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Diseases of the Dog’s Anal Area

Trying To Squeeze InLet’s face it: Dog owners spend a lot of time discussing dog butts and what emerges from them. Puppy bums lend themselves to lots of joking. But this article, adapted from one I wrote for Your Dog, the Tufts University veterinary school newsletter, deals with some medical problems that are no laughing matter.

That doesn’t mean I was going to put in graphic disease photos. Dog butts are cute and funny.

***

Diseases of the anal area occur frequently in dogs, from those that are easily prevented and resolved to others that are unpredictable and persistent. Although owners might prefer not to think about or investigate this part of their dog’s anatomy, anal diseases naturally benefit from early diagnosis and treatment.

Luckily, symptoms are generally easy to spot.

“It’s worthwhile to know what normal looks like in this area, so it can be checked periodically,” says surgical specialist John Berg, DVM, at Cummings School of Veterinary Medicine at Tufts University. “Owners of older dogs, especially those whose tails cover the anal region, need to be especially vigilant.” Frequently encountered diseases include anal sac impaction, perianal fistulas, and perineal hernias, discussed here.

Anal Sac Impaction

The most common problem, one particularly affecting small and overweight dogs, is impaction of the anal sacs. Located beneath the skin and anal sphincter muscles at the 4 and 8 o’clock positions, these organs are lined by cells that produce a malodorous, oily brownish fluid. It’s usually discharged in small quantities when feces pass through the rectum and squeeze the sacs.

“We don’t know for certain why the sacs are there or why the fluid is produced,” Dr. Berg says. “It’s theorized that the fluid may lubricate the stool and make it easier for the dog to defecate.”

Unquestionably, the fluid has a marking function, creating a signature odor that other dogs can identify — which explains why dogs sniff each other’s rears. Dogs, and especially puppies, may also expel the fluid out of fear. The effect is skunk-like, as some owners can attest.

If it’s not eliminated naturally, the fluid in the anal sacs thickens, becoming more difficult to expel. “Sacs have narrow necks that the fluid has to travel through to come out,” Dr. Berg says. “If the fluid thickens, it’ll get blocked inside that neck.”

The sacs will then distend and the dog will experience discomfort. Bacteria may develop in the sacs and eventually abscesses can form. With no escape route for the infected contents, the anal sacs can rupture.

But that’s the worst-case scenario. The complications of anal sac impaction can usually be avoided by eliminating the sacs’ contents before they thicken, an easy procedure called “expressing” that can be done by veterinarians, groomers and, if properly instructed, owners (see instructions, below).

The obvious sign of a dog’s having blocked anal sacs is “scooting” or “scooching.” The dog will drag his rear across the floor, sometimes leaving behind a brownish stain. This behavior may simply mean that your dog needs to scratch an itch, but more often it’s intended to relieve the pressure of built-up fluid.

Sometimes, scooting is enough to resolve the problem after one or two attempts. If your dog continues to rub, lick or otherwise exhibit discomfort around the anal area, you should consult your veterinarian.

Many owners never need to have their dogs’ anal sacs expressed. And most owners of dogs with a tendency toward anal sac blockage — and if your dog becomes blocked once that usually indicates a tendency — an easily deal with the problem by having a groomer express the sacs regularly or by learning how to do it themselves.

But in some cases, particularly if the anal sacs are prone to infection, it may be best to have them permanently removed. Because the sacs are in the same area as the sphincter, which rings the anus, some owners worry that the procedure will sever nerves in the area and leave their dogs fecally incontinent. However, if the surgery is done properly, that shouldn’t occur, Dr. Berg says, acknowledging that incisions in this area may be more at risk of infection than usual incisions in other areas, but noting that infections are usually easily treated with antibiotics.

Expressing Your Dog's Anal Glands

No question: You should consult a veterinarian before trying to express your dog’s anal sacs for the first time. However, once you see the proper technique, you can expect to follow these steps.

  • Have a damp, sterile cloth ready.
  • Put on disposable surgical gloves.
  • Raise your dog’s tail and find the anal sacs. You can feel but not see them. They’re soft, half the size of a grape, at the 4 and 8 o’clock positions of the area around the anus.
  • Grasp the skin surrounding both sacs between your thumb and forefinger and squeeze. If you feel resistance, which suggests that the sacs are blocked, insert a finger into the anal canal and a thumb on the outside and squeeze them gently.
  • When you see and smell the secretions, wipe your dog’s anal area with the damp cloth.

Note: Normal secretions are brownish and either liquid or, if the sacs are blocked, the consistency of peanut butter. If discharge looks pus-like or bloody, an infection may be present and you need to consult your veterinarian.

Perianal Fistulas

The problems associated with keeping the anal area infection-free are exacerbated in dogs with broad-based, low-slung tails. This anatomical feature is one of the reasons, it’s hypothesized, that German shepherds are predisposed to a less common and far more serious condition: perianal fistulas.
As this disease, which is sometimes termed anal furunculosis, progresses, an initial scattering of pinhole-size sores may become deep, draining, painful ulcers surrounding the anus. “The warm, moist area under the tail and the large numbers of bacteria in the area make an excellent environment for bacteria to multiply,” Dr. Berg says. “Abscesses form, open and then drain.”

Although perianal fistulas are sometimes diagnosed in other breeds, including Irish setters, Labrador retrievers and some Arctic breeds, the great majority of them occur in German shepherds. The condition usually develops when the dog is 5 to 8 years old, occurring more frequently in males than females. The diagnosis is visual. The disease doesn’t show up in blood tests, and no special imaging techniques are required to see the lesions. Owners must simply remember to check under their dog’s tail.

The cause of perianal fistulas remains unknown and, for many years, antibiotics were the standard treatment. When the drugs didn’t provide more than temporary relief, as frequently occurred, veterinarians often recommend surgical removal of the infected tissue. This was expensive and often ineffective in preventing the fistulas from returning.

In recent years, oral doses of the immunosuppressant drug cyclosporine have had a far higher success rate in treating the disease. This success may also shed light on why German shepherds are prone to developing perianal fistulas. The breed is hereditarily predisposed to disorders of the immune system, and the dogs’ responsiveness to an immunosuppressant suggests the disease falls into this category.

Although a course of cyclosporine is expensive — $1,000 to treat a typical GSD — Dr. Berg estimates that approximately 80 percent of dogs who take the drug experience a complete resolution of their fistulas. “Generally, they will have a very dramatic improvement within a couple of weeks,” he says. Some dogs who don’t have a good response initially may improve with a higher dose. “Some vets measure the dose by monitoring the blood levels of the drug. Other vets gauge the dose by the response to treatment,” he says.

Generally, dogs stay on the drug for six to eight weeks. In the majority of cases, the fistulas disappear by this time and tend not to recur. “There are dogs who do relapse and some whose fistulas don’t totally dry up,” Dr. Berg says, “But with this disease, if you can make it much, much better that’s often enough to produce a significant improvement in quality of life.”

A small percentage of perianal fistulas is resistant even to cyclosporine. They recur even when the infected tissue is surgically removed. In those cases, a veterinarian may recommend amputation of the tail. This may seem like a drastic measure, but because it prevents the area from becoming reinfected by exposing it to the air, it is an effective one.

Brenda Griffin of Tucson [Ed. note: yes, she's a friend, though I never met Bean] was shocked when her veterinarian suggested tail amputation for her 3-year-old German shepherd, Bean, a decade ago, before cyclosporine was widely prescribed. But when Bean continued to develop fistulas after several rounds of antibiotics and three surgeries, she was desperate enough to try it — and surprised at the results.

“I thought not having a tail would throw off his balance and make him look odd,” Griffin says, but neither of those things happened. Bean resumed his athletic activities with his previous grace, and no one who wasn’t acquainted with him pre-surgery noticed anything amiss. “People would ask, ‘What kind of dog is that?’ because they’d never seen a German shepherd without a tail,” she laughs. “But the surgeon was so neat you never would have guessed a tail was ever there.”

More important, the perianal fistulas didn’t return. “I’m convinced the tail amputation saved his life,” Griffin says. Bean lived to the ripe old age — for a GSD — of 12 without experiencing more anal area problems.

Perineal hernias

Like perianal fistulas, perineal hernias are often easy for owners to diagnose by sight. When the muscles of a dog’s pelvic diaphragm weaken, the pelvic and/or abdominal organs may intrude through the pelvic canal into the region around the anus called the perineum. When this intrusion, or herniation, occurs, owners can observe an abnormal soft mass on one or both sides of the anus. They’re also likely to notice that the dog strains to defecate.

“Because the rectal wall has lost support, it deviates to one side,” Dr. Berg says. “And if the dog’s stools may not easily pass through the deviated area, having to go around a U-shaped bend, defecation is more difficult.” A veterinary visit for a rectal exam will almost always confirm a perineal hernia.

The reasons for the development of perineal hernias aren’t completely understood, but most cases occur in middle-aged or geriatric male dogs who are intact. This points to prostate enlargement and the concomitant straining to defecate as a source of the problem. Testosterone may also directly weaken the pelvic diaphragm. Other theorized causes of perineal hernias include hormonal imbalances, damage to the nerves of the pelvic diaphragm and straining due to other rectal diseases. “Also, females may have a stronger pelvic diaphragm because they need it to be stronger during child birth,” Dr. Berg says.

Although the distended area may look frightening to an owner, perineal hernias shouldn’t be considered a cause for immediate alarm unless the bladder is involved and the dog can’t urinate. The condition isn’t particularly painful and some dogs display no symptoms at all. Nevertheless, surgery to repair the hernia is recommended. “Most dogs are straining to defecate or they’re constipated, and only surgery can take care of the problem,” Dr. Berg says.

The standard surgery to resolve perineal hernias is fairly simple. “The surgeon makes an incision over the swelling next to the anus, pushes the organs back into place and then uses a flap of a muscle in the area to coverlose the defect, creating a new diaphragm,” Dr. Berg explains.

While the dog is under anesthesia, another simple surgery is indicated: neutering. If the prostatedog is left intact, the problem is likely to recur, Dr. Berg says. “One reason, among many, to get your dog castrated early in life is to prevent perineal hernias.”

Anal tumors

It’s not uncommon for owners who check an older dog’s anal area to notice masses, or tumors, in the area. There’s no reason to panic, especially in the case of intact male dogs, who are subject to perianal adenomas. These tumors of the skin in the anal sacarea are benign most of the time.

Along with removing or biopsying the mass and submitting it for histopathology to determine its type, neutering is recommended in these cases. Cancerous tumors of the anal area are much rarer, but they do occur, so it’s important to have your veterinarian check any growths.

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17 Comments

  1. Posted March 5, 2012 at 9:14 am | Permalink

    Important article, Edie, thanks, I’ll keep a closer eye on the bums!
    And congratulations on your new directions

    view recent posts at: http://www.examiner.com/judaism-in-albuquerque/diane-schmidt
    Diane Schmidt recently posted..Near-death experience and two hawks and a half-cup of cranberry juiceMy Profile

  2. Posted March 5, 2012 at 9:53 am | Permalink

    Cyrano, aged legally blind Beagle, just had the “works” done at my friend Stacy’spet products store; his anal glands were stretched and full, though I saw no scooting. After Debbie expressed them, his bath and nails were a cinch, he was so relieved. My vet has shown me how to express the glands and while I can be handy, it is a skill I in which need a lot of coaching. Excellent article – I have other dogs in need but no fistulas, etc. so far.
    Roberta Beach recently posted..Starfish & Dog RescueMy Profile

  3. Posted March 5, 2012 at 11:27 am | Permalink

    Great post, my dogs are so smart, we trained them where to pee and pooped and we make sure that they are not going to sit and lay in the soil.so they will be free from the parasites.
    Angel Collins recently posted..OSHA Gets Serious About Modernizing Its Injury and Illness Data CollectionMy Profile

  4. Posted March 5, 2012 at 11:39 am | Permalink

    This is some very important information. I don’t think I realized how many things could go wrong before. It’s so important to be aware of all the major health concerns for our pets, probably more so than for ourselves. We can feel if there is something wrong in our own body whereas we may not be able to tell if there is something wrong with our pets before the symptoms get worse.
    Kristine recently posted..Those Dang WeavesMy Profile

    • Edie Jarolim
      Posted March 5, 2012 at 12:25 pm | Permalink

      Yes, it’s been a revelation. But I gotta say, writing for Tufts has made me aware of way too many things that can go wrong!

  5. Posted March 7, 2012 at 1:10 pm | Permalink

    Thank you for the educational article. The subject is almost as uncomfortable to talk about as when similar issues occur in humans, but maybe even more important to talk about. As pet owners, we speak on behalf of our pets, so identifying issues to the correct doctors and care givers is ever so important. Thank you for doing the research to familiarize us with the symptoms, as well as the treatments for these diseases. Identifying and eliminating the problems will lead to happier dogs!
    Petntek recently posted..Your Phone Could Someday Let You Communicate With Your PetMy Profile

  6. Posted March 7, 2012 at 11:10 pm | Permalink

    I must admit I had a visceral reaction to this post—it made me queasy!

    It’s hard to imagine being able to perform an anal gland extraction on my squirmy dog—I can barely trim his nails successfully.

    All of these issues are great reasons to keep our dogs in good overall health, with strong immunity— starting with providing them the basics of clean fresh water, complete nutrition, plenty of exercize and a clean (toxin-free) home and yard environment.

  7. Posted May 7, 2012 at 10:01 am | Permalink

    Well I digested all that quite slowly as I suspected my dog has an issue with what you describe as scooting and the brownish smear left behind, so I shall have to get a vet to do what you describe as expressing the glands, as I can’t really be sure of doing it myself without hurting him or properly. I just thought he was constipated. It started two days ago on the last day of our boating holiday and he was scooting around on the boat deck and later having trouble doing number 2. He was wearing one of those doggie life jackets as he’d been swimming and I thought maybe something in the water had upset his tummy but other dog owners in the area reassured me but never suggested this problem. Thanks for enlightening advice.
    Juliette recently posted..EzyDog Dog Life Jacket ReviewMy Profile

    • Edie Jarolim
      Posted May 7, 2012 at 10:17 am | Permalink

      Most groomers know how to do this too, Juliette, so you can save yourself some money. It’s very common, especially among small dogs. The combination with constipation is a bit unusual, though: It’s usually firm stools that cause the anal sacs to express themselves naturally. So maybe, for this first time, a vet visit would be smart.

  8. Posted February 16, 2014 at 12:54 pm | Permalink

    I just read this post after having given my 5 year old female shitzu-cross a bath. When I bath her I always comb out the residual poo near her anus under the water to loosen it off. When I did this today, the poo was stuck a bit and when I pulled it it created a hole on a brownish bump under her anus. Then all this brownish gunk with white specks came oozing out. I squeezed it gently, and a LOT more came gushing out until it became a clearish brownish liquid. Once I took her out of the bath, I trimmed the hair around her bum, applied hydrogen peroxide and ozonol cream. She did not show any signs of discomfort or scooting previously. But I could tell she was relieved to have this done. However, when I watched a youtube video of how to express anal glands it showed them expressing from above and inside the anus hole. This hole is like a pimple under her anus hole. Is this cause for concern?

    • Edie Jarolim
      Posted February 16, 2014 at 2:41 pm | Permalink

      I think it sounds fine — what you describe sounds very much like anal gland fluid. But I am not a vet and I never expressed Frankie’s anal glands. So I would keep an eye on it, just to make sure, and consult a vet if anything changes.

      Good for you for taking such good care of your pup!

  9. Posted February 17, 2014 at 5:11 pm | Permalink

    our little chihuahua is 13 years old. Strains to go to bathroom, been on different types of meds nothing seems to work. When he does go it is very little. There is a tumor so I assume that is what is causing the blockness The vets say just keep him comfortable with the meds and all and if no better it is our call.
    How do you put your dog down when they seem fine one day and not the next, how do you know they are even in pain.
    Don’t know what else to do for him. He just stays close to us and follows us around all the time
    Teresa recently posted.. My Funny ValentineMy Profile

    • Edie Jarolim
      Posted February 17, 2014 at 5:34 pm | Permalink

      Oh, I’m so sorry to hear about this; it’s so heartbreaking. 13 isn’t old for a chihuahua. I would get a second opinion to see if there are other options. There are also ways to determine quality of life, when the bad days become more common than the good ones. I would also suggest a hospice vet, someone who could help you through this difficult time. They have more experience in pain regulation and assessing quality of life than many other vets.

  10. Clocker
    Posted March 13, 2014 at 1:44 pm | Permalink

    I have a six week old lab mix she has a red sore above her anus. It’s not coming out of the hole or connected to it it’s more out of lower tail near the anus. It would be considered the 12oclock position. She’s not biting it, scratching it, or rubbing her butt across the floor. Any ideas? Maybe food allergy I did just change her food when I got her yesterday and it appeared today?

    • Edie Jarolim
      Posted March 17, 2014 at 10:35 am | Permalink

      Sorry — this ended up in my spam bin! Hope by now the problem resolved itself and that a visit to the vet wasn’t required.

  11. betty welch
    Posted September 15, 2014 at 8:12 am | Permalink

    My dog is half german Shephard, half lab. Hes 7 years old. He is eating, doing his normal batheroom thing, nothing different. Hes a inside dog. When he was walking away from me I noticed something sticking out under his tail, this is at 12 oclock. Its hard and a lump. You havevto lift his tail to see this. What is this? Going to call the vet today to get him in. My dog is my world, my husband just finished radiation/chemo, and I have my 89 year old mom living with us, due to early stage altimerz sp? My dog I love him and cant see without him. I pray its not cancer. I cant handle more bad news here. What else can it be besides cancer. Im not working, husband on SSDI, dont know how im going to pay for treatment if cancer. My dog comforts me as being a care provider is hard enough for 1 but I care for 2. With no help. Hes my best friend. Follows me all day, end of my day, I lay curled up beside him until he falls asleep, I do this every night. Sorry this is long, I just love my dog so much. Hes a male dog.

    • Edie Jarolim
      Posted September 15, 2014 at 8:37 am | Permalink

      Aw, Betty, let me give you a virtual hug; I’m sorry you’re going through such a tough time. There are a LOT of benign anal area tumors; it’s an area that gets inflamed quite a bit because of…well, where it is. I am sending good thoughts that it is not anything serious. Please let me know what your vet says.

      And you never have to apologize here for loving your dog and finding comfort in him!

      All my best, Edie

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