By Rene C. Gandolfi, DVM, DABVP
It isn’t the most serious of problems for your ferret, but it is both a very uncomfortable condition and it can be a sign of something much more dangerous going on inside. It is not a pleasant topic to think about and probably even worse for your ferret to experience. It is called a rectal or anal prolapse. The technical term is proctitis, or inflammation of the anus or rectum.
What It Is
What you observe protruding from the anal region is red, swollen tissue that is sometimes soiled with diarrhea or mucus from the lower bowel. Or, you might just see your little guy scooting along the floor as it tries to rub or scratch the irritated area — and the rubbing is only going to make the situation worse.
In simple terms, proctitis means that some irritation or inflammation in the intestinal tract of the ferret is causing the swelling or sensitivity that you see. Just about anything that causes inflammation in the colon or straining to defecate can trigger this ailment.
In a true rectal prolapse, the lining layer of the end of the colon gets pushed out past the anal sphincter. This may seem somewhat like hemorrhoids, but is actually more like what happens when you pull part of a sock inside out. Many things can lead to a rectal prolapse. Probably the most common cause is chronic diarrhea. When the ferret has to strain to defecate, it is repeatedly pushing, tensing the abdomen in an attempt to force out stool even though there may not be anything left in the colon to expel. The diarrhea can itself be a cause of the prolapse or, more likely and more importantly from a treatment standpoint, whatever is causing the diarrhea creates the development of rectal swelling and protrusion.
What are the possible causes of diarrhea in the ferret? Intestinal parasites, though fairly rare in ferrets that are fed a good quality commercial ferret (or kitten food) diet, can lead to both intestinal irritation and diarrhea. A number of different small and sometimes microscopic little creatures can invade the intestines. The most common of these is a protozoan parasite called Coccidia. It is a disease spread from ferret to ferret in contaminated feces and is most often found in juveniles that have yet to develop their own natural immunity. If the kit is especially stressed by transport, poor nutrition or other diseases, Coccidia tend to get the upper hand. Diagnosis is made by examination of the stool looking for microscopic eggs. Treatment with an oral sulfa antibiotic is usually effective.
A more serious and far more commonly encountered cause of diarrhea is a bacterial infection of the intestines. Ferrets can become infected with a number of pathogenic bacteria — including Salmonella, Campylobacter and Mycobacteria (tuberculosis) — by eating contaminated raw meats. Again, ferrets living on a diet of commercial food would not be at risk of infection. Many ferret enthusiasts swear on a raw meat diet for their ferret, but veterinarians will tell you that they rarely see these types of invaders if foods are properly cooked to destroy the bacteria.
For most bacterial infections of the gut, veterinarians prescribe “broad spectrum” antibiotics. This means that the ferret is usually getting a combination of two (or more) different antibiotics at the same time. With this approach, the doctor is essentially trying to “cover all the bases” and simultaneously treat many different types of bacteria that might be causing the infection, without knowing exactly which bacteria is the culprit.
One particular bacterial infection of the intestines of ferrets cannot be treated with this kind of approach. Most of the “broad spectrum” antibiotics that are commonly used in ferrets do not seem to be effective in treating this disease. Though textbooks seem to make a big deal of a condition called proliferative bowel disease or proliferative ileitis, this condition is quite rare in the United States. Usually seen in ferrets below 18 months of age and caused by infection with a bacteria called Lawsonia intracellularis, this disease leads to significant thickening of the ileum (the very last part of the small intestine) and or colon. The ferret can experience severe tenesmus (straining to defecate), which leads to rectal prolapse. Infection can cause serious debilitation with chronic diarrhea and significant weight loss. Because of the severe inflammation, the thickened section of colon can often be palpated during a physical examination.
Another intestinal disease is called eosinophilic gastroenteritis, and it can result in significant intestinal complications, straining and diarrhea included. The cause of this condition is not well understood but, fortunately, this too is a fairly rare condition. Diagnosis is made with intestinal and lymph node biopsy demonstrating the characteristic infiltration with large numbers of white blood cells called eosinophils, as well as sometimes finding changes in the blood count with an elevation of the eosinophil population of cells. Treatment is similar to that for inflammatory bowel disease.
Inflammatory bowel disease (IBD) and intestinal cancer (usually lymphoma) are two serious causes of intestinal upset. Either can lead to fatal consequences and complications, and one, IBD is probably the most commonly encountered intestinal disorder of any of the various conditions to which ferrets are prone.
Lymphoma is a cancer of lymphocytes, blood cells that can circulate throughout the body. As a result, this disease can affect just about any organ in the body. The role of lymphocytes is to regulate the immune system and to help deal with infections of various types. For this reason, lymphocytes tend to concentrate in places where invading organisms can find an entry into the body. Your tonsils are an accumulation of lymphocytes positioned at the beginning of your throat where bacteria and viruses try to enter through your nose or mouth.
Lymphocytes are found throughout the intestinal tract. Because everything we eat and drink is composed of foreign substances, they are not made up of cells from our own bodies, and lymphocytes in the gut must constantly be deciding if something in the intestine is friend or foe. When the body begins to feel that there is something in the intestines that might be an attacker, the lymphocytes coordinate the defense and help mount an inflammatory response. If the target is a bad guy like some E. coli bacteria, this response is both appropriate and protective. If, however, the body seems to think that something in today’s lunch is trying to attack, the same defensive reaction will take place. And the battlefield is within the walls and lining of the intestine. The result is inflammatory bowel disease.
Many different conditions can then be triggered in the inflamed intestine. Besides swelling or thickening, the environment may become conducive to the growth of bacteria that are dangerous — and bacterial overgrowth, bacterial enteritis or even body-wide sepsis can result. Chronic inflammation can cause microscopic scarring and loss of digestive capabilities that prevent proper digestion and absorption of nutrients, and lead to bouts of diarrhea and straining.
If the lymphocytes are kept in a highly stimulated state, the chance that they will overgrow and turn into a cancerlike lymphoma of the intestines increases. If this happens, all of the same problems that happen with IBD can develop, only in a more serious form.
Not all the causes of anal inflammation occur inside the intestines. Most ferrets in the United States are de-scented, that is they have had their scent glands surgically removed. The scent glands are located within the anal sphincter muscles and are responsible for producing a secretion with a very noxious odor. If you have ever had the opportunity to get a whiff of ferret anal gland material, it is an experience you will make every effort to avoid in the future. If a ferret has its scent glands and one of these glands becomes impacted or infected, the area around the anus can become swollen and inflamed. Infections are usually treated with antibiotics. Occasionally the area fills with pus and needs to be surgically drained.
The scent glands produce a secretion which is usually quite liquid. Impactions change the character or consistency of these secretions. If they thicken or develop a more granular consistency due to infection or inflammation, the narrow duct leading from the gland to the surface can become plugged, causing the gland to swell much like an abscess. Gentle manipulation (usually under anesthesia) and flushing of the duct and gland can sometimes relieve the obstruction and allow the gland to drain. Persistent problems are best dealt with surgical removal of the glands. Though the surgery is not terribly difficult, seek a veterinarian to do it who is very familiar with ferret anatomy, as improper removal can end up leaving behind glandular tissue that may later cause an abscess even though most all of the gland has been removed.
As you can see, many different conditions can lead to proctitis or rectal prolapse. Arriving at a proper diagnosis is the job of your veterinarian. Only by identifying the cause can proper and effective treatment be achieved. It usually isn’t enough just to manage the area around the anus.
With the correct complete diagnosis, therapy is directed at all of the underlying factors. For bacterial infections, antibiotics are given. If the ferret is dehydrated from loss of water through diarrhea or vomiting, fluids can be given intravenously or by injection under the skin. IBD requires more aggressive actions designed to suppress the inflammation, in essence, to turn off the lymphocytes that are over-reacting.
For treatment of IBD, two drugs, prednisone or azathioprine (an anticancer agent) can be given as an oral medication. In addition dietary management is often tried. Since IBD may happen because the body “thinks” something in the current diet is the foreign material, a switch is made to a different food, often one designed to have the least antigens (stimulants of immunity). Alternatively, diets with a higher protein and greatly reduced carbohydrate content can be tried with the hope that better digestion of the food will leave less material in the intestines for troublesome bacteria to feed on. In some cases, just as is true for some of humans, increasing the amount of the fiber in the diet can sometimes lead to better bowel function.
Treatment of cancer is certainly possible. Many different protocols (mixtures of drugs) exist for the control of lymphoma. These protocols differ in the way the drugs are administered (orally or by injection), possible side effects, and, most importantly, the likelihood of successful remission of the cancer. Veterinarians speak in terms of remission (getting rid of all visible signs of cancer) rather than cure. At the moment, as long as the ferret feels good, it really doesn’t matter if the cancer may come back later. If later turns out to be years in the future, the little guy just may out live the cancer.
Many times what is called a rectal prolapse is really just the tissue of the anus becoming inflamed and swollen, with no internal tissues protruding. This is best defined as proctitis. Symptomatic treatment of proctitis is aimed at decreasing the inflammation. Topical mediation with an anti-hemorrhoid cream or ointment that contains hydrocortisone is often helpful. If tissue is actually protruding, as in a true rectal prolapse, the veterinarian may gently push the lining back inside and place a purse-string suture around the anus to prevent it from being pushed out again while the causes of the inflammation and straining are addressed. The suture is usually removed about two or three weeks later, once things have had a chance to quiet down.
- Topical anti-inflammatory creams
- Topical hydrocortisone
- Purse-string suture
- Dietary management
- Treatment of the underlying causes
Be Alert For Possible Problems
As an owner of a ferret, it is your responsibility to know all the day-to-day habits and activities of your little friend. Remain alert to the signs of intestinal inflammation that can lead to proctitis or rectal prolapse. If you notice changes in the character of the stool or any changes in your ferret’s behavior that might indicate abnormal bowel function, consult with your ferret’s veterinarian and get on top of the problem before things get out of hand. Proctitis and rectal prolapse are terribly uncomfortable for your ferret, but the more serious internal problems that cause them must be found and corrected.
Rene C. Gandolfi is owner and chief veterinarian of Castro Valley Companion Animal Hospital. Gandolfi is a national lecturer and author on ferret medicine and surgery.