over the eye, whereas prolapse implies a more pronounced slippage, such as rectal tissue extending through the anus.^[10] This condition manifests across various systems, including cardiac valves and pelvic organs, but its core mechanism remains the failure of anatomical supports.^[15]

Classification

Prolapses are classified primarily by the anatomical location and organ system affected, encompassing cardiovascular types such as mitral valve prolapse, where the valve leaflets bulge into the left atrium; gastrointestinal types like rectal prolapse, involving protrusion of the rectal mucosa or full-thickness rectum through the anus; genitourinary types including pelvic organ prolapse, which features descent of structures such as the bladder (cystocele), uterus (uterine prolapse), or rectum (rectocele) into the vaginal canal; and obstetric types exemplified by umbilical cord prolapse, where the cord descends ahead of or alongside the presenting fetal part during labor.^[5]^[16]^[3] Severity grading systems provide standardized assessment, particularly for pelvic organ prolapse, with the Baden-Walker Halfway System categorizing descent into four stages relative to the hymenal ring: stage 0 indicates no prolapse with normal position; stage 1 involves descent halfway to the hymen; stage 2 reaches the hymen; stage 3 extends halfway past the hymen; and stage 4 represents maximal descent beyond the hymen.^[17] This system, alongside the more quantitative Pelvic Organ Prolapse Quantification (POP-Q) approach, aids in clinical evaluation across compartments but is most commonly applied to genitourinary prolapses.^[18] Epidemiological data highlight varying global prevalence by type, with symptomatic pelvic organ prolapse affecting approximately 3.6% of women in midlife, rising to higher rates in those over 50 due to factors like parity and aging, while mitral valve prolapse has a population prevalence of 2-3%, representing a common cardiovascular variant with a lifetime occurrence in this range.^[19]^[20] Umbilical cord prolapse occurs in 0.1-0.6% of deliveries, underscoring its rarity but acute obstetric impact.^[16] In terms of affected species, patterns differ markedly, with humans showing higher incidence of cardiovascular prolapses like mitral valve prolapse compared to reproductive types, whereas livestock such as cattle and sheep exhibit more frequent reproductive prolapses, including uterine prolapse with rates up to 1.1% in beef breeds like Herefords and elevated occurrences in sows during farrowing.^[21]^[22] These species-specific trends reflect differences in anatomy, obstetrical demands, and management practices, with veterinary literature emphasizing post-parturient risks in ruminants and monogastrics.^[23]

Prolapse in Humans

Mitral Valve Prolapse

Mitral valve prolapse (MVP) is characterized by the abnormal billowing or hooding of one or both mitral valve leaflets into the left atrium during ventricular systole, primarily resulting from myxomatous degeneration of the valve tissue.^[24]^[25] This degeneration involves the accumulation of proteoglycans and glycosaminoglycans in the spongiosa layer of the leaflets, leading to excessive tissue redundancy, leaflet thickening, and disruption of the collagen framework, which impairs proper coaptation.^[26]^[27] The condition often affects the middle scallop of the posterior leaflet or the anterior leaflet, with annular dilatation contributing to the prolapse in advanced cases.^[27] MVP affects approximately 2-3% of the general population, with a higher prevalence in women, where it is diagnosed more frequently, particularly in younger individuals.^[28]^[29] The condition is also notably more common in individuals with connective tissue disorders, such as Marfan syndrome, where up to 75% of patients exhibit MVP due to inherent abnormalities in fibrillin-1 leading to increased leaflet redundancy.^[30]^[31] Most individuals with MVP are asymptomatic, with the condition often discovered incidentally during routine cardiac evaluation.^[32] When symptoms occur, they typically include palpitations due to arrhythmias like premature ventricular contractions, atypical chest pain that is non-ischemic, and fatigue, particularly with exertion.^[33]^[32] Rare but serious complications include progressive mitral regurgitation from incomplete leaflet closure, which can lead to left ventricular volume overload and heart failure, as well as an elevated risk of infective endocarditis, especially in the presence of a regurgitant murmur.^[25]^[30] Diagnosis of MVP relies primarily on transthoracic echocardiography, which demonstrates systolic displacement of the mitral leaflet(s) by more than 2 mm beyond the annular plane into the left atrium in the parasternal long-axis view.^[34]^[35] Additional echocardiographic features include leaflet thickening greater than 5 mm in classic MVP and evidence of mitral regurgitation via color Doppler flow imaging.^[34] Transesophageal echocardiography may be employed for better resolution in ambiguous cases or to assess surgical candidacy.^[36] Treatment for MVP is generally conservative for asymptomatic patients or those with mild symptoms, focusing on reassurance and periodic monitoring with echocardiography.^[37] Beta-blockers, such as metoprolol, are commonly prescribed to alleviate symptoms like palpitations and chest pain by reducing heart rate and myocardial oxygen demand.^[37]^[38] For severe mitral regurgitation complicating MVP, surgical intervention is indicated, typically involving valve repair through leaflet resection, annuloplasty, or chordal replacement to restore coaptation, which offers better long-term outcomes than replacement.^[24]^[37] The severity of regurgitation is quantified using the effective regurgitant orifice area (EROA), calculated via the proximal isovelocity surface area (PISA) method on echocardiography:

\text{EROA} = \frac{2 \pi r^2 \times V_a}{V_p}

where r is the PISA radius, V_a is the aliasing velocity, and V_p is the peak regurgitant velocity by continuous-wave Doppler; an EROA greater than 40 mm² indicates severe regurgitation warranting intervention.^[39]^[40]

Rectal Prolapse

Rectal prolapse, also known as procidentia, is a condition in which the rectum loses its normal attachments within the pelvis, allowing it to telescope through the anus. This protrusion can range from partial involvement of the rectal mucosa to full-thickness inversion of the entire rectal wall. It is a relatively uncommon disorder, with an annual incidence of approximately 2.5 per 100,000 people, affecting about 2.5 per 1,000 individuals overall, though prevalence rises significantly after age 50 and is notably higher in women.^[7]^[41] The condition is classified into three main types: external full-thickness prolapse, where the entire rectal wall protrudes circumferentially through the anus; mucosal prolapse, involving only the inner lining of the rectum; and internal rectal intussusception, a precursor stage where the rectum folds inward without external protrusion, often occurring 6-8 cm above the anal canal. Full-thickness prolapse represents the most advanced form and is easily visible as a reddish mass, while internal intussusception may progress if untreated. In children, rectal prolapse is less common but can occur due to chronic diarrhea or conditions like cystic fibrosis, whereas in adults, it predominantly affects the elderly due to age-related tissue degeneration.^[41]^[7] Causes of rectal prolapse primarily involve chronic mechanical stress and structural weaknesses in the pelvic region. Persistent straining from chronic constipation or diarrhea weakens the supporting ligaments, tendons, and muscles of the pelvic floor, facilitating rectal descent. Other contributing factors include a deep pouch of Douglas, redundant sigmoid colon, prior pelvic surgery or injury, and neurological disorders affecting pelvic innervation, such as spinal cord issues. Weakened pelvic floor muscles, often linked to aging or multiparity, increase susceptibility, with up to one-third of cases occurring in women without a history of childbirth.^[42]^[41]^[7] Symptoms typically manifest during or after defecation and include a sensation of incomplete evacuation, mucus or blood discharge from the anus, and fecal incontinence, which affects 50-75% of patients. Constipation is reported in 25-50% of cases, alongside rectal bleeding, pain, and itching due to ulceration or irritation of the prolapsed tissue. The prolapsed rectum may spontaneously reduce after straining but recurs with repeated episodes, potentially leading to incarceration if irreducible.^[42]^[41]^[7] Diagnosis begins with a thorough physical examination, including a digital rectal exam where the patient strains to elicit the prolapse. Imaging studies such as defecography or dynamic MRI are essential for confirmation, revealing rectal descent greater than 4 cm below the puborectalis muscle or intussusception on evacuation. Ancillary tests like anorectal manometry assess sphincter function and rule out coexisting conditions, while colonoscopy excludes polyps or malignancy. The Oxford grading system (I-V) via defecography further classifies the severity based on descent extent.^[43]^[41]^[7] Treatment strategies depend on the prolapse type, patient age, and comorbidities, starting with conservative measures for mild or internal cases. These include stool softeners, dietary fiber supplementation, and biofeedback therapy to improve pelvic floor coordination and reduce straining. Surgical intervention is indicated for external prolapse or persistent symptoms, with options divided into perineal and abdominal approaches. Perineal procedures, such as Altemeier's perineal rectosigmoidectomy for full-thickness prolapse or Delorme's mucosal sleeve resection for short-segment mucosal prolapse, are preferred in high-risk elderly patients due to lower invasiveness. Abdominal surgeries, including laparoscopic ventral mesh rectopexy or suture rectopexy, offer fixation of the rectum to the sacrum and are suitable for healthier individuals, providing better long-term continence. Recurrence rates vary from 5-15% for abdominal approaches to 10-30% for perineal methods, with overall success in restoring function exceeding 90% in selected cases.^[43]^[41]^[7]

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) refers to the descent of one or more pelvic organs, including the bladder, uterus, rectum, or small bowel, into or beyond the vaginal canal due to weakened supporting structures in the pelvic floor. This condition primarily affects women and arises from a combination of mechanical stress and tissue degradation, leading to herniation through the vaginal walls. Common subtypes include cystocele, where the bladder protrudes into the anterior vaginal wall; rectocele, involving rectal bulging into the posterior vaginal wall; uterine prolapse, in which the uterus descends toward or outside the vaginal introitus; and enterocele, characterized by small bowel herniation into the upper posterior vaginal wall or rectovaginal space.^[5]^[8] Risk factors for POP encompass vaginal childbirth, particularly with high parity or instrumental delivery, which stretches and damages pelvic support tissues; menopause, due to estrogen deficiency weakening connective tissues; and obesity, which increases intra-abdominal pressure. Additional contributors include chronic conditions like constipation or chronic cough that elevate abdominal strain. Prevalence estimates indicate that POP affects 41% to 50% of women based on physical examinations, with higher rates among parous women over 50, where up to 40% may experience some degree of prolapse; however, only 3% to 20% of cases are symptomatic, depending on severity and population studied.^[5]^[44] Symptoms of POP often include a sensation of vaginal fullness or bulging, urinary retention or incontinence, bowel evacuation difficulties, and dyspareunia during sexual intercourse. Severity is quantified using the Pelvic Organ Prolapse Quantification (POP-Q) system, which measures nine sites relative to the hymen as the zero reference point: anterior vaginal wall points (Aa at -3 cm from hymen, Ba at the most distal anterior point); posterior points (Ap at -3 cm, Bp at the most distal posterior); cervical or cuff point (C); posterior fornix exposure (D); genital hiatus (Gh); perineal body (Pb); and total vaginal length (Tvl). Staging ranges from 0 (no prolapse, all points -3 cm or higher) to IV (complete eversion); for example, stage II involves the leading edge of prolapse extending between 1 cm above (-1 cm) and 1 cm below (+1 cm) the hymen. The rectocele subtype links to broader rectal prolapse mechanisms but manifests as vaginal wall involvement rather than isolated anal descent.^[5]^[45] Diagnosis typically involves a detailed medical history followed by a pelvic examination in the lithotomy position, with the patient performing a Valsalva maneuver to elicit maximal prolapse descent. This clinical assessment confirms the subtype and stage using tools like POP-Q. For complex cases, imaging such as dynamic MRI or ultrasound may provide additional visualization of organ positions and pelvic floor dynamics.^[8]^[44] Treatment is tailored to symptom severity and patient preferences, starting with conservative options for mild cases. Pessaries, removable vaginal support devices, are effective for many women, with success rates of 77% continuation after one year and 85% successful fitting. Pelvic floor muscle training, often guided by physical therapy, strengthens supporting muscles. For severe or refractory POP, surgical interventions include native tissue repairs (e.g., colporrhaphy for cystocele or rectocele) or mesh-augmented procedures like sacrocolpopexy, considered the gold standard for apical support with high anatomic success rates up to 98%; obliterative surgeries like colpocleisis are reserved for non-sexually active patients. Vaginal estrogen therapy may adjunctively improve tissue quality in postmenopausal women.^[5]^[8]

Umbilical Cord Prolapse

Umbilical cord prolapse is an obstetric emergency in which the umbilical cord descends through the cervix ahead of the presenting part of the fetus, potentially leading to compression and fetal hypoxia.^[16] This condition arises during labor when the cord slips into the birth canal before the baby, interrupting blood flow and oxygen delivery to the fetus.^[46] It is classified into two main types: overt prolapse, where the cord is visible or palpable in the vaginal vault, and occult prolapse, where the cord descends alongside the presenting part but is not externally detectable.^[16] The incidence of umbilical cord prolapse ranges from 0.1% to 0.6% of all deliveries, with higher rates observed in cases involving breech presentations, malpresentations, or multiple gestations.^[16] Pathophysiologically, the prolapse causes mechanical compression of the cord between the presenting fetal part and the maternal pelvis, resulting in umbilical artery vasoconstriction, reduced venous return, and acute fetal hypoxia.^[16] Key risk factors include polyhydramnios, prematurity, preterm premature rupture of membranes, and iatrogenic factors such as artificial rupture of membranes during labor induction.^[46] These elements create space in the uterus that allows the cord to precede the fetus into the lower genital tract.^[16] Clinically, the condition often manifests suddenly with fetal bradycardia or severe variable decelerations on cardiotocographic monitoring, indicating compromised fetal oxygenation.^[16] In overt cases, a pulsating cord may be visible or palpable during vaginal examination following membrane rupture.^[46] Diagnosis is primarily intrapartum and confirmed through sterile speculum or digital vaginal exam to identify the cord below the presenting part, or via ultrasound to visualize its position relative to the fetus.^[16] Continuous fetal heart rate monitoring is essential for early detection, particularly in high-risk labors.^[46] Management prioritizes immediate relief of cord compression and rapid delivery to prevent irreversible fetal damage. Initial steps include maternal positioning in the knee-chest or Trendelenburg position to reduce pressure on the cord, along with manual elevation of the presenting fetal part off the cord (funic decompression).^[16] Tocolytic agents may be administered briefly to halt uterine contractions and allow time for transfer to the operating room, where emergent cesarean section is the definitive treatment in most cases.^[46] If unmanaged, perinatal mortality can reach 10-20%, though modern interventions have reduced this to approximately 3-10% in hospital settings with prompt cesarean delivery.^[16]

Prolapse in Animals

Prolapse in Reptiles

Prolapse in reptiles primarily manifests as cloacal prolapse, where internal tissues such as the colon, bladder, oviduct, or reproductive organs protrude through the cloaca, the single posterior opening serving digestive, urinary, and reproductive functions. This condition is distinct from mammalian prolapses due to the reptiles' unified cloacal anatomy, which combines multiple orifices into one, increasing vulnerability to multi-organ involvement during straining.^[47]^[48] Common types include cloacal prolapse in various species and hemipenal prolapse specifically in male lizards and snakes, where one or both hemipenes—paired reproductive organs—extrude and fail to retract. These often result from excessive straining triggered by intestinal parasites, egg-binding (dystocia) in females, constipation, or hypocalcemia associated with metabolic bone disease. In chelonians (turtles and tortoises), phallic prolapse may occur similarly, while oviductal prolapse is frequent in egg-laying females across taxa.^[49]^[47]^[50] Prevalence is relatively low overall at approximately 1.9% among reptile veterinary cases, but it is more frequent in captive herpetofauna, particularly chelonians and lizards compared to snakes, with females 7.5 times more likely to experience true cloacal prolapse (involving no other organs) than males, often due to reproductive stressors like dystocia. Contributing factors in captivity include poor husbandry, such as inadequate humidity leading to dehydration and impaction, nutritional deficiencies causing hypocalcemia, and parasitic burdens from suboptimal diets. High-producing egg-laying species, like certain lizards, show elevated risk during breeding seasons.^[50]^[49]^[48] Symptoms typically involve visible extrusion of pink, fleshy tissue from the cloaca, often edematous or ulcerated, with potential progression to necrosis, darkening, and foul discharge if untreated. Affected reptiles may exhibit straining, lethargy, anorexia, or cloacal swelling, signaling an underlying systemic issue like infection or obstruction. Prolonged exposure leads to desiccation and tissue death, necessitating immediate intervention.^[49]^[48]^[51] Treatment focuses on emergency stabilization and addressing root causes, beginning with manual reduction under sedation or anesthesia using lubrication (e.g., surgical gel) and hypertonic solutions like sugar to reduce edema. Temporary purse-string sutures around the vent prevent re-prolapse for 3-4 weeks, while antibiotics, analgesics, and fluid therapy support recovery. Irreparable necrotic tissue, such as in hemipenal cases, may require surgical amputation, which is well-tolerated if unilateral. Long-term management involves correcting husbandry—optimizing temperature, humidity, and diet—and treating parasites or dystocia via ovocentesis or salpingectomy. Prognosis varies, with good outcomes (over 80% success) for early cases but poorer if necrosis or comorbidities are present.^[49]^[48]^[47]

Prolapse in Birds

In birds, prolapse most commonly manifests as cloacal or oviductal prolapse, particularly in laying hens, where the distal oviduct or cloacal tissues evert through the vent due to incomplete retraction after egg passage. This condition is often triggered by the physical strain of laying large or double-yolked eggs, as well as obesity, which impairs tissue elasticity and muscle tone in the reproductive tract.^[52]^[53] In commercial poultry operations, it represents a notable welfare and production challenge, with reported incidences varying under suboptimal conditions.^[54] Key causes include genetic selection for elevated egg production, which prioritizes yield over robust pelvic and oviductal development, leading to structural weaknesses. Nutritional imbalances, such as diets high in energy that promote overweight birds or deficiencies in calcium and protein, exacerbate the risk by weakening oviduct musculature and promoting hormonal disruptions like low estradiol levels. Symptoms typically involve a bright red, swollen protrusion of tissue from the vent, potentially accompanied by egg fragments or mucus, with affected birds showing straining, lethargy, or reduced feed intake; in flock settings, the exposed tissue often invites pecking and secondary infection.^[53]^[55]^[56] Diagnosis relies on visual examination of the vent for the characteristic everted tissue, supplemented by coelomic palpation to rule out egg binding. Radiographs are useful to evaluate egg position, detect abnormalities like shell-less eggs, or identify concurrent issues such as enteritis or parasites that may contribute to straining.^[57]^[58] Management in commercial flocks generally involves humane euthanasia of affected individuals to curb cannibalism and disease transmission, given the poor prognosis and economic impact. For pet or backyard birds, immediate intervention includes isolating the bird, cleaning the area, and attempting manual reduction with a lubricant like sugar syrup or saline to reduce edema, followed by broad-spectrum antibiotics and anti-inflammatories to prevent necrosis or infection; supportive measures such as fluid therapy and calcium supplementation address underlying causes. Prevention emphasizes breed selection for prolapse-resistant lines, balanced nutrition to maintain optimal body weight, controlled lighting to delay sexual maturity and avoid early heavy laying, and environmental enrichments like adequate nesting space to minimize stress and pecking.^[52]^[55]^[53] This prolapse is far more prevalent in galliform species like chickens (Gallus gallus domesticus) and turkeys (Meleagris gallopavo), where intensive egg production imposes significant reproductive stress, than in passerines such as finches or canaries, which experience lower laying demands. Cloacal extrusion, a variant involving partial cloacal eversion, bears resemblance to prolapse forms seen in reptiles but is distinctly tied to avian oviposition dynamics in endothermic species.^[59]^[60]

Prolapse in Ruminants

Prolapse in ruminants primarily affects cattle and sheep as reproductive emergencies during late pregnancy or postpartum periods, with vaginal and cervical prolapses manifesting as a prepartum pink mass protruding from the vulva, and uterine prolapses appearing as a postpartum red inversion of the uterus.^[61]^[62] Vaginal prolapse occurs in approximately 1-5% of ewes during lambing, while uterine prolapse affects about 0.5% of cows during calving, though rates can vary by flock or herd management.^[62] These conditions arise from weakened pelvic floor support, leading to eversion of reproductive tissues. Key risk factors include multiple fetuses, which increase intra-abdominal pressure, and nutritional deficiencies such as hypocalcemia that reduce uterine tone and myometrial contractility.^[63]^[64] Other contributors encompass obesity, chronic straining from coughing or constipation, short tail docking in sheep, and dystocia during delivery.^[61]^[65] Complications often involve hypovolemic shock from hemorrhage, tissue necrosis, and secondary bacterial infections if untreated.^[66] Symptoms typically include visible protruding edematous tissue—pink and vaginal in prepartum cases or dark red and fleshy in uterine inversions—accompanied by animal distress, straining, and potential hemorrhage or foul odor from infection.^[62]^[67] Affected animals may exhibit reluctance to move, pain upon palpation, and systemic signs like lethargy if shock develops. Treatment focuses on prompt manual reduction under epidural anesthesia to minimize stress, followed by administration of oxytocin to promote uterine contraction and antibiotics to prevent infection.^[61]^[66] If tissue is necrotic or reduction fails, surgical amputation may be necessary, with supportive care including fluid therapy and monitoring for recurrence.^[67] Economic impacts are significant in sheep farming, where prolapses contribute to ewe mortality, reduced fertility, and treatment costs, leading to substantial losses in productivity.^[68] Prevention strategies emphasize genetic selection for larger pelvic dimensions to enhance structural support, alongside culling affected animals and optimizing nutrition to avoid deficiencies.^[69]^[70]

Prolapse in Monogastrics

In monogastric species such as pigs, prolapse primarily manifests as vaginal prolapse in sows during the periparturient period and rectal prolapse in piglets, often linked to gastrointestinal disturbances. Vaginal prolapse typically occurs in the last third of gestation or immediately pre-farrowing, with an incidence ranging from 1.8% in purebred sows to 3.9% in crossbred sows across parities, though rates are lower in gilts at approximately 0.7-1.7% due to less pronounced ligament relaxation.^[71] This condition arises from hormonal surges, particularly relaxin, which relaxes pelvic ligaments to facilitate farrowing, combined with increased intra-abdominal pressure from large litters exceeding 12-16 piglets.^[72]^[73] Symptoms of vaginal prolapse include vulvar swelling, persistent straining, and protrusion of vaginal or cervical tissue through the vulva, which may initially retract when the sow stands but becomes edematous and non-retractable in advanced cases.^[72] Rectal prolapse in piglets is commonly associated with diarrhea from enteritis or dysentery, leading to tenesmus and protrusion of the rectal mucosa, representing one of the most frequent gastrointestinal issues in swine.^[74] Diagnosis for both types is primarily clinical, based on visual inspection of the protruding tissue, with vaginal cases requiring differentiation from dystocia or urinary bladder eversion through gentle manipulation.^[72]^[74] Management of vaginal prolapse involves immediate manual reduction under sedation or epidural anesthesia to minimize straining, followed by supportive measures such as calcium supplementation to address potential hypocalcemia and culotte or purse-string sutures to retain the tissue.^[72] For rectal prolapse in piglets, treatment includes lavage of the prolapsed tissue with hypertonic saline or sugar to reduce edema, manual replacement, and a temporary purse-string suture allowing passage of one finger, alongside antibiotics to prevent infection and resolution of underlying diarrhea.^[74] Recurrence rates are high, particularly in subsequent pregnancies for sows with prior episodes, often exceeding 1.5-fold risk in parities 3 and above.^[73] These prolapses significantly affect sow welfare and productivity in intensive farming systems, contributing to removal rates of up to 0.8% annually and economic losses from reduced litter output and culling.^[73] Uterine inversion, a related periparturient risk, shares similarities with conditions in other species but is less commonly reported in swine.^[75] Prevention strategies emphasize genetic selection for lower heritability (0.09-0.11), balanced nutrition to avoid obesity or high-starch diets, and environmental modifications like non-slippery flooring to reduce abdominal pressure.^[71]^[72]

Prolapse in Equines

Prolapse in equines primarily affects horses and mules, with uterine and rectal types being the most documented. Uterine prolapse occurs rarely, with a reported period prevalence of 0.05% in mares presenting to veterinary teaching hospitals over a 31-year span.^[76] This condition typically manifests immediately after or within hours of foaling, often following dystocia, retained fetal membranes, or abortion.^[77] Rectal prolapse, while also uncommon, arises secondary to conditions causing tenesmus, such as colic, enteritis, intestinal parasitism, or diarrhea, and is noted more frequently in mares than stallions due to periparturient straining risks.^[78] In mules, rectal prolapse has historically been more prevalent among working animals burdened by heavy loads, compounded by exhaustion and parasitism.^[79] Risk factors for uterine prolapse in mares include prolonged labor during dystocia, which increases straining and uterine atony, as well as potential nutritional deficiencies like selenium that impair uterine tone.^[76] Poor perineal conformation may exacerbate vulnerability by facilitating contamination and trauma during parturition, though it is more directly linked to secondary infections.^[80] For rectal prolapse, primary triggers involve gastrointestinal disturbances like colic or heavy parasite burdens, which provoke persistent tenesmus and elevate intra-abdominal pressure.^[74] Symptoms of uterine prolapse include a visible, dangling, edematous uterine mass protruding from the vulva, often accompanied by tenesmus, shock signs such as tachycardia, and potential hemorrhage.^[81] Rectal prolapse presents as a protruding cylindrical or tubular rectal mucosa through the anus, with associated straining, mucosal edema, and risk of necrosis if untreated.^[82] Diagnosis of uterine prolapse relies on visual inspection of the prolapsed tissue, supplemented by rectal palpation to assess uterine position and integrity, and ultrasonography to evaluate vascularity and detect tears or thrombosis.^[76] For rectal prolapse, external examination confirms the protrusion, while rectal palpation identifies the extent (mucosal versus complete) and underlying causes like colonic involvement; ultrasound may aid in assessing devitalized tissue.^[74] Treatment for uterine prolapse involves immediate stabilization with fluid therapy to address hypovolemia and shock, followed by gentle manual reduction after lubrication and edema reduction using hypertonic solutions like 50% dextrose.^[83] Broad-spectrum antibiotics are administered systemically to prevent infection, alongside nonsteroidal anti-inflammatory drugs for pain and oxytocin to promote uterine involution; epidural anesthesia facilitates non-straining reduction.^[84] Rectal prolapse management prioritizes treating the inciting cause (e.g., antiparasitics for helminths or analgesics for colic), with manual replacement under sedation, purse-string sutures to maintain reduction, and antibiotics to avert sepsis.^[82] Surgical resection may be required for irreparable rectal damage. Prognosis for uterine prolapse is generally favorable for survival to discharge (approximately 74% in hospital cases) if addressed promptly, but becomes guarded if prolapse exceeds 24 hours due to risks of irreversible shock, uterine necrosis, or peritonitis from contamination.^[76] Fertility post-recovery varies, often compromised by endometrial scarring, though many mares resume breeding.^[81] For rectal prolapse, outcomes depend on early intervention and resolution of tenesmus, with good success in non-gangrenous cases but higher mortality if small colon prolapse or vascular compromise occurs, particularly in working equines.^[74]

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Overview of Pelvic Organ Prolapse (POP) - Gynecology and Obstetrics
Prolapse of the vaginal wall allows surrounding organs to protrude into the vagina; commonly used terms include cystocele, urethrocele, enterocele, and ...<|separator|>
[16]
Umbilical Cord Prolapse - StatPearls - NCBI Bookshelf
Umbilical cord prolapse (UCP) occurs when the umbilical cord exits the cervical opening before the fetal presenting part. It is a rare obstetric emergency ...Continuing Education Activity · History and Physical · Treatment / Management
[17]
Pelvic Organ Prolapse - AAFP
May 1, 2010 · The Baden-Walker (grades 0 through 4) and pelvic organ prolapse–quantification (pelvic organ prolapse-Q; stages 0 through IV) are the two main ...
[18]
Pelvic Organ Prolapse Quantification System (POP–Q) – a new era ...
Uterovaginal Prolapse, This term is used to describe prolapse of the uterus, cervix and upper vagina ; Enterocele, Prolapse of the upper posterior wall of the ...
[19]
Symptomatic pelvic organ prolapse at midlife, quality of life, and risk ...
The prevalence of symptomatic POP was 3.6% (96) and that of surgery for POP, 2.7% (70). POP symptoms were associated with difficulty defecating, lower abdominal ...
[20]
Epidemiology and Pathophysiology of Mitral Valve Prolapse - NIH
Based on a prevalence of 2-3%, MVP would be expected to affect approximately 7.8 million individuals in the United States and over 176 million people worldwide.
[21]
Animal models of female pelvic organ prolapse: lessons learned - NIH
May 1, 2012 · Pelvic organ prolapse is a vaginal protrusion of female pelvic organs. It has high prevalence worldwide and represents a great burden to the ...
[22]
[PDF] Prolapse Incidence in Swine Breeding Herds Is a Cause for Concern
Aug 28, 2017 · Uterine prolapse (Figure 3) can occur in any species; however, it is most common in dairy and beef cows, ewes and less frequently in sows [23].<|control11|><|separator|>
[23]
Identification of the genetic basis of sow pelvic organ prolapse
In contrast, the incidence of POP has been relatively low in other livestock species, ranging from under 1% for cattle (Jackson et al., 2014) to between 1% and ...
[24]
Mitral Valve Prolapse: Symptoms & Treatment - Cleveland Clinic
It's harmless for most people, but can become dangerous if it leads to severe mitral regurgitation (leaky valve). People with severe regurgitation may need ...Missing: lifetime | Show results with:lifetime
[25]
Mitral valve prolapse - Symptoms & causes - Mayo Clinic
In mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) into the left atrium like a parachute during the heart's contraction. Sometimes ...Overview · Symptoms · When to see a doctor · CausesMissing: degeneration | Show results with:degeneration
[26]
Myxomatous degeneration of the mitral valve - PMC - PubMed Central
Nov 30, 2018 · Myxomatous degeneration of the cardiac valves (MDMV) stands for the non-inflammatory progressive disarray of the valve structure caused by a defect in the ...
[27]
Epidemiology and Pathophysiology of Mitral Valve Prolapse
May 27, 2014 · Histologically, the mitral leaflets in MVP are characterized by myxomatous degeneration. A detailed explanation of myxomatous changes ...
[28]
Mitral Valve Prolapse and Its Motley Crew‐Syndromic Prevalence ...
Jun 22, 2021 · By one estimate, ≈0.2% to 3.5% of patients with prolapse will require surgery for their condition at some point in their lifetime, depending on ...
[29]
Valve Disease in Women | Division of Cardiothoracic Surgery - WashU
Mitral valve prolapse is more often diagnosed in younger women, and the incidence decreases dramatically with age. In men, the occurrence of mitral valve ...
[30]
Mitral Valve Prolapse - Medscape Reference
Apr 4, 2024 · In fact, 75% of patients with Marfan syndrome have MVP due to the increased redundancy of the mitral leaflets and apparatus that occurs due to ...Practice Essentials · Pathophysiology · Etiology · Epidemiology
[31]
Clinical and Phenotypic Correlates of Mitral Valve Prolapse in ...
May 13, 2025 · Mitral valve prolapse (MVP) is highly prevalent in Marfan syndrome (MFS), but its associations with significant valvular regurgitation, the need for mitral ...
[32]
Mitral Valve Prolapse - StatPearls - NCBI Bookshelf
MVP can be asymptomatic and can also present with symptoms of atypical chest pain, palpitations, dyspnea on exertion, and exercise intolerance. Other symptoms ...
[33]
Problem: Mitral Valve Prolapse | American Heart Association
May 23, 2024 · The most common cause of MVP is abnormally stretchy valve leaflets, called myxomatous valve disease. A person can be born with the genetic ...Missing: degeneration | Show results with:degeneration
[34]
Mitral Valve Prolapse Workup - Medscape Reference
Apr 4, 2024 · Nonclassic MVP: Displacement is more than 2 mm, with a maximal leaflet thickness below 5 mm. Other: Other echocardiographic findings that should ...
[35]
Mitral valve prolapse - Symptoms, diagnosis and treatment
Sep 27, 2024 · The echocardiographic definition of MVP is prolapse of leaflet(s) by ≥2 mm above the level of the annulus during systole in the long-axis ...Diagnostic Tests · Contributors · Peer Reviewers
[36]
Mitral Valve Prolapse—The Role of Cardiac Imaging Modalities
Current echocardiographic criterion for diagnosis includes >2 mm displacement of 1 or both mitral valve leaflets above the annulus within the LA in end-systole.
[37]
Mitral valve prolapse - Diagnosis & treatment - Mayo Clinic
Beta blockers. These drugs relax blood vessels and slow the heartbeat ... During mitral valve repair surgery, the surgeon might remove excess tissue ...
[38]
Mitral Valve Prolapse Treatment & Management
Apr 4, 2024 · A trial of beta-blockers for symptomatic ... mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair.
[39]
A Complete Guide to Performing MR PISA! - Cardioserv
Aug 24, 2017 · Step-by-step guide to MR PISA for mitral regurgitation. Learn key tips, equations, and pitfalls in echocardiographic assessment.
[40]
PISA Calculator
Our mitral regurgitation echo calculator uses the following equations: PISA = 2πr² ,. where: PISA stands for the proximal isovelocity surface area, given in cm² ...
[41]
Current diagnostic tools and treatment modalities for rectal prolapse
Rectal prolapse is a circumferential, full-thickness protrusion of the rectum through the anus. It is a rare condition, and only affects 0.5% of the general ...Types Of Prolapse · Internal Rectal Prolapse... · Treatment Options
[42]
Rectal prolapse - Symptoms and causes - Mayo Clinic
Jun 21, 2025 · Rectal prolapse happens when the rectum slips out of the anus and can be seen outside the body. While rectal prolapse may cause pain, ...
[43]
Rectal prolapse - Diagnosis and treatment - Mayo Clinic
Jun 21, 2025 · Treatment for rectal prolapse often involves surgery. Treatment for constipation with stool softeners, suppositories and other medicines are often needed.Symptoms and causes · Doctors and departments · Rectal prolapse surgery
[44]
Pelvic organ prolapse in women: Diagnostic evaluation - UpToDate
Apr 21, 2025 · INTRODUCTION. Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, occurs in up to 50 percent of ...
[45]
Pelvic Organ Prolapse Quantification (POP-Q) System - Physiopedia
This system provides characterisation of a woman's prolapse and allows a uniform recording method to be used by clinicians that enables contrast and disclosure ...Objective · Intended Population · Method of Use · Evidence
[46]
Umbilical Cord Prolapse: Causes, Diagnosis & Management
Types of umbilical cord prolapse Umbilical cord prolapse can be overt or occult (nonovert). An overt prolapse means that the cord slips down into your cervix ...
[47]
Reproductive Diseases of Reptiles - Exotic and Laboratory Animals
Prolapses of the hemipenes (in lizards and snakes) and the phallus (in chelonians) can be amputated after induction of general anesthesia or intrathecal (caudal ...
[48]
Cloacal Prolapse Occurs in any Reptile Species - Veterinary Partner
Jun 20, 2018 · Any species of reptile can have a cloacal prolapse. Cloacal prolapses are painful, potentially very serious, and treated as emergencies. See ...
[49]
Cloacal organ prolapse in Reptiles | Vetlexicon
Common causes include intestinal parasites, uroliths, metabolic bone disease (MBD), egg binding, etc. Signs: tissue protruding from the cloaca that has fallen ...
[50]
Cloacal prolapses in reptiles: a retrospective study of 56 cases
This study reviewed cloacal prolapses in reptiles, finding 56 cases out of 3019 (1.9%). Chelonians and lizards were more likely to have them than snakes. ...
[51]
Cloacal Prolapse | Arizona Exotics | Reptiles & Amphibians Resources
Cloacal prolapse is when tissue normally inside the cloaca protrudes out. It's an emergency requiring vet care to reduce and replace the tissue.
[52]
Common Management-Related Problems in Backyard Poultry
For mild cases in backyard poultry, approaches that can help prevent cloacal prolapse are to stop the hen from laying (by decreasing light or sharply decreasing ...Missing: symptoms | Show results with:symptoms
[53]
Prolapse in Laying hens
Nov 7, 2022 · Prolapse in laying hens occurs when part of the oviduct does not retract to its normal position and is exposed, outside the cloaca, after the hen lays an egg.
[54]
Admission Causes, Diagnostics, and Clinical Findings in Chickens ...
Hence, such cases should always undergo comprehensive diagnostic workups. The prevalence of cloacal prolapse was relatively low, accounting for 2.4% (10/419) ...
[55]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106171/
[56]
Diseases of small poultry flocks | UMN Extension
Cloacal prolapse is when the vent of laying hens turns outwards when a hen lays her egg. The vent can remain out permanently and swollen if pecked by other hens ...
[57]
https://lafeber.com/vet/presenting-problem-cloacal-prolapse-in-birds/
[58]
Cloacal Prolapse in Birds | Tree of Life Exotic Pet Medical Center
Diagnostic Testing: Your veterinarian may recommend radiographs, fecal parasite testing, and a complete blood count and serum biochemistry panel. Treatment ...
[59]
Reproductive Diseases of Pet Birds - Exotic and Laboratory Animals
Cloacal Prolapse of Pet Birds. Cloacal prolapse can occur in any bird that strains frequently. It is seen in egg-bound hens and in adult cockatoos, typically ...
[60]
Reproductive Diseases of Pet Birds - Exotic and Laboratory Animals
Cloacal prolapse can occur in any bird that strains frequently. It is seen in egg-bound hens and in adult cockatoos, typically males. The exact cause is not ...Egg Binding Of Pet Birds · Impacted Oviduct Of Pet... · Cloacal Prolapse Of Pet...
[61]
Vaginal and Cervical Prolapse in Cattle and Sheep
Although most common in mature animals in late pregnancy, vaginal prolapse can occur in young, nonpregnant ewes and heifers, especially in fat animals.
[62]
Lambing Part 3 Vaginal and Uterine Prolapse - - NADIS
The incidence may reach 1-2 per cent in some housed flocks. Excessive body condition, triplet pregnancy, and high fibre diets are thought to be risk factors, ...
[63]
Prolapses in Sheep - Eastern Alliance for Production Katahdins
Dec 12, 2021 · A vaginal prolapse occurs when a ewe's vagina protrudes out of her vulva. Most prolapses occur in the last few days or weeks of pregnancy.
[64]
Uterine prolapse and hypocalcemia in dairy cows - PubMed
Dec 15, 1984 · It was concluded that hypocalcemia was associated with uterine prolapse in multiparous dairy cows and, along with other factors, is involved as an etiologic ...
[65]
Vaginal prolapses – Large Animal Surgery – Supplemental Notes
Besides pregnancy, other risk factors include coughing, obesity, hormonal changes (including estrogenic feeds), trauma, short tail docks (sheep) and previous ...
[66]
Bovine uterine prolapses – causes, correction and care - Vet Times
Sep 3, 2024 · This article will review the causes of bovine uterine prolapses, offer guidance to vets regarding replacement, and discuss appropriate aftercare.
[67]
Managing Prolapses in Cows | Oklahoma State University
Jan 28, 2020 · This article covers the predisposing factors of each type of prolapse, the differences in treatment for each prolapse, and the implications each has for ...<|control11|><|separator|>
[68]
[PDF] Common Reproductive Disorders and Associated Impacts on ...
The diseases are associated with reduced reproductive performance, reduced milk production, milk withdrawal and increased costs for treatment leading to ...
[69]
https://www.agriculture.vic.gov.au/support-and-resources/newsletters/sheep-notes-newsletter/autumn-2022/the-prolapsing-ewe
[70]
Pelvic size in Merino ewes selected for lamb-rearing ability is ...
Previous studies have shown that selection for lamb-rearing ability is associated with an increase in pelvic dimensions in Merinos and Romney sheep (Knight et ...
[71]
https://doi.org/10.3389/fgene.2024.1441303
[72]
Prolapse of the Vagina and Cervix | The Pig Site
Prolapse of the vagina and cervix is more common prior to farrowing and may be seen in the last third of pregnancy including the pre-farrowing period.
[73]
https://doi.org/10.1016/j.prevetmed.2018.12.016
[74]
Rectal Prolapse in Animals - Digestive System
Rectal prolapse occurs in a wide range of species and may be caused by enteritis, intestinal parasites, rectal disorders and other underlying conditions.
[75]
Prolapse Incidence in Swine Breeding Herds Is a Cause for Concern
The main prolapse problems were in uterine (30.8% - 45.6%), rectal (32.7% - 41.0%), and vaginal (21.2% - 28.2%). Although, prolapses have been recorded in all ...
[76]
Good prognosis for survival to hospital discharge in a group of ...
May 21, 2022 · The lowest period prevalences of uterine prolapse was observed in Thoroughbreds (0.05% [5/10,177]) and American Quarter Horses (0.05% [5/10,438]) ...
[77]
Reproductive Emergencies in the Mare - ScienceDirect.com
Uterine prolapse is an uncommon complication of equine parturition. It is generally considered to be more common after dystocia or retained fetal membranes.
[78]
Disorders of the Rectum and Anus in Horses - Horse Owners
Rectal Prolapse The condition may occur in foals in association with severe diarrhea and straining to defecate or urinate. It can be caused by intestinal, ...
[79]
Gastrointestinal Disorders of Donkeys and Mules - PMC
Rectal prolapse is seen more commonly in working donkeys, where exhaustion and parasitism are common. It has been associated with Gasterophilus nasalis in ...
[80]
Uterine Prolapse in Horses - Horse Owners - MSD Veterinary Manual
Vulvitis (inflammation of the vulva) and vaginitis (inflammation of the vagina) can develop due to difficult labor, chronic contamination of the reproductive ...
[81]
Uterine Prolapse in Horses - Horse Owners - Merck Veterinary Manual
It is rare in horses, but may occur immediately after or within a few hours of delivery of a foal. When it does occur, uterine prolapse is a serious problem ...
[82]
Rectum: prolapse in Horses (Equis) | Vetlexicon
Excessive straining causes prolapse of rectum through anus. This may be mucosal only, or may be complete with colonic invagination. Secondary mucosal edema, ...
[83]
Managing Reproduction Emergencies in the Field - Veterinary Clinics
Uterine prolapse is amenable to management in the field but necessitates assistance and aftercare. The emergent problems arising in the pregnant mare usually ...
[84]
Obstetrical Management of Partial Uterine Prolapse in a Mare
The successful outcome in the treatment of uterine prolapse depends on the repositioning of the uterus and straining management. Lubricants, like Cetrimide ...