The rearing of buffaloes is unique in many ways compared to cattle in many aspects of animal health. The reproductive performance of buffalo is poor due to various diseases of the reproductive system, including delayed puberty, long calving interval, genital prolapse. Prepartum vaginal prolapse is one of the major reproductive disorders in buffaloes.
A five-year-old, 8 months pregnant Mehsani buffalo was suffering from recurrent pre-partum vaginal prolapse since 6 months of her pregnancy, which did not respond to conventional line of treatment. Even with rope truss method the animal was straining while urinating and defecation.
In such condition, clinicians should also look into the possibility of urinary bladder involvement and if left untreated results in delay in recovery due to persistent straining originating from irritation in vagina, urethra and urinary bladder.
The animal was treated with homoeopathic formulation “Prolapse Cure”, 2ml orally twice a day with syringe for 15 days and no recurrence or straining was observed during the course of treatment and continuing till parturition.
Hence it can be concluded that homoeopathic treatment with “Prolapse Cure” was very effective in this instance. It is non-invasive, non-antibiotic, non-hormonal, and easy to administrative and was a less expensive method in this instance, for successful treatment of pre-partum vaginal prolapsed in this buffalo.
“Prolapse Cure” is a homoeopathic formulation of (Lilium tigrinum 200 CH 20%W/V, Podophyllum peltatum 200 CH 20%W/V, Atropa belladonna 1M 20 %W/V, Aloes socotrina 30 CH 20%W/V, Murax purpurea 30 CH 20%W/V, Ashoka Homoeopathic Lab, Hisar, India
Keywords: Buffalo, Pre-partum, Vaginal prolapse, Vaginitis, Cystitis
Buffaloes are unique in many ways compared to cattle in many aspects of animal health (Azawi, 2010). The reproductive performance in buffalo is poor due to various diseases of the reproductive system, including genital prolapse (Rao and Sreemannarayana, 1983; Akhtar et al., 2012).
Prepartum vaginal prolapse is one of the major reproductive disorders in buffaloes (Azawi, 2010). It mostly occurs in the seventh month of pregnancy or later immediately after parturition (Sah and Nakao, 2003). Etiologic factors of prepartum vaginal prolapse in buffaloes may be attributed to nutritional imbalance (Kelkar et al., 1989; Ahmed et al., 2005), hormonal imbalance (Roberts, 1971; Sharma et al., 1977; Arthur et al., 1989; Galhotra et al., 1991; Tyagi et al., 2002), seasonal-managemental factors (Mishra et al., 1998; Gurcharan et al., 2003; Akhtar et al., 2010) and hereditary predisposition (Nanda and Sharma, 1982).
The hormonal changes that occur during this last trimester of pregnancy, especially the increase of estrogen and the production of relaxin, cause a relaxation of the pelvic ligaments and surrounding soft tissue structures (Wolfe, 2009).
Chronic vaginal prolapse is mostly associated with tenesmus resulting from constant irritating condition i.e. cervicitis, vaginitis, traumatic wounds on vagina and vulva (Nayak and Samantara, 2010). In managing cervico-vaginal prolapse various surgical or nonsurgical techniques (Kumar, 2015) and medicines (Dhillon et al., 2006) have been practiced with varying degrees of result.
Pre partum vaginal prolapse often terminate in uterine prolapse post-partum resulting from the influence of parturition. The present communication has been placed to record a successful treatment of recurrent pre-partum vaginal prolapse which complicated into vaginitis and cystitis in a mehsani pregnant buffalo using homoeopathic formulation “Prolapse Cure”.
CASE HISTORY AND CLINICAL OBSERVATIONS
A Mehsani buffalo aged about 5 years and in the eight month of gestation was reported initially with the problem of intermittent prolapse of the vagina since 6 months of her pregnancy. Initially, according to history, the problem was intermittent with protrusion of the vagina between the vulvar lips when the animal was lying down or while on recumbency (Figure-1).
In due course of time it became aggravated and the vagina prolapsed even on standing (Figure-2). The buffalo had already been treated with calcium borogluconate, antibiotics, and progesterone injections with application of shoe lace vulvar suture for several occasions in last two months but all regimens failed to prevent recurrence with each of episodes of treatments.
The owner also reported that with advancement of pregnancy the degree of prolapse was increasing along with the increased straining of the buffalo. The buffalo exhibited discomfort with frequent attempts to urinate. Clinical examination revealed swollen, oedematous and congested vaginal mucosa with some lacerations.
The temperature recorded was 102.0° C. Considering the not responding history to any conventional treatment and on the basis of present findings treatment with homoeopathic formulation “Prolapse Cure” was given for management of the recurrence of the protrusion of the vagina in this present case.
TREATMENTS AND DISCUSSION
During the first indication of low grade vaginal prolapsed, the buffalo was restrained with the help of two attendants (Figure-3). The prolapsed mass was first cleaned and washed with potassium permanganate (1:1000) solution. Prolapse mass should be lifted in order to allow urination, as during prolapse urethra remains at an acute angle that prevents urination.
Therefore lifting the prolapsed mass leads to straightening of urethra which allows urination, resulting in additional comfort to animal and reduced straining. Reduction of prolapsed mass can be achieved by using hypertonic solutions i.e. aerosol sprays or by using no-irritant hygroscopic powders or by use of cold fomentation (dry ice or chilling cold water).
Thereafter, the prolapsed mass was manually repositioned by gentle pushing with fisted hand simultaneously elevating the mass with the palm of other hand. Prevention of recurrence was achieved with the application of rope truss technique following standard operational procedure described by Kumar (2015) with a 3 mm diameter sized jute rope (Figure-4).
Only a rope truss was applied for physical immobilization around the vulva. Lakde et al., (2014) stated the rope truss was very effective, safe, non-invasive and easy method for retention of ante-partum cervico-vaginal prolapse. The buffalo was then administered with Melonex plus® Injection (meloxicam 5 mg and paracetamol 150 mg per ml, Intas Pharmaceuticals®) as anti-pyretic and analgesic 20 ml daily by IM route for 3 days. Dicrysticin-S LD Injection (Procaine Penicillin G, Penicillin G Sodium, Streptomycin Sulphate IP, Zydus AH Division of Cadila Healthcare, Ahmedabad , Gujarat – India) 5 gm given as systemic antibiotic once daily by IM route for 5 days. Injectiphos Injection (Butaphosphan and Cynocobalamine, Zydus AH Division of Cadila Healthcare, Ahmedabad , Gujarat – India) 15ml once a day by IM route for 2 days and Tinacal Injection ( Calcium, Vitamin D3 & Vitamin B12, Tineta Pharma Pvt. Ltd. , Mumbai, Maharashtra, India) 15ml once a day by IM route for 2 days.
Calcium and phosphorus was supplemented on the assumption that hypocalcium may be one factor for the prolapse. Hypocalcaemia results in myometrial fatigue and delays cervical involution (Murphy and Dobson, 2002). Sood et al. (2011) also reported use of strepto-penicllin, meloxicam and calcium borogluconate for managing postpartum complications in buffalo.
Hydroxyprogesterone (Duraprogen® Vetcare®) Injection 2 ml (0.50 gm) IM at 7 days interval for 2 occasions. A decrease in progesterone concentrations has been reported (Zicarelli, 2000) in buffaloes suffering with vaginal prolapse. Wolfe (2009) reported that the vaginal or cervico-vaginal prolapse most commonly occur in the last trimester of pregnancy when placental estrogen production increases.
The enhanced estrogen production induces relaxin production leading to relaxation of the pelvic ligaments and adjacent structures, ultimately resulting in edema and relaxation of the vulva and vulvar sphincter muscles. Some cow and buffaloes developed greater relaxation of the pelvic structures near term and with increased abdominal pressure, the loosely attached vagina and the bladder get everted through the vulva.
Several predisposing factors responsible for vaginal prolapse can be listed as, atony due to hypocalcaemia, open cervix, slack pelvic ligament and abdominal straining. Successful progesterone therapy in pre-partum vaginal prolapse in buffaloes (Sah and Nakao, 2003) and cattle (Bhattacharyya et al., 2012) has been reported indicative of the role of low serum progesterone concentrations in causing pre-partum vaginal prolapse.
There was appreciable improvement initially with decrease in straining and vaginal prolapse. After 18 days of treatment prolapse recurred with higher grade, showing prolapse of the vagina even when animal was in standing position and straining was moderate (Figure-5).
Higher incidence of genital prolapse was also observed in buffaloes having more than 8 months of gestation by Patidar et al. (2010). High incidence (around 43%) of prolapse has been reported in buffaloes (Samad et al., 1987). However, again straining was observed while urinating and the animal tended to remain in urinating posture for some time after urination (Figure-6).
Straining was suspected to result from infection of the urethra and vagina resulting from contamination of the prolapsed mass at the time of vaginal prolapsed. Suspecting the possibility of urinary tract infection based on results of urine examination and clinical symptoms, the buffalo was treated with Gentamicin Injection @ 5mg/kg bwt 12 hours interval was also administered by IM route daily for 3 days.
Homoeopathic formulation “Prolapse Cure” (1) administered (2ml twice a day with help of syringe in mouth for 15 days. The buffalo responded well to this treatment and straining decreased after 3 days of treatment with proper urine flow was observed (Figure-7).
There was also improvement in the feed intake of the animal, no straining and vaginal prolapse. Rope truss was applied for physical immobilization around the vulva which was removed after 3 days of treatment. Treatment of homoeopathic formulation “Prolapse Cure” 2ml twice a day with help of syringe in mouth continues and no other treatment was provided due to buffalo nearing expected date of delivery. The buffalo gave birth to female male calf. Parturition was normal and non-eventful except for slight manual assistance provided for removal of the calf.
The results of present case trial show excellent recovery in the management of pre-partum vaginal prolapsed in Mehsani buffalo. Homoeopathic complexes have commercially popular in European countries. In India, some preliminary trials using homoeopathic combination remedies in the treatment of dairy animals have been reported with promising results.
Average total cost of therapy was significantly lower with the homoeopathic formulation “Prolapse Cure” than with allopathic treatment. Further, animal treated with homoeopathy easy to administer and did not have the problem of residue in animal products, as is the case with allopathic treated animals.
Economic pressure on dairy farms caused by the inability to market milk during “withdrawal period” following allopathic treatment and ban on prophylactic antibiotic treatments under organic farming standards have also contributed to search for alternatives. Although often progressive farmers as well as veterinarians are increasing interest to use alternate therapy in organic farming system and homoeopathy has become one of the preferred alternative methods.
Hence it can be concluded that homoeopathic treatment with “Prolapse Cure” was, in this instance, very effective, non-invasive, non-antibiotic, non-hormonal, easy to administrative and less expensive method for successful treatment of pre-partum vaginal prolapsed in this buffalo without any complications and difficulties at parturition.
The authors acknowledge the support of Ashoka Homoeopathic Lab, Hisar, India in the form of supplying homoeopathic formulation “Prolapse Cure” is gratefully acknowledged.
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Fig 1 Prolapse while on sitting or recumbancy position
Fig 2 Prolapse while on standing position
Fig 3 Correction of prolapsed mass manually
Fig 4 Application of Rope Truss technique
Fig 5 Re occurrence of prolapsed with straining
Fig 6 Urinating posture after urination
Fig 7 Proper urine flow without straining
91) Prolapse Cure : Lilium tigrinum 200 CH 20%W/V, Podophyllum peltatum 200 CH 20%W/V, Atropa belladonna 1M 20 %W/V, Aloes socotrina 30 CH 20%W/V, Murax purpurea 30 CH 20%W/V, Ashoka Homoeopathic Lab, Hisar, India)