Procedures for Rectal Palpation

Rectal palpation of the genital organs of the cow may be performed to:

1) Determine the stage in the reproductive process exhibited by the organs,

2) Determine ovarian conditions associated with variations in the estrous cycle,

3) Detect recognizable causes of sterility,

4) Inseminate artificially, and

5) Modify ovarian structures.

The stanchioned cow, restrained at the sides, is approached from the rear and the tail is grasped firmly about midway of its length so as to lift it from the anal opening and turn it to one side. Usually, the cow will not kick, but will jump from side to side as the hand is inserted into the rectum. The examiner must be prepared to move readily from one side to the other with the cow, and at the same time, stand as far back from the cow as conveniently possible to be on guard to dodge an occasional kick.

The arm, covered with a plastic sleeve, should be lubricated. The hand is inserted by forming the thumb and fingers into a cone tip and with a slight rotary motion, forcing it into the rectum. Waves of peristaltic contractions will soon be encountered from the rectal wall. These often feel like rings you must past through. Judgment must be developed as to how much resistance to exert with the hand against these contractions so that the animal will not be injured. The examiner is neither insistent against these waves, nor is he(she) passive.

After the fecal material has been expelled or "raked" from the rectum with the hand, the floor of the rectum is depressed with the hand which has been inserted approximately half way to the elbow. The genital tract should lie just below and wholly, or in part, on the floor of the pelvis. The whole genital tract may be contracted and lying in the caudal part of the pelvic canal, or its position may vary forward until uterus is hanging over the brim of the pelvis into the abdominal cavity and with only the vagina and possibly the cervix in the pelvic canal. This is true in later pregnancy or early in the postpartum interval. It may also be true in certain pathological conditions such as pyometra. Certain breeds, particularly of beef cattle, also tend to have abdominally pendulous uteri even in the normal, non-pregnant state.

Tumors and abscesses in the retroperitoneal tissues around the vulva and vagina or in the wall of the genital tract may be felt as hard, unyielding masses lying below or to one side of the rectum.

The cervix will appear as a firm, rope-like structure, 3" or more in length and 1" or more in diameter. Some describe the cervix as feeling like a turkey neck. It can be picked up in the hand and moved about. A pendulous uterus, if empty, may be pulled up into the pelvic canal, or the uterine horns, when tightly coiled, may be partly uncoiled by grasping the cervix and pulling it caudually.

The cervix ordinarily lies along the midline of the pelvis, directly under the rectum and above the bladder. But if the bladder is full and remains in the pelvic canal, the reproductive tract, particularly the cervix, may lie over on the right side of the pelvis and be wedged inbetween the bladder and the wall of the pelvis.

Introduction of a tube into the cervix, as is done in artificial insemination , involves difficulty first in actually locating and introducing the tube into the external cervical os, and second in manipulating the tube to get past each of the transverse folds or anular rings. The caudual end of the cervix protrudes into the vagina. This creates a crevice or fornix vaginae between the protruding portion of the cervix and the vaginal wall. Unless guided otherwise, the tube will enter this crevice rather than the cervical canal. The cervix may be grasped by the thumb and the first two fingers and the vaginal wall may then be compressed by the third and fourth fingers around and slightly caudal to the mouth of the cervix. this forms a constricted vaginal passageway through which the tube can be guided into the mouth of the cervix.

The transverse folds of the lining of the cervix are compressed and folded caudually so that a succession of crypts or crevices is encountered in passing the tube through the canal. The tip of the tube must "feel" its way forward past the folds with short probing motions which are shifted slightly up or down and from side to side. At the same time, the position of the cervix is shifted from side to side, or up and down with the other hand until the passageway past each fold is found.

Examination of the uterine horns in the open cow or in early pregnancy involves the partial uncoiling of the horns so that each one may be examined along its entire length. This can be accomplished by first grasping the cervix and pulling caudally. The hand is then placed over the coiled horns, palm down, and the middle finger inserted under the intercornual ligament. Traction is then applied upward and backward, uncoiling the horns.

Examination for pregnancy involves palpation of the uterine horns to determine size differences and then latter the presence of fetal membranes, cotyledones and increased blood flow in the uterine artery.

The ovaries may best be palpated by starting from the position where the hand is placed over the coiled uterine horns. The cephalic margins of the broad ligaments lie directly on either side of the coiled horns and lead dorso-laterally to the body wall. The ovaries will be found along the margins or will be tucked slightly under their free edges.

The oviducts, if normal, are not readily palpated. Starting from the ovary, however, the bursa and a portion of the oviduct may be palpated (21) and the presence of adhesions or the occurrence of enlargement or distension of the oviducts detected.

The ovaries are palpated to detect the presence and size or degree of developments of follicles and corpora lutea. The ovary, when picked up under the edge of the broad ligament is turned up and backward on the top of the broad ligament for examination. It is held in a transverse position with the free edge of the ovary toward the examiner and the resovarial edge away from the examiner. The attached end of the ovary (end to which the bursa is attached) is lateral.

The determination of size and location of ovarian structures requires measurement with the finger tips and the consistent orientation of the ovary with respect to the body wall; also the identification of the structure as being in certain defined regions of the ovary. Finger widths constitute a rough unit of measurement. More repeatable determinations between different observers, however, can be made by calibrating the finger tips in millimeters when the fingers are held in the general position used when grasping the structure to be measured. Measurements should be made of the tip of the first finger alone, then of the first and second fingers together, and then of the first, second and third fingers, etc. Half finger widths and quarter widths can be estimated.

There are nine definable regions of the ovary. There is an upper surface and a lower surface and a greater curvature along the free margin. Each of these has a right, left and middle region, making nine in all. Recognition of the following regions should become quite repeatable at different times or between different examiners: 1) upper right, 2) upper middle, 3) upper left, 4) right greater curvature, 5) middle greater curvature, 6) left greater curvature, 7) lower right, 8) lower middle, and 9) lower left.

Follicles are detected as fluctuating, turgid, fluid-filled bodies usually smooth and protruding slightly from the surface. Corpora lutea, when fully formed, frequently protrude more definitely from the surface and usually the papilla is detected as a roughness on the protruding surface. The fully formed corpus luteum is somewhat more firm to the touch than the follicle and on deeper palpation, appears as a solid unyielding body embedded in the ovary.

The removal of the corpus luteum from the ovary can be accomplished by holding the ovary in the same position as that used for examination of the ovary. After the ovulation papilla of the corpus luteum has been located, the fingers are placed on one side of the ovary and the thumb on the other side. Pressure is applied with the thumb on the region of the ovary where the corpus luteum is most deeply embedded. Then the thumb is moved in the direction of the ovulation papilla. The corpus lutem will be forced out into the hand. Pressure should not be applied on the whole corpus luteum, but only on the quarter most deeply embedded.

In order to rupture a cyst, the ovary is brought into the position under for ovary examination. Pressure is then applied to the body of the cyst. The exact way in which pressure is applied differs according to the region where the cyst is located.