Physical examination should include abdominal palpation for a mass. Cytology and bacterial culture should be performed on
prolapsed tissue to aid in antibiotic therapy. A fecal wet mount and Gram stain are also recommended. A complete inspection
of the cloaca should be performed, usually under general anesthesia. If possible, a vaginal speculum and strong light source
should be used to permit examination deep into the cloacal cavity. CBC, chemistry panel, radiographs, ultrasound, and endoscopic
exam are useful to determine predisposing causes.
Identification of tissue
Rectal prolapses can occur from intusussception, intestinal obstruction, intestinal masses, chronic straining, or severe diarrhea.
Rectal prolapse is more common than intestinal prolapse. Rectal prolapse can be identified as a tubular structure devoid of
longitudinal folds, centrally located within the cloaca. The cloaca itself should be normal in appearance. It is difficult
to differentiate intestinal prolapse from rectal prolapse. For rectal prolapse it should be possible to insert a lubricated
cotton-tipped applicator into the lumen, but not on either side of the prolapsed loop. If a cotton-tipped applicator can be
inserted into the lumen and also into the folds surrounding the prolapse, then intestinal prolapse should be suspected.
Rectal and intestinal prolapses are rare and in most cases result from serious and life-threatening problems. Fecal Gram stain,
radiographs, and contrast studies may be helpful to establish a potential etiology. Treatment should be directed at the specific
etiology. In most cases reduction of the prolapse will need to be accompanied by surgery to remove a foreign body, biopsy
or remove a mass, or reduce an intusussception.
Female birds have a reproductive tract on the left side only. The oviduct is a tubular structure with longitudinal folds that
are usually visible on the lumen. Prolapses are generally associated with egg laying, although rarely they may be associated
with masses/tumors of the reproductive tract. When prolapsed, the tissue may become edematous, but a lumen should be clearly
identifiable, and in most cases it will be possible to see the longitudinal folds. The tissue should appear on the left side
of the bird, and the cloacal lining itself should also be evident and normal, with the prolapsed tissue protruding through
the cloacal cavity.
Treatment of reproductive tract prolapse is always directed at identification and resolution of the primary disease process.
In most cases, this will be associated with egg laying. It is essential to thoroughly evaluate for the presence of a retained
egg or egg fragments. Radiographs should always be performed, but can be misleading if the egg shell is not mineralized. Ultrasound
is very useful for detection of eggs, as well as follicular activity and ovarian or uterine masses. In cases where there appears
to be caudodorsal enlargement or a mass effect, or the location of enlargement cannot be determined, then contrast radiographs
can be useful in differentiating the intestines and the region of enlargement/mass. If there is an obvious egg within the
prolapsed mass, then it can be collapsed or surgically removed. Salpingohysterectomy is recommended to prevent future episodes
of egg retention and prolapse.
A prolapsed cloaca most commonly occurs due to either papillomatous disease or sexual behaviors (typically males). It often
begins as a mild prolapse which the bird seems to be able to control voluntarily, and eventually leads to persistent prolapse.
Examination of the cloaca may reveal one or several fleshy masses at the mucosal border, papillomas having a cobblestone or
"raspberry-like" appearance. Some papillomas are pedunculated and intermittently extrude from and retract back into the cloaca.
Papillomas can cause mechanical obstruction of the cloaca, resulting in infertility, hematochezia, straining, fecal retention,
and secondary bacterial (clostridial) cloacitis.
A quick in-house test can be performed by applying white vinegar to the suspected tissue; if it is a papilloma it will blanch.
A complete exam should be performed to rule out oropharyngeal and laryngeal papillomas. Medical evaluation should include
fecal Gram stain (check for spore-forming rods), CBC/chemistry profile, and radiographs to check for the presence of a mass
or any other abnormality. A thorough endoscopic exam of the cloaca should be performed to rule out obstruction of the gastrointestinal,
urinary and reproductive tracts. Diagnosis should be confirmed by biopsy.
Behavioral prolapse of the cloaca is most common in cockatoos and other Old World psittacines; males are more often affected
than females. It is often associated with reduced sphincter tone, and affected birds typically show obvious sexual behavior
towards and individual or individuals. These prolapses may be chronic, and cloacitis is a common secondary finding. Although
prolapsed cloacal tissue may be inflamed, it will appear red, smooth, and rounded like a ball; rectal or urogenital orifices
may be identifiable on the prolapse surface. A cotton-tipped applicator cannot be placed between a prolapsed cloaca and the
vent sphincter; there is no space in this region with prolapse of the cloaca.
A detailed evaluation of the home environment and human-bird interactions is essential. Any behaviors or situations that the
bird may perceive as sexual stimuli must be completely eliminated. This includes stroking of the back and dorsal tail feathers
(mimics mating), cuddling and covering the bird (mimics nesting), and feeding of any warm soft food items (mimics regurgitation
by mate). Any perceived "nest sites" in the environment also need to be removed; the bird should not be permitted to shred
paper, to have a hide box, or seek out cabinets, corners, and similar spaces. Birds with a behavioral prolapse should not
have access to perceived mates (stuffed toys, feather toys), including individuals it reacts to sexually. The GNRH agonist
leuprolide acetate (Lupron) can also be administered to lower sex hormone activity.
Regardless of origin, prolapsed tissues should be lavaged and lubricated with a water-soluble lubricant to prevent desiccation.
If edematous, solutions such as 50% dextrose or DMSO can be applied topically to try to alleviate some of the edema. Tissues
should be replaced as soon as possible to prevent infection and necrosis. However, in many cases, this may not be possible
until the underlying problem is corrected. Even when the prolapse can be reduced, the underlying problem must still be identified
and addressed. Prolapses must be reduced into anatomically correct orientation; it is essential to identify the opening of
the intestines and maintain patency. Tissue should invert back into normal position inside the cloacal cavity, as if putting
a pants pocket back into place. Stay sutures may be placed in order to prevent immediate reprolapse.