A perineal laceration refers to an injury to the perineum, the area between the vulva (the externally visible female reproductive organs) and the anus. It is one of the most common birth injuries in mares. A perineal laceration should always be treated surgically, unless it is very small.
A perineal tear can be incomplete or complete; incomplete tears are more common.
Incomplete perineal tears are defined as tears in the upper vulvar angle extending into the perineum. However, the anal ring and the rectum remain intact.
In a complete perineal tear, the entire perineum—from the vestibule of the vagina to the rectum, including the anal sphincter—is severed. This results in a common opening for the rectum and vagina. Consequently, the vagina is constantly contaminated with feces, leading to associated inflammation.
Perineal lacerations in mares usually occur during the birth of foals with abnormal positioning, such as foot-neck presentation or a twisted head. During strong contractions, the foal’s limbs or head can then perforate the vaginal vault, extending into the rectum. However, perineal lacerations can also occur independently of postural abnormalities. This can happen when there is insufficient stretching of the birth canal combined with strong contractions. Human assistance during birth that is provided too early or with excessive force can also lead to a perineal laceration.
In addition to visible injuries, affected mares often exhibit moderate to severe impairment of their general well-being. However, it is usually impossible to determine to what extent this is due to the stress of a difficult birth or to the birth injury itself.
As part of the postpartum examination, your veterinarian can make this diagnosis easily through a simple visual examination. By spreading the vulva and palpating the area, he or she can determine the extent of the injury.
In the case of a fresh perineal tear, your veterinarian will first clean the wound. If your mare’s general condition is significantly impaired, she will be given fluids via a continuous IV drip. She will also be given antibiotics and pain medication over several days. To prevent the development of a purulent uterine infection caused by ascending bacteria, your veterinarian will perform additional uterine flushing. If your mare does not have adequate or clear tetanus protection, she will also receive a tetanus vaccination (see the corresponding article).
Incomplete perineal lacerations can heal on their own by scarring over. However, once they reach a certain size, this can result in a permanent incomplete closure of the vulva, allowing air to be heard entering. In addition, this makes it easier for germs to ascend into the genital tract and cause inflammation—in the worst case, leading to purulent uterine infections. For this reason, surgical treatment is recommended even for incomplete perineal lacerations. Complete perineal lacerations must always be treated surgically.
Incomplete perineal tears can be sutured either immediately—that is, within a maximum of six hours after they occur—or after scar formation, meaning five weeks or more after delivery. Surgery for a complete perineal laceration can also be performed immediately, which allows for better restoration of the anal sphincter. However, the sutures often tear due to hard fecal balls, making it necessary to feed the mare a laxative diet and fast her before and after the surgical procedure. To avoid this metabolic strain on the lactating mare, the procedure is often performed only after the wound inflammation has completely subsided. This typically occurs approximately two months after birth. Alternatively, it is also possible to wait until the foal is weaned.
The surgery is usually performed on the horse while standing under medicated pain relief, but it can also be performed under general anesthesia with the horse in a supine position. In cases of previously scarred injuries, your veterinarian will first re-expose fresh wound surfaces. The wound is then closed—depending on its depth—with a single suture or in three layers. Particularly large perineal lacerations may initially be sutured only internally and then fully closed after one month.
To keep the tail hairs away from the wound, the tail should be wrapped in a bandage for the first few days after the surgery. Your mare will also be given antibiotics and pain medication. The stitches are removed ten to twelve days after the surgery.
The prognosis for recovery is generally good following surgical treatment, and your mare can continue to be used for breeding. However, even with the most careful approach, wound infections can occur, some of which lead to the rupture of sutures.
In cases of complete perineal lacerations, suturing the anal sphincter may result in permanent, uncontrolled leakage of small amounts of feces and air-sucking.
Proper monitoring of the birth and, if necessary, proper assistance during delivery can minimize the risk of a perineal tear. If complications or delays occur during birth, call your veterinarian immediately. Among other things, the veterinarian will check the foal’s position. If the foal’s hooves threaten to drift upward, your veterinarian will gently push them downward.
If manual assistance is needed, pull only in sync with your mare’s contractions and not too hard. The pull must also always be directed straight down toward the mare’s hocks and never upward or straight backward.
This article is for informational purposes only and does not replace veterinary advice. Please contact your veterinary practice directly.
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Many pet owners start by comparing the monthly premium when looking at pet health insurance. 30 euros or 45 euros? Zero euros or a 250-euro deductible? 80 percent or 100 percent coverage? These questions are important, but they are by no means the deciding factor in whether a pet health insurance plan will actually cover the costs in an emergency. After all, two plans can both advertise “100 percent coverage” and still differ in their benefits—differences that could amount to several thousand euros down the line. That’s exactly why it’s worth taking a close look at the fine print. In this article, we’ll show you ten benefits that many pet owners overlook when signing up, but which can make a huge difference in an emergency.
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