Ckd and constipation

[JustBrian]

Hi all. My cat Simba has Ckd. Not sure what stage. He has been getting constipated and the vet put him on lactulose. 5 ml twice daily until he has a movement then 2ml twice daily. He was stopped up for a week. Took him to the vet and he was anesthetized and given an enema. The tech said the poop was not rock hard. He gets a mixture of hard kibble and wet food. I’m going to greatly limit the hard kibble.
I saw on here about using Miralax instead of lactulose. Within the week of him not pooping we were giving him 5ml twice daily with no luck. We are on our last ditch effort to get this managed properly or unfortunately we are out of options.
what I’m asking for is suggestions on managing this constipation. He was trying to poop but it just was not coming out. I know hydration is huge. We have numerous water bowls and fountains around the house to encourage drinking. Any and all help or suggestions are appreciated

 

[FeebysOwner]

Hi and welcome to TCS! 5ml of Miralax? Since Miralax is a powder, what is the teaspoon dosage, and are you quoting it in ml because you mix it with water?

Feeby is in early Stage 3 CKD, and it wasn't until her dose of Phos Bind was increased that she started pooping every other day instead of every day. It was a bit on the 'too firm' side. I give her 1/8 tsp of Miralax in a bite of food or lickable treat, so I don't add any water. She still mostly only goes every other day, but it is softer now. Some folks have to go as high as 1/4 tsp twice a day to get results. There are others who need to use both lactulose and Miralax.

If he likes his kibble, you could try to mix it with water to add moisture to his diet and see if he will eat it that way. I also add water to Feeby's wet food.

CKD in general can contribute to constipation. Depending on his kidney values, he might benefit from sub-Q fluids. Feeby had a bout last May with very elevated kidney numbers and she was started on sub-Q fluids. Her numbers dropped back down - still in the Stage 3 range, though. It might be one of the reasons that she didn't need Miralax before now.

Do you use Tanya's web site as a source for all things CKD? If not, you might find it helpful. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). It covers just about everything, including constipation as well as sub-Q fluid use. It is very comprehensive but contains a lot of valuable information.

 

[JustBrian]

Hi and welcome to TCS! 5ml of Miralax? Since Miralax is a powder, what is the teaspoon dosage, and are you quoting it in ml because you mix it with water?

Feeby is in early Stage 3 CKD, and it wasn't until her dose of Phos Bind was increased that she started pooping every other day instead of every day. It was a bit on the 'too firm' side. I give her 1/8 tsp of Miralax in a bite of food or lickable treat, so I don't add any water. She still mostly only goes every other day, but it is softer now. Some folks have to go as high as 1/4 tsp twice a day to get results. There are others who need to use both lactulose and Miralax.

If he likes his kibble, you could try to mix it with water to add moisture to his diet and see if he will eat it that way. I also add water to Feeby's wet food.

CKD in general can contribute to constipation. Depending on his kidney values, he might benefit from sub-Q fluids. Feeby had a bout last May with very elevated kidney numbers and she was started on sub-Q fluids. Her numbers dropped back down - still in the Stage 3 range, though. It might be one of the reasons that she didn't need Miralax before now.

Do you use Tanya's web site as a source for all things CKD? If not, you might find it helpful. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). It covers just about everything, including constipation as well as sub-Q fluid use. It is very comprehensive but contains a lot of valuable information.

Not 5ml of miralax. 5ml of lactulose

 

[FeebysOwner]

So, you haven't tried Miralax so far? Maybe this older thread might be of help?
Miralax vs. Lactulose-your experiences? | TheCatSite

I have not used lactulose, so I have no idea how to compare doses. But, here is another older thread that talks about both of them.
Feline Constipation-Miralax vs. Lactulose/or both at the same time? | TheCatSite

Also -
Miralax for Cats: Uses, Dosage, & Side Effects - Cats.com
Lactulose for Cats: Overview, Dosage & Side Effects - Cats.com

 

[mrsgreenjeens]

Here is the specific page within Tanya's website (referenced above) that is all about constipation in kidney cats. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Constipation Some times, as alluded to above, if some of their other values are out of whack, like potassium or calcium, OR, if you are giving them certain medications, that can add insult to injury and cause the problem.

Two of my kidney cats did well on Miralax. 1/8 to 1/2 teaspoon dissolved in a little bit of water, then mixed with a tiny bit of wet food, given twice per day. Once they ate that, then I would give them more food, but first I wanted to make sure they consumed all of the Miralax without me having to force it into them.

 

[JustBrian]

What brands of food does everyone use? We’ve tried the prescription kidney diet wet foods and he will not touch it. We are trying to get him on an all wet food diet. This is so emotionally draining as we try to learn how to manage this. Our vet suggested giving him 5ml of lactulose twice per day and 1/2 teaspoon Mira-Lax once per day. Thoughts? Also which pumpkin name brands should I try?

 

[FeebysOwner]

I can't be of much help with regard to the food. Feeby is pretty picky and really doesn't like many of the lower phosphorus foods, which is part of the equation with kidney prescription foods. So, when Feeby's phosphorus level reached a point, I began to give her Phos-Bind with the foods she will ear.

Tanya's web site has a listing of lower phosphorus foods you could look at. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease- Canned Food Data USA (felinecrf.org). There is even a section on dry foods too. One wet food that is newer is Weruva Wx that some cats seem to like. Of course, my cat hates it!!

I am not a real supporter of using foods with pumpkin in them, as there are some cats that have constipation issues with too much fiber and that is what the pumpkin is for.

I wish I could answer about the combo lactulose and Miralax. Did any of the links I give you help at all? If not, then I would start with adding 1/8 tsp daily, along with the lactulose. If that doesn't help, use 1/8 tsp of Miralax twice a day, and increase to 1/4 tsp once a day, and then 1/4 tsp twice a day. It really is all about experimenting to find the right dosages for Simba. There is not one solution that fits all cats. As you saw above mrsgreenjeens has gone up to 1/2 tsp twice a day - of course, that was without the lactulose.

 

[JustBrian]

I can't be of much help with regard to the food. Feeby is pretty picky and really doesn't like many of the lower phosphorus foods, which is part of the equation with kidney prescription foods. So, when Feeby's phosphorus level reached a point, I began to give her Phos-Bind with the foods she will ear.

Tanya's web site has a listing of lower phosphorus foods you could look at. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease- Canned Food Data USA (felinecrf.org). There is even a section on dry foods too. One wet food that is newer is Weruva Wx that some cats seem to like. Of course, my cat hates it!!

I am not a real supporter of using foods with pumpkin in them, as there are some cats that have constipation issues with too much fiber and that is what the pumpkin is for.

I wish I could answer about the combo lactulose and Miralax. Did any of the links I give you help at all? If not, then I would start with adding 1/8 tsp daily, along with the lactulose. If that doesn't help, use 1/8 tsp of Miralax twice a day, and increase to 1/4 tsp once a day, and then 1/4 tsp twice a day. It really is all about experimenting to find the right dosages for Simba. There is not one solution that fits all cats. As you saw above mrsgreenjeens has gone up to 1/2 tsp twice a day - of course, that was without the lactulose.

We would hope to not have to use the lactulose especially since he was getting 5ml twice daily and it did not help. We’re looking at management options and this site looks like an excellent starting point. Simba is very picky also with food which is what makes this all the harder. We currently give him a variety of fancy feasts wet food which includes two senior options of beef and chicken

 

[FeebysOwner]

You cannot go wrong utilizing that site, trust me! It has helped me loads. Feeby is not a fish eater at all, so all the foods I mentioned are mainly chicken, beef or a combo of. Her favorite (so far) is Purina Pro Senior 11+ chicken & beef. Why - I have no idea. It is high protein which some think is not great for a CKD cat, but muscle wasting is a big thing with older cats, and especially those with CKD. So, I am willing to take my chances given she leans in that direction in terms of her food anyway.

Feeby requires a rotation of foods that extend from 7 to 10 days in order to keep her interested in eating.

 

[JustBrian]

Does anyone have any good wet food suggestions?

 

[stephanietx]

One of my kitties was recently diagnosed with stage 2 CKD and I had noticed her poops have changed. Took her to the vet and she was also a little constipated. We are feeding her RAWZ rabbit with pumpkin and I'm giving her Visbiome Vet probiotic. We give her a mix of the rabbit with pumpkin, duck, and chicken wet food. We also add a couple of teaspoons of water to her wet food.

The vet recommended Miralax, 1/4 teaspoon 1-2 times a day mixed with wet food, but I'm holding off on that. You can also add plain canned pumpkin or Firm Up pumpkin powder. Pumpkin is interesting because it can help loose stools become firm and firm stools become softer and easier to pass..

 

[FeebysOwner]

Does anyone have any good wet food suggestions?

Did you check out the food list on the link I provided above?

 

[stephanietx]

I forgot to mention food in my post! Ack!

I have had 2 previous CKD kitties. With my first one, we put her on a prescription diet. She did well on it, but we also gave her "real wet food" that we gave our other kitties in with her rx canned food. For my second CKD kitty, we didn't change her food. We supplemented and kept her on grain-free food and she did well on it. We fed her Instinct chicken, venison, and rabbit flavors.

 

[JustBrian]

Did you check out the food list on the link I provided above?

I gave it a Quick Look over. To help me understand I want the ones at the top of that list right?

 

[FeebysOwner]

I gave it a Quick Look over. To help me understand I want the ones at the top of that list right?

Ideally, yes. The list is in order of phosphorus content - low to high. Lower is better, but there has to be some leeway due to a cat's preferences and availability. Depending on your cat's phosphorus level (did you tell us and I missed it?), it may not be necessary to go as low as you can - on that note, I'd shoot for ones that are 1.0% or less.

There are other factors to consider when picking cat food, but this is a good starting point until you have a chance to delve more deeply into Tanya's web site.

 

[JustBrian]

Ideally, yes. The list is in order of phosphorus content - low to high. Lower is better, but there has to be some leeway due to a cat's preferences and availability. Depending on your cat's phosphorus level (did you tell us and I missed it?), it may not be necessary to go as low as you can - on that note, I'd shoot for ones that are 1.0% or less.

There are other factors to consider when picking cat food, but this is a good starting point until you have a chance to delve more deeply into Tanya's web site.

I don’t know what his phosphorus level is

 

[FeebysOwner]

I don’t know what his phosphorus level is

Didn't you have blood work done (including a chemistry panel)? Phosphorus is in the results. The test results are yours for free, all you have to do is ask the vet to email you a copy. I get a copy of all my cat's tests each and every time. It is helpful to become familiar with what all is being tested and it enables you to look for trends that a vet may or may not miss over time. They are looking at results for tons of cats, so I figure I can pick up on things since I only have to look at the results for one cat.

 

[mrsgreenjeens]

As far as giving both Lactulose AND Miralax, we never gave both. Just Miralax. Started with Lactulose and then switched to Miralax when the Lactulose stopped working.

As far as wet food, I used that list on Tanya's site and tried to stay under 1% phos, but sometimes that wasn't possible as my old girl was picky as her kidney issue progressed. But our Vet was fine with feeding her whatever she would eat. None of our kidney cats ever ate the kidney foods, they didn't like them. And we never used phos binders either, since their phos never got too high.

What worked well for us was to switch up the foods frequently, and also to feed smaller meals more frequently. this also helps with the over acidic tummies that often accompany kidney disease. I even fed two small meals in the middle of the night. All in all she would get 8 - 9 meals in a 24 hour period. At the 10 p.m. feeding, I would also prepare two additional meals and put the bowls in ziplok bags. Then I would set the bowls on my nightstand, one of them on an icepak. She would wake me when she was hungry and all I had to do was reach over and take her bowl out of the ziploc bag and set it on the bed so she could eat. Then I took the other bowl off the icepak so it could reach room temp for her next feeding in 3 or 4 hours. I have more than one cat, so I also kept a little bag of treats handy to give the others if they waited patiently while she ate. It worked great and I never had to wake up fully! OH, and I always added water to every single meal, as kidney cats need to keep very hydrated. I still do that to this day with my healthy cats because I'm paranoid.