A review on

AFFECTIONS OF ANAL GLALND AND

THEIR SURGICAL MANAGEMENT

PRATAP KAFLE
B. V. Sc. & A.H, 9th semester
IAAS, Rampur, Chitwan

April, 2011
AFFECTIONS OF ANAL GLANDS AND THEIR SURGICAL MANAGEMENT

Anal glands
The anal glands or anal sacs are small glands
found near the anus in many mammals,
including dogs and cats. They are not found in
humans or other primates. They are paired sacs
located on either side of the anus between
the external and internal sphincter
muscles. Sebaceous glands within the lining
secrete a liquid that is used for identification of
members within a species. These sacs are found
in all carnivore except bears and sea otters. The
liquid produced usually smells foul to humans.
These are the same type of organs that a skunk
has to scare away its enemies. Although dogs can
use these for the same purpose, most dogs live in
an environment that has no enemies. Because the
sacs are rarely emptied, the fluid builds up,
solidifies, and becomes an ideal environment in
which bacteria can grow.
The archaic anal sacs are an organ of the past and
have no purpose in modern pets. The anal sacs
are paired organs located beneath the skin and
anal sphincter muscles at about the five and
seven o'clock positions surrounding the rectum
(See the first image below). Tiny ducts lead to
the tissue just inside the rectum. The secretion
that comes from these glands is brown in colour and about the consistency of water or oil.
The secretion has a very disagreeable odour to humans. As the pet defecates, the anal
sphincter squeezes the sacs against the hard passing faeces and causes the anal secretion to
discharge onto the faecal mass. In olden times, this was used to mark a unique scent on the
BM. It was like a sign-post used to communicate with the other dogs and cats.
Function
The only known function of the anal glands is to produce small amounts of secretions,
ranging in colour from yellow brown to gray. The fluid is watery to pasty in consistency. It is
thought that these secretions are used as a way to mark territory and identify the dog to other
dogs. The secretions from these glands are very pungent and may also be expressed when the
animal is frightened or alarmed.
They also play a role in defence in skunks and stripe-necked mongooses.

AFFECTIONS OF ANAL GLANDS

Although the specific cause of anal sac disease is unknown, prolonged retention of secretions
(i.e., impaction) in the sacs may be the initiating factor. Cats rarely have impacted anal sacs,
suggesting that the sebaceous secretions in cats may provide enough lubrication to prevent
impaction. In dogs, secondary bacterial infection leads to sacculitis and abscessation in many
cases. Contributing factors include diarrhoea, glandular hyper secretion, and poor muscle
tone of the anal sphincter in small and obese dogs.

Incidence
Common disorders of dogs ( affecting almost 12% ) but is rarely diagnosed in cats.
Most commonly seen in breed dogs. But other may also suffer.
There is no age or sex predisposition to anal sac pathology. Uncommon in large breeds,
infections and impactions are often experienced by small breeds such as Toy and Miniature
Poodles, Chihuahuas, and Lhasa Apsos. Cocker Spaniels, Basset Hounds, and Beagles rank
high on the list of breeds affected by anal sac difficulties.
Many dogs never develop problems with these glands, and most people are unaware of their
presence. In a some dogs, anal gland impactions, infections, abscesses, ruptures and tumours
occur. Diseases of the anal glands vary in severity in the signs they produce. Common
symptoms of anal gland disease include
"scooting" (dragging the rear end across the
floor), a foul odour near the anus, and pain,
licking or biting at the rectal area.

Anal gland impactions are the most common

disorder associated with the anal glands in
dogs. For unknown reasons, the fluid
produced in the glands becomes too thick to
be expressed naturally through the opening
of the ducts into the anus. The fluid
continues to be produced, resulting in an
enlargement of the gland, secondary
irritation, and possibly infection.

Anal gland infections are typically bacterial

infections that cause local irritation and
inflammation. Abscesses develop when an
infection worsens and a significant
accumulation of pus occurs within the anal
gland. The anal gland may be impacted at the
same time. The abscess may continue to enlarge until it ruptures through the skin, causing a
small draining hole to develop near the anus. Pus may drain from this small hole.

Anal gland tumors in the dog are often malignant and are classified as adenocarcinomas.
Sometimes anal gland tumors result in elevated blood calcium levels, which can cause
significant organ damage, including kidney failure.
Thus there are mainly four forms of affections of anal glands and symptoms are almost
similar in all the cases
1. Impaction
2. Infection / Sacculitis
3. Abscess formation
4. Neoplasia
Anal Sac Impaction
Impaction is the accumulation of pasty secretions in the anal sacs. The sacs become distended
and mildly tender. The expressed secretions are thick and dark brown or grayish brown. The
sacs become impacted when they don't empty completely. This may be due to insufficient
pressure on the sacs during defecation because of small, soft stools; inadequate sphincter
pressure; or blockage of the openings by thick, dry secretions. Impactions tend to occur most
often in small-breed dogs and in overweight dogs.
Treatment: Impaction is treated by manually expressing the secretions. Dogs with recurrent
anal sac impactions should have their sacs emptied at regular intervals. Place the dog on a
high-fiber diet or a bulk laxative to increase the size of the stools .

Sacculitis (Anal Sac Infection)

Anal sac infection complicates impaction. Infection is recognized by a painful swelling on
one or both sides of the anus. The anal secretions are thin, yellowish, or blood-tinged. The
dog will scoot, lick, and bite at his rear.
Treatment: Begin by expressing the anal sacs. Repeat in one to two weeks. For recurrent
infection, empty the sacs weekly. After emptying, an antibiotic is instilled into the sacs. This
procedure should be done by your veterinarian.
Dogs with recurrent anal sac infections should have their anal sacs surgically removed. This
is best done during a period between infections.

Anal Sac Abscess

Abscess is recognized by fever and the signs of anal sac infection. The swelling, usually on
one side, is red at first, then later turns a deep purple. Unlike anal sac infection, the swelling
of an abscess cannot be reduced by emptying the sac. An abscess often ruptures through the
adjacent skin, producing a draining tract.
Treatment: If the abscess has not ruptured spontaneously, it should be lanced by your
veterinarian when it becomes soft and fluid like. The cavity is flushed repeatedly and the dog
is placed on an oral antibiotic. Your veterinarian may ask you to flush the cavity twice a day
with a topical antiseptic such as dilute Betadine solution for one to two weeks, and apply
warm compresses to the area

Anal Sac neoplasia

Anal sacs can become impacted and even develop abscesses or tumours. Tumours are most
often observed in non-neutered males. The tumours can either be a benign adenoma or a
malignant adenocarcinoma.
Clinical Signs: Tumours may form in the glands around the animal's hind end (anus). The
perianal gland tumour is a neoplasm that arises from modified sebaceous glands around the
anus in dogs (perianal glands do not exist in felines). These tumours can range from harmless
(benign adenomas) to malignant (adenocarcinomas). To determine which type of tumour
exists, have your dog seen by a veterinarian immediately.
Diagnosis: If a tumour exists in the anus, groin or tail have your animal seen by a veterinarian
immediately. Adenomas (benign tumors) are more common than adenocarinomas. Tumours
are 10 times more likely to be seen in intact males than neutered males or intact or spayed
females. The most commonly affected breeds for adenocarcinomas are Siberian Husky,
Cocker Spaniel, Pekingese and Samoyed. Adenomas and adenocarcinomas look similar in
that they are both
round, pink and usually less than 3 cm in width. Both types of tumors should be removed and
sent to a pathologist for identification.
Treatment: Tumours should be removed and sent to a pathologist to determine whether they
are a benign adenoma or malignant adenocarcinoma. Intact male dogs with adenomas should
be neutered to prevent recurrence of the adenoma. Dogs with adenocarcinomas should be
treated with aggressive surgery, radiation therapy and chemotherapy if necessary. Aggressive
surgery when adenocarcinomas are present is warranted because the metastatic potential of
these tumors to spread to lymph nodes.

Etiopahtogenesis of anal sac diseases

The specific cause of anal sac disease is unknown, but the possible predisposing factors may
be
1. Change in character of the glandular secretions
2. Chronically soft faeces or a recent bout of diarrhoea
3. Abnormal bowel elimination failing to empty the sacs
4. Hypersecretion associated with generalized seborrhoea
5. Poor muscular tone in small or obessed dogs
6. Less intake of dietary fiber and reduced exercise
7. enough oil secreted by the skin.

Clinical signs
Symptoms of anal sac disease are:

1) Scooting or dragging the anal area.

2) Excessive licking under the tail.
3) Pain, sometimes severe, near the tail or anus.
4) A swollen area on either side of the anus.
5) Bloody or sticky drainage on either side of the anus.
6) Prolonged and painful defecation
7) Pain/ discomfort in sitting.
8) tail chasing

In dogs with chronic anal sac problems other clinical signs have been noted as
1. skin irritation of the abdomen, groin and axilla
2. otitis externa
3. periorbital dermatitis
4. areas of alopecia due to self trauma

Diagnosis
Proper diagnosis is required in the case of anal sac disease in cats, so as to rule out other
diseases with similar symptoms and to determine the type of anal sac disease. very essential
to determine the degree of involvement and duct patency. During rectal examination the sacs
can be expressed atraumatically and their contents are examined. In a 17 kg dog, the normal
volume is about 0.25 to 0.5 ml and the content should be almost clear and pale yello to
brown.
The diagnostic procedure includes:
 Medical history: A complete medical history is required in order to determine health
issues such as loss of appetite, weight loss, drinking and urination habits, defecation
problems. Pain and other symptoms such as scooting or licking.
  Physical examination: The anal area is physically examined by the vet to look for any
abnormalities such as inflammation, presence of abscess or pus, and the quality of
secretions.
 Blood tests: Complete blood count is recommended in case of an underlying infection.
Serum chemistry panel can be recommended in case a tumor is present.
 X-rays: The tumours of the anal sac disease can spread to the lungs, lymph nodes and
affect parts like the abdominal area. X-rays may be recommended by the vet to look for
any signs of spreading cancer in the body.
 Ultrasounds: Due to defecation issues, the flow of faeces can be blocked creating a
number of abdominal problems. An abdominal ultra sound can be done to look for
abnormal functioning of the digestive system.

Differential diagonosis
1. Fled allergy
2. Perianal tumour
3. Perianal fistula
4. Tail fold pyoderma
5. Perianal hernia
6. Perianal neoplasia
7. Atresia ani
8. Rectal pythiosis
9. Vaginal tumors etc.

1. Treatment for anal sac disease may include the following:

 Manual expression (squeezing) of the sac contents.
(temporary relief) Expressing your dog's anal glands
is relatively easy. Use one hand to hold up the dog’s
tail and pull it gently toward the head. Hold a
disposable cloth or tissue in the other hand. Place
your thumb externally over one anal gland and your
fingers over the other (see the diagram below for
correct position). Press in and apply firm pressure as
you pull your fingers posteriorly over the glands. The glands should empty out into
your tissue.
 Flushing the sacs and instilling antibiotics into them. (longer remedy to symptoms)
 Surgical drainage or removal of the sacs. (This treatment is usually performed if the
patient has a chronic history or the sacs have ruptured. Healing can be slow though
because of the location.)
 Medication must be given as directed.

 Diet: A higher fibre diet can in some cases help slow impaction but check with your
vet for your specific pet's nutritional needs.
Notify your Veterinarian if Any of the Following Occur:

SURGICAL TREATMENT of affections of anal sacs

Failure of medical therapy and suspicion of neoplasia are indications for anal sacculecotmy/
anal sac ablation. If a draining tract persists after anal sac rupture , surgery should be delayed
until inflammation is controlled. Both anal sacs should be remoced even if only one is
obviously involved , to avoid a second surgery. Either an open or closed technique may be
used. However, open technique carries a greater chance of fecal incontinence and local
infection.

Preoperative management
Anal sacculitis , abscessation should be treated for several days as described above to reduce
inflammation before surgery. Inflammation and
fibrosis present at the time of surgery increase the risk
of damage to the anal sphincter . temporary or
permanent fecal intontinence may result secondary to
sphincter damage.

Site of operation
- Perianal region at anal sac orifice i.e just
interior to the anal opening

Control and anaesthesia

- Dorsoventral recumbency
- Standard protocol for anaesthesia

Positioning
- Positioning the patient in ventral recumbency with the tail fixed dorsally over the
back. Elevate the pelvis and pad the hindlegs when using a perineal positioning.

Surgical techniques
Palpate the anal sacs to determine their location and extent by placing the index or middle
finger in the rectum and the thumb over the sacs. Manually evacuate the faeces from the
rectum if present. Prepare the perianal area for surgery.

Closed techniques
 Insert a small probe haemostat or balloon tip catheter into
the orifice at he anal sac duct. Advance the instrument or

inflate the ballon with saline until lateral extent of the sac Infusing the left anal sac with
paraffin in order to facilitate
is identified. location and removal of the sac.

 As an alternative, wax or synthetic resin may

be infused to distend the sac before resection.
 Make a curvilinear incision over the anal sac.
Bisecting directly against the anal sac.
Separate the internal and external anal
sphincter muscle fibers from the sacs exterior
with small metezenbaum or iris scissors.
 Avoid excising or traumatizing the muscles
or the caudal rectal artery medial to the duct
 Continue dissecting to freeze the anal sac and
duct to its mucocutaneous junction at he anal
canal. Closed techniques for anal sacculectomy
 Perforation of the sac may occur during
A. Insert a small probe into the anal sac
B. Make an incision at the lateral aspect of
the anal sac and carefully dissect the sac
from the sphincter m/s fibers.
C. Ligate the duct near the orifice.
 dissection and tissues ma be contaminated with secretions. Place a ligature around the
duct at the mucocutaneous junction using 4-0 polydioxanone polyglyconate. Excise
the anal sac and duct then inspect for completeness of removal
 Control haemorrhage with ligatures, electrocoagulation or pressure. Lavage the
tissues thoroughly. Appose subcutaneous tissues with interrupted sutures of 4-0
polydioxanone, polyglyconate and appose the skin with nylon or polypropylene.

Open technique
 Place the scissor blade or groove
director into the duct of the anal sac
 Apply medial traction on the duct
while incising through the skin,
subcutaneous tissue, external anal
sphincter duct and sac.
 Continue the incision to the lateral
extent of the anal sac
 Elevate the cut edge of the sac and use
small metzonbaum or iris scissors to
dissect the sac free of its
open technique for sacculectomy
attachments to muscle and
surrounding tissue. A. Insert the balde of the scissors into the sac and incise through
 Complete the procedure as for the skin, subcutaneous tissues, external anal sphincter and
anal sac
closed sacculectomy.
B. Elevate the cut edge of the sac and dissect it formthe anal
sphincter
C. Appose the sphincter, s/c tissues and skin.

Locating and isolating the sac. With minimal bleeding and little A view of the resected anal sacs...
Careful dissection of the sac is trauma to the anal sphincter
imperative to preserve anal muscle, an excellent outcome is
sphincter muscle. expected.

Postoperative care and management

 Systemic analgesics should be given
 Perianal area should be kept clean and Elizabethan collar or other restraining devices
should be used
 A stool softner may be added to the food for 2 to 3 weeks
 The surgical site should be monitored for signs of infection or drainage and the
rectum and perianal area should be palpated for the evidence of stricture when sutures
are removed at 7 to 10 days. Faecal continence may be impaired during the healing
process but usually returns to normal within several weeks.
Complications
 A drainage tract after surgery suggestes that a piece of anal sac was left at the surgical
site. This occur more commonly with inexperienced surgeons or inflamed and fibrotic
tissues. Surgical excision is needed.
 Other complications are infection, dehiscence , tenesmus, rectal prolapsed, dyschezia,
haematochezia, permanent incontinence and anal stricture.

Conclusion
Anal sac diseases are not well understood and very little scientific work has been done. This
is surprising as it is often suggested that anal sac problems are relatively common. It is
misnomer to refer to these conditions as anal gland disorders and the true anal glands are not
associated with the anal sacs. The odor of the contents may have a function in social
recognition among dogs though limited studies have shown it is not important in sexual
attraction of male dogs. They have no definitive purpose or benefit and are not necessary for
normal function or life. Abnormalities have been defined as impactions, infections,
abcessation, and neoplasia. A relationship of anal sac disease to chronic tonsillitis, cough,
pruritus and recurrent pyoderma has been anecdotally suggested in the past.
The prognosis of neoplastic anal sac disease is good if it is not associated with perianal
fistulae. Though most of the cases of anal saculitis can be treated medically, chronic cases
need the surgical intercentation. Though anal sac diseases are not found in other animals. It is
common dog followed by cat. Proper medical care can prevent this condition.
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