Hedgehog prolapse: rectal tissue, paraphimosis and the first thirty minutes

Quick answer

Everything you need in the first half hour is soft, plain and unmedicated: a clean towel, saline, gauze, and a carrier ready to go.

Tissue protruding from a hedgehog's back end, or from the small opening in the middle of a male's belly, is an emergency measured in hours, not days.

Two things decide the outcome: whether the tissue is still alive when a vet sees it, and whether the hedgehog is still warm. Prolapsed tissue swells the moment it is outside, and once it swells it cannot go back on its own. Every hour it stays out, the blood supply gets worse.

• Do not pull on it. Do not force it back in.
• Keep it wet and clean with sterile saline on gauze, and keep the hedgehog warm.
• Move him off fleece and shavings onto plain kitchen paper or a smooth towel, because loose fibres stick to wet tissue.
• Photograph exactly where the tissue is emerging from before you cover it. Anus, vulva and preputial opening are three different problems.
• Ring an exotics vet now and say the word prolapse. This is not a wait-and-see.

:::danger
If a thread, hair or fibre is wrapped around anything, do not cut it and do not pull it.

Swollen tissue and a tight fibre look almost identical once the area is congested, and owners routinely cut into the animal instead of the thread. Fibre constriction kills tissue within hours. It needs magnification, good light and usually sedation.
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Decide in 60 seconds

The three prolapses, and how to tell them apart

Getting this right on the phone changes how fast the clinic reacts, so look before you cover it.

Rectal prolapse.

Tissue emerges from the anus, directly under the tail. It looks like a short pink or red tube or a doughnut of moist tissue. It is caused by prolonged straining, so there is nearly always a reason underneath: diarrhoea, a heavy internal parasite burden, constipation from swallowed bedding, dehydration, or a mass.

A longer, sausage-like protrusion can be an intussusception, where one part of the intestine has telescoped into another and pushed through. It looks similar from the outside and carries a much worse prognosis. Only a vet can tell them apart, and the difference decides the surgery.

Penile prolapse and paraphimosis.

Male African pygmy hedgehogs have a preputial opening in the middle of the abdomen. When the penis comes out and does not go back, it swells, and once it swells it physically cannot pass back through the opening.

The most common trigger in pet hedgehogs is a fibre from bedding or from the wheel wrapping around the shaft. Fleece with cut edges, loop-pile towels and long hair are the usual sources. Other causes are trauma, infection, over-mating, and neurological disease.

The first sign is often not the swelling. It is a hedgehog repeatedly licking or biting at its own belly, or an unexplained wet patch there.

Uterine or vaginal prolapse.

Tissue from the vulva, which sits just in front of the anus. In pet hedgehogs this is far less common than uterine disease, which produces blood spotting rather than protruding tissue. Either way it is a same-day problem and the underlying uterine disease is common enough in this species that a female with any blood or tissue at the back end needs examining properly.

What is not a prolapse

Naming the look-alikes saves both panic and delay.

A matted plug of faeces.

Stuck stool and bedding can form a hard ball over the anus that looks like a protrusion. It still needs dealing with, because underneath it the skin scalds, but it softens with warm water and does not need surgery.

A mass.

Tumours are common in pet hedgehogs, including around the back end and the reproductive tract. A mass is firm, does not look like moist bowel lining, and does not change hour to hour.

An abscess.

Warm, tense, often with a small wound. Hedgehog abscesses form thick, solid pus that does not drain the way a dog's does, which is why they usually need surgery rather than lancing.

A hernia.

A soft, reducible swelling under the skin rather than tissue coming through an opening.

Normal male anatomy.

The preputial opening in the middle of the belly is normal and startles a lot of new owners. Brief, transient extrusion during self-cleaning is also normal. The problem is only when it stays out.

The first thirty minutes

Do these in order, and do not let any of them delay ringing the clinic.

Make the ring first, or have someone else make it.

Ask specifically for a vet who sees African pygmy hedgehogs. Say prolapse. Ask whether they have the ability to sedate, because almost every hedgehog examination of the back end requires it: a hedgehog will curl, and a curled hedgehog cannot be examined at all.

Get him warm and keep him warm.

Move him into a carrier lined with plain kitchen paper or a smooth, thread-free towel. Put a covered heat source under one half of the carrier, never directly against the skin, and leave the other half unheated so he can move off it. A hedgehog that gets cold while you deal with the prolapse can be lost to the cold alone.

Get him off fibres.

No fleece, no loop-pile towels, no shavings, no paper strands. Anything loose sticks to exposed wet tissue and to constricted skin, and every fibre you add is another thing the vet has to remove under anaesthetic.

Keep the tissue wet.

Sterile saline on plain gauze, laid over the tissue, not wrapped tightly. Cooled boiled water is acceptable if there is no saline. Lukewarm, not cold. Wet tissue stays viable far longer than tissue that dries out and crusts.

Photograph it first, from a short distance, in good light.

One photo showing the whole underside so the vet can see where it is coming from, one closer for colour and texture. Photographs taken before it is covered are genuinely useful, because the appearance changes on the journey.

Do not.

Do not push it back. Do not pull. Do not cut fibres. Do not apply antiseptic, cream, ointment, honey or sugar unless a vet has told you to on the phone. Do not offer food. Do not syringe water into a collapsed animal, because it will go into the lungs.

What to assemble while someone else rings: a carrier lined with something smooth, plain gauze, saline, and a heat source. The clippers and scissors are for the vet, not for you.

Reading how bad it is

Colour is the single most useful thing you can report.

Bright pink to red, moist, and slightly shiny means the tissue still has a blood supply. Reduced early, tissue like this usually survives.

Dark red to purple means congestion: blood is getting in but not out. It is still salvageable, and it is getting worse by the hour.

Grey, black, dry, cold or gritty means the tissue is dead. That changes the plan from reduction to surgical removal, and it changes the conversation about outcome. Say this on the phone.

Then check the whole animal, because a hedgehog can be losing blood or going into shock while your attention is on the visible problem.

Gum colour is the fastest shock check you have. Healthy gums are pink. Pale, white or greyish gums mean circulation is failing and the journey becomes the priority over anything else.

Cool ears and feet, a hedgehog that will not uncurl at all, one that lies flat and does not respond, or one that is wobbly and cannot right itself, are all signs that this has moved beyond a local problem.

Why straining matters more than the prolapse

Rectal prolapse is a symptom. Reducing it without finding the cause means it comes straight back out.

Diarrhoea.

Green, loose or bloody stool with straining points at diet change, internal parasites, or bacterial enteritis. Hedgehogs carry Salmonella often enough that this also matters for the people in the house.

Constipation and impaction.

Hedgehogs swallow fleece, foam, thread and litter. Dry stool, straining without result, and a firm abdomen suggest an obstruction, which is a surgical problem rather than a laxative problem.

Dehydration.

A hedgehog on dry food that is not drinking enough produces hard stool and strains. Cold enclosures make this worse, because gut movement slows with body temperature.

Parasites.

Worth testing rather than assuming, particularly in a recently acquired animal or one with any outdoor access.

A mass.

In an older hedgehog with progressive straining, a tumour has to be on the list.

This is why the vet will want a stool sample if you can bring one, and why treating the prolapse alone is never the whole job.

What the vet will do

Expect sedation or a short anaesthetic. It is not caution; it is the only way to examine and treat the back end of an animal that curls.

The tissue is cleaned, assessed for viability, lubricated and reduced if it is alive. A purse-string suture is commonly placed around the anus for a rectal prolapse, tight enough to hold and loose enough to pass soft stool, and removed after a few days.

For paraphimosis, any constricting fibre is found and removed under magnification, the tissue is lubricated and reduced, and swelling is treated. If the tissue is dead, surgical removal is the only option.

Dead bowel means resection, which is major surgery in an animal this size.

Alongside that, expect fluids, warmth, pain relief and a search for the cause: a faecal examination, possibly imaging, a weight, and a full physical.

Ask directly about prognosis and about cost before you agree to surgery. Both vary enormously with how much tissue is involved and how long it has been out.

What to bring.

The photographs from before you covered it. A stool sample if there is one. The exact bedding you use, or a piece of it. Your weight records. What he has eaten in the last few days and whether the diet changed. His age, sex, and whether he has been bred. The enclosure temperature, measured rather than estimated.

Prevention, which is mostly bedding and warmth

What never to do

Do not push tissue back with a finger, a cotton bud or anything else. Prolapsed tissue is fragile and perforates easily, and if it is intussusception you can make it far worse.

Do not apply sugar, salt or honey on your own initiative. Osmotic agents are a real veterinary technique for reducing swelling, but the dose, the timing and whether the tissue is viable all decide whether it helps or harms, and that decision needs the vet on the phone.

Do not use human antiseptics, antibiotic creams or anything containing alcohol.

Do not bath the hedgehog. It chills him, and water pressure damages exposed tissue.

Do not wait overnight to see if it goes back on its own. Swelling is one-way.

Do not let the carrier get cold on the journey, including in an air-conditioned car.

When to get help

Now, in every scenario in this article. There is no version of protruding tissue in a hedgehog that waits until morning.

Ring ahead rather than driving to the nearest clinic and hoping. Confirm they see hedgehogs, confirm they can sedate, and confirm someone is there. If the nearest exotics vet is far away, ask them to talk you through anything they want done during the drive.

Once he is home, expect a recheck. Watch for straining, for stool that stops or becomes bloody, for a swollen or painful back end, for loss of appetite, and for any tissue reappearing. Weigh him daily during recovery, because weight is the earliest honest measure of whether he is coping.

Recovery is measured in eating, drinking and normal droppings. A hedgehog that goes back to the bowl and passes formed stool is telling you the underlying problem was dealt with too.