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Prolapse reduction should be attempted in any patient where the exposed tissue is deemed viable. Most prolapses can be reduced with appropriate interventions.

For partial and smaller, acute complete prolapses, reduction can typically be achieved with the patient heavily sedated. Tissues should be thoroughly lavaged with warm, sterile, isotonic solution and sterile lubrication generously applied. Application of gentle, continuous pressure to the prolapse should result in reduction at which point a purse‐string suture can be placed at the anal mucocutaneous junction, taking care to avoid the anal sac ducts. Monofilament, non‐absorbable suture is recommended for this purpose (2‐0 for large dogs, 3‐0 for small dogs and cats). The suture should be tied tight enough to prevent prolapse while allowing enough space for soft stool to pass without inciting tenesmus. To avoid excessive tightening of the suture a spacer, such as a 3‐cc syringe casing or a finger, is placed in the rectum prior to tightening and tying the purse‐string suture.

For moderate to severe, viable, complete prolapses, patients should be placed under general anesthesia to allow adequate relaxation of the rectum and perineal muscles. Epidural anesthesia can also be useful in preventing rectal spasming and providing analgesia during the reduction process as well as during the recovery. In additional to cleaning the prolapse, hyperosmotic agents can be applied to help reduce tissue edema and swelling. Various agents, including 50% dextrose solution, 70% mannitol, glycerol solution, and granulated sugar can be used for this purpose, although there is no evidence that supports the effectiveness of one agent over another. Again, gentle and consistent pressure applied to the prolapse will promote reduction. For large prolapses, this process can be time consuming but rewarding (Figure 7.2). Once reduced, a rectal exam should be performed to ensure normal anatomy prior to placement of a purse‐string suture as described above.

With the prolapse reduced, further treatment should focus on medical management of the primary inciting cause. Additionally, patients should be fed a low‐residue diet and placed on a stool softener such a lactulose or polyethylene glycol while the purse‐string suture is in place. Anti‐spasmodic medication such as aminopentamide hydrogen sulfate (Centrine^®, Fort Dodge Animal Health; 0.01–0.03 mg/kg subcutaneously, intramuscularly, or orally every 8–12 hours) can be considered, but should be used cautiously as there is the potential for serious adverse effects, including ileus [8]. Topical steroids have also been recommended by some to treat anorectal inflammation [5]. Purse‐string sutures should be left in long enough to allow medical therapies to take effect in treatment of the primary disease process. Published recommendations range from five days to two weeks and are likely related to the severity of the prolapse and initial clinical signs [5, 6, 8].