Could adding Cisapride help when Miralax and Lactulose don't work?

Elvgrengrl

TCS Member
Thread starter
Young Cat
Joined
Mar 17, 2018
Messages
35
Purraise
29
Hi. Me again. I continue to battle getting my 16 year old cat Bert regular. Now I'm noticing more frequent rectal prolapse which luckily does recede.

A month ago I took him to the vet due to constipation. They ran blood which was normal aside from a mild increase in Creatine (not enough to worry about). The Xray showed constipation and slightly enlarged colon, though not megacolon and a mildly plumped kidney. Ultrasound from last summer when I took him to ER showed some thickening of the intestines but without further tests couldn't be told why.

Anyway, the vet gave him an enema, told me to switch foods to Royal Canin Fiber Response (we needed something to keep crystals down in his urine because he had become blocked in the past). They said to increase Miralax from 1/4 tsp/day to 1/4 tsp twice a day. They also gave me a Rx for Lactulose if I wanted to try it.

He's been on the new food for almost a month. I think that's a fair amount of time to give it and the increase in Miralax to work. There has been no change in his inconsistent bowel movements. Some days are good. Some days are pretty bad. And now I have to make sure he doesn't prolapse and if he does that it goes back. So 4 days ago I tried the Lactulose. The next day he had a wonderful poop. I was excited. But the past 2 days his poops have gotten hard or tar-like and just now he tried to go, couldn't and is now hiding under the sofa. So I'm back to Miralax. I'm considering switching him back to his old food too. Because why hasn't the doubling of Miralax done anything? Now I'm wondering if Cisapride would make sense to add in.

The vet suggested I take him to an internist. I called and the cost to do that plus any tests are insane not to mention they're booked out 2 weeks. I could try to find a new vet but from I'm reading on this site I might hit a dead end with that. I would prefer to not do anything invasive unless absolutely necessary. I refuse to put him under the knife. He has a heart murmur so certain medications are a no-go (like cortisone shots for his hip arthritis, which could be contributing).

Please don't suggest pumpkin, or psyllium husks, or baby food, or slippery elm, or any of the alternate options. I've tried. I've tried every wet food. Every supplement that got decent reviews - including probiotics. Either it doesn't work (and trust me I give each thing a while to kick in) or he snubs it.

So until I can either find another vet or talk myself into the cost of the internist could Cisapride help? TIA!

I've started a spreadsheet and I'm so perplexed. Same food (Royal Canin FR + Fancy Feast Petites Pate - the only kind he'll sometimes eat). Same amount of Miralax (1/4 tsp 2x/day). Nothing additional. Same times of day:

DateAppetitePoo Type# of times poopedVomit
9/9/22MediumSoft10
9/10/22PoorNoneNone3
9/11/22PoorNoneNone0
9/12/22GoodSoft10
9/13/22GoodSoft10
9/14/22GoodSoft10
9/15/22GoodSoft10
9/16/22MediumNoneNone4
9/17/22PoorMix LOTS with crying1
9/18/22GoodNoneNone0
9/19/22MediumHard10
9/20/22GoodHard30
9/21/22MediumSoft21
9/22/22GoodNormal20
9/23/22GoodNormal31
9/24/22PoorNoneNone3
9/25/22PoorHard11
9/26/22PoorMix20
 

Gary O

Mad Cats
Young Cat
Joined
Sep 27, 2022
Messages
56
Purraise
70
Location
Essex UK
When I was fostering, I had a couple of cats with bad constipation, a combination of normal human generic lactulose and clear soup (as much as they would drink) did the trick. I used fresh salmon boiled in a lot of water for one who was fish lover and chicken for the other. I also added water to all wet food. Obviously, if he is already drinking a good amount of water, this won't apply, but mine were not drinking very much at all.
 

artiemom

Artie, my Angel; a part of my heart
Top Cat
Joined
Dec 22, 2014
Messages
10,306
Purraise
20,045
Location
near Boston
Sorry to say this but, If you cat has a borderline enlarged intestine, pretty bad constipation-- there is a motility issue. Which is also described as Megacolon.

My Artie had that. It was treated as Megacolon. Artie's colon was never enlarged, to the Megacolon, but he did have a motility issue. The muscles could not contract to push the poop out. I had to find some kind of Mix, that worked; and the mix was not consistent--- it was constantly in flux.

I did see an IMVet, as it was a bit beyond my regular vet's expertise.
Artie was on many medications: Cisapride, Lactulose, Miralax, and daily sub-q fluids; along with many enemas.

I ended up using an extra calendar, to track stools; correlating it with amount of meds given. This way, I was able to see that his transit time was about 3 days. What I gave him that day for meds, would show up 3 days later. I was constantly adjusting his doses accordingly.

I wish you luck.. It is a long tuff diagnosis. (hugs)
 
  • Thread Starter Thread Starter
  • #4

Elvgrengrl

TCS Member
Thread starter
Young Cat
Joined
Mar 17, 2018
Messages
35
Purraise
29
Sorry to say this but, If you cat has a borderline enlarged intestine, pretty bad constipation-- there is a motility issue. Which is also described as Megacolon.

My Artie had that. It was treated as Megacolon. Artie's colon was never enlarged, to the Megacolon, but he did have a motility issue. The muscles could not contract to push the poop out. I had to find some kind of Mix, that worked; and the mix was not consistent--- it was constantly in flux.

I did see an IMVet, as it was a bit beyond my regular vet's expertise.
Artie was on many medications: Cisapride, Lactulose, Miralax, and daily sub-q fluids; along with many enemas.

I ended up using an extra calendar, to track stools; correlating it with amount of meds given. This way, I was able to see that his transit time was about 3 days. What I gave him that day for meds, would show up 3 days later. I was constantly adjusting his doses accordingly.

I wish you luck.. It is a long tuff diagnosis. (hugs)
Thank you SO MUCH for this and sorry it was so rough for you and Artie. It has been hard and I'm doing my best in general and with keeping track - use his own calendar but then input into a spreadsheet. It's still so very hard to make sense of it. The enema experience was horrible for me and Bert. It took him daaaaaaays to get back to his normal personality and now he hides after he poops probably because he thinks he's going to the vet. The clean up on my end was exhausting (he was leaking a good 48 hours afterward). I'm not sure how I feel about giving him subQ fluids if that is his destiny. I'm alone and have no in-person support and he won't come out for anyone so long-term daily medications would be tricky if he ended up needing that, which is why I'm trying to keep it simple, because Mama needs to take vacations. Oof.

Would you recommend seeing a IMVet? Or did you feel like it was a waste of time? Was a dietary change made as well? Did the Cisapride help?
 

Dos Gatos

TCS Member
Young Cat
Joined
May 6, 2021
Messages
45
Purraise
56
My Echo had constipation for most of her life but the last year of her life was awful. She was never officially diagnosed with megacolon but definitely had a pretty significant motility issue. She was on 1/2 tsp Miralax and occasional lactulose. There are a lot of mixed reviews on Cisapride but she was one that it definitely helped, at least for a few months. We had it flavored with a fish flavor and she actually took it willingly, unlike the many other meds she was on. We did take her to an internist but it was not a good experience for us. Because she was 17yo, he didn’t seem very willing to help and just chalked everything to her age.
I am so sorry you and Bert are dealing with this. Kitty constipation is awful, especially when it seems like nothing helps.
 
  • Thread Starter Thread Starter
  • #6

Elvgrengrl

TCS Member
Thread starter
Young Cat
Joined
Mar 17, 2018
Messages
35
Purraise
29
My Echo had constipation for most of her life but the last year of her life was awful. She was never officially diagnosed with megacolon but definitely had a pretty significant motility issue. She was on 1/2 tsp Miralax and occasional lactulose. There are a lot of mixed reviews on Cisapride but she was one that it definitely helped, at least for a few months. We had it flavored with a fish flavor and she actually took it willingly, unlike the many other meds she was on. We did take her to an internist but it was not a good experience for us. Because she was 17yo, he didn’t seem very willing to help and just chalked everything to her age.
I am so sorry you and Bert are dealing with this. Kitty constipation is awful, especially when it seems like nothing helps.
Aw, poor Echo. I'm sorry.

I appreciate this feedback. I have been really resistant to spending the money that the IMVet charges ($150 consult; $400-600 for an Xray; $600-800 for an ultrasound? C'mon). I'm going to try to find a new vet this week. He just tried to poo again and it got stuck half in and out of his butt. Luckily he was able to scoot it off. And then he vomited 6 times. Sigh. This is so hard. I'm not feeling well myself today and just don't have it in me to keep cleaning the messes. :(
 

fionasmom

Moderator
Staff Member
Moderator
Joined
Jun 21, 2014
Messages
8,774
Purraise
12,059
Location
Los Angeles
I have taken my pets to specialists. The consult fee is standard, maybe less expensive than some others/other places would charge. US sounds on the high side. I have paid $500 even when they were done by specialists. Do you have very recent xrays which could be taken to the specialist if they would accept them. The ones I saw did not mind interfacing with the regular vet for procedures like xrays and blood tests.
 

artiemom

Artie, my Angel; a part of my heart
Top Cat
Joined
Dec 22, 2014
Messages
10,306
Purraise
20,045
Location
near Boston
Aw, poor Echo. I'm sorry.

I appreciate this feedback. I have been really resistant to spending the money that the IMVet charges ($150 consult; $400-600 for an Xray; $600-800 for an ultrasound? C'mon). I'm going to try to find a new vet this week. He just tried to poo again and it got stuck half in and out of his butt. Luckily he was able to scoot it off. And then he vomited 6 times. Sigh. This is so hard. I'm not feeling well myself today and just don't have it in me to keep cleaning the messes. :(
Those prices sound high. I take my guys to a huge specialty animal hospital. Are you sure you got this correct?

The reason why you cat is vomiting so much is because he is full of poop!! It is backing up in his system, causing him to vomit.

OK, here are my thoughts, as blunt and harsh as they come.. I apologize in advance.

Yes, I feel an IMVet is necessary. An IMVet is well versed in many areas. They are a great source of information and help. I think this is beyond a regular vet; no matter how many you see. And at his age of 16, there can be so many more additional issues. The IMVet can help putting it all together.

An ultrasound, at a specialty hospital, cost me around $2-300. The initial office visit is usually $150. I take it that you do not have pet insurance; that makes things even harder.
Daily medications are a must, multiple times a day, as well as variations in the doses, per his daily symptoms. I live alone, also, and I can manage, with my past 3 cats.

Sub-q fluids are not that bad. We all thought that Artie would be a terror; but, for me, he was so good. He was a terror at the Vet's. Cats get used to things.. especially when they know it helps them.

My guy runs under the bed, when he suspects medications. I have to take my Swiffer and gently shoo him out, but it is for his own good. Sometimes, you just have to do it.

Ok- here comes the very blunt part. If you are planning on a Vacation, you need to find someone you trust, who is well versed in caring for a sick cat...Sometimes a Vet Tech will do this.Someone who can adjust medic actions as per symptoms. Someone you cat knows, and trusts.. Someone experienced. This is just a fact of life with a sick cat, as it is with a sick child. You have to think of their welfare, health first; especially a senior cat.

I wish you well.. I hope you can come to some decision on how to help your kitty. Megacolon and motility issues are so hard to deal with. It really stinks. Good Luck
 

kudzu kitty

TCS Member
Kitten
Joined
Sep 30, 2022
Messages
6
Purraise
6
When you said you're back to Miralax, do you mean that you were only doing either lactulose or miralax but not both at once? Was that restriction on your vet's advice? From what I understand/what I was told by several vets when treating my cat, lactulose dosage can safely be increased quite a bit as needed, and my older cat was on both lactulose and miralax at the same time for several weeks this summer.

Best of luck figuring it out. I didn't make it to spreadsheet phase, but hoo boy did I have an extensive set of notes.
 

Cheryl2

TCS Member
Kitten
Joined
Apr 24, 2022
Messages
5
Purraise
1
Hi. Me again. I continue to battle getting my 16 year old cat Bert regular. Now I'm noticing more frequent rectal prolapse which luckily does recede.

A month ago I took him to the vet due to constipation. They ran blood which was normal aside from a mild increase in Creatine (not enough to worry about). The Xray showed constipation and slightly enlarged colon, though not megacolon and a mildly plumped kidney. Ultrasound from last summer when I took him to ER showed some thickening of the intestines but without further tests couldn't be told why.

Anyway, the vet gave him an enema, told me to switch foods to Royal Canin Fiber Response (we needed something to keep crystals down in his urine because he had become blocked in the past). They said to increase Miralax from 1/4 tsp/day to 1/4 tsp twice a day. They also gave me a Rx for Lactulose if I wanted to try it.

He's been on the new food for almost a month. I think that's a fair amount of time to give it and the increase in Miralax to work. There has been no change in his inconsistent bowel movements. Some days are good. Some days are pretty bad. And now I have to make sure he doesn't prolapse and if he does that it goes back. So 4 days ago I tried the Lactulose. The next day he had a wonderful poop. I was excited. But the past 2 days his poops have gotten hard or tar-like and just now he tried to go, couldn't and is now hiding under the sofa. So I'm back to Miralax. I'm considering switching him back to his old food too. Because why hasn't the doubling of Miralax done anything? Now I'm wondering if Cisapride would make sense to add in.

The vet suggested I take him to an internist. I called and the cost to do that plus any tests are insane not to mention they're booked out 2 weeks. I could try to find a new vet but from I'm reading on this site I might hit a dead end with that. I would prefer to not do anything invasive unless absolutely necessary. I refuse to put him under the knife. He has a heart murmur so certain medications are a no-go (like cortisone shots for his hip arthritis, which could be contributing).

Please don't suggest pumpkin, or psyllium husks, or baby food, or slippery elm, or any of the alternate options. I've tried. I've tried every wet food. Every supplement that got decent reviews - including probiotics. Either it doesn't work (and trust me I give each thing a while to kick in) or he snubs it.

So until I can either find another vet or talk myself into the cost of the internist could Cisapride help? TIA!

I've started a spreadsheet and I'm so perplexed. Same food (Royal Canin FR + Fancy Feast Petites Pate - the only kind he'll sometimes eat). Same amount of Miralax (1/4 tsp 2x/day). Nothing additional. Same times of day:

DateAppetitePoo Type# of times poopedVomit
9/9/22MediumSoft10
9/10/22PoorNoneNone3
9/11/22PoorNoneNone0
9/12/22GoodSoft10
9/13/22GoodSoft10
9/14/22GoodSoft10
9/15/22GoodSoft10
9/16/22MediumNoneNone4
9/17/22PoorMixLOTS with crying1
9/18/22GoodNoneNone0
9/19/22MediumHard10
9/20/22GoodHard30
9/21/22MediumSoft21
9/22/22GoodNormal20
9/23/22GoodNormal31
9/24/22PoorNoneNone3
9/25/22PoorHard11
9/26/22PoorMix20
Hi,
struggled with cat constipation for a while. It really came down to trial and error. He did need enemas before. Switched to a mixture of wet and dry cat food. Added a water fountain. Cat loves drinking from this. Vet recommended it because they like moving water not still water. I found the lactulose did not work well. He gets 2 1/4 teaspoons in the morning in his wet food. He gets another 2 (1/4 teaspoons in the evening) we use restoralax but miralax is the same.
 
  • Thread Starter Thread Starter
  • #11

Elvgrengrl

TCS Member
Thread starter
Young Cat
Joined
Mar 17, 2018
Messages
35
Purraise
29
When you said you're back to Miralax, do you mean that you were only doing either lactulose or miralax but not both at once? Was that restriction on your vet's advice? From what I understand/what I was told by several vets when treating my cat, lactulose dosage can safely be increased quite a bit as needed, and my older cat was on both lactulose and miralax at the same time for several weeks this summer.

Best of luck figuring it out. I didn't make it to spreadsheet phase, but hoo boy did I have an extensive set of notes.
Correct. The vet said not to give him Miralax and Lactulose at the same time. It's so fascinating that different vets take different approaches. I def need to get him in to see someone new. Thanks for the feedback.
 
  • Thread Starter Thread Starter
  • #12

Elvgrengrl

TCS Member
Thread starter
Young Cat
Joined
Mar 17, 2018
Messages
35
Purraise
29
Hi,
struggled with cat constipation for a while. It really came down to trial and error. He did need enemas before. Switched to a mixture of wet and dry cat food. Added a water fountain. Cat loves drinking from this. Vet recommended it because they like moving water not still water. I found the lactulose did not work well. He gets 2 1/4 teaspoons in the morning in his wet food. He gets another 2 (1/4 teaspoons in the evening) we use restoralax but miralax is the same.
Maybe I'll get another water fountain. I tried one years ago and he just stared at it. I'm just not sure where I'd put it. My space isn't designed for a high-maintenance cat. That's good to know that you were giving 1/2 tsp twice a day. I think my guy needs an increase until I can get him into a vet. Thanks!
 
  • Thread Starter Thread Starter
  • #13

Elvgrengrl

TCS Member
Thread starter
Young Cat
Joined
Mar 17, 2018
Messages
35
Purraise
29
Those prices sound high. I take my guys to a huge specialty animal hospital. Are you sure you got this correct?
...
Ok- here comes the very blunt part. If you are planning on a Vacation, you need to find someone you trust, who is well versed in caring for a sick cat...Sometimes a Vet Tech will do this.Someone who can adjust medic actions as per symptoms. Someone you cat knows, and trusts.. Someone experienced. This is just a fact of life with a sick cat, as it is with a sick child. You have to think of their welfare, health first; especially a senior cat.
Yep. Those are the prices. I'm okay with the consult but the imaging fees seem a bit ridiculous.

Here's the rub. The ONLY person he has come out for over the past 13 years is my mom and she lives in another state. My cat sitters can't even look at him under the bed without him hissing or lunging at them. He has become way more socially adverse as he's gotten older and I rarely have company which I'm sure doesn't help. So I'm kinda screwed here. I don't think boarding an anxious kitty would be great either. One day at the vet takes him 5 days to behaviorally bounce back. I can't imagine 5-7 days. But I appreciate the suggestion.
 
Top