Constipation, Cisapride, And Calcium

[tmig]

My mom and I have been losing our minds trying to figure out exactly where our 5 year old Alfie's constipation is coming from. We just adopted him last October, but from what I can remember, the first few months of pooping were just fine. In mid March of this year we brought him to the vet because he was making sad sounds while trying to poop and nothing was coming out. They said he was extremely constipated, did two or three enemas overnight, and he came home and started pooping normally - on what I now believe was a very high dose of lactulose. They prescribed us 3ml 3x a day. He hated it, and he is a long haired cat, so any time he would turn his head or lick his lips or what not, it would dribble into his mane and get tangled and turn the fur yellow. Another month later he was back at the vet again for another enema. Cue the pooping and lactulose dosage again.

This past week we brought him back into the vet because he had some really liquidy, dark vomit and seemed to be backed up again. They kept him for over a day, gave 3 enemas, and did blood tests as I asked if there were any underlying issues here. The vet called back with the blood results and said there was a high level of calcium, which can be idiopathic or linked to tumors (Great). We're now waiting to hear back about specifics regarding the blood testing, but I just saw a post on here about Lactulose having a correlation with high calcium levels. I'm especially suspicious because when we first brought him in as a new adoptee in November, they checked his blood and the calcium levels were normal. The vet said the hypercalcemia may or may not be related to the constipation.

In the past week they prescribed cisapride twice a day, and my mom and I have started giving him 1/4 teaspoon of miralax 2-3 times a day in a new grain-free wet food. He absolutely hates the cisapride and I feel so bad giving it to him. Since that vet visit he's pooped a few times but it's been so watery (fixable with lessening the Miralax dose I'm assuming) and slightly green/yellow?? Is that normal for cisapride? Poor guy is walking around dropping lil poops and can't even help it.

I just wonder what the heck else it could be that is causing his poor lil self to be constipated. He's only 5 years old! Plus, I'm moving out of state next month and I'm worried about making his condition worse... Oh, and one more thing - he's supposed to lose 3 more pounds, which is originally what the doctor said was the cause of his constipation - being overweight. It's been a whirlwind few months for poor Alfie.

 

[neely]

First, I'd like to welcome you to TCS! Thank you for adopting Alfie. He is a very handsome boy. I'm glad you joined the forum but sorry to hear about his health problem(s). I thought this Article which goes into detail about constipation would be helpful for you: Everything You Need To Know About Constipation In Cats
I also wanted to note this recent thread which discusses problems with constipation:
Some Constipation Questions

There are other members on the site who have had experience with the same health issue and I'm hoping they will be able to offer their advice. Once again, I'm glad you came here for support. Best of luck with Alfie and please keep us updated with his progress.

 

[mrsgreenjeens]

What was the big guy eating before you recently switched him to his new grain free wet food? Cats who don't take in enough water are more prone to constipation, and so are long haired cats. IF he was eating dry food and not drinking enough, and especially if he ate wet food before you adopted him, that might explain why he started "plugging up" after a few months. I'm just guessing here...have no idea if he was even eating dry food after you adopted him.

Now, as to the hypercalcemia, there is certainly a possibility that the lactulose caused it. I don't think it's proven, but there have certainly been lots of cats who've been on lactulose who've gotten hypercalcemia. Coincidence? Perhaps, but maybe not. I, personally, HATE lactulose, but much prefer Miralax. It's not messy, for one. And I just think it works better. Plus the cats never even know they are getting it, since it has no smell or taste, so no stress on them trying to get it into them. And it's so easy to adjust the dosage. I DO think you need to lower his dosage if he is "dripping". One of our guys had that issue...he wouldn't even realize he was having little poops while he was just laying around until we lowered his dose. We found 1/8th teaspoon twice a day worked well for both of our chronically constipated cats, although they didn't weigh much.

Was Alfie diagnosed with Megacolon? Usually that's when cisapride is prescribed, as far as I know. And I don't think that would cause his stools to be greenish/yellow, BUT, rapid transit can cause it, and cisapride helps with the transit of the stools, so I guess, in a round about way, maybe it IS the cause. And if so, maybe he doesn't need it. I would call his Vet and tell them his stools have changed color and see what they say (unless his new food is greenish/yelllow, which I doubt)

So...bottom line, IMHO he needs lots of water. You could even add more water to his wet food. Maybe 1 tablespoon per meal. You could also try adding in some pumpkin, maybe 1 teaspoon per meal. This is a good type of fiber that is good for both constipation AND diarrhea (unless the Vet specifically told you NOT to increase his fiber). This might also help him lose weight because it'll help fill him up without adding alot of calories. Our Vet had us do this with out pudgy guy. BTW, wet food is the ONLY way we got our guy to lose weight! Additionally, try to groom him several times a week to keep him from ingesting too much hair. That should help too. And exercise him. Getting him to play and run around also helps with constipation. Keeps things moving along

 

[Yodasmom]

I get the cisapride in capsule form and mix it with the Lactulose to give my cat using the mouth syringe.

 

[tmig]

What was the big guy eating before you recently switched him to his new grain free wet food? Cats who don't take in enough water are more prone to constipation, and so are long haired cats. IF he was eating dry food and not drinking enough, and especially if he ate wet food before you adopted him, that might explain why he started "plugging up" after a few months. I'm just guessing here...have no idea if he was even eating dry food after you adopted him.

Now, as to the hypercalcemia, there is certainly a possibility that the lactulose caused it. I don't think it's proven, but there have certainly been lots of cats who've been on lactulose who've gotten hypercalcemia. Coincidence? Perhaps, but maybe not. I, personally, HATE lactulose, but much prefer Miralax. It's not messy, for one. And I just think it works better. Plus the cats never even know they are getting it, since it has no smell or taste, so no stress on them trying to get it into them. And it's so easy to adjust the dosage. I DO think you need to lower his dosage if he is "dripping". One of our guys had that issue...he wouldn't even realize he was having little poops while he was just laying around until we lowered his dose. We found 1/8th teaspoon twice a day worked well for both of our chronically constipated cats, although they didn't weigh much.

Was Alfie diagnosed with Megacolon? Usually that's when cisapride is prescribed, as far as I know. And I don't think that would cause his stools to be greenish/yellow, BUT, rapid transit can cause it, and cisapride helps with the transit of the stools, so I guess, in a round about way, maybe it IS the cause. And if so, maybe he doesn't need it. I would call his Vet and tell them his stools have changed color and see what they say (unless his new food is greenish/yelllow, which I doubt)

So...bottom line, IMHO he needs lots of water. You could even add more water to his wet food. Maybe 1 tablespoon per meal. You could also try adding in some pumpkin, maybe 1 teaspoon per meal. This is a good type of fiber that is good for both constipation AND diarrhea (unless the Vet specifically told you NOT to increase his fiber). This might also help him lose weight because it'll help fill him up without adding alot of calories. Our Vet had us do this with out pudgy guy. BTW, wet food is the ONLY way we got our guy to lose weight! Additionally, try to groom him several times a week to keep him from ingesting too much hair. That should help too. And exercise him. Getting him to play and run around also helps with constipation. Keeps things moving along

Thank you so much for your thoughtful reply! When I first got him, his owner gave me a big tub of dry food that he had been eating - not sure what kind exactly, but it was some kind of Purina. That's what my other cats are used to eating (of course they have no issues whatsoever! ha), so I fed him some of their Purina One. It seemed to look very similar to his old food and he seemed okay, though he wasn't crazy about dinnertime. It was my mistake that I left the food out for too long, as I'd never gotten the hang of the 'let them eat, pick up bowl' etc. So basically - I let him graze too much, and then he got overweight. He did also enjoy the Sheba perfect portions at the same time though, and tuna, so I knew he liked wet food.

The first diet food my vet recommended was the W/D Hills wet food. Alfie hated it so we asked for another recommendation, and then they gave us the Metabolic Hills dry food. He seemed to like that much better so that's what he's been on for about a month and a half. Recently though, a cat friend of mine told me the grain/manufactured ingredients weren't doing much good for him and she recommended I try grain free food. I told my vet about the change and he said to go ahead and give it a try. So for the last week he's been on Purina Beyond (chicken, beef, and carrots)! And he's in love with it, lol. I've read grain free food can make them poop less because their body absorbs more nutrients, so that's good, but I'm kind of at a loss to what is normal anymore. He did a real soft poop the night we came home from his last enema vet stay, then the next night was the same but a bit bigger, and then the past couple days it's been those sad little drops that I don't even think he knows is happening. So I skipped his Miralax last night and I skipped a dose today (the vet said 1/4 tsp 3x a day) - I'm not sure whether to skip the third dose tonight but it's getting pretty late and he still needs his second Cisapride.

He wasn't diagnosed with megacolon, I asked and the vet said "his colon is enlarged but we're not there yet." So I guess I'm just kind of wary about the cisapride. The lactulose I'm going to return because it's just made such a mess of his fur and the miralax is so much more convenient. That makes a lot of sense about the stool passing so fast it doesn't get to darken in color. I'll definitely call tomorrow and tell the vet about that. I also checked in with the emergency clinic nearby and they said a specialist might be a good option, though I'm moving out of state very soon so I probably won't get to her by then. But, I could still stop in and have them evaluate him for a second opinion. We're still waiting on his blood results and it's been a week

I didn't even think of adding more water to his wet food. That sounds perfect. The vet didn't specify one way or another re: fiber, and they've kind of been vague about the whole thing. He's been playing more lately so I'm hoping that'll help! He's lost a pound so far in his weight loss journey haha. It took him about a month and a half to lose it. Do you have any recommendations for brands or types of pumpkin? Ty

 

[laura mae]

Cisapride helps with the transit of stool. It isn't necessarily for megacolon, but helps cats who have difficulty with regular bowel movements. My cat Booberry was officially adopted by us after having been hit by a car. He had a shattered pelvis. Cage rest for weeks and weeks healed him on his owns (Cats are literally magic). My vet thinks that the injury has made it more difficult to go meaning that because of the fracture, his pelvis is a fraction smaller. However, it could be the case that he tended toward constipation before for all we know.

It's a vexing problem. While water is one aspect of the issue, water isn't the only issue. There's something about the gut's ability to have both soluble and insoluble fibers that work to produce more regular stool.

For some cats, like my Booberry, extra fiber is not the solution. It bulks up the stool which in some situations helps things move through better. But for him it forms solid round balls of poop that are next to impossible for him to pass.

My regular vet was convinced that after the last enema (4 nights in a vet emergency hospital on a constant drip of mega doses of something close to Miralax) that he had megacolon, but x rays after he could pass the stool, showed a regular size colon.

He was prescribed Royal Canin Gastrointestinal dry food by the er vets. It did work in making his stool regular but the second bag I purchased smelled like some sort of funky contaminated crud--different from the first bag. Given the price of the food, I stopped giving it to him.

He gets Weruva with Miralax mixed in. We still struggle with constipation because he also loves freeze dried raw which I give to my 18 year old Scooter for the extra calories. He gets treated for hyperthyroid and is thin now. The regular canned food plus the freeze dried raw ups his protein. Booberry cannot handle the freeze dried for long without straining to poop afterwards. Probably the bone content---or as you have noted---too much calcium.

 

[tmig]

First, I'd like to welcome you to TCS! Thank you for adopting Alfie. He is a very handsome boy. I'm glad you joined the forum but sorry to hear about his health problem(s). I thought this Article which goes into detail about constipation would be helpful for you: Everything You Need To Know About Constipation In Cats
I also wanted to note this recent thread which discusses problems with constipation:
Some Constipation Questions

There are other members on the site who have had experience with the same health issue and I'm hoping they will be able to offer their advice. Once again, I'm glad you came here for support. Best of luck with Alfie and please keep us updated with his progress.

Thank you so much for the help! It's good to be here! I'm glad I joined.

 

[LTS3]

Do you have any recommendations for brands or types of pumpkin? Ty

Any brand of canned 100% pumpkin puree from the supermarket or big box store (Target etc) or even the dollar store will work. Libby's is one big brand name. Just be sure to get pumpkin puree not pumpkin pie filling. You can portion the puree out and freeze for later use.

 

[Yodasmom]

Here is what finally got Yoda's colon to work (check with your vet though):

• Royal Canin Gastrointestinal dry food (prescription from the vet)
• Lactulose twice a day
• Cisapride 3 times a day
• Cascara (an herbal supplement recommended by my vet, but talk to your vet about your situation)
• Prednisone and Cosequin for arthritis and knee problem

I have been doing this regimen since April. Yoda only poops every 2 to 5 days, but she is comfortable and happy, and I can't afford the expensive colon surgery. I really thought she was a goner, but she finally started to poop. I think it also helped that she got the manual de-obstipation procedure first (for about $450), so we restarted her system out clean.

Definitely look into the Royal Canin Gastrointestinal food. Its a dry food and my picky eater loves it. I think it really helped to turn things around.

 

[Frankfrank]

Hey! Just wanted to post in case it helps someone. My cat has a paralyzed tail, and limited bowel and bladder control, so she gets constipated (sometimes to the point of needing enemas).
We got the constipation kind of controlled on a combo of pumpkin puree mixed with hill's w/d wet (we also tried dry), miralax, lactulose, and cisapride (all 2x per day).
Then she developed idiopathic hypercalcemia. We tried taking her off lactulose in case that was the culprit, and giving her subq fluids, but her calcium levels continued to go up.
Then as a last ditch effort, the vet swapped her to Royal Canin dry gastrointestinal fiber response instead of the w/d, and she is now normalized! Constipation has cleared up and calcium levels going down.
The vet has now put other cats on the Royal Canin gastro fiber response, and it has been effective for them too. I see Yodasmom had similar success and more vets and people should know about it--it's worth a shot!

 

[artiemom]

My last guy was diagnosed with both Inflammatory Bowel disease and MegaColon; even though the colon was not at the "mega" size, he had a motility issue which was causing the constipation.. and caused the bowel to stretch and loose it's contractility.
The motility issue was linked to the nerves which are involved with the contraction of the bowel.

No test to diagnose this.. it is just watch, see, symptoms..

Artie ended up being on Cisapride, Miralax, extra water added to his food, and lactulose. and his pred for the IBD..

We eventually changed his food over to the Royal Canin Fiber Response food. It is dry food, but does do wonders.

The Lactulose caused Artie to have Hypercalcemia. We ended up doing an in-depth test for it.. When this happened, we had to discontinue the lactulose.

Once the lactulose was stopped, his calcium levels went down to normal levels.

We tried pediatric colace (stool softeners) which I had to order from Amazon.

Artie was very stubborn with his food.. being allergic to chicken.. and fussy. This complicated things so much.

We also resorted to daily sub-q fluids, to keep him hydrated; thus, helping his constipation.

I began the miralax with 1/8 tsp and worked up.. He was up to 1/4 tsp twice a day.
When he was eating the Fiber Response food, I cut down on the miralax-- giving it in a syringe.

You have to go slowly with these med.. unfortunately., using enemas, until you get the dosages correct.

I also logged everything.. a flow sheet for his daily meds, and a real calendar for his stool consistency. I discovered his transit time was 2-2.5 days.. meaning what dose I gave him 2-3 days before would affect him that day...
Very complicated...

Lactulose dose was to affect. At one point he was up to 6 cc, occasionally.. that is when the hypercalcemia came in.

I do not know if this is any help.. I am kind of reliving things.. and going from memory..

If you have days to read, you can follow our journey in Artie's thread.. a very, very long thread.. and see how things transpired.. keep looking back at the dose to see how long it takes to see a difference.. that is 'transit time'...

There are many, many people here who can help you..

I wish you luck...

Also, Are you seeing a regular Vet or going to see a specialist? I would suggest an Internal Med specialist~~ especially if you have any questions.... a great resource to have..

Also, some cats do take the lactulose when it is mixed in with wet food.. not a lot of lactulose mixed in, but they do eat it... weird..

Artie was a bear with it. I do not blame him.

((hugs))