With how many major body systems are involved with the cloaca, it makes cloacal prolapses very difficult to assess fully, as cloacal prolapses are often severe consequences of other diseases.
Both as a veterinarian and a keeper, there is one condition that is very challenging to manage and that is cloacal prolapse. My first experience with this was in my first year of veterinary school with my pet occelated uromastyx, Drogon. I came home from class one day to find his slate rock covered in blood and found prolapsed tissue coming from his vent. He had been declining for some time and eventually had to be euthanized due to sepsis or blood-borne systemic infection. His autopsy showed a massive colitis, or inflammation in the colon, with bacteria floating around his belly. I wouldn’t have a run-in with prolapses again until just recently as a veterinarian. One of my first appointments was a large green tree python that presented with the all too familiar tissue hanging from the vent.
To better understand cloacal prolapses, we first need to understand reptile anatomy. The cloaca is the one-way exit for a reptile’s gastrointestinal tract, reproductive tract, and urinary tract. It consists of three parts: 1) the coprodeum- where the gastrointestinal tract empties 2) urodeum- where the urinary and reproductive tracts empty; and 3) proctodeum- the “mixing pot” where all waste enters before leaving the body.
With how many major body systems are involved with the cloaca, it makes cloacal prolapses very difficult to assess fully, as cloacal prolapses are often severe consequences of other diseases. For the gastrointestinal tract, any diseases causing diarrhea—inflammation in the intestines, parasites or causing constipation with excessive straining foreign bodies, chronic dehydration, parasites, too large prey items offered—can lead to prolapse.
For the reproductive tract, if a female reptile is hypocalcemic or egg bound, the straining can lead to prolapse. The prolapse may not even be related to any of the aforementioned organ systems, and may be due to systemic illness such as nutritional secondary hyperparathyroidism (NSHP) aka metabolic bone disease, sepsis, or gout. Whatever the cause, excessive exertion of the cloacal muscles weaken the sphincter over time, allowing tissue to pass through. As the tissue sits in the outside world, it swells with fluid and can become infected, leading to death if not treated properly.
To truly work up a cloacal prolapse, a number of steps must be taken. First, the problem at hand, the everted tissue, must be addressed. The tissue needs to be assessed for viability, or whether it is dying. If the tissue is pink and healthy, then it can be replaced back into the body. If the tissue is black or necrotic, it needs to be surgically removed. If tissue is viable, the reptile will often be soaked in a sugar water solution, as the sugar reduces the swelling of the tissue. Afterward, the reptile will be sedated and the tissue lubricated and gently pushed back. Stay sutures will be placed to minimize the size of the cloaca to prevent further prolapses.
With the immediate life-threatening issue handled, the next step is a thorough history of husbandry conditions and diagnostics such as bloodwork and imaging. The bloodwork has two components: the complete blood count or CBC, and the chemistry. The CBC looks at the white blood cells, red blood cells, and platelets for signs of anemia, infection, and inflammation. The chemistry assesses organ function, electrolytes, and minerals such as calcium. Imaging allows veterinarians to assess whether there are foreign materials in the gastrointestinal tract, if there are bladder stones (for reptiles that possess urinary bladders), and if there are eggs/follicles.
When a definitive diagnosis is obtained, the primary disease process needs to be addressed. Additionally, antibiotics may be given as internal body structures were exposed to the outside. At home, your reptile will likely need to live on a paper towel substrate in a minimalistic enclosure as it recovers. If an infectious cause is behind the prolapse, thoroughly disinfect and clean the primary enclosure and replace all substrate being used. Once the primary issue is treated, the stay sutures can be removed and the reptile can continue to be monitored. The prognosis for a cloacal prolapse depends on the viability of the tissue and the underlying cause for the prolapse. Regardless of cause, there is always a chance of re-prolapsing, and typically reptiles are given a three-strike rule for prolapses. After the third prolapse, the cloacal muscles are too weak to hold in internal organs and the reptile cannot function properly. Thus, in these sad cases, euthanasia needs to be considered.
At home, ensuring you are providing the most up-to-date husbandry is important to prevent cloacal prolapses. Ensuring the environmental parameters are correct, you are feeding appropriately sized food items with proper supplementation, and ensuring optimal hydration are important for the health of your reptile. Additionally, establishing your reptile with a qualified reptile veterinarian is paramount, as animals can be screened for parasites and some diseases can be picked up before your reptile shows clinical signs.
For finding a local veterinarian in your area that sees reptiles, look up the “Find a Vet” feature on the Association of Reptile and Amphibian Veterinarians’ website. Should your reptile prolapse when your veterinarian is closed, ensure the tissue remains moist and protected from rough surfaces/substrate. You can make a sugar water solution for your reptile to help reduce tissue swelling so that when you bring your reptile to your veterinarian, the swelling is already being controlled which will make it easier for your veterinarian to treat. The above advice is meant solely for emergency situations as cloacal prolapses should not be managed at the home and require a veterinarian to treat. REPTILES
Eric Los Kamp, DVM is an exotic animal and wildlife veterinarian at Winter Park Veterinary Hospital in Winter Park, Florida who has aspirations to board certify in reptile /amphibian medicine. In addition to being a member of the Association of Reptile and Amphibian Veterinarians (ARAV), he is an avid Ackie monitor keeper.