In early October 1999 a 7-year old mare presented with a rectal prolapse of one week's duration. The owner had delayed calling me because his usual vet had said that conventional treatments were not promising because of the severity of the prolapse in this case. The owner decided to try acupuncture (AP).
The mare was somewhat thin (she had worked heavily all summer). She had sensitivity at the SP Shu (BL20). She had moderate rectal and anal pain, especially when the tail was lifted. She had pale mucous membranes and had an appetite although she no fever and appeared sad. The prolapse was large (diameter circa 30 cm) and very congested. Some areas of the rectal mucosa were necrotic, had a very foul smell and an awful appearance.
In TCM theory, prolapses often involve deficiency of Spleen Qi. All of the above signs supported a diagnosis of SP Qi Deficiency in this mare.
As the prolapse was severe, and the tissues were debilitated and necrotic, my prognosis was poor. I warned the owner not to expect much success.
Conventional treatment of an anal prolapse would be to sedate the animal for chemical restraint to permit handling and repositioning of the prolapse, and to reduce the frequency and violence of tenesmus. Some authors recommend epidural anaesthesia to induce topical anaesthesia of the rectal mucosa and/or perirectal structures. Most prolapses can be reduced by gentle manipulation and retained with a purse-string perianal suture.
Before repositioning, topical medical therapy of prolapsed tissues involves cleansing with mild soap and water and thorough rinsing to remove any residual soap. The rectal mucosa should be kept moist by application of antimicrobial dressings such as nitrofurazone, silver sulfadiazine, or tolnaftane cream. Petroleum jelly or mineral oil may be used for the same purpose but it has no antibacterial effect. To reduce oedema, some authors recommend application of hot compresses to the rectal mucosa. In cases in which severe oedema has caused a prolapse the size of a volleyball, some authors advise shallow incision through the mucosa on the ventral surface of the prolapse. In such cases several parallel longitudinal incisions are made, 3 cm apart. This decreases the tension on the mucous membrane and relieves venous congestion. It permits edema to resolve through the normal hemolymphatic system, and allows drainage of fluid through the incisions.
This mare was not a good candidate for conventional treatment. There was no need to sedate her because she was calm and relaxed, had no tenesmus, and I had decided not to attempt manual reposition. Although she had local oedema, I decided that it was too risky to attempt manual repositioning because the wall of the prolapse was very degenerated, and I feared that I might provoke a rectal perforation. For the same reason, I judged it risky to suture the area even if a manual reposition were to be possible.
I used iodised soap to cleanse and moisten the tissues. I did not use petroleum jelly or mineral oil. For antibacterial effect, I decided to apply homeopathic Mucosa compositum. That increases the defences of the organism and helps mucosal regeneration in mucosal infections. Instead of hot compresses, to reduce oedema I followed the old law of giving cold to the heat and heat to the cold. I instructed the owner to apply ice locally and moxibustion distally.
I decided to use AP to strengthen her Spleen Qi, and to restore tone and position to the Large Intestine, without depleting the mare's Spleen Qi with anaesthetics. Treatment was by simple AP + moxibustion + supportive homeopathy (Mucosa compositum, 5 ml, i/m, on days 1, 2, 5, 8 and 11).
The main acupoints, needled daily for 4 consecutive days, were BL13, 20, 25 + GV20 (AP). In addition, the owner was instructed to put ice on the prolapse several times/day, and to apply moxibustion once/day at ST36 + CV08.
On day 1, AP was added at BL57 + GV01. On day 2, AP was added at BL57, PC06 + SP03 + tapping with the 7-tipped AP hammer at Huatojiaji points in area L3-S2. On days 3+4, AP was added at GV06, SP06 + PC06.
On day 3, there was a small improvement; the prolapse looked better and did not smell bad. On day 4, the prolapse looked good. Only a little of the mucosal zone that originally looked bad, remained outside. On day 6 (2 days after the last AP session), except for a little piece of mucosa, the remainder of the prolapse disappeared into the body.
In spite of a poor initial prognosis, the mare recovered uneventfully. It took only three days from the last AP session for the prolapse to disappear fully. The total time from the first session until full resolution of the prolapse was 8 days (Oct 3 to Oct 11, 1999).
I thank Phil Rogers, Dublin, for help in the final preparation of this text.