Definition of Anal Sac Disease
Dogs, like other carnivores, have a pair of small sacs on either side of their anus (commonly called the “butt hole”), which is the end of the digestive tract. These anal glands produce a smelly, yellowish-gray to brownish pasty material, which normally is expelled when a dog poops or when it is startled or frightened. This is often attributed to territorial marking. The actual cause of anal sac problems is not well-understood. Anal sac “disease” happens when the sacs become inflamed, impacted, infected, irritated, abscessed or affected by tumors. Dogs with anal sac problems can’t properly eliminate the fragrant material that their glands normally produce. This causes lots of itchiness, pain and general discomfort. Unfortunately, anal sac problems are fairly common in domestic dogs.
Causes of Canine Anal Sac Disease
The underlying causes of anal sac problems are not fully understood. Several predisposing factors have been suggested, including obesity, bouts of diarrhea, poor muscle tone around the anus, chronically soft feces and excessive or retained anal glandular secretions. Normally, the paired anal sacs act as reservoirs for secretions from the glandular tissue that lines them. Changes in the amount or character of those secretions, or changes in muscle tone or the consistency of a dog’s stool, can plug the anal sacs and cause them to overfill, sometimes to the point of rupturing. This causes pressure, inflammation and irritation. It also promotes abnormal overgrowth of bacteria that normally are present inside the sacs, which in turn increases the chances of infection, impaction and formation of pus-filled abscesses. Both benign and malignant tumors of the anal sacs can also occur, causing symptoms similar if not identical to those caused by more temporary and treatable problems. Why tumors develop in the area around the anus (the “perianal” area) is not known, but they are fairly common in domestic dogs.
Prevention of Anal Sac Disease
One of the best ways to prevent anal sac disease is to feed dogs a high quality diet that is low in saturated fats and has enough indigestible dietary fiber to reduce the frequency of loose or sloppy stools and increase fecal bulk. Anal sac secretions can’t be evacuated naturally unless there is a sufficient amount of firm, formed feces passing through a dog’s rectum. Obese or overweight dogs should be put on a weight loss regimen, because excess weight has been associated with anal sac problems. Routine manual expression of the anal sacs by veterinarians, veterinary technicians, groomers or owners should not be necessary in normal dogs. In fact, chronic manipulation of the anal sacs can damage their sensitive tissues and increase the risk of more serious problems. However, in certain situations, it may become necessary to manually express a dog’s anal glands. Good routine hygiene can help prevent the accumulation of bacteria and other infectious microorganisms around the anal area. Unfortunately, given the current state of medical knowledge, there is no way to prevent perianal tumors. Research into the causes and treatment of cancer remains in the forefront of both human and veterinary medicine. A veterinarian is the best person to assess a particular dog’s anal sac health and discuss appropriate management protocols with its owner.
Initial Evaluation
Anal sac problems are fairly common in domestic dogs. Fortunately, they are not particularly difficult to diagnose. Owners usually bring their affected dogs to the veterinary clinic because they have been licking at their rear end and scooting their butts across the floor. They may also complain about a nasty smell coming from their dog’s rear and bad breath. The veterinarian will take a history from the owner about the dog’s general health, including when the current symptoms showed up and whether they have gotten worse or stayed about the same over time. The veterinarian will also perform a thorough physical examination. She will inspect the anal area visually and digitally (by hand). The digital rectal examination involves inserting a finger into the dog’s anus and physically expressing, or squeezing out, the contents of both anal sacs for further evaluation. This procedure can be painful, depending on the severity of the dog’s condition. Sedation or general anesthesia may be needed to complete the rectal examination. Normal anal sac secretions are clear to pale yellowish or grayish brown. Impacted anal sacs become plugged with a thick, pasty material; inflamed sacs often contain a creamy yellow or thin greenish secretion. Abscessed anal sacs typically discharge a reddish-brown material containing pus and blood, accompanied by a fever and obvious swelling and redness around the anal area. The veterinarian’s initial evaluation of the perianal area and the anal sac secretions will give her a good idea about the dog’s condition.
Diagnostic Procedures
Most veterinarians will draw blood and urine samples. The results of routine blood work (a complete blood count and serum chemistry panel) and a urinalysis are usually normal in dogs with anal sac disorders, unless the sacs are infected. Some dogs will anal sac tumors will have elevated blood levels of parathyroid hormone-related protein and calcium. The veterinarian may recommend radiographs (X-rays) of the chest and pelvis, and possibly an abdominal ultrasound, to look for evidence of metastasis (spread of cancerous cells), especially to the lymph nodes. Samples of the anal sac contents will be examined microscopically through a process called “cytology.” Anal saccular secretions can be cultured to look for infectious microorganisms. However, culture results can be difficult to interpret, due to the normal presence of a so many different bacteria (“normal flora”) in that region. If a mass is found, it can be sampled by a fine needle aspirate or, more diagnostically, by a tissue biopsy. The sample will be sent to a laboratory for detailed evaluation, to confirm or rule out cancer.
Special Notes
Most anal sac disorders in companion dogs are not especially serious and are not hard to diagnose, especially since the area involved is so isolated and accessible. Nonetheless, it is important for owners to take these problems seriously and to seek veterinary assessment and advice when they notice that something is amiss in their dog’s perianal region.
Effects of Anal Sac Disease – From the Dog’s Point of View
Canine anal sac disorders are relatively common. The anal sacs are paired structures located on either side of a dog’s anus (the terminal end of the digestive tract through which feces is expelled). Normally, the anal sacs secrete a very smelly substance when a dog defecates, which probably acts as a form of territorial marking. When these sacs become irritated, inflamed, impacted or infected – which can occur for a number of reasons – their contents can’t drain normally, although the glandular tissue lining the sacs continue to produce the substance. The discomfort, itchiness and pain suffered by dogs with impacted anal glands can range from quite mild to extremely severe. Affected animals will be uncomfortable, at best.
Symptoms of Anal Sac Disease – What the Owner Sees
Dogs with anal sac disorders usually show signs of physical discomfort in the area around their anus, called the “perianal” or “perineal” region. The region may be swollen and red, both of which are recognized signs of inflammation and irritation. Blood and/or pus may be seen on the dog’s feces or on the skin and hair around its anus; this is more common in long-haired breeds and when an anal sac abscess has ruptured. Owners may notice one or more of the following signs if something is wrong with their dogs’ anal sacs:
- Licking and biting at the perianal area (can be intermittent or relentless)
- Tail-chasing
- Straining to defecate (tenesmus)
- Scooting the rear end along the floor, grass or ground in a sitting position
- Reluctance to sit still
- Fresh blood on fecal material
- Pus on fecal material (pus is a protein-rich inflammatory byproduct made of cells (leukocytes), a thin liquid (liquor puris) and cellular debris; it usually is a sign of bacterial infection)
- Visible swelling and redness around the anus
- Open, weeping wounds adjacent to the anus, with or without the presence of pus or blood
- Constipation
- Foul odor coming from the anal area
- Bad breath (halitosis; from licking the rear end)
- Fever, if infection is present
If a dog has anal sac tumors, its owner may (or may not) notice a visible mass or bulge near the dog’s anus.
Dogs at Increased Risk
Small breed dogs develop anal sac disorders more commonly than do larger breeds – particularly Miniature Poodles, Toy Poodles and Chihuahuas. Long-haired dogs and fat animals are at a higher risk, as well. Older female dogs are particularly predisposed to developing anal sac tumors, which may or may not be malignant or even visible to the naked eye. Dogs suffering from chronic diarrhea, soft feces and/or poor rectal muscle tone, regardless of the cause of those conditions, are predisposed to anal sac disease, as well.
Treatment Goals
When an owner suspects that his dog may have something unusual going on in the area around its anus, he should take his pet to a veterinarian as soon as possible. In most cases, an anal sac problem is not an emergency. However, if ignored, the condition can quickly get worse and become increasingly difficult to treat. The goals of treating anal sac disease are to relieve the dog’s discomfort and pain, unplug and empty impacted sacs, reduce inflammation, eliminate associated infections, heal abscessed areas and remove identifiable tumors.
Treatment Options
The first and most urgent treatment for a dog with impacted anal sacs is to manually – and very gently - express the contents of the sacs. This should be done by a veterinarian or by a skilled veterinary technician. In cases that recur frequently, the dog’s owner can be taught how to perform this procedure at home. However, most owners find the process offensively smelly and unpleasant and prefer that somebody else handle it outside of their presence. If an infection is present, the veterinarian will flush the anal sacs with sterile saline or another appropriate substance and apply an antibiotic or antibiotic-and-steroid medication directly into the affected areas. It is almost always necessary to use heavy sedation, and sometimes general anesthesia, for those procedures. Anal sac abscesses often rupture. They are treated the same way, using saline, antibiotics and topical steroid treatments. If an abscess is present but has not yet ruptured, hot packs can be applied to the area several times a day, to help bring the abscess to a head. The veterinarian can then lance the abscess to establish a route for drainage, which will greatly reduce the dog’s discomfort. A full course of broad spectrum oral antibiotics are often recommended for dogs with anal sac disease. Some dogs have chronic recurrent anal sac problems. In those dogs, long-term treatment includes managing the dog’s weight, increasing the amount of insoluble fiber in its diet and making sure that it gets an adequate amount of physical exercise. In severe cases, the anal sacs can be removed surgically by a procedure called an “anal sacculectomy.” Identified tumors can also be surgically removed, if necessary.
Prognosis
With appropriate treatment, the outlook for dogs with non-malignant anal sac disease is good. Most dogs respond well to non-surgical medical management of the condition. When the anal sacs are surgically removed, because of cancer or for some other reason, the prognosis becomes more guarded. Dogs may develop fecal incontinence after an anal sacculectomy, or if a lot of scar tissue has built up from recurrent problems. If no treatment is undertaken, the prognosis for a return to normalcy is guarded to grave.
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