Scoot on over to this episode of ‘Your Vet Wants You to Know,’ with returning guest, veterinary dermatologist Dr. Meagan Painter, as she helps explain common anal sac problems in dogs and why dogs scoot. Sharing the tale of Sadie the Vizsla, Dr. Painter and Dr. Lancellotti explore the mysterious and often messy reasons behind why dogs scoot, lick their butts, and leak that awful fishy smell. Armed with wit and wisdom, they reveal how an innovative infusion procedure can transform tails from troublesome to terrific. Tune in to learn how bulking up poop and banishing butt bother can make everyone happier at home. Plus, discover the surprising link to allergies and the collaborative magic between vets and pet parents that makes tails wag everywhere!
Table of Contents
Introducing Dr. Megan Painter
[00:01:04] Dr. Lancellotti: Welcome, everyone, to today’s episode of Your Vet Wants You To Know. Today, I am delighted to welcome back Dr. Megan Painter. She is a board certified veterinary dermatologist practicing in Waltham, Massachusetts at Angell-West. This is a world renowned hospital in Boston, and practicing outside of Boston as well. And she is one of my very dear friends. She’s appeared on other great episodes of the show, like Diet Trials and Ear Infections, some of my absolute favorite and most helpful episodes. I am so happy to welcome her back, today, to talk about itchy, irritated butts. Thank you for joining us, Dr. Painter.
[00:01:46] Dr. Painter: Oh, the pleasure is mine. I’m thrilled to be here, and a huge supporter of this very important podcast as a trusted resource for pet owners.
[00:01:55] Dr. Lancellotti: And I’m excited about this particular topic. Not only are you going to be telling pet owners all about this, you’re also going to be talking to our veterinary colleagues, when you join me for the Muller-Ihrke-Kwochka Veterinary Dermatology Seminar in Hawaii in October of 2024. I’m very excited to have you (and Dr. Alicia Webb Milam) join me for that great event.
[00:02:17] Dr. Painter: I think we’re going to have a good time. I’m pretty certain of that. It’s the biggest event on my calendar for 2024, that’s for sure.
[00:02:25] Dr. Lancellotti: Yeah. It should be really fun. So if you are a veterinary professional, and you want to learn more about this topic, that’s a great opportunity for you to get some more in-depth information. But for pet owners, we’re going to be talking all about what you need to know today.
The Story of Scooting Sadie
Dr. Lancellotti: Dr. Painter, do you have a specific story of a pet that has dealt with some anal gland or anal sac issues?
[00:02:49] Dr. Painter: I have more stories than I could tell you, but I will share one, in particular. Full disclosure- anal glands weren’t really on my radar for a long time. Even as a dermatologist, I knew that pets had issues, that they were scooting a lot, that they had frequent expression, and that it was a troublesome spot for a lot of our patients. But I never really knew what to do about it. To be honest, I just ignored it, or just said, “Yep, keep getting them expressed,” and had this kind of approach that it wasn’t something I necessarily needed to help them with. Then, a general practitioner actually helped me learn a little bit more about a specific procedure to help reduce inflammation within these glands, and it started to change the lives of my patients very dramatically.
One of those patients is named Sadie. She was a Vizsla who was about 4.5-5 years old, and she really wasn’t a very allergic dog, overall, but she had a very significant issue with her anal glands where they were pretty much leaking all of the time. They had been for months, maybe even up to a year. She was leaking on literally everything in their house. Not only that, she was very uncomfortable, scooting a lot, licking her bum all of the time. She was very bothered by this and just couldn’t ever really get comfortable. And she had floated through with the general treatments (gland decks, fiber diets, etc) expression all the time, through the groomer and the vet. Nothing was really ever helping her get through it and resolve the problem. It was always just small management things that would maybe buy her a few days or a week or two of relief.
Then, she came to see me. And because of the work I had done with another colleague, and being open minded to some new ways of practicing, I said, “Yeah, let’s get this dog through and have an infusion,” which is a procedure that we’ll talk about today. Her life immediately became better, and she continues to live a life without a problem with her bum. And who doesn’t want that? So, Sadie’s a thankful patient, and there are many others like her.
[00:05:07] Dr. Lancellotti: Yeah, that’s great. I know this is something that can certainly bother the pets, but also bothers the owners, as well. It’s a gross thing for dogs to do- lick their butts and scoot and chew- and it’s upsetting for everybody in the household. I’m excited to dive into this a little bit more, to give pet owners a better understanding of the options out there in relieving this issue.
What Are Anal Glands?
Dr. Lancellotti: Our listeners might be familiar with the term anal glands. Can you take a moment and explain a little bit of the back-end anatomy, to help people better understand our discussion of the diseases that can affect that area?
[00:05:43] Dr. Painter: Totally. The first thing that is really important is that pet owners shouldn’t know that their dog has anal glands. These are little things on the inside, so if you know about them, it’s probably because your dog has a problem. And that’s important to know. You don’t need to do anything for the glands. This is just a normal piece of anatomy. But if you have an allergic dog that has some issue with their butt, and now you’re all of a sudden talking about anal glands all the time, maybe we should look into that further.
So when people are like, “what are the anal glands?” I’m telling them “you don’t even need to know.” This isn’t necessary for general pet owner discourse, but if it becomes a problem, then you’re going to become experts listening to podcasts about anal glands. And you probably thought, “Oh gee, I didn’t think I’d be doing that.” So depending on the size of the dog, these little glands are about the size of a blueberry or maybe a grape. Technically, it’s a sack which contains glands, and the glands produce a bunch of fluid. These are normal secretions of skin cells and some sebum, smelly stuff, etc. There can be bacteria in there too, and that’s all normal flora. Don’t forget, this is around the butt, so this is an area that isn’t really truly infected ever.
We can see impactions and sometimes abscesses, and that’s a different story, but in general, the fluid that’s in the gland is going to contain all sorts of stuff- mostly secretions, plus or minus some bacteria. And this, we think, serves some sort of marking purpose. Why are these glands there? Nobody wants them to begin with. But it’s some sort of evolutionary something. And again, they really shouldn’t become a factor in your dog’s life until they might become inflamed, impacted, or abscessed- which is when we start to see clinical disease associated with these glands. They’re located at 4 o’clock and 8 o’clock, if you’re looking at the butt as a clock face, they’re in the right lower and left lower quadrants.
[00:07:56] Dr. Lancellotti: I think that’s a great description. I love that you explained that pet owners should not need to know what these are, and that’s absolutely right. I have dogs that have never had to have their anal sacs expressed, and the reason is that when dogs poop, they’re expressing those anal sacs on their own. That poop passing through just puts enough pressure that those secretions come out with the poop and take care of themselves. It’s only when they have a problem or disease that we start to see that they need that extra care.
Why Is My Dog Scooting?
Dr. Lancellotti: If there is a disease, what might pet owners notice at home, if their pet has a problem with those anal sacs? What are some of the behaviors that a pet could experience, to tell their pet owner that their butt’s itchy or irritated?
[00:08:41] Dr. Painter: Great question. So what’s interesting is that we can see cancers associated with these glands, as well. In this conversation, it’s important to know that what we’re talking about isn’t that. We’re not talking about the adenocarcinoma that can affect an anal gland. That’s a very important issue that your vet might bring up to you. What we’re talking about is inflammation of these glands. And when these glands are inflamed, they’re often itchy. So what dogs will express and (no pun intended) what they’ll show us is that they’re licking, uncomfortable, they might struggle to sit down, scoot, and they might even have that fishy smell that they emit.
Sometimes, that only happens when they’re very excited or scared by something. Typically, you’re dressed really nicely, about to go to a dinner party and your dog’s like, “Where are you going?” and then whoops, now you’ve got some anal gland mixture on your pants. This has happened to me. This is so gross, but here we are, talking about anal glands. If you’re a pet owner and you listen to this podcast, you know what I’m talking about.
If they’re leaking, that’s pretty gnarly, but that can happen, as well. Leaky glands are like loose ducts, where the duct itself is supposed to stop up that gland. When the duct is not really working, because it’s inflamed or diseased in some way, then you can have some leakage of the material that would be within that gland.
The scooting and the licking are the most common for sure, but pain, leaking, and all of those other things can occur, as well. Sometimes, we also see abscesses. Abscesses are incredible. Sometimes, the gland will rupture right through the skin. So you’ll see at that 4 or 8 o’clock region, sometimes on both sides, an irritated area that looks almost like a cellulitis- like some sort of raw skin- and that can obviously be very painful and uncomfortable for that dog.
Do Cats Have Anal Sac Problems?
Dr. Painter: Oh, and fun fact- cats have (thank God) many less problems with their anal glands, overall, than compared to dogs. But they do have them. They are present in cats and they can become inflamed, as well. But thank goodness they did not give cats this affliction when they have their allergies. Luckily, we don’t have to deal with this being a cat issue. This conversation is really about the dog and their butt.
[00:11:07] Dr. Lancellotti: Yeah. Thank goodness for that. As we know, cats basically want to do whatever they want, whenever we’re dealing with their diseases, and if they had anal sac issues, our jobs would be so much harder. So that is very much a blessing.
What is Perianal Fistula?
Dr. Lancellotti: You mentioned some really good differentials or different problems that can occur with those anal sacs- inflammation, impaction (where all that stuff gets stuck down there), and the abscesses. I think it’s important to note that there is a condition called perianal fistulas. This is something that is not as much of an inflammation, impaction, or abscess issue, as it is an autoimmune disease that we see in some very specific breeds. We’ll cover that in depth in its very own episode, down the line, but this relates to, the inflammation, impaction, and abscess issues.
[00:11:59] Dr. Painter: One thing just about fistulation- it is interesting that perianal fistula is a condition in and of itself. As you mentioned, it’s an autoimmune condition that can affect the perianal tissue. Sometimes, it can be very difficult to tell. Is it a perianal fistula autoimmune disease? Or is this anal gland so far gone that now there’s fistulous tracks in the skin? And so there can be cases (and I certainly have had them) where it’s difficult to tell them apart. If you’re a dog owner who’s really struggling with this, just know that the line can be difficult to figure out. But all of these roads lead back to a tremendous amount of inflammation, whether it’s inflammation of the perianal tissue, the anal tissue, or of the anal sac itself. It’s up to your veterinarian to figure that out, but sometimes, a specialist might need to get involved.
What Tests are Recommended for Anal Sac Disease?
Dr. Lancellotti: If we suspect that there’s a problem with the pet’s anal sacs, what are we going to do as veterinarians, in terms of recommending tests in order to figure out what’s going on?
[00:13:27] Dr. Painter: It’s a clinical diagnosis, so what we’re going to do is talk to the owner. “What are you seeing at home? How many times a day does your dog scoot?” There have been a lot of really elegant, very well done studies that look at normal dogs versus dogs with anal gland issues. Normal dogs are not scooting and licking their butt, so if your dog is going to the groomer and having their anal glands expressed, because you feel that it’s necessary to help them- again, you shouldn’t even know that they have these things.
You shouldn’t talk about expression routinely with your groomer every 3 weeks. This should be something that if you’re feeling like it’s an issue, it probably is. Your veterinarian asking you, you know, “Do you feel like your dog needs their anal glands expressed? Do you see them scooting? Do you see them licking?” That’s a big clue that they have an issue. And also, it’s very tightly associated with allergies. So I think it’s part of the general allergy workup , which obviously we talk heavily about on this podcast.
[00:14:25]Dr. Lancellotti: So really just doing a good physical exam is something that your veterinarian is going to recommend. Call them. Make that appointment. Get your pet in to be evaluated, so that we can figure out what’s happening back there. Is it just inflammation? Is there an impaction that we need to remove? Is there even an abscess that we need to address?
Treatment Options for Anal Gland Issues
Dr. Lancellotti: Once we’ve figured out if the pet has an impacted anal sac, a very inflamed anal gland, or even one that’s ruptured, what are some common treatments that we might recommend to these pets? And thinking about those different treatments, when might you recommend one over the other, in terms of benefits and risks to each treatment?
[00:15:04] Dr. Painter: Totally. A lot of veterinarians start with expression of the anal glands. Most dogs with underlying inflammation creating a problem for them are only going to have about 3-4 weeks of relief from that expression. If they have a real ongoing problem of inflammation involving their anal glands, you’re going to be requesting that in three weeks. Then, you would think about escalating the treatment plan.
So, starting with expression like, “Oh, he’s been scooting, this is weird. It’s never really happened before.” It’s totally appropriate to examine and express the anal glands, to make sure that there’s nothing physically wrong. Maybe one is extremely full and impacted, and we can relieve that impaction by manually expressing the gland- something along those lines.
But you should watch, as the pet owner, to see how long that lasts for your dog. Because then, that could alert you that this might be a bigger problem with inflammation, and that maybe it’s heavily associated with that dog’s underlying allergic disease, and we might want to do a broader workup.
Some other things that are tried are adding fiber to the diet. We think that if the stool is somewhat bulkier, then it might put a little bit more pressure on the duct, during the time and activity of defecation. In some cases, that can work. There are products available that are proprietary blends of fiber and omega three fatty acids. The most commonly known is Glandex. Some people find that this does help their pet.
But again, if you’re like, “I do the Glandex and the expressions every three weeks, and my dog is still licking or scooting all of the time,” or “I have to do this every three or four weeks,” there might be some broader considerations to look at this issue differently, and to approach it in terms of actually solving this problem versus putting little patches on the issue. And that can involve lots of different types of procedures.
Anal Sac Infusion Procedure
[00:17:08] Dr. Lancellotti: Let’s talk a little bit about those procedures. Both you and I have done these in our clinic to help with these pets that have the recurrent issues, where they’re coming in every three or four weeks, they’re getting their anal sacs expressed, and it’s really not giving them the relief that they’re looking for, even during those three or four weeks between the anal sac expressions. What’s the most common procedure that we’re going to do to relieve them of that inflammation?
[00:17:33] Dr. Painter: When we’re thinking about the pathology of this problem, why they’re scooting and licking is because the gland tissue itself and/or the duct is experiencing inflammation. Typically, inflammation is happening because there’s a larger problem of some sort of allergy, in most cases. These conditions of anal sacculitis, anal gland impaction, and even anal gland abscessation are heavily linked and tied with dogs who have underlying allergies. And so it’s important to think about both things. Where’s the inflammation coming from? If you’ve listened to my ear episodes, we talk a lot about that. Where’s the inflammation coming from? That’s what’s leading to these ear infections. If you haven’t heard those episodes and your dog struggles with ear infections, check out episodes 44 and 45.
It’s important that we think about inflammation, globally. Then, we can make sure that we’re addressing the root cause for this dog. A big part of this is that your veterinarian might recommend working up the role that food plays. Episode 17 (great one, by the way) about the diet trial– this is our diagnostic test for food allergy. Is inflammation being caused, in your dog, to lead to some anal gland sacculitis that is ultimately because of a food issue? It’s just important to have that back story. In a lot of cases, it’s not happening idiopathically. It’s happening because there’s this broader brushstroke of inflammation.
So if you have inflamed glands, what you want to do is treat that inflammation. As a pet owner, you might’ve noticed that even if you give Apoquel, Prednisone, or a medication that’s meant to treat inflammation, they’re still scooting. So what we’ve learned is that local treatment of the inflammation is, in most cases, more effective than systemic treatment.
Local treatment occurs, in this procedure, called an anal sac or anal gland infusion. The infusion procedure involves isolating the duct, threading that little duct with tiny little catheter- or something that allows you to gently and very safely go into the actual anal sac or gland- and then you infuse or put material (a fluid, typically) into the gland. This medicine is going to contain some sort of anti inflammatory, typically a steroid. Also, it will often contain some sort of antibiotic and antifungal. Doing this locally into that gland or sac is going to settle that inflammation.
Oftentimes, this is a “one and done” kind of procedure. Most vets do this under sedation. In a few studies that have been done looking at the success of this procedure, sometimes it does need to be repeated if the signs continue. And that’s not a failure. It’s just that some dogs have a lot of inflammation. But my experience has been that this is incredibly helpful, in most dogs. I would say more than 80 or 90 percent of my dogs that I’m doing this procedure on don’t need a repeated procedure, and they feel better within a day or two. It’s very dramatic, in terms of how it brings down that inflammation locally, and helps them feel better.
Can Allergies Cause Scooting in Dogs?
Dr. Painter: You also can’t have tunnel vision and forget about the broader issue of why they have inflammation of their little glands in the first place.
[00:21:07] Dr. Lancellotti: I love that. That is such a great explanation of having that primary disease, which we did talk about on Ear Infections. The primary disease is usually the allergy that’s driving the recurrence of these problems, but then also treating the secondary issues. In this case, we’ve got a lot of inflammation in those anal sacs, so doing that infusion is helpful for breaking that cycle of inflammation, stopping the irritation that animal is experiencing, while at the same time, giving us the opportunity to start investigating the underlying causes.
So we have to do a really good elimination diet trial, to figure out how much of a role food is playing into their allergic triggers, and then also manage any environmental allergies with things like medications, to relieve the symptoms of the allergies, and immunotherapy to reverse the underlying disease. Those things are very helpful in minimizing the risk of relapse of that inflammation, so that the pet can avoid those infusions. In the infusions that I’ve done, the overwhelming majority of those pets get relief from one treatment. I think I’ve had to repeat it on maybe one or two patients, but for the most part, that one infusion can be a real game changer for those animals.
That’s something to certainly talk about with your veterinarian- if you are still struggling with anal sac issues, they’ve been expressed, and you’re using the fiber, and things just aren’t going away. That infusion and working up the primary disease can really make a big difference in your pet’s quality of life, and decrease the risk of you getting anal sac contents all over your nice outfit before going out for dinner.
Veterinary Dermatology Specialists Can Help with Scooting
[00:22:45] Dr. Painter: It’s interesting. I’ve had some people say, “My vet didn’t even offer this.” It’s important to know that being a general practitioner requires so much knowledge about so many things. If you had met me, as a dermatologist, three years ago, I wouldn’t have talked to you about anal gland infusions. It just wasn’t on my radar. And then, it just took working with and learning about this to start integrating it into my practice.
If your vet hasn’t mentioned this to you, it’s maybe just because they don’t know about it- and that’s okay. We can teach them. I’m happy to hop on a call and be like, “This is how you do it. I have videos.” All the things! We all work in community and collaborate with each other, to help our patients live better lives, so if this isn’t something on your vet’s radar, bring this episode to them and we can help them get there, so that they can help your pet. Or consider working up with a specialist, if you feel like your dog needs more global attention to things like allergies, which is what we spend our day doing, as dermatologists. And we love it.
[00:23:47] Dr. Lancellotti: I love that point. Your family veterinarian is there to help you with those things that they do on a very regular basis but they are by no means expected to know every treatment and every disease that’s out there. And that’s where we, as specialists, really love being supportive of those family veterinarians, helping with those cases that don’t clear up as quickly as we expect them to. That’s why we’re here.
Dogs Do Not Need Anal Glands Expressed Every Month
Dr. Lancellotti: So Dr. Painter, what are some of the big takeaway points that you would like pet owners to remember, in terms of struggling with anal sac issues?
[00:24:19] Dr. Painter: If you’re struggling with anal sac issues, you are not alone. There are a lot of other pet owners going through this, and it is something that can be treated in a way that’s more effective than maybe what you’re doing right now. I would be open minded to considering an infusion procedure, if your pet is just on this merry-go-round of expression every three weeks, and really not having a lot of relief from that. And if you’ve tried all the supplements and the diets, then looking at treating that inflammation directly, through an infusion procedure, is oftentimes a very successful option for these patients.
Also, being aware that this particular problem is heavily tied with allergy and being open to that allergy work up, to prevent that relapse, is a really important and key point. Again, similar to ears, if we’re not really truly treating or understanding that root cause, it’s very likely that we’re going to have another ear infection. Similarly, with anal sac issues, if we’re not looking at that root cause, it’s very likely that your pet’s going to start having problems again. So working with your vet, considering linking up with veterinary dermatologist think about allergy more globally is also another key point. But overall, you shouldn’t know that your dog has anal glands. If they are causing your dog problems, I’m sorry that’s going on for you and for your pet, and there is something that can be done to help them.
[00:25:49] Dr. Lancellotti: Yeah. We’re sorry that you had to listen to this episode, but we’re very happy that you found us. Hopefully, you got some good information out of this.
Resource for Veterinarians
Dr. Lancellotti: If you are a veterinary professional that is listening to today’s episode, I do want to make sure that you’re aware that Dr. Painter has some really amazing resources for helping you manage tough allergy cases. She’s got a website, livelearnvet.com, which has a couple of great courses on understanding medications for treatment of allergies, and when to select which one. She’s got a great course on feline allergies. And she’s also got an amazing course on immunotherapy and understanding how to use this amazing tool for reversing the underlying disease process. Dr. Painter, do you want to talk a little bit about your courses?
[00:26:34] Dr. Painter: I’d love to. Yeah. I poured my heart and soul into this, just because I know that allergies are a common problem that veterinarians are seeing. There are so many different treatment options that we have available and it can be difficult to understand when to use what, and for whom, and which patient, and what’s the side effect of this, etc. I put a lot of time into medication masters. It’s an eight hour race approved course.
The allergen testing and immunotherapy course is a really mind expanding course, where you’ll learn a lot about what that all is. What is immunotherapy? What are we doing for that? And when and how to use allergy tests in the right context for your patient- which is hot topic right now. And of course, cats can be incredibly frustrating and wonderful all at the same time. That course reviews through all of that. And I hope to very soon have a diet trial and anal gland style course, because I know this information is incredibly useful and something that people are looking for. More to come! It’s a passion of mine, to have these education opportunities that people can do in their pajamas on their own time, and they have lifetime access.
Scratching the Itch: A Heartwarming Story
Dr. Lancellotti: I like to end each episode with a segment I call Scratching The Itch. This is a segment that highlights something- either a human interest story, a product, a website- basically something that just provides relief and makes you feel good. Hence, scratching the itch. Dr. Painter, do you have a ‘scratching the itch’ for us, today?
[00:28:28] Dr. Painter: I have a lot of scratching the itches, but this one in particular is a current event in my life and I’ve been working with this pet owner (with their cat) and their cat is experiencing some pretty terrible medical issues. Just in the last week, I have collaborated with more veterinarians on this cat’s case than I could share, and it has allowed this family, myself, other veterinarians, and this cat all to benefit from that feeling of community and collaboration. And I think I want to just highlight that in vet med, we are still really good, caring people who want to help our patients. And sometimes, we do that within these limited resources.
This cat is owned by a single mom whose husband passed away very early (at age 45), she has three kids, and she loves her cat. The collaboration and coming together that we’re all showing to help this particular animal and this family is not unique. This is something that’s happening in clinics across our country (and even the world) all the time, in this profession. And I’m just celebrating that. Sometimes, it is challenging being a veterinarian, but it is ultimately just the best job in the world because you really have the opportunity to help people and animals, all at the same time. And I just want to share that. It’s something that is such a gift. It’s such an honor to be a veterinarian and to be able to speak to pet owners. So to the listeners of this podcast, thank you for being a part of our community and for trusting your pet in our care. It’s just such a cool job, and I just can’t stress enough that good feeling of collaboration.
[00:30:36] Dr. Lancellotti: Yeah. I love the idea of collaborating with other veterinarians. Our local veterinarians, here in Los Angeles, are amazing. Not just the family veterinarians, but also the other specialists that I have the good fortune of being surrounded by. But I also love collaborating with the pet owner. They see everything. They know what’s going on at home. And they give such good feedback, in terms of what’s working, what’s not working, where we need to make changes, etc. And when you establish that trust and build that relationship, it just fills my cup so much. It makes me so thankful and grateful to be in this profession and have this opportunity to help so many people in so many different ways. So yeah, I love that you’ve highlighted that. That’s a great ‘scratching the itch.’ Oh, I got goosebumps.
[00:31:21] Dr. Painter: Thanks. Yeah. It’s just amazing. You get to be a little part of their lives- and maybe a big part- to help in a way that maybe people didn’t ever expect. Just being real, honest, and providing options and resources, and doing your best- I think those are features of veterinarians everywhere. And thanks for allowing that share.
[00:31:47] Dr. Lancellotti: You have certainly been an amazing resource for the pet owners listening. Thank you very much for coming on and sharing your wisdom. Again, all of the episodes that you have done for the show have been some of my favorite and most helpful in the clinic, so I’m really excited to have this as a resource for my pet owners. Thank you, Dr. Painter.
[00:32:06] Dr. Painter: You’ve got it.
[00:32:07] Dr. Lancellotti: And for everyone out there listening, I look forward to your next visit with Your Vet Wants You To Know.
