What is an Inguinal and Castration Scar Manipulation or Gelding Scar Manipulation…… What is everyone talking about?
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I have been getting asked this question quite a lot lately! And to answer this question we need to understand the internal anatomy of our horses and how the body reacts to injury.
The concept of castration scar and inguinal ring manipulation stems from the osteopathic fraternity where looking at the horse as a whole and not just one problem at a time is their philosophy, and knowing the body has a very set way it responds to injury or damage. This is very popular throughout Europe and the USA however, is only just starting to gain acceptance and credability in Australia of late.
As a Vet my scientific mind kicks in and says “Why and how does this work?” and “Where are the studies to prove/ disprove this theory?” Well the short answer is- there are none, as it is not an area we scientific Veterinarians can completely explain. Yes we understand how the body heals when injured and side effects of this, but we can’t fully explain certain pain phenominons and responses. For example no one can explain the way an amputee can still feel their limb, or having surgery and removing organs, but still having pain associated with the organ even though it is not there anymore. The visceral pain that is present is hard to understand. None of our fancy toys/ equipment or tests can explain this.
Yes we all understand scar tissue and how it is less flexible and not as elastic as other surrounding tissue, and how it also has less blood supply. Scar tissue can become restricted and adhere to underlying tissue, and in turn cause pain- so why can this not happen to your colt when he is castrated?
Throughout the world castration is basically performed the same way, with only a few variances. The first variance is whether your colt is standing or recumbant ( laying down). The next step is preparing the incision site and injecting local anaesthetic. An incision is made into the scrotum near the midline and the testicle is exteriorised from the scrotum. The tunica vaginalis ( testicle wrapping) may or may not be incised, then emasculators or a henderson drill are placed onto the testicular bundle (cremaster muscle, testicular artery/vein and nerve along with ductus deferens) and the testicle is removed. After a short period of time ( approximately one minute per year of life of colt is the rule of thumb) the apperatus are removed and the “stump” is released and allowed to recoil into the abiss. This may be the scrotum, superficial or deep inguinal ring, or the abdomen and this is up to the gods above and the length that the stump was left and the reaction of the colt.
Some vets may close the superfiical inguinal ring by suturing the edges of the ring together, and some may suture the skin together, however most vets leave these open. I don’t believe the variables dramatically increase or decreasae the risks of internal castration scarring or inguinal scarring as the “stump” and the body’s reaction to this injury are the main problem!
Signs & Symptoms
The extent of castration surgery complications is not fully understood and can manifest in many different ways. Your horse can have gait anomalies but no “true” lameness, such as transitional difficulties, disunites at the canter, spinal flexion or extension restrictions, idiopathaic hindlimb lameness that is not consistent, resentment for a particular lead or, inability to maintain posture. These can also lead to severe behavioural issues of chronic consistent pain and your horse may develop a buck into the canter or pig root when asked to flex etc.
What we know is the body heals wounds by sending inflammatory cells and an immune response to the area of damage to assess the situation and then the body goes into “healing” mode by laying down fibrin which in turn can adhere to surrounding tissue and organs and may develop adhesions. Many people who have had any type of abdominal surgery may relate to adhesions forming. This is also a common risk of colic surgery in horses. These adhesions can cause pain when put under tension. The pain can be short and sharp or a constant ache depending on where they have formed.
The abdominal cavity is designed to move freely with organs, intestines and viscera being able to freely glide and slide past one another. Some organs are quite fixed in location, but they are situated up against the abdominal wall so everything else can glide past them without any restrictions. Examples of these would be the kidney spleen and liver. Whereas other organs need to expand and move without restrictions for example the bladder as it fills and empties and the intestines as ingesta (food) passes through them..
Adhesions, when formed, can prevent this free movement and can lead to restrictions and pain. The “stump” created when castration occurs can form adhesions anywhere from the scrotum to the internal abdomen and I have found adhesions form on the bladder, spleen, caecum and often in the deep inguinal ring and anywhere in between!
What can you feel internally?
The answer to that is A LOT. During the internal examination the kidneys are found and palpated for any restrictions as this is the area where the nerve bundle heads down to the testicle and this can have adhesions from the pulling of the testicles during surgery. It is also a perfect opportunity to examine the iliopsoas muscle. Then the exploration of any adhesions begins with a methodical abdominal examination. If identified, adhesions are easily broken down and freed with gentle manipulation through the rectum.
The iliopsoas muscle is a very important muscle and can only be palpated internally as it is the deepest of all muscles and its role is hip flexion and lateral ( or outward) rotation of the thigh. This muscle can be easily damaged from hyperextension of the hindlimbs such as taking off on wet grass and your horses legs slip from underneath them. Another issue with this muscle is overdevelopment of one particular side due to guarding of pain or inability to engage a particular hindlimb and this can malalign the entire spine. Iliopsoas issues are often “diagnosed” as sacroiliac problems in the horse and often given no treatment other than inject the area with steroids or anti inflammatories- which does give short term relief, but doesn’t get to the root of the problem.
What are the risks of having a Gelding Scar – Castration Scar Manipulation performed?
The biggest risk is perforation of the rectum during examination and this can be fatal if the tear is completely through the rectum. The other risk is your horse often needs sedation and is placed in a stock- they can react badly to both of these in some individuals.
Make sure whoever is performing the procedure is experienced in rectal palpation and is able to deal with any ill effects of the procedure- Oh and you need a long arm to be able to thoroughly examine the abdomen and palpate kidneys!!
Will my horse be sedated for the Gelding Scar – Castration Scar Manipulation?
In more than 80% of cases, it is necessary for your horse to be sedated to ensure we can perform the Castration Scar Manipulation as required. The horse will be able to be floated approximately 30-60 minutes after the procedure has been completed.
What if your vet won’t or can’t perform the Gelding Scar – Castration Scar Manipulation?
Vets are science based, as this procedure is not based on science the majority of vets can be closed minded and initially not open to learning. In early February 2020, Dr Louise Cosgrove will be heading to The Vluggen Institute in Texas, USA to further her knowledge in this space.
When should my horse have the Gelding Scar – Castration Scar Manipulation procedure done?
If you have a colt that you are looking to have castrated, it would be ideal to have the internal Castration Scar Manipulation procedure done about 12 months post castration. This is to make sure that everything internally is healing correctly, and nothing is adhering where it shouldn’t be. Even if the wound looks fine from the outside, there may be restrictions on the inside that we can’t see, but a vet could feel.
If you have a gelding that you would like seen, the best time is while he is in work, as he will be encouraged to move straight away. The reason for this is that I like the horse to feel their new “body” as soon as possible, and it’s important to get the internals moving and sliding as they’re supposed to, before the body can start to lay down any more scar tissue.
How often do you recommend this procedure for my horse?
Unlike mares, this procedure is usually a “one and done” thing. Your gelding should only need this procedure once, as when the restrictions have been freed, the body is unlikely to return to how it was.
Dr Louise recorded a podcast with Sarah Attwater from Healthy Horse Happy Hound Podcast.
You can find it here