 Barked: Sat May 14, '11 12:20pm PST |
 | |  | | Anal Gland is actually a misnomer that has entered into our everyday speech. The actual term is Anal Sac since the glands actually line the inside of the sac meaning diseases affect the sac NOT the gland. I have always thought that vets wanted to avoid the accidental slip of the tongue that terms the words "anal sac's" into an uncomfortable sexual reference (no pun intended ).
Chronic anal sac disease can be cause by inflammation/allergies/unknown-usually termed chronic anal sacculitis, tumors usually termed anal sac tumors or (rarely) foreign material. When the sacs become inflamed it causes them to have a smaller interior (IE they fill up faster) and causing a narrowing of the the duct they empty into the anus with. Expression can actually cause inflammation which can sometimes then become the reason why they get impacted. Tumors of the anal sacs are most commonly diagnosed by palpation (feeling) which happens as they are expressed. I can assume no one has felt this since otherwise you would be asking different questions.
Dogs who regularly express their own anal glands will do it when they go BM or if scared. The firmness of the stool seems to be the factor that allows for complete expression so when dogs suffer from chronically soft stool they may also in turn suffer from AG problems. With food allergies we often see corresponding inflammation of the GI tract which can encompass the anal sac area leading to problems. This is why chronic allergic pets (especially those with food allergies) seem to be overrepresented in this disease.
Expressing anal sacs manually does come with a small risk of abscess if not done correctly as well as the additional inflammation putting the dog at risk for future impactions. So the need to frequently express anal sacs is not an ideal position to be in either.
As for surgery.....there is definitely a small risk that Zepplin could lose the ability to control his rectal sphincter. The anal glands lay very close to this sphincter and the removal of them requires the surgeon to slice within mm's of this sphincter. If a mistake is made, even if the surgeon slips or nicks a mm one way or the other, your dog will be unable to hold its bowels either temporarily (weeks to months) or for the rest of his life. Many dogs have successfully done the surgery early on but suffered the rectal incontinence later in life, some suffer temporary fecal incontinence lasting weeks to months, some have never had fecal incontinence and others start with incontinence immedietely following the surgery. There are also other complications such as seeping/weeping of anal sac material (if removal not complete), seeping/weeping of rectal fluid from weakened sphincter, chronic fistula formation and scarring which can cause tenesmus or the feeling that you need to "go" but there is actually no stool (IE excessive straining, cramping, sometimes severe abdominal pain).
In the last 6 months (avg. 180 days) you have had his anal sac expressed 3 times right? When was the last time the VET (not the groomer) expressed him? Did he check for infection? The anal sacs are lined with specialized sebaceous glands that produce a normally light yellow material. These glands continue producing material even if the material is unable to leave the sac. As the material builds up it thickens to the point where it can become almost paste-like and gritty. It also turns dark closer to black. If an infection is present the material will have a purulent appearance to it, meaning that it appears green or pus-like....it also can be bloody. Infections are usually more painful when expressed than just an impaction. Keep in mind that improperly performed expression can lead to future abscess up to several weeks later.
To be honest with you, your case is not one that I would think of surgery for as a first option. In my experience, the GP's I have worked with as well as the Surgeons usually don't start recommending surgery until the impactions are occurring weekly to monthly and seriously affecting the patients quality of life. Zepplin hasn't had frequent enough impactions to suggest that this will be a life-long problem....it may actually be all related to one event of inflammation of the anal sac area. Basically there is inflammation in the sacs that hasn't returned to normal (possibly complicated by the manual expressions).
So the first thing I would say is start taking a look at the previous 9-10 months of Zepplins life. The first impaction may have been the start of an inflammation that has not resolved so you want to look before it for reasons why the impactions occurred. Look at any food changes...where there any episodes of diarrhea lasting more than 2-3 days...any new treats or food indiscretions (IE did he get into anything)...where there any flare ups of his allergies in general???
Is Zepplin on an antihistamine? If so name and mg and how often do you give it? Is he on any other medications? Has he been on oral antibiotics in the last 9 months? If so what type and how long?
Have you tried adding additional fiber to his meals? Even though you report he rarely has soft stool it may benefit him to make his stool actually more firm so he has to strain some to go. This straining can actually help them express the sacs more effectively on their own.
Although we are not 100% sure of all the reasons why anal sac impactions happen we do tend to see them happen more often for several reasons (not sure which ones would apply to you):
-Obesity - Dogs who have too much fat can actually cause the duct to be "crushed" close so they can't be expressed with stool. Also there is some suggestion that grooming by the dog keeps the ducts open and cleaned as well as occasionally causing small expressions. If the dog is too fat to reach that area they cannot groom predisposing them to impactions.
-Lack of fiber or bone material in diet - Many people believe that a kibble based diet predisposes our pets to anal sac issues. When fed raw diet with bone material there are occasions of firm stool with hard pieces that encourage additional straining helping to successfully empty the sacs.
-Allergies - Food and Seasonal - Since inflammation can cause the duct to narrow allergic response in the area may make it hard for the pet to express the sac OR may make it fill faster. Hypoallergenic diets and oral antihistamines have shown some success with limiting impactions.
These are all considerations to be made when figuring out the risk/benefit's of this surgery for your dog and you. If you don't want to express anal glands how will you feel about cleaning up stool 2-5x daily? The risk of incontinence may be low overall but in the long run its a much worse place to be (for some owners-depends on your POV) than with impacted anal glands. This is a cosmetic surgery in that this is not a life threatening disease or something that grossly affects the pets QOL at this point so I would want to make sure I have exhausted all other options prior to considering surgery.
Here are just some good links to see all POV on disease, medical management and surgery.....I would suggest it may be worth it to take a couple weeks to months to decide if this is the right decision for you, your family and Zepplin.
Surgical Description
Abstract from Medical Journal on Anal Sacculectomy prognosis - Published 2008
More info
Merck Vet Manual - Anal Sac disease
PetPlace - Anal Sac Disease in Dogs
PetPlace - Anal Sac Removal
ETA - Take some time and write down a pros cons list to help determine where you stand on the surgery at this time....then take some time to read the literature and remake the list....see if it changes and make a decision based on that list.
Any INFORMED decision you make for YOUR pet is the RIGHT one no matter what you choose. Even though surgery is not right for me and my pets now doesn't mean I wouldn't find myself with a change of mind if they suffered frequent impactions. Talk with your family, vet and others to gather info then sit down and think about it.
---> Sometimes I also find its helpful to talk the issue over with my dog - outloud - Their eyes are non-judgemental so I can lay the information out and really spend time processing it - when we found out Cara had cancer I told her about it and it actually made me feel better about it. IDK - maybe this is just me !?! Edited by author Sat May 14, '11 12:28pm PST
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