Vaginal Prolapse in Pregnant Goats

It can be scary for a goat owner to see something bulging from the vulva of a pregnant goat days or even weeks before the doe is due.

In today's episode, we are talking to Dr. Jamie Stewart, Assistant Professor at Virginia-Maryland College of Veterinary Medicine, about what causes vaginal prolapses, the different levels of vaginal prolapse in goats, when to use a prolapse retainer, and when to call the vet.

Dr. Stewart also talks about the difference between a vaginal prolapse and a uterine prolapse, including when you can wait and watch — and when you have an emergency situation.

And finally, we talk about the genetics involved and when it's a good idea to stop breeding a doe.

See full show notes here >> https://thriftyhomesteader.com/vaginal-prolapse-in-goats/

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Transcript

Introduction  0:03  
For the love of goats! We are talking about everything goat. Whether you're a goat owner, a breeder, or just a fan of these wonderful creatures, we've got you covered. And now, here is Deborah Niemann.

Deborah Niemann  0:19  
Hello, everyone, and welcome to today's episode! We are joined once again by Dr. Jamie Stewart from the Virginia Maryland College of Veterinary Medicine, where she is an assistant professor, and today we are going to be talking about something that thankfully, I've never personally experienced. And, that is vaginal prolapse in pregnant goats. Welcome to the show again, Dr. Stewart!

Jamie Stewart  0:42  
Thank you for having me again.

Deborah Niemann  0:44  
The first thing I want to do—because I think there needs to be some clarity on exactly what we're talking about today. So, can you first tell us, like, exactly what is a vaginal prolapse and also how that compares to a uterine prolapse? Because, they are two completely different things.

Jamie Stewart  1:01  
Absolutely. That's a very important distinction, because as a veterinarian, it's very important to me to know what the situation is at hand. And, there's a couple reasons for that that I'll get into. So, when we're talking about the reproductive tract, you know, the vagina is the most external portion. And then, it's connected to the cervix, and then, obviously, connected to the uterus, which is where the babies are being housed. And so, all of it should be inside. But, we're talking about the degree of which things are outside. And, when we get more worried, vaginal prolapse is definitely a concern, but it's a little bit lower on our concern meter versus something like a uterine prolapse, which, you know, has a much further distance to go. And, it's going to be stretched out more; it's connected to more important things. So, we tend to worry more about the uterine prolapses. So, it does make a difference when you're calling your veterinarian to tell which of those structures you believe is out. 

Jamie Stewart  1:55  
And, when you're looking at them, there's some key differences. One, if she's still pregnant, and there's not any kids outside the body, then it's most likely a vaginal prolapse, because obviously, if the kids are inside the uterus, then the uterus is still inside the body. Whereas, if she recently just kidded, and you see something hanging out, we would be more concerned about it being a uterine prolapse. But, we do see some vaginal prolapses after birth, too. So, it's not uncommon. 

Jamie Stewart  2:23  
So, if you're trying to differentiate, "Is this a uterus or vagina?" usually size is a big indicator. Vaginal prolapses are going to be much smaller. They're going to be more rounded in appearance and smooth in appearance. Whereas, we talked about the placenta one of our last meetings. So, the placenta has the little, what we call, the "dots" on them, or the "buttons"—the "cotyledons" are the appropriate name. And so, they attach to the maternal carbuncle, which are these bumps on the uterus. So, when you see the uterus is out, it's actually going to be this really big, red structure, and you're gonna see the buttons all over it. So, it's going to be lumpy, bumpy, down, hanging out, sometimes past the hocks. So, that's a really important distinction. 

Jamie Stewart  3:05  
And, when you think about all the blood flow that's coming to the uterus during parturition, now all of that, what we call the "uterine artery" that supplies the main part, is now exposed to the world. And, that's why we're really concerned. So, when you have a uterine prolapse, we absolutely don't want you to put her on a trailer; we want her to stay as still as possible so we can try to get that back in before that uterine artery ruptures. Whereas, if you have a vaginal prolapse, we want you to call us the next morning, but you don't need to call us at 2:00 AM. So, that's why that's such an important distinction. Because the uterus, we definitely want to get out there ASAP. And, a lot of times, the vaginal prolapses will go in and out first, and then they eventually get to the point where they end up staying out, just because of all the pressure.

Deborah Niemann  3:47  
Okay. So, the vaginal prolapse, let's talk about it just in pregnant goats to start. I know I said I've never had one, but, like, I have sort of, you know, seen something that was, like, maybe the beginning of it. But, it was, like, the super basic, like, you know, the goat was a few days away from giving birth. And, when she's laying down, it looks like, you know, something, like, I don't know, maybe a little bigger than a quarter. And, there's, like, skin inside the vulva. It's, like, really small, and it's only when she's laying down, but then when she stands up, it disappears. You don't see it anymore. And, like, that's the most I've ever seen. So, can you talk a little bit about how far away from kidding—like a week away, two weeks away from the due date—you can see a vaginal prolapse? And then, kind of how it progresses from, like, "That just looks like a little bit of skin inside the vulva" to... At what point do you need to start getting concerned?

Jamie Stewart  4:48  
Absolutely. So, we can see them, you know, as far as, commonly, a month away from parturition. So, it can occur, you know, quite a little bit a ways out, sometimes even, you know, farther away from parturition than that. There's a few factors that it will depend on. It'll depend on the age. So, some of the older females might be a little bit more prone to having it occur sooner. It's going to also depend on diet, and the number of babies. And so, the reason for that is that there's a lot of abdominal pressure, especially when you have three, four babies—sometimes, you know, some of these goat breeds are prone to having quads, and sometimes more than that. That takes up a lot of room in the abdomen. 

Jamie Stewart  5:30  
And so, where the diet comes in with that is that if the hay that they're getting is not really that high-quality to maintain their energy demand for feeding all of those babies, also, is they're going to continuously eat more and more hay. And, if it's not the highest quality, it increases the bulk in the rumen. So, there's more fiber in the rumen. And so, then that's taking up more room in the abdomen. So, as you're taking up all this space in the abdomen, then the only thing that's left that can move is that vagina. And so, that leads to the other predisposing factor, which is over-conditioned does and ewes that, again, you have those extra fat stores in the abdomen that then are taking up more space. So really, it's just what's left to get pushed out? And, that's where the vagina ends up going. 

Jamie Stewart  6:14  
Other things that you might consider as factors is if they're on a lot of clover, which has a high estrogen component. That tends to make those muscles a lot more kind of relaxed, and so that makes them predisposed for getting it. And, the last thing to be concerned about is the fact that vaginal prolapses are considered genetic. So, if you have a female that has a prolapse, especially if it's her first season, you can expect that she's going to continuously prolapse year after year, so be prepared for that, if it's a female that you want to keep, because it can be a little bit of a pain to maintain these.

Deborah Niemann  6:51  
Okay. And so, at what point should you call the vet?

Jamie Stewart  6:55  
So, our general rule of thumb... So, we end up giving these grades. So, the one that you were describing, where it kind of comes out when they're laying down versus, like, it sucks back in when they're laying up, they're really close to parturition? We consider those Grade Ones. And, really not of much concern, as long as it's going back in. Where we do get concerned is where it starts staying out for a prolonged period of time. And, the reason why we get concerned about that, it has to do with parturition, because as I was explaining, the cervix is connected to that vagina. And so, if the vagina is out, the cervix is being pushed closer to outward. 

Jamie Stewart  7:31  
And so, one, that puts the cervix exposed to the outside elements, which means that there's a risk that you could get some infection going in through the cervix to the uterus and causing some kind of infection with that baby—what we would call a "placentitis," which we talked a little bit when we talked about the placenta. So, it puts them at a risk for getting an infection that way. Also, with that cervix kind of being into the pelvis, when the baby's ready to induce parturition, it can't bump up against that cervix. And, that's a key part of that labor process. We call it the Ferguson reflex, is where the baby bumps up against that cervix, and then that sends a trigger to the brain that triggers all the oxytocin to come down, and that's what triggers that cervix to start dilating. It's a whole reflex within itself, and it requires that baby to be able to have contact with that internal part of the cervix, which, if that cervix is constantly prolapsed out, it cannot. So, we've seen a lot of issues with some of these chronic vaginal prolapses, even if they are going out and in just not dilating their cervix, because they're not getting the appropriate signals. 

Jamie Stewart  8:36  
So certainly, if it's staying out for more than just when she stands up, maybe it stays out for a little bit, we would still be concerned, because that's when we would want to consider putting a stitch in, so that it stays in, so that the baby can have the contact with it.

Deborah Niemann  8:50  
Okay. So, you just mentioned putting a stitch in, which is one thing that you can do to deal with this. So, I'd like you to talk about that. And then, also, if anybody, you know, Googles this, you're gonna find prolapse retainers. So, also talk about, like, when you would decide to do a stitch versus a retainer, and what the pros and cons are of the two different options.

Jamie Stewart  9:13  
Absolutely. So, the retainers are nice, because a lot of owners can have them on-hand. You can buy them at the store. You'll see them called the "prolapse retainers," the "prolapse paddles," or a "prolapse spoon"—I've heard that one, too. So, it looks like kind of, like, a big spoon that basically, it's got these little wings on the side. And basically, the idea is, it's easier for owners if you've got the ones that are kind of going in and out, and you want to prevent it from getting stuck out. So, those are ones, you just put the little spoon part into the vagina, and then the little wings, you can put a little bit of umbilical tape or some kind of string, and you can actually just tie it to the fur there to hold that in. 

Jamie Stewart  9:50  
The nice thing about it is, usually, if you get it tied to the fur, when she does start to kid, is that when she's kidding—because they can shed the fur out—it can actually remove the paddle, and she can go ahead and give birth past that, or usually she just kicks the retainer out while she's birthing. So, that's a nice thing about them. The big disadvantage is, she can also prolapse through it, which we've seen more common than not. And, that's usually when we get called, is because she's continuously prolapsing through it; it's not keeping it in. Some people will... Again, something that owners can do at home, you know, if they've got the supplies for this, before needing the vet, is you can actually pair that prolapse retainer with a harness system. And basically, it's just a big harness you put around it, and it's got a little area back there that just holds that retainer in so that she can't push it out. So obviously, the big disadvantage with that is if she tries to lamb or kid—or all the interchangeable terms there—it's stuck in there, because, you know, it's got something that's holding it in there. So, what we say for those is you have to be able to watch them closely. So, you have to be watching them for signs of labor, because as soon as she goes into labor, you need to take that harness off. 

Jamie Stewart  11:02  
So, versus the stitch. So, the stitch is something that the veterinarian would come do. We usually come out. We'll put an epidural in a lot of times, which will just stop her from straining, give her a little relief from all the straining. And then, we'll make sure that the vagina goes back in. And then, there's a few different stitches. Most commonly, you'll see us do a modification of what we do in cattle called the Buhner stitch. And, we basically just kind of go up, and we come back down, and then we tie it up into a little knot. And, it just kind of closes it together like that. You'll see us usually stick a couple of fingers in there to make sure that she can still urinate out of it. And so, the main way that we do that is we tie it at the bottom. And again, if you get it on correctly, she is not going to be able to give birth through it. So, that tends to be another issue with that. It's a very good retainer, in that it will definitely hold that vagina in, but it's also not going to let her give birth through it. 

Jamie Stewart  11:55  
There is a modification of that—again, it's something that we've adapted from the cattle industry—called a Barth Blowout stitch, where we actually, instead of tying it at the bottom, we can actually just put a little suture on there, and just suture the actual umbilical tape closed, so that, while she's straining, it should hold enough that she can't blow out through it, but when she starts actually having those big abdominal contractions, it should break. And, just kind of like with everything else, like, the risk of that—of us putting not something that's as tight as a tie in there—is that if she straining hard enough with the vaginal prolapse, she could still break through it, and we would have to go back in and tie it up again. But again, the risk of her having any damage done, because it's not going to break, is going to be much lower, because she should be able to break through it.

Deborah Niemann  12:44  
Okay. And so, when you talk about damage, what exactly could happen if you don't snip those sutures in time?

Jamie Stewart  12:52  
Death of the baby is going to be the biggest one, because you know, she's going to be having those abdominal contractions. She's going to be basically detaching that placenta. All the normal processes, but the baby is just not coming out. Other things are, you can get some serious damage to that vaginal wall. So, you can get cuts, nicks, things like that of it trying to push out and just not being able to, or getting cut on that umbilical tape as it's trying to come out.

Deborah Niemann  13:15  
Okay. So, once the kid is out, then are you pretty much done with the whole problem with of the vaginal prolapse? Like, it pretty much stays put?

Jamie Stewart  13:25  
Ninety percent of the cases? Yes. And, I say that because, yeah, there are just a few problem children that, yeah, once you take all that bulk out of the abdomen, those babies, they basically stopped prolapsing. But, there are a few that, if it's a matter of a lot of estrogenic influence or age, things like that, that are causing her to be predisposed to it, then there's the rare few that you might see some after birth that continue. But, that's in the minority.

Deborah Niemann  13:51  
Okay. So, if your goat has, like, successfully given birth and everything, and passed the placenta, you are pretty much out of the woods at that point. Like, you're not gonna see any kind of a prolapse after that?

Jamie Stewart  14:04  
Some people are concerned about whether or not she's going to have a uterine prolapse after she's had a vaginal prolapse. And, it's a good concern to have, always, about a uterine prolapse. But, there's really no evidence that having a vaginal prolapse makes you prone to getting a uterine prolapse, unless it's something like that estrogenic influence or something like that; I'd be a little bit more concerned to watch over. The biggest things that we worry about with the uterine prolapses occurring are the dystocias, where she's been going at it for a long time, because the uterine prolapse is more of a low-calcium problem. So, the uterus is exhausted. And then, sometimes there's a little eversion of the horn that causes her to continue to strain and strain until it comes out. So, it's really not related to the process of the vaginal prolapse, where it's just a lack of space in the abdomen. So, the uterine prolapse is more of a regular pathology following the dystocia. So, there's not a lot of relationship between the two. 

Deborah Niemann  15:01  
Okay. One of the things that popped into my head today when I was thinking about our episode is that, way back in the beginning, when I first started raising goats, I remember there were people online,who talked about pulling out the uterus if you pulled too hard, if you were trying to help a big kid. And, I don't hear... I don't know why I don't hear that much anymore. But, I used to hear it quite a bit. Is that any kind of a real concern? It seems to me like that wouldn't happen with, like, a normal, healthy goat. Like, you're not going to be able to pull the uterus out.

Jamie Stewart  15:29  
Right. Yeah, I... I'm trying to think mechanistically. It would be very, very difficult to do. And again, most of the time, it might seem like it's related, because if it's a big kid, and she's been going at it for a while, it's more of a problem that uterus is just exhausted, and it's not able to start going down after parturition, because it just doesn't have the calcium stores to start contracting like it needs to to get down. And so, it might just seem like it's kind of related, because you would have an exhausted uterus after her trying to deliver such a big kid.

Deborah Niemann  16:01  
Yeah, that totally makes sense. Because, I know a lot of times people see something, and they misinterpret what they're seeing. So, it totally makes sense that if she's exhausted, and you're pulling, and then the uterus comes out, you think you caused it, when in reality, you didn't; it just happened because of all the other things that were already happening in the doe's body. 

Jamie Stewart  16:21  
Right.

Deborah Niemann  16:22  
Okay. Is there anything else that people need to know about prolapses?

Jamie Stewart  16:26  
A lot of times, it's common to see that you'll get a rectal prolapse along with it. So, and again, it's nothing to be of super concern about if it's, you know, continuously going back in. And, most of the times, you know, if you fix a vaginal prolapse, it makes her stop straining enough that the rectal prolapse stays in. But, a lot of times, if those are happening at the same time, we'll put a stitch in both places. And, you do have to be concerned a little bit when we put the stitch in around the rectum about her becoming constipated. So, we have to always make sure that they're able to defecate and everything okay. But otherwise, you know, we really recommend just not breeding these females again. Because, especially, like, if they have it in their first season, it's going to continuously be a problem. 

Jamie Stewart  17:09  
There are permanent stitches that can be put in. I guess, they're not really stitches, per se... But, they're very invasive. And basically, you end up having... And, this would be, you know, going into a referral hospital kind of situation, where you would have to go in, and basically you tack the vagina from the inside. So, it's one that... It's a permanent pexy procedure, is what they call it, because you're pexying the vagina to the inside so that it can't come out. But again, the ethical dilemma comes into the fact that we shouldn't really be breeding these females, so should we be doing these procedures that are going to allow us to continue to propagate her genes on to females that we might want to use for breeding? So, that comes down to that issue to think about when you're trying to pursue something like that.

Deborah Niemann  17:50  
Yeah, that totally makes sense. 

Deborah Niemann  17:52  
Well, thank you so much for joining us today! I think a lot of people will find this really helpful, and I think we probably cleared up a lot of misconceptions.

Jamie Stewart  17:59  
Yeah, thank you.

Deborah Niemann  18:02  
And that's it for today's show. If you haven't already done so, be sure to hit the "subscribe" button so that you don't miss any episodes. To see show notes, you can always visit ForTheLoveOfGoats.com, and you can follow us on Facebook at Facebook.com/LoveGoatsPodcast. See you again next time. Bye for now!

Transcribed by https://otter.ai