Disease anal sacs. Medical search. Frequent questions

Anal Sac Disease happens when anal sacs, also called anal glands, become impacted, infected and abscessed. (revivalanimal.com)
The anal sacs (also called anal glands) are two small structures that are positioned under the skin, one on each side of the anus. (cornell.edu)
Anal sacs, also called anal glands, are located within a pet's rectal area, between the internal and external sphincter muscles. (airportvethospital.com)

Tumors of the anal sacs are treated by complete removal of the affected sac. (petplace.com)
Anal sac tumors ("apocrine gland adenocarcinomas") are not often painful and do not usually have redness on the overlying skin or any open wounds. (petplace.com)
Cats with anal sac tumors can also have symptoms associated with other types of anal sac disease ("scooting," excessive licking, straining to defecate, reluctance to sit, or sitting asymmetrically). (petplace.com)
Anal sac disease occurs when these glands become disturbed by tumors or are otherwise obstructed, constricted, or irritated, though cats most frequently experience the disease when these glands become impacted. (airportvethospital.com)
Treatment of perianal and anal sac tumors" (PDF). (wikipedia.org)
The most common malignant tumor of the perianal region is the anal sac (gland) carcinoma accounting for 16.5% of all perianal tumors. (livs.org)
These tumors are locally invasive and metastasize early in the course of the disease. (livs.org)
It has been shown that up to 25% of dogs with anal sac tumors will have elevated calcium levels in the blood. (livs.org)
Anal sac disease (ASD) results when these glands are unable to empty themselves due to reasons such as skin inflammation, obesity, diarrhea, and tumors. (atlaspethosp.com)
Conditions such as anal gland issues, trauma, or tumors should be explored with a veterinarian. (thepetstaff.com)
Other oral diseases, such as mouth ulcers and melanoma or other tumors of the oral cavity can also cause very bad breath. (blogspot.com)

Vets treat anal sac impaction by manually emptying a dog's anal glands. (betterpet.com)
Remember that it's important a vet or vet tech express your dog's anal glands. (betterpet.com)
What are a dog's anal glands? (cuteness.com)
When a dog's anal glands become impacted, they can not only make it uncomfortable to defecate but they may also rupture or abscess, which causes pain and requires medical intervention. (cuteness.com)
Your dog's anal glands, the most common reason why they might smell that way, is what emits the fishy odor. (watchmebark.com)
Anal sac disease is an umbrella term describing any problem relating to your dog's anal glands. (watchmebark.com)
This could happen for a couple of reasons: your dog's anal glands could be suffering an abnormality, or if your dog usually has soft stool, it would not be firm enough to express the glands. (watchmebark.com)
Asides from your dog having a fishy smell, there are other signs you could look out for to figure out if your dog's anal glands are a cause of bother. (watchmebark.com)
Luckily, resolving this issue is relatively easy: your local vet or groomer can simply manually empty your dog's anal glands (which produces a pasty brown fluid) to resolve the odor issue. (watchmebark.com)
Another probable reason for dogs still smelling after the expression of anal glands is that your dog's anal glands refill quite quickly. (thehalopets.com)
So, if you notice a stinky smell after a few days of anal gland expression, it might be the case that your dog's anal glands have started to fill up again. (thehalopets.com)
There are times when a dog's anal glands are inflamed or impacted. (thehalopets.com)

If your dog or cat is experiencing any signs of anal gland problems you should consult your veterinarian immediately because anal sac problems left untreated can develop into further problems including infection or abscess. (revivalanimal.com)
There are varying degrees of anal gland problems and according to VCA Hospitals , "The abscess will appear as a painful, red, hot swelling on one or both sides of the anus. (betterpet.com)
‌ While a healthy dog may experience doggy gas or occasional bowel movements that offend one's sense of smell, dogs that exhibit smelly anal secretions on a regular basis may be dealing with anal gland impaction, anal gland sacculitis, an anal gland abscess, or even an anal gland tumor. (cuteness.com)
‌ Likewise, an anal gland abscess is a more serious condition where the glands become so obstructed and infected that the pus and anal sac fluid build up and may rupture through the skin. (cuteness.com)
There might be a case where your dog is suffering from an anal gland abscess or an infection. (thehalopets.com)

Chronic cases of impaction or inflammation may require surgical removal of the anal sacs. (petplace.com)
Some veterinarians suggest increasing fiber (thus bulk) to the diet to prevent anal sac impaction. (petplace.com)
Anal sacculitis is more painful than anal sac impaction. (petplace.com)
Anal sac abscesses are more painful than anal sac impaction. (petplace.com)
In addition to benign disease conditions of the anal sacs including impaction, sacculitis and abscessation, the anal sacs can also be affected by cancer. (cornell.edu)
Anal gland impaction. (betterpet.com)
Anal gland impaction happens when one or both of the anal glands are not emptying properly and become obstructed. (cuteness.com)
Anal sac problems such as impaction or infection. (veterinary-practice.com)

The most common type is known as anal sac adenocarcinoma or apocrine gland anal sac adenocarcinoma (AGASACA). (cornell.edu)
An anal sac adenocarcinoma is an uncommon and aggressive malignant tumor found in dogs that arises from the apocrine glandular tissue of anal sac. (wikipedia.org)
Cases in which toceranib was used to treat dogs with apocrine gland anal sac adenocarcinoma (AGASACA), metastatic osteosarcoma (OSA), thyroid carcinoma, head and neck carcinoma and nasal carcinoma were included. (avmi.net)

It occurs in the apocrine glands in the walls of the anal sacs. (betterpet.com)
Apocrine gland anal sac adenocarcinomas first appear as small lumps associated with one of the anal sacs (rarely bilateral), but they can grow to a large size. (wikipedia.org)
Apocrine gland anal sac adenocarcinomas also have a tendency to metastasize to the regional lymph nodes, spleen, and eventually lungs and, less commonly, bones. (wikipedia.org)

Symptoms of anal gland problems can vary for every pet, however, common signs that your pet may display include scooting, excessive licking of the anal area, straining to defecate, releasing a sudden foul odor, pain or discomfort of the hind end, or bleeding and swelling near the anal area. (revivalanimal.com)
‌ Excessive licking of the anal area. (cuteness.com)

Common reasons why your pet may be experiencing anal sac problems include soft or loose stools, digestive issues , allergies , infection, obesity, poor anatomy or a combination of these things. (revivalanimal.com)

The anal sacs are glands located near the anus (rectum) that produce secretions that are normally expressed during defecation. (petplace.com)
The anal sacs are located at the 4:00 and 8:00 positions around the anus, embedded in the muscle of the anal sphincter (the muscle that closes the anus). (petplace.com)
The anal glands line the wall of the anus and produce a foul-smelling fluid that may vary from serous to pasty in consistency and brown to off-white. (betterpet.com)
Each sac opens into the lateral margin of the anus by a single duct. (betterpet.com)
Hold up a tissue to the anus and squeeze both sides of the anal area at the 4 and 8 o'clock positions. (betterpet.com)
Insert a lubricated, gloved finger in the anus and squeeze the sac between the thumb and forefinger held externally. (betterpet.com)
Anal glands are present on each side of the anus in the 4 and 8 o'clock positions. (atlaspethosp.com)
Anal sacs are a set of glands that are just under the skin near your pet's anus. (vcotp.com)
Anal glands or anal sacs are a pair of specialty scent glands on either side of your dog's anus. (watchmebark.com)
If your dog scoots on the floor, bites or licks their anus, or has difficulty defecating, you might want to get their anal sacs checked. (watchmebark.com)
Blood originating directly from a cat's anus usually indicates conditions or injuries impacting the rectum, anus, or nearby structures, such as anal glands. (thepetstaff.com)
Internal intussusception may be a full-thickness or a partial rectal wall disorder, but the prolapsed tissue does not pass beyond the anal canal and does not pass out of the anus. (medscape.com)
Anal sacs are glands found on either side of the anus. (escworldwide.com)

In dogs with clinical signs, perianal swelling, straining to defecate, licking the perianal region, and bleeding, were most commonly seen and resulted from a large anal sac tumor or severely enlarged regional lymph nodes pressing on the colon. (livs.org)
In one study, 75% of the dogs treated experience improvement of their clinical signs, 43% experienced a reduction in the size of the tumor and ~ 30% had disease stabilization. (livs.org)
Distinguishing a tumor from an inflammatory disease can sometimes be difficult. (merckvetmanual.com)
While some of these conditions are easily treated, others, such as a malignant anal gland tumor, could be potentially life threatening, which is why the first course of action should always be to have the dog examined by a veterinarian. (cuteness.com)
If the dog is having trouble defecating, this could also be caused by an anal gland tumor. (cuteness.com)

This pus-filled anal sac results from a bacterial infection. (petplace.com)
Other complications include infection, poor wound healing and anal stricture. (cornell.edu)
During the expression, if the vet or vet tech notices that a more serious infection is present, the anal glands will be doused in a sterile saline solution, and an antibiotic ointment will be applied to the affected areas. (airportvethospital.com)
‌ A veterinarian can assess the dog's health to make sure there is not a more serious medical condition, such as anal gland sacculitis, where the glands become inflamed and bacteria invades, causing an infection. (cuteness.com)
Infection with A. phagocytophilum is a tick-borne infectious disease spread by Ixodes species ticks. (vetstreet.com)
When your dog's sacs do not express naturally or are not emptied completely, they could become dry and fall under the risk of infection and abscesses. (watchmebark.com)
Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease is an infection of the upper female reproductive organs (the cervix, uterus, fallopian tubes, and ovaries). (msdmanuals.com)

The presence of bright red blood in a cat's stool indicates problems within the lower intestinal tract, particularly in the large intestine, rectum, or anal region. (thepetstaff.com)
The rectum is the distal 12-15 cm of the large intestine between the sigmoid colon and the anal canal. (medscape.com)
The internal anal sphincter is a smooth muscle that is the most distal extension of the inner circular smooth muscle of the colon and the rectum. (medscape.com)
The second theory holds that rectal prolapse starts as a circumferential internal intussusception of the rectum beginning 6-8 cm proximal to the anal verge. (medscape.com)
The prostaglandins also cause contraction of the rectum, pelvic floor muscles, and muscles around the anal canal," Raj tells viewers. (medscape.com)
in some descriptions (and the author agrees), it also includes the anorectum (rectum and anal canal). (medscape.com)
The rectum lies in the concavity of the sacrococcygeal hollow and changes to the anal canal at the puborectal sling formed by the innermost fibers of the levator ani muscle. (medscape.com)

High fiber diets have been shown to help prevent anal sac disease in at-risk dogs, especially those that are obese. (dogfoodadvisor.com)

This disease is the result of large amounts of thick anal sac secretions that cannot be expressed by the cat during defecation. (petplace.com)
The secretions build up and cause discomfort as the sac becomes distended or even infected. (petplace.com)
This is inflammation of the anal sac, which can be caused by impacted anal sac secretions or bacterial infections of the anal sacs. (petplace.com)
Additionally, the anal gland secretions help dogs pass their poop more easily. (cuteness.com)

Anal sac contents may also be expressed in times of fright (producing a terrible odor in the area). (petplace.com)
Dogs also use these anal glands to express extreme fear - which is why you might smell a fishy odor when your doggie is scared. (betterpet.com)
‌ The most common sign of impacted anal glands is the odor. (cuteness.com)
The fishy odor could usually be associated with anal sac disease. (watchmebark.com)
One of the most likely reasons for a dog's continued odor after anal sac expression is that its glands were never completely empty. (thehalopets.com)
3. Another common source of bad odor is anal sac disease . (blogspot.com)
Impacted glands may releases at inappropriate times (like when your dog scoots across the carpet), and the micro-organisms in an infected anal sac can produce quite a pungent odor of their own. (blogspot.com)

If you have more questions on cat and dog anal gland infections, call us at 800.786.4751 . (revivalanimal.com)
If your pet has frequent reoccurrences of anal gland infections, the veterinarian may teach you how to express their anal glands on your own. (airportvethospital.com)
To treat anal gland infections, vets empty the anal sacs and apply an antibiotic into the sacs through the duct openings. (betterpet.com)
Usually, smaller dog breeds and obese dogs are more prone to anal gland infections. (watchmebark.com)
Dental disease can cause a lot of pain, and the bacteria associated with dental disease can lead to life-threatening infections affecting the heart, kidney and liver! (blogspot.com)
CLASSIFICATION OF DISEASES AND INJURIES I. INFECTIOUS AND PARASITIC DISEASES (001-139) Includes: diseases generally recognized as communicable or transmissible as well as a few diseases of unknown but possibly infectious origin Excludes: acute respiratory infections (460-466) influenza (487. (cdc.gov)
certain localized infections Note: Categories for "late effects" of infectious and parasitic diseases are to be found at 137. (cdc.gov)

Anal sac carcinoma in the dog" (PDF). (wikipedia.org)
In most cases all three types of therapy are used (surgery, radiation therapy, and chemotherapy) in the treatment of dogs with anal sac carcinoma. (livs.org)

There are several types of anal gland or anal sac diseases - Anal glands can become impacted, infected, or abscessed. (betterpet.com)

It could be Anal Sac Disease (ASD), a common problem in dogs and cats. (revivalanimal.com)
Anal sacs are two small glands located on either side of the anal opening of all dogs and cats at the five o'clock and seven o'clock position. (revivalanimal.com)
What Causes Anal Gland Problems in Dogs and Cats? (revivalanimal.com)
Whenever the anal glands on dogs or cats become blocked, over-filled or inflamed it causes discomfort for your dog or cat and can lead to further problems. (revivalanimal.com)
Anal sac problems can be prevented in dogs and cats very simply by feeding a quality diet. (revivalanimal.com)
Anal sac disease in dogs is very common. (betterpet.com)
Anal sac disease is very common in dogs Trusted Source The Merck Veterinary Manual Trusted provider of veterinary medicine. (betterpet.com)
It is a disease of middle-age to older dogs and even though early reports described spayed females as more commonly affected, multiple recent studies have shown no gender overrepresentation. (wikipedia.org)
Do Dogs Empty Their Anal Glands When Scared? (cuteness.com)
Penny Watson's research focuses on liver and pancreas disease in dogs and cats, particularly chronic disease and fibrosis. (epi4dogs.com)
Concurrent clinical studies funded by the Pet Plan Charitable Trust identified the same breed relationships and showed the importance of chronic pancreatitis in causing clinical disease in dogs. (epi4dogs.com)
Anal sac disease is a common problem in dogs that can be very uncomfortable or painful. (courtanimalhospital.com)
Ear diseases in dogs and cats. (edicionesedra.com)
Clinical benefit (CB) was observed in 63/85 (74%) dogs including 28/32 AGASACA [8 partial response (PR), 20 stable disease (SD)], 11/23 OSAs (1 PR and 10 SD), 12/15 thyroid carcinomas (4 PR and 8 SD), 7/8 head and neck carcinomas [1 complete response (CR), 5 PR and 1 SD] and 5/7 (1 CR and 4 SD) nasal carcinomas. (avmi.net)
Some dogs have a stinky smell after anal gland expression for a few days due to inadequate anal gland expression, anal sac diseases, and quick refilling of fluids in the anal sac. (thehalopets.com)
Generally, dogs smell for the next 24 hours after expressing their anal sacs. (thehalopets.com)
In such dogs, monthly or even weekly anal gland expression is needed to squeeze out all the fluid. (thehalopets.com)
At times, people think that the previous anal gland expression in dogs wasn't correctly done, that is why the glands are filling up so quickly. (thehalopets.com)
Dogs that developed disease were withdrawn from the study and classified as sick dogs. (bvsalud.org)
RESULTS: Thirty dogs developed disease during the follow-up period: 13/67 (19.4%) in the group treated with domperidone and 17/44 (38.6%) in the placebo-treated group (P = 0.03). (bvsalud.org)
CONCLUSIONS: Healthy dogs with low L. infantum antibody levels treated with domperidone were less likely to develop disease compared to placebo-treated dogs. (bvsalud.org)

The external anal sphincter is striated muscle that forms a circular tube around the anal canal. (medscape.com)
Control of the external anal sphincter is voluntary. (medscape.com)
Objective: Our purpose wthe application of the transvaginal ultrasound, for the ddescription of the main structures annals: mucus, internal anal sphincter, external anal sphincter and fascicle pubococcigeal of the muscle elevator of the year. (who.int)
Results: Obtains the following dimensions: internal anal sphincter: 2.9 +/- 0.9 mm, external anal sphincter: 2.7 +/- 0.9 mm, pubococcigeal of the elevator: 1.9 +/- 0.8 mm. (who.int)

Be aware of your cat's normal defecation habits and stool appearance so that you can notice any changes, and contact your veterinarian if you notice any signs of anal sac disease. (petplace.com)

The diagnosis generally begins when your veterinarian finds a mass in the area of one or both anal sacs while performing a rectal examination. (cornell.edu)
It could be linked to conditions such as colitis, anal fissures, or rectal bleeding and should prompt a veterinary consultation. (thepetstaff.com)
Rectal prolapse occurs when a mucosal or full-thickness layer of rectal tissue protrudes through the anal orifice. (medscape.com)
These features include a patulous or weak anal sphincter with levator diastasis, deep anterior Douglas cul-de-sac, poor posterior rectal fixation with a long rectal mesentery, and redundant rectosigmoid. (medscape.com)

Radiation therapy may be used preoperatively, intraoperatively or postoperatively on the anal sac mass and the lymph nodes - reducing the risk of recurrence in cases where complete removal is not possible. (cornell.edu)
Surgery offers the only chance for long-term control (a cure is sometimes possible) and involves removing the anal sac and regional lymph nodes if enlarged. (livs.org)

Crohn Disease Crohn disease is an inflammatory bowel disease where chronic inflammation typically involves the lower part of the small intestine, the large intestine, or both and may affect any part of the. (msdmanuals.com)

Anal gland problems are often very painful and owners need to watch for these signs - The first sign is scooting or dragging along the ground. (betterpet.com)
Smelly anal glands or excessive butt licking or scooting may indicate that a dog has impacted anal glands. (cuteness.com)
Licking and scooting are often an attempt on the dog's part to ease the irritation that comes with impacted anal glands and are a sign that those glands are in need of attention. (cuteness.com)

If your dog or cat is exhibiting symptoms of Anal Sac Disease, contact your veterinarian for treatment. (revivalanimal.com)
You're not going to see any heartworm disease symptoms in your dog, and here's why. (pethealthnetwork.com)
Patients with Chronic Myeloproliferative Neoplastic Disease (MPN) experience a wide range of symptoms. (psychokinesis.co.il)
Chronic Myeloproliferative Neoplastic Disease (CMPD) symptoms are varied. (psychokinesis.co.il)
Some people with these diseases do not have any symptoms, and may have no signs of the disease at all. (psychokinesis.co.il)
The odors associated with skin diseases usually occur in tandem with other symptoms, such as an abnormally greasy coat, itching, flaking, or skin lesions. (blogspot.com)
Sep 7, 2019 - These clinical symptoms are difficult to be certain about over email, but there are a few things that could cause it such as arthritis, a problem with their anal glands or exercise intolerance and I will go over these in more detail. (escworldwide.com)

If you pet's anal sacs are full, they will need to be emptied by your veterinarian. (revivalanimal.com)
After a thorough examination and diagnosis, a veterinarian or veterinarian technician will perform a manual expression of the anal glands. (airportvethospital.com)
Additionally, foul-smelling anal glands may be a sign of a more serious problem, so it's important to see a veterinarian to find out what is causing the issue before determining the best possible treatment option. (cuteness.com)

Surgery to remove the mass and the entire anal sac (anal sacculectomy) is the treatment of choice. (cornell.edu)

Most problems with the anal glands are not life threatening, but anal gland disease can quickly worsen if left untreated. (airportvethospital.com)

Below is an overview of Anal Sac Disease in Cats followed by detailed information on the diagnosis and treatment of this condition. (petplace.com)
The disease exists in cats as well, but is much less common in that species. (wikipedia.org)
In cats small bowel disease inhibits cobalamin uptake, and cobalamin deficiency can result in metabolic acidosis. (vin.com)

This may produce a bulkier stool and the sacs may be more likely to be expressed naturally. (petplace.com)

The anal glands are often referred to as the scent glands, and in a skunk, these serve an important purpose! (betterpet.com)
A dog has two anal or "scent" glands. (betterpet.com)

If the fluid is very thick and pasty, this method may not work to empty the sacs. (betterpet.com)
Expression of the anal sacs every few weeks or months often will help prevent anal gland fluid from accumulating and becoming thickened again. (dogfoodadvisor.com)
The anal sacs fill with a foul-smelling fluid that is normally expressed through a tiny duct when animals defecate. (vcotp.com)
After you have expressed your dog's anal gland, it is important to wipe your dog's back to remove any residual fluid sticking to its fur. (thehalopets.com)

Anal sac adenocarcinomas are often suspected due to location (palpable masse in anal sac) and behavior, but a biopsy and histopathology is necessary for a definitive diagnosis. (wikipedia.org)

Diagnostic tests may be required to confirm the diagnosis and exclude other diseases causing similar signs. (petplace.com)
Early, incidental diagnosis of small anal sac masses may lead to a better prognosis with surgery alone (ongoing study). (wikipedia.org)
Interested audience should consult other texts for in-depth description of the diagnosis and treatment of each disease. (vin.com)
Providing continuing information on changes over time in the extent of disease at diagnosis, trends in therapy, and associated changes in patient survival. (cdc.gov)

anal sacs · smell. (akc.org)
A fishlike smell is one possible indicator of impacted anal glands. (cuteness.com)
At times, a strong fishy smell comes out of the dog even after the anal glands have been expressed. (thehalopets.com)
2 Ways To Get Rid Of Anal Gland Smell? (thehalopets.com)

Last week we had to get his anal glands expressed for the first time (outside of groomings), and I believe it's because of this. (dogfoodadvisor.com)

The anal sacs are paired structures, approximately 1 centimeter in diameter. (betterpet.com)

Healthy anal sacs produce an incredibly foul smelling liquid, but under normal circumstances it is only released when a dog defecates or is terrified enough to use them as a defense mechanism. (blogspot.com)

Abscesses of the anal sacs are lanced and flushed, and then treated with oral antibiotics. (petplace.com)
Major anal gland problems may start when abscesses form within the glands themselves. (betterpet.com)

Anal Sac Disorders. (vacante-insorite.ro)

Resolving any underlying causes of your pet's anal gland problems such as allergies or digestive issues is also key. (revivalanimal.com)
She has no anal gland issues, but she did (briefly) years ago before she received treatment by a dermatologist for environmental allergies. (dogfoodadvisor.com)

Initial work in English Cocker spaniels suggest a disease similar to autoimmune chronic pancreatitis in humans. (epi4dogs.com)
Anemia of Chronic Kidney Disease. (vacante-insorite.ro)
Also, there are supplements that make it easier for the anal glands to express naturally on their own if this is determined to be a chronic problem. (skoutshonor.com)
Chronic Myeloproliferative Neoplastic Disease is a rare type of blood cancer that causes abnormal blood cells. (psychokinesis.co.il)
A doctor should be able to rule out underlying conditions that may be related to Chronic Myeloproliferative Neoplastic Disease. (psychokinesis.co.il)

Antibiotics or anti-inflammatory drugs may be given orally or infused into the sacs if necessary. (petplace.com)
Sometimes irritated anal glands can be infected and antibiotics may be necessary. (skoutshonor.com)

The dentate line is the junction of the ectoderm and endoderm in the anal canal. (medscape.com)

To treat, vets usually need to manually empty the anal sacs - Manual expression and an antibiotic or steroid ointment clear up most cases. (betterpet.com)

Anal glands naturally express on their own when a dog has normal, solid stools. (betterpet.com)
These anal sacs are also 'expressed' when your dog is frightened and are generally emptied naturally every time your dog goes for a number two. (watchmebark.com)

027.8 Other 027.9 Unspecified OTHER BACTERIAL DISEASES (030-041) Excludes: bacterial venereal diseases (098. (cdc.gov)
It is provided as an additional code where it is desired to identify the bacterial agent in diseases classified elsewhere. (cdc.gov)

Anatomy3

Diseases3

Called anal glands3

Tumors11

Dog's anal glands12

Abscess5

Impaction8

Adenocarcinoma3

Apocrine3

Licking of the anal area2

Experiencing anal sac problems1

Anus13

Tumor5

Infection7

Rectum7

Prevent anal sac1

Secretions4

Odor7

Infections7

Carcinoma2

Types of anal1

Dogs21

External anal sphi4

Signs of anal1

Rectal4

Lymph nodes2

Large intestine1

Scooting3

Symptoms7

Veterinarian3

Sacculectomy1

Left untreated1

Cats3

Stool1

Scent glands2

Fluid4

Adenocarcinomas1

Diagnosis4

Smell4

Glands expressed1

Structures1

Foul1

Abscesses2

Disorders1

Allergies2

Chronic5

Antibiotics2

Canal1

Manually empty1

Naturally2

Bacterial2