Recurring constipation, vets don’t seem to know why, appetite down

[catloverfromwayback]

My 4yo spayed cat has been going for a month with this, her second bout of constipation since January. I don’t see her straining and she hasn’t vomited. She’s been on three 3ml doses of Lactulose since this started, and at first improved but then went right back to not defecating for - it was 60 hours between poops last time, it’s been around 36 hours so far today. What really worries me is that her appetite is way down. She doesn’t like wet food much, never eats a whole small sachet at the best of times, and now she’s just eating a couple of mouthfuls of her usual food (Applaws dry). The vet said she may be nauseated by the irritation in her colon and gave her an anti-nausea shot yesterday, but unlike the last time she had one it’s had little effect. He also said to get her onto Osmolax (same stuff as Miralax) which is difficult since it’s powder and there aren’t any adequate directions for dosage that I can find online. I’m worried sick (literally) about her, and what this prolonged inadequate food intake will do to her. The one good thing is she’s drinking; she’s always drunk plenty of water.
Has anyone else been through this with your cats, and if so, were you able to resolve it?

 

[Furballsmom]

Hi
If the osmolax is PEG3350, the dosage is 1/8 teaspoon.

Here's a recent thread - I found research supporting PEG3350 that's one of the last posts.

Cat strains so hard she pukes

 

[catloverfromwayback]

Hi
If the osmolax is PEG3350, the dosage is 1/8 teaspoon.

Here's a recent thread - I found research supporting PEG3350 that's one of the last posts.

Cat strains so hard she pukes

Thank you! Yes, it’s that.

 

[Jcatbird]

Yes. I have a cat on Lactulose now. She has been on it awhile and we had to raise the dose now have lowered it. I don’t know if your vet would approve but here is what we are doing for Banjo. 1.5 ml of lactulose once daily. It was twice daily but giving her Weruva wet food with pumpkin and Fancy Feast broths made a difference. Canned unflavored pumpkin is something that is thought to help constipation or diarrhea. I find that feeding her and then making sure her litter box is scooped encourages her. She likes to go right after I scoop it even if I’m not really removing anything. Lol The Fancy Feast broths have been a big hit with her. They are not a balanced diet but they contain a lot of liquid and she loves it. She goes for things with lots of juice, although she likes dry food too. Does the vet see any reason for the constipation? Too much dry food maybe? Has your kitty been properly tested for parasites? We usually associate loose stool with parasites but I have learned that this is not always the case. Banjo is a bit of an unusual case and it may be totally different from your kitty but she is doing well. The higher dose of lactulose and the food change has her on a regular schedule now. Please do keep us updated.

 

[catloverfromwayback]

Yes. I have a cat on Lactulose now. She has been on it awhile and we had to raise the dose now have lowered it. I don’t know if your vet would approve but here is what we are doing for Banjo. 1.5 ml of lactulose once daily. It was twice daily but giving her Weruva wet food with pumpkin and Fancy Feast broths made a difference. Canned unflavored pumpkin is something that is thought to help constipation or diarrhea. I find that feeding her and then making sure her litter box is scooped encourages her. She likes to go right after I scoop it even if I’m not really removing anything. Lol The Fancy Feast broths have been a big hit with her. They are not a balanced diet but they contain a lot of liquid and she loves it. She goes for things with lots of juice, although she likes dry food too. Does the vet see any reason for the constipation? Too much dry food maybe? Has your kitty been properly tested for parasites? We usually associate loose stool with parasites but I have learned that this is not always the case. Banjo is a bit of an unusual case and it may be totally different from your kitty but she is doing well. The higher dose of lactulose and the food change has her on a regular schedule now. Please do keep us updated.

Hi, thanks for responding!
Canned pumpkin isn’t sold here in Australia, I was searching all the supermarkets for it and zilch, so the best I can hope for is to try getting a piece of pumpkin and putting it in the blender. I’m dubious about whether Daisy will eat it, though. There’s also a newish digestive care food from Royal Canin that’s done well in a very small study of constipated cats. She’s certainly liked the flavour when she’s had a taste, but getting her to eat enough of anything at present is hard (and she’s overweight, 5kg, she’s always liked her food). I scoop the litter every time I hear one of them use it, which is often since I’m almost always at home. I haven’t had an answer from any of the multiple vets at the clinic about what might be causing this. I suspect it’s her diet - she was on Hill’s Perfect Weight last year and didn’t have this problem, but was also *gaining* weight on it, which is why I changed her to Applaws, which has good ratings from cat nutritionists, unlike Hill’s, and is about 1/5 the price.
She’s highly unlikely to have parasites, as she’s indoor-only and I dose them regularly with Bravecto flea and tick drops and Milbemax worming tablets.

 

[Jcatbird]

My cat is indoor only as well but be aware that they only have to be in contact or ingest a single flea to get a parasite. They can also get them from their mom as babies and carry them still. The litter box can then be a place to re infect. Parasite eggs can live a very long time! The Bravecto is strong stuff. I am using it too but Tapeworms require something else. Actually I use Bravecto plus but just had to use Praziquantel on one cat and Profender on the others. Ingesting one flea that may have hit hiked inside is all it takes. Tapeworms and other parasites can stop up a kitty.
Sometimes just a change in food can cause differences. Maybe a new food would help? If you use fresh pumpkin, make sure it is not skin, stem or seeds but the soft inner part. Cooked by itself and puréed it is easy to add to what your cat likes to eat. Can you get Weruva cat food there? They make several flavors that contain pumpkin. Hopefully this will all straighten out with the Miralax your vet suggested but if not them I would ask them about the pumpkin and other foods. Maybe they can suggest something you can get there?

 

[catloverfromwayback]

My cat is indoor only as well but be aware that they only have to be in contact or ingest a single flea to get a parasite. They can also get them from their mom as babies and carry them still. The litter box can then be a place to re infect. Parasite eggs can live a very long time! The Bravecto is strong stuff. I am using it too but Tapeworms require something else. Actually I use Bravecto plus but just had to use Praziquantel on one cat and Profender on the others. Ingesting one flea that may have hit hiked inside is all it takes. Tapeworms and other parasites can stop up a kitty.
Sometimes just a change in food can cause differences. Maybe a new food would help? If you use fresh pumpkin, make sure it is not skin, stem or seeds but the soft inner part. Cooked by itself and puréed it is easy to add to what your cat likes to eat. Can you get Weruva cat food there? They make several flavors that contain pumpkin. Hopefully this will all straighten out with the Miralax your vet suggested but if not them I would ask them about the pumpkin and other foods. Maybe they can suggest something you can get there?

I just looked up Weruva and it only seems to be available online. I bought a half butternut pumpkin and I’ll try cooking the flesh from that (never cooked pumpkin). She has Milbemax all wormer tablets every three months. I got another appointment at the vet on Monday but I suspect she’ll be back there tomorrow, they said to ring first thing if she isn’t eating properly and I’m sure she won’t be.

 

[Jcatbird]

If she is getting worm treatments that kill all worms she should be clear. I looked up the treatment you give and it does cover tapeworms too. That’s great. I hope she’ll go ahead and eat. Eat something kitty and Maybe the miralax will get her straightened out. Hoping for good news by morning.

 

[Antonio65]

The cat in my avatar was prone to recurrent constipation, and she used to go through some periods of no poop or straining in the litter box. Sometimes I could hear her moaning while she was trying to poop. It was heart breaking.

I would use Lactulose along with paraffin oil. The first one was to soften her stools, the latter one was to lubricate her bowels, though it couldn't be used for longer than two to three days because it causes irritation.
Lactulose works better if the patient drinks lots of water, because in order to soften the stools, it has to recall water, moisture, from the tissues. You say that Daisy drinks lots of water, so you're fine.

At the end we fixed the issue for good by using the psyllium seeds in her wet food.
The vet advised me about using 15 seeds in the wet food once or twice a day. Those seeds works fine when they have absorbed moisture.
So, you can either let them sit in a tiny cup with a little water for about an hour. They turn into a jelly that you add to the wet food. Or you can add them to the wet food, then add one or two table spoon of water and let it all sit for a while before serving.

With these seeds, my cat lived the last two years of her life constipation-free.
I wish I had found them earlier.

 

[catloverfromwayback]

If she is getting worm treatments that kill all worms she should be clear. I looked up the treatment you give and it does cover tapeworms too. That’s great. I hope she’ll go ahead and eat. Eat something kitty and Maybe the miralax will get her straightened out. Hoping for good news by morning.

Thank you! She ate a little more Royal Canin just now and went and did a decent size but slightly dry poo. I think I‘ll try to get her into the vet tomorrow anyway, because I really want them to find out what’s going on and that may mean blood tests and so on. (She’s going to have to get a job after all this!)

 

[Jcatbird]

Get a job! Maybe she can become a vet tech and give you a discount?

 

[catloverfromwayback]

The cat in my avatar was prone to recurrent constipation, and she used to go through some periods of no poop or straining in the litter box. Sometimes I could hear her moaning while she was trying to poop. It was heart breaking.

I would use Lactulose along with paraffin oil. The first one was to soften her stools, the latter one was to lubricate her bowels, though it couldn't be used for longer than two to three days because it causes irritation.
Lactulose works better if the patient drinks lots of water, because in order to soften the stools, it has to recall water, moisture, from the tissues. You say that Daisy drinks lots of water, so you're fine.

At the end we fixed the issue for good by using the psyllium seeds in her wet food.
The vet advised me about using 15 seeds in the wet food once or twice a day. Those seeds works fine when they have absorbed moisture.
So, you can either let them sit in a tiny cup with a little water for about an hour. They turn into a jelly that you add to the wet food. Or you can add them to the wet food, then add one or two table spoon of water and let it all sit for a while before serving.

With these seeds, my cat lived the last two years of her life constipation-free.
I wish I had found them earlier.

I wish Daisy liked wet food, because it would make dealing with this so much easier! All the additives - laxative powders, pumpkin puree, psyllium (I have plain Metamucil on hand) need wet food. Dampening dry food doesn’t work (she refuses it). I wishI could get the laxatives into her without having to use a syringe. She’s quite good about taking it but it’s stressful for her, especially having to do it several times a day. That itself may be contributing to her lack of eating.

At least she did a decent size, if a bit dry, poo this evening and had a little Royal Canin kibble.

 

[catloverfromwayback]

Get a job! Maybe she can become a vet tech and give you a discount?

Brilliant idea!

 

[Jcatbird]

Every poo is a good poo in this case. Progress! Banjo seems to actually like the lactulose. Thank goodness. Quick squirt, praise and pets followed by a treat. I find that using kibble like it is a treat and just tossing a piece for her to pursue has become something she enjoys. Reward time! Lol Good girl!

 

[catloverfromwayback]

Every poo is a good poo in this case. Progress! Banjo seems to actually like the lactulose. Thank goodness. Quick squirt, praise and pets followed by a treat. I find that using kibble like it is a treat and just tossing a piece for her to pursue has become something she enjoys. Reward time! Lol Good girl!

I wish Daisy liked the lactulose! I susp even if she ad, she’d be put off it by now because of having it by syringe.

Yet another vet visit this evening. I must find out if the shot they gave her was Mirtazapine. That’s being used as an appetite stimulant as well as anti nausea. Whatever they gave her hasn’t restored her appetite this time. I also want to know if using Osmalax and Lactulose at the same time is okay; the vet seemed to say to do so, but that isn’t what I’ve read, just the opposite.

 

[Caspers Human]

Our cat, Casper, has this problem.

He got backed up and hadn't eaten or used his box in two days... Off to the vet he went.

Physical exam: Inconclusive.
Blood sample: Clean.
X-Ray: Megacolon!

If a cat's colon is normally the diameter of, say a US Nickel (5¢) his was the size of a half-dollar.
It took three enemas, laxatives and an overnight in the hospital but we did get him cleaned out but we didn't get a firm diagnosis.
We just got instructions to feed him more wet food than dry food and to make sure he gets enough water to drink.

It happened again about two months later. We were aware of the problem and caught it early.
This time, X-rays showed constipation but no megacolon.

When they were giving Casper the enema, he turned on the vet tech who was holding him. He bit hard enough to draw blood and he scratched a 1-inch gash in her wrist! We were all surprised by this because this is very, very uncharacteristic of Casper!

Casper NEVER bites or scratches with intent to hurt. Not even when I'm holding him still for the vet to give him a shot.
He has only ever bitten once. That was when I was trying to make him take a pill and he didn't like it. Ya' can't blame him for that one, can you?

Anyhow, I was helping the vet tech bandage up her hand while the vet and the intern were in the other room with the cat when I hear the vet say, "Hey! He's got a perineal hernia!"

So, we finally found the reason why Casper had been having trouble! He has a torn muscle just inside his rectum.
(At the 7-O'clock position as seen from the hind end.)

We took Casper to a specialist and they verified our vet's diagnosis. It is correctable with surgery but that will cost about $5,000. (Ain't gonna' happen!)

Instead, we manage Casper's digestion using Cisapride (10 mg./day) mixed in his food and approx. 1/4 tsp. of Miralax, also in food.

We monitor Casper's litter box and adjust the dosage of Miralax based on observation. We make sure that the amount of food he eats matches up with the amount of waste that ends up in his litter box. If everything's okay, we cut the laxative back. If he's getting stopped up, we add a little more.

So far, Casper has been going for for almost two years on Cisapride plus Miralax and he does okay.

The vets say that Casper can continue like this indefinitely, as long as he gets enough water and medicine.

 

[catloverfromwayback]

Well, the vet said “enlarged bowel”

Our cat, Casper, has this problem.

He got backed up and hadn't eaten or used his box in two days... Off to the vet he went.

Physical exam: Inconclusive.
Blood sample: Clean.
X-Ray: Megacolon!

If a cat's colon is normally the diameter of, say a US Nickel (5¢) his was the size of a half-dollar.
It took three enemas, laxatives and an overnight in the hospital but we did get him cleaned out but we didn't get a firm diagnosis.
We just got instructions to feed him more wet food than dry food and to make sure he gets enough water to drink.

It happened again about two months later. We were aware of the problem and caught it early.
This time, X-rays showed constipation but no megacolon.

When they were giving Casper the enema, he turned on the vet tech who was holding him. He bit hard enough to draw blood and he scratched a 1-inch gash in her wrist! We were all surprised by this because this is very, very uncharacteristic of Casper!

Casper NEVER bites or scratches with intent to hurt. Not even when I'm holding him still for the vet to give him a shot.
He has only ever bitten once. That was when I was trying to make him take a pill and he didn't like it. Ya' can't blame him for that one, can you?

Anyhow, I was helping the vet tech bandage up her hand while the vet and the intern were in the other room with the cat when I hear the vet say, "Hey! He's got a perineal hernia!"

So, we finally found the reason why Casper had been having trouble! He has a torn muscle just inside his rectum.
(At the 7-O'clock position as seen from the hind end.)

We took Casper to a specialist and they verified our vet's diagnosis. It is correctable with surgery but that will cost about $5,000. (Ain't gonna' happen!)

Instead, we manage Casper's digestion using Cisapride (10 mg./day) mixed in his food and approx. 1/4 tsp. of Miralax, also in food.

We monitor Casper's litter box and adjust the dosage of Miralax based on observation. We make sure that the amount of food he eats matches up with the amount of waste that ends up in his litter box. If everything's okay, we cut the laxative back. If he's getting stopped up, we add a little more.

So far, Casper has been going for for almost two years on Cisapride plus Miralax and he does okay.

The vets say that Casper can continue like this indefinitely, as long as he gets enough water and medicine.

It sounds suspiciously like megacolon is Daisy’s problem. The vet said “motility issue” and “enlarged bowel” which sounds like he’s avoiding the term, but it’s the same thing. He gave her a Cerenia tablet and a shot of Mirtazapine, which has definitely helped for the moment because she’s eaten more food in the last half hour than she has for days. He’s talking putting her on Cisapride, which makes me balk because it’s $180 a bottle - though as he said, that’s cheaper for a 50 day supply than twice weekly vet visits. I’m trying to find out where subtotal colectomies are done here, because if that’s what this is and I can afford it, I would like to get it fixed instead of her having a lifetime of pills and problems. My only concern there is that she has a heart murmur I’ve never been able to investigate (only one hospital here does ECGs for cats, they’re booked months ahead, and it’s $800).
Oh Daisy darling.

 

[Caspers Human]

Megacolon isn't necessarily a disease but more of a condition.
It can be fatal if it isn't treated but, if caught early it is quite manageable.

Think of megacolon more in terms of "stages" of something rather than a thing by itself.
You've got, as your vet said, "motility issues." Then it progresses to constipation, enlarged bowel and, finally impaction.
Megacolon is, basically, an enlarged bowel when it gets beyond a certain size. I forget, exactly, what our vet told me but it's something like two or three times the bowel's normal diameter.

Imagine what a feline pelvic bone looks like. It's, sort of, shaped like a butterfly with a gap in the middle.
A cat's large intestine passes through that gap in the pelvis. This gap is relatively narrow.
If a cat gets constipated and the bowel enlarges, the fecal material can become impacted against the pelvic bone and the animal won't be able to get rid of its own poop.

That stage between where "enlarged bowel" occurs and where the bowel becomes impacted is what we call megacolon.

If megacolon occurs, medication and enemas can clear the blockage if you catch it in time. If megacolon progresses to impaction, your only option might be surgery. Depending on the severity, surgery could be a "hit-or-miss" affair. The longer it goes on, the less the cat's chances of surviving.

This is how our vet explained it to me. At least, as well as I can remember, anyhow.
When she explained it to us, my reply was, "That sounds like a shitty way to go!"
(Gut laughs all around... )

We caught Casper's problem early enough and we were able to "clean him out," so to speak.
As long as we monitor his "input vs. output" and adjust his meds accordingly, Casper is just fine and has no problems.
He has to take a pill and some Miralax every day but, now, it's just part of his feeding routine. He will sit there and watch his Girl-Human grind up his pill and mix it with his food. We make sure that he drinks lots of water and he's good to go.

If we didn't tell, you'd never even know that Casper has a problem.

It sounds, to me, like you caught your cat's problem even earlier than we caught Casper's.
If that's true, just give her whatever medicines your vet prescribes and make sure she gets plenty of water.

As our vet said while she pounded her fist on the table, "Water! Water! Water!"

Also, switch to wet or canned food as much as possible. Our vet said 50/50 or better in favor of wet. 60/40 is even better and 100% wet if you can.

Honestly, your cat's case sounds like a walk in the park, compared to Casper's.
Just keep up on your vet's instructions.

 

[Caspers Human]

Medications... $180 seems rather high to me!

We get Casper's pills directly from our vet. He takes 10 mg. of Cisapride (compounded) per day and it costs about $50 for a 30-day supply. We tried to get his pills on-line and it's hard to find the right dosage, in the amounts we need and a lot of places sell it non-compounded. When given to cats, Cisapride needs to be compounded to improve absorption or else the dosage needs to be adjusted differently.

How many pills do you get for $180? Are they capsules, powder or pills?
I have been told that Cisapride can also be made into a transdermal preparation. It also can be made into a liquid suspension that you measure with a syringe.

Recently, we had a "supply problem" where we couldn't get Casper's next batch of pills in time, before he ran out.
I had to call all over town and "beat the bushes" in order to find a backup supply.

Casper is a support cat for his Girl-Human and she would be beside herself if anything happened to him.
Let me tell you! It was a rough couple-three days before I found a place that had the medicine!

There's a company called "Pharmacy Innovations." It's a compounding pharmacy that can make preparations for your pets as well as for humans, according to a doctor's prescription.

Casper had one pill left before I called them up and explained our problem. They said that it normally takes 24 hours to fill a prescription after the vet/doctor calls in the order but I begged them and they were able to put in a rush order for us. I called the vet. They called the pharmacy and I had my medicine in-hand in just a couple of hours.

In the end, I got a 30 ml. bottle of Cisapride/compounded, in tuna flavored oil suspension and it only cost a little under $40.
I even offered to pay an "expedite fee" but they only charged me the regular price!

The people at Pharmacy Innovations are super nice! They are knowledgeable, helpful and willing to go the extra mile whenever they can. They only have locations in a few cities around the country but, if you live near one of them, I absolutely recommend them!

Home - Pharmacy Innovations

pharmacyinnovations.net

 

[catloverfromwayback]

Thank you, this is very encouraging - unlike googling vet sites, which are rather doom and gloom!

The steeper prices are probably because we’re in Australia and everything costs more here, plus of course there’s the different currency. $180 here is $125 US. I think he said it’s 100 tablets but that she’d have to have two a day. I’d certainly have to order from the vet, but they get it from a compounding pharmacy. (Gah ... went through that with my late Maddie (my avatar) who was misdiagnosed with IBD. She had late-stage cancer.)

Aaand I’ve just seen a compounding pharmacy for pets offering it at $89 for 100 2.5mg capsules ... I may well get a prescription and buy it that way!