Lizard prolapse: tissue protruding from the vent, and the first hour

Quick answer

Tissue hanging from a lizard's vent is an emergency, and the clock is running from the moment it appears. Exposed tissue dries, swells, loses its blood supply and dies, often within hours.

There are two jobs before you reach a vet. Keep the tissue wet, and stop anything making it worse. That means no substrate, no cage mates, no ointments, and no attempt to push it back in.

Move the animal onto clean, damp paper towel immediately. Loose substrate sticks to exposed tissue and makes the repair much harder.

• Do not push the tissue back in. What is protruding may be intestine, oviduct, bladder or reproductive tissue, and each is handled differently.
• Keep it wet. Sterile saline or clean lukewarm water, applied continuously, is the single most useful thing you can do.
• Separate the animal from any cage mate immediately. Other lizards attack exposed tissue.
• Do not use antiseptics, creams, ointments or oils.
• Prolapse is a symptom. The underlying cause, usually straining, is what has to be treated afterwards.

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Exposed cloacal tissue dies quickly, and the damage is not reversible.

Once tissue is outside the body it dries out, swells because the blood cannot drain, and then loses its arterial supply. Tissue that could have been replaced in the first hour may need to be removed by the time it has been out for a day.

Telephone a reptile veterinary practice now. While you arrange it, keep the tissue continuously moist, keep the animal warm, and keep it on clean damp paper towel with nothing else in the container.
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Decide in 60 seconds

What has come out, and why it matters

The vent is a single opening into the cloaca, which receives the digestive tract, the urinary system and the reproductive tract. That is why several very different structures can appear at the same place, and why the treatment is not the same.

Cloacal prolapse. The cloacal lining itself turns outward. Usually a rounded mass of pink tissue.

Colonic or rectal prolapse. A tubular structure, often longer, with a visible lumen at the end. This one is serious because a length of bowel is outside the body and its blood supply is at risk.

Oviductal prolapse. In a female, usually following egg laying or a difficult one. The tissue is often ribbon-like or folded.

Hemipenal prolapse. Males have paired hemipenes stored in pockets at the base of the tail. One or both can evert and fail to retract, often after breeding activity, after infection, or secondary to straining. They appear as one or two symmetrical structures either side of the midline rather than centrally.

Bladder prolapse. Some lizards, including green iguanas, have a urinary bladder. A prolapsed bladder appears as a thin-walled, fluid-filled sac and is fragile.

You are not expected to identify which it is. You are expected to photograph it, keep it moist, and get to someone who can. But knowing that the list exists explains why pushing it back in is the wrong instinct: replacing a hemipenis, a colon and a bladder are three different procedures, and one of them may involve deciding not to replace it at all.

Why lizards prolapse

Straining is the common route, and there is usually something behind the straining.

Impaction and constipation. Ingested substrate, dehydration, cool temperatures, oversized prey items, or foreign material. The animal strains repeatedly against an obstruction and eventually everything comes with it.

Dystocia and egg laying. Prolonged straining to pass eggs, particularly where there is no suitable lay site, or where the animal is calcium deficient.

Low blood calcium and metabolic bone disease. Calcium is required for muscle contraction and for tone. A calcium-deficient lizard has poor tone throughout, including in the structures that hold the cloaca in place, and it also strains less effectively, which makes constipation and dystocia more likely.

Parasites and gastrointestinal disease. Heavy parasite burdens and enteritis cause straining and tenesmus.

Cloacal infection or inflammation.

Dehydration. Hard, dry urates are difficult to pass, and the effort to pass them is exactly the effort that causes a prolapse.

Neoplasia and other masses.

Neurological problems affecting the muscles around the vent.

Every one of these needs treating in its own right. A prolapse that is replaced without addressing why the animal was straining usually comes back.

What to do, step by step

Separate the animal immediately. Take out any cage mate, or move the affected animal into its own container. Lizards housed together will investigate and bite exposed tissue, and so will the affected animal.

Move it off substrate. Line a smooth-sided container with plain paper towel, dampened with clean water. Sand, bark, soil, wood chip and coir all adhere to exposed mucosa and have to be removed later, sometimes at the cost of the tissue.

Keep the tissue moist. This is the most useful thing you can do. Sterile saline is ideal. Clean lukewarm water is an acceptable substitute. Keep applying it, or drape a saline-soaked gauze or paper towel over the tissue and keep it wet. Do not let it dry out at any point, including during the journey.

Keep the animal warm. A cold reptile cannot respond physiologically and cannot process medication normally. Warm the container gently from outside, and do not use a direct lamp on the animal.

Telephone a reptile veterinary practice now. Describe what you can see and where it is coming from. Ask what they want you to do on the way in. Some vets will advise applying a specific solution to reduce swelling before you travel, and that instruction should come from them rather than from a search result.

Photograph it before you leave. Swelling changes during transport, and a photograph taken at home is useful.

Travel promptly. This is a same-hour problem, not a same-day one.

A smooth-sided container, damp plain paper towel, and nothing else. The point is to keep tissue clean and wet with nothing to stick to it.

What never to do

Do not push the tissue back in. Beyond the fact that the identity of the tissue matters, a prolapse that has been outside for any length of time is swollen, and forcing it back damages it and does not stay. It also hides the problem from the person who needs to see it.

Do not apply antiseptics, disinfectants, wound creams, antibiotic ointments, petroleum jelly, or essential oils. Several are directly toxic to exposed mucosa and all of them complicate surgery.

Do not use sugar, honey or salt on your own judgement. Hypertonic solutions are used in veterinary practice to draw fluid out of swollen prolapsed tissue, and that is exactly why the decision and the concentration should come from a vet on the telephone rather than from an internet post.

Do not leave the animal on loose substrate for even a short period.

Do not attempt to pull anything, including a partially passed egg or a piece of retained shed.

Do not put the animal in water to soak. A prolapse needs to be kept wet, not submerged, and tank or bath water is not clean.

Do not leave the animal with a cage mate for any length of time.

Do not wait to see whether it retracts on its own overnight.

The things that look like a prolapse but are not

Normal droppings and urates. A urate mass at the vent, or a dropping partly passed, is not a prolapse. It should be soft and it should come away.

Retained shed around the vent. Rings of stuck shed can build up around the vent and are sometimes mistaken for tissue. They also cause genuine problems by constricting, so they need dealing with, but by softening and gentle removal by a vet, not by pulling.

Hemipenal plugs. In male lizards, particularly leopard geckos, secretions can solidify inside the hemipenal pockets and form firm plugs. They appear as swellings at the base of the tail either side of the vent. They are not raw tissue and they do not bleed, but they need removing because they cause discomfort and can lead to infection and to a genuine prolapse later.

Abscesses and swellings around the vent, which are firm and covered by normal skin.

A partially laid egg, which will look like a smooth ovoid rather than like tissue. This is an emergency in its own right.

Normal breeding-season hemipenal bulging in males, which is a change in shape at the tail base, not tissue outside the body.

Preventing the next one

Prolapse is almost always secondary, so prevention is about the causes.

Get the temperatures right. A lizard that cannot reach its preferred body temperature cannot digest, and undigested gut contents lead to straining. Measure the basking surface with an infrared thermometer and the cool end with a probe, and confirm the targets for your species with a reptile vet.

Get hydration right. Dry, hard urates are difficult to pass. Match the water delivery to how your species actually drinks, and check the urates: they should be soft and white, not hard, yellow or gritty.

Reconsider the substrate. For any animal that has had an impaction or a prolapse, a solid or paper substrate removes an entire category of risk while the problem is being sorted out.

Get calcium and UVB right. Adequate dietary calcium and a functioning UVB source underpin muscle tone throughout the body. Note the age of the lamp, because output falls long before the light goes out.

Screen for parasites. A faecal examination is inexpensive and identifies a common cause of straining.

Provide a lay site for females. A female with nowhere suitable to dig will retain eggs and strain.

Feed appropriately sized prey. Oversized items are a recognised cause of gut problems in several species.

Look at the vent every time you handle the animal. Straining, redness or a small amount of protruding tissue that retracts is the warning stage.

When to get help

Go immediately for any tissue protruding from the vent, for a partially passed egg, or for tissue that has already darkened or dried.

Go the same day for repeated straining without a dropping, for a female that has been trying to lay without success, for hard yellow urates with straining, or for blood at the vent.

Book promptly for a firm symmetrical swelling at the tail base of a male, for retained shed around the vent, or for any animal that has had a prolapse before, because recurrence is common and the underlying cause needs to be found.

Recovery depends as much on treating the reason for the straining as on repairing the prolapse itself.

Bring photographs taken when you first found it, the species and sex, whether the animal has laid eggs or bred recently, the substrate, the measured basking and cool end temperatures, the age of the UVB lamp, the diet and supplementation, the date and appearance of the last dropping, and a fresh faecal sample if you can get one. Expect the vet to examine the tissue, look for the underlying cause with imaging and faecal testing, and address both. Treating the prolapse alone is what makes it come back.