The term "anal gland" and "anal sac" are used interchangeably. Anal glands are a pair of scent glands located along the side of the anus. The anal gland has a small duct (tube) that opens on the rim of the anus. As formed stool passes through the anus, a small amount of the anal gland secretion is released. The foul smelling secretion is used to mark the pet's territory. The external anal sphincter wraps around the outer side of the anal gland. This muscle acts as a valve to prevent stool from dropping out of the rectum and can be consciously controlled by the pet. The internal anal sphincter lies on the inner side of the anal gland and its control is dependant on the autonomic nervous system, which means it, is not controlled by direct conscious thought processes. Cells that produce a thick, brown colored, fishy odiferous material line each anal gland. Interestingly, each dog's anal gland secretion is unique and identifies the individual pet, like a fingerprint. Thus, a dog’s territory is marked by the scent of the secretion. Skunks spray the contents of their anal glands as a form of defense against predators; without these glands they are helpless. Dogs and cats, however, can function normally without these scent glands.
Anal Gland Conditions
Anal glands can become impacted; this means that the secretion is too thick to be excreted naturally. The secretion becomes thicker as it stagnates in the anal gland. If the duct of the anal gland becomes narrowed due to inflammation, scar tissue, or for other reasons, the secretion cannot escape from the gland. Infection of the anal sac may accompany anal sac impaction. With infection, pus forms in the anal sac. A swollen or scarred duct may not allow the infection to escape from the gland, thus the gland ruptures internally and the infection spreads to neighboring tissues. As the abscess (pocket of pus) enlarges, it will break through the skin at the 5 and 7 o'clock positions around the anus (see photo below - arrow).
Warning signs of an impacted anal sac may include dragging or "scooting" the dog's anal area on the ground or floor. Anal gland infection likewise may present with signs of scooting and licking of the anal region. Anal sac abscessation is much more painful and the pet may try to bite the owner if the hind end is touched. In addition, the pet may have a red or purple raised area (lump) along side of the anal region, may strain excessively during bowel movements, or may refrain from having bowel movements, be constipated, and may carry the tail very low. If the abscess has ruptured, a bloody material may ooze from a hole in the skin near the anus and the pet will feel much better. Commonly, once a dog develops an abscess of the anal gland, then the problem will recur repeated.
Impaction of the anal glands is treated by manually emptying of the anal glands on a regular basis. Typically, this is done monthly by a veterinarian. Anal gland infection may not respond to oral antibiotics, as the glands normally have a blood-anal gland barrier. Thus the treatment usually entails expressing all secretion from the gland and filling the gland with an antibiotic/steroid medication via the duct of the anal gland. Many veterinarians use a product called Panalog, but other products can also be used. The anal gland always should be evaluated about 2 weeks after treatment to ensure that the infection is resolving and the treatment is usually repeated. Abscessation of the anal glands should be treated with surgical drainage of the abscess, flushing the area, infusion with Panalog and administration of oral antibiotics. At home, application of a warm compress to the affected area, cleaning discharge from the anal and perianal region with baby wipes and administration of medication (pain meds and antibiotics) may be needed. If the pet is constipated, a stool softener may be prescribed. When more than one episode of abscessation of the anal gland occurs, surgical excision of the anal gland is recommended. Ideally, the infection should be treated first with antibiotics for a few weeks prior to surgical removal of the gland.
The day of surgery
The anesthesia and surgical team will prescribe a pain management program, both during and after surgery that will keep your companion comfortable. This may include a combination of general anesthesia, injectable analgesics, epidural analgesia, oral analgesics, and anti-inflammatory medication.
Anal gland removal (anal sacculectomy) is procedure that will provide the pet with permanent relief of anal gland impaction, infection, and abscessation. The procedure entails making an incision near the anus over the anal gland. The gland is gently dissected from external and internal anal sphincters. Care is taken to minimize disruption of the anal sphincter, as this could result in permanent fecal incontinence. Some surgeons prefer to remove only the affected anal gland and leave the normal gland intact, as unilateral anal sacculectomy is not associated with fecal incontinence. The owner may find stool nuggets around the home or in the pet's (or owner's) bed if a pet develops fecal incontinence. If fecal incontinence is very mild, the owner may note that the dog passes more gas, yet the pet has full control of the stool. If a piece of the anal sac is left in the patient, an abscess or chronic draining tract may develop. If the surgeon inadvertently cuts a hole in the side of the rectum during removal of the gland, a nonhealing fistula (channel) may develop from the skin along side of the anus to the rectum. In the hands of an experienced surgeon, these complications are uncommon.
While your pet is recovering at home, a pain relieving medication should be administered, as directed by the pet's surgeon. Antibiotics are commonly prescribed. If your pet does not pass stool after 3 to 4 days after surgery, a stool softener should be administered. Unflavored metamucil, lactulose, or other stool softener can be administered to the pet until bowel movements are seen. If the pet is very irritated following surgery, a medication called Proctafoam will be prescribed. This medication, which contains a corticosteroid and local anesthetic medication, is instilled into the rectum with a special applicator for about 5 days. The incision should be checked daily for signs of infection, which include swelling, redness, pain, and discharge. The pet, when not under direct supervision, should wear an Elizabethan collar. Pet stores and some veterinarians sell inflatable Elizabethan collars which are much more comfortable and better tolerated than the traditional "lamp shade" style Elizabethan collar. External sutures, if present, are removed from the anal region in about 10 days after surgery.
Frequently Asked Questions After Surgery
When should my dog have the first bowel movement after surgery?
- Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
- Reasons that a dog will not have regular bowel movements after surgery include:
- The dog has been fasted prior to surgery
- Dogs do not eat well during the hospital stay
- They frequently do not eat well when they go home
- They are fed highly digestible food that produces little stool
- Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
- If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
- Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable
My pet had surgery and will not eat. What can be done?
- Most pets will not eat their regular dog food after surgery, especially if it is kibble.
- Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked). The carbohydrate can be pasta, potato or white rice.
- Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
- Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
- Try Hill's A/D diet available at most veterinary hospitals
- Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
- Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
- Remember that most pets will not eat the first day or two after they get home from surgery
- Offer smelly foods that contain fish such as tuna or smelly cat foods
- Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
- Hand feeding: with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
- Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
- Some cats will only eat dry food, try kibble if your cat normally has been fed that food
- Petting and stroking your cat frequently will help to stimulate appetite
- Remember that most pets will not eat the first day or two after they get home from surgery
- Appetite stimulants such as cyproheptadine may be helpful
- If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop
My pet is vomiting. What can be done?
- The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled. Usually the regurgited material will be clear or brown colored fluid.
- Next is to identify the cause of the vomiting or regurgitation.
- Causes and treatment of vomiting after surgery
- When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
- Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery. In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued.
- Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
- An uncommon cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
- If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
- Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days. Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
- Causes and treatment of regurgitation after surgery
- The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis. This results in poor motility of the esophagus, therefore water and food will accumulate in this structure. In most cases, esphagitis is self-eliminating and will resolve within two or three days.
- If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week. This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
- Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other). Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
- Signs of pain include
- biting if you get near the surgical site
- grimacing (lips are pulled back and the the dog looks anxious)
- tragic facial expression
- restlessness and unable to sleep; pacing
- if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
- the worst pain will be for the first 2 to 3 days after surgery
What can I do to control my dog's pain?
- Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
- Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
- If an orthopedic surgery has been done cold packing the surgical site may be helpful
- A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern. Cooling the surgical site helps to numb the area.
How do I know that my cat is in pain following surgery?
- Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
- Signs of pain in a cat include the following:
- biting if you get near the surgical site
- growling or deep cry
- not wanting to eat
- hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)
What can be done for pain at home for my cat?
- Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
- Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
- Anti-inflammatories can be used, but the dose is much less than dogs
Is it okay for my pet to lick the incision?
- If a dog licks the incision, the healing process may be delayed.
- Licking can remove stitches and cause the incision to open
- Licking can become a severe habit that is difficult to break
- Licking can cause infection as the mouth has many bacteria
- Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
- To stop your pet from licking the following can be tried:
- Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
- Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
- A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
- A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
- Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
- Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
- Antipsychotic medication in some cases is needed