Repeating Rectal Prolapse

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
Hey folks,
After reading a bunch of the prolapse threads here, I've finally made an account and figured I'd ask for help. One of my cats just started week 3 of having a purse string suture in for a rectal prolapse. I dont know for sure what caused the prolapse originally. I suspect it was due to inflammation caused by a C. Perf infection that he had. The first prolapse happened on Jan 4th and I took him to the vet immediately. They prescribed him Metro, Prednisone, some Grey Wolf probiotics since I was wary of the Metro destroying his good gut bacteria, and Lactulose. The instructions said to give 1cc of Lactulose twice a day. I did that for the first few days and Cosmos struggled to poop, only producing small very sticky pieces of poop. I asked the vet about this and they said I could give him 3cc of Lactulose.

Between then and now, Cosmos had gotten a variety of doses of the Lactulose as I am very wary of giving him 3cc twice daily. That's a huge amount! I've also seen that 2cc and over makes him bloated and uncomfortable. My question to you all is when you have a purse string suture in, what exactly is the consistency of poop that you want your cat to be producing? Giving him 2cc in the AM and 1.75cc at night results in pudding splats and sometimes watery runs. I feel like you especially don't want watery poop, as the point isn't to cause diarrhea. When I asked the vet, they simply said it should be soft, which isn't very helpful. Cosmos has never hard poop to begin with. He eats raw food and prior to the prolapse, produced nice soft logs that the litter sticks to.

Cosmos had the original sutures removed on Jan 10th. The vet gave him a clean bill of health, no more inflammation and everything was supposedly great....only for him to prolapse that evening when he went to poop. I returned him to the vet and they put in another set of purse string sutures, the same set he's currently still wearing. On Monday, he went to poop and blood came out. His bottom was protruding as if it was trying to prolapse but was prevented from doing so thanks to the sutures. This morning, the same thing happened, less blood (thankfully) but the prolapse tried to reoccur. The potential prolapse happened twice more today with his poop attempts. I am at a loss as to why this is happening. Having read about prolapses and diarrhea causing irritation and leading to them, that's what's caused me to finally ask for help here. Is pudding consistency too soft/close to diarrhea and possibly leading to this problem? It seems like with using the Lactulose his poop is either sticky, (only small pieces partially come out and stick to his anus) or ranges from pudding to watery. Is there a middle ground that I'm missing here for what his poop should be like with these sutures?

Oh, also when Cosmos has 2cc of Lactulose after breakfast and 1.75cc at bedtime, for some reason in the morning (before breakfast) its like the Lactulose has worn off completely and he's back to trying to poop while producing either nothing or a tiny sticky piece that sticks to his anus. He doesn't then produce a pudding splat until the afternoon since he gets more Lactulose with breakfast.
 

Sarthur2

Cat lady extraordinaire
Staff Member
Advisor
Joined
Mar 8, 2015
Messages
34,185
Purraise
14,626
Location
Sunny Florida
This is not my area of expertise, but I wanted to ask if getting a second opinion from another vet practice might help? They may have a different take on how to handle the meds and lactulose.

I’m sorry that you and your cat are dealing with this uncomfortable issue. I wish I could be of more assistance.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
When your Vet said his stools should be soft, that's exactly what it should be. To me soft is NOT like pudding, nor it is hard like a rock. It is formed, yet has some "give" to it. His stool should be firm enough to hold it's shape and keep it's shape, but if you were to press it between your fingers, you could squish it. Is that a better explanation? Does that sound like what his stools used to be like?

I haven't used Lactulose on my cats in years and years, but rather we use Miralax. It makes their stool softer by drawning water into the colon. If you use too much it can cause diarrhea, but we've never had that problem. We use between 1/8th and 1/4 teaspoon dissolved in about 1 teaspoon of water and then add that to wet food or raw food that also has more water added to it. And we give it twice a day to our raw fed cat because he has issues with straining. This really helps him.

Have you discussed these latest issues with your Vet? The bleeding and the fact that it looks like it's trying to prolapse with each poop attempt? If not, I definitely would. If they don't seem concerned, then I would definitely seek advice from another Vet. AND, the underlying cause the prolapse does need to be confirmed, not just theorized. If it isn't treated, it will continue to happen. How long ago did he have C-diff?
 
  • Thread Starter Thread Starter
  • #4

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
Hey Sarthur2 and Mrsgreenjeans, thanks for responding to my post!

What you've said about soft vs pudding confirms my suspicions. I haven't given Cosmos any Lactulose today and he already seems much better. He's more actively, enthusiastically ate some pumpkin, and his belly feels soft and comfy, instead of bloated. I am not a fan of the vet's attitude regarding how much Lactulose should be given and what his poop should be. They seemed rather dismissive of the idea that Cosmos could be getting too much Lactulose. Poop wise, they said they dont want diarrhea but said small squirts of poop was fine. (Though in mine mind, squirts are very close to being diarrhea???????) The soft consistency that you described MrsGreenJeans is exactly how his poop normally is.

I've read that cats can be given Mirilax. Unfortunately, I'm in Canada and Mirilax isn't sold here. Instead they sell Restolax. I dont know if that's safe to be used instead. I also completely agree about wanting to for sure know the reason why he prolapsed in the first place. He had been having bits of blood on his bottom when pooping since November. When I brought him in for that, the vet gave him a dewormer and said maybe it was a food allergy (he had been eating bison and hasn't had any since then). In December I brought him back since it hadn't stopped. They did x rays and said everything was normal. A stool sample was sent out and it came back positive for C. Perf at 760 thousand. Cosmos was given a week of Metro in December to try to treat the clostridium. I also gave him S Boulardii as well. Despite all of this, the blood on his bottom continued. It lessened but didn't go away completely.

When he prolapsed on Jan 4th, the prolapse itself was very short, shorter than the end of a finger but it was very inflamed. He was put on another week of Metro when they fixed the prolapse and on prednisone as well. Today is the last day of daily prednisone before going to giving it every other day as it tapers off. Prior to this week, I didn't see any blood on his bottom since the original prolapse happened. But there was some yesterday and some streaks on this morning's poop squirt. I asked if there was a way to tell when the clostridium was gone, but the technician said the only way to know is to do another PCR test.

At this point, I'm not sure if this new bit of blood is from this weeks attempted prolapses and potential irritation or if it means the clostridium is still lingering. I also noticed that Cosmos tries to desperately groom his bottom through the cone after these squirty poops, even though I clean him up myself immediately afterwards. I very highly suspect that the Lactulose is the problem. Based on what I've read here, it sounds like his poop attempts that result in squirts and pudding is due to irritation and that giving him more Lactulose (per the vet's advice) is making it worse instead of helping.

So today he wont be receiving any Lactulose at all. I gave him some pumpkin instead and am hoping things will calm down in there. If he gets any tomorrow, it wont be more than 1cc, especially after hearing that pudding isn't soft poop like I suspected. I've also called the vet and talked to them about a plan going forward. They're going to try gradually loosening the purse string at his weekly rechecks rather than removing it all at once. I'm hoping this gradual adjustment will give his body a chance to heal while still having a safety net in place just in case.

He goes in for a recheck on Wed. I'll ask them when he's there if it looks like his colon is inflamed. I'll also ask if Restolax can be used instead of Lactulose. I told them about the blood and prolapse attempts and it's just been added to his file. All of my concerns about his poop have been met with being told to try giving him more Lactulose. The technician said if the purse string sutures don't help Cosmos improve then he'll have to go to surgery. Seeing as how the amount that came out when he prolapsed was so small, I would much rather continue trying to get to the bottom of this before putting him through a colopexy. If the source of his previous inflammation isn't solved then a colopexy won't help with that either.

As for the source of the problem, I dont know what else can be done to find out what it is. Going in for an ultrasound even though his x ray was normal? He doesn't have any symptoms either. Back in November/December everything was normal, he just had the mysterious bits of blood on his bottom (not mixed with the poop) when he had a bowel movement. No diarrhea. no constipation, no vomiting, etc. Is there a test or procedure that I'm missing?
 
  • Thread Starter Thread Starter
  • #5

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
Also, when the bleeding started in November, I started giving him S Boulardii every day. He's had some twice a day between his November appointment and Jan 4th. I stopped giving it to him since the vet said he doesn't know whats caused the inflammation and wants to pump the brakes on things. So no S Boulardii and no psyllium husk in his food (I make batches of cat food every week). Since Jan 4th he's only gotten food, water, the course of Metro and Prednisone, and Lactulose.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
S. Boulardi needs to be given every 12 hours to be effective. I'm going to attached a link to an old thread made by a former member whose cats got clostridium perfringens from eating raw food, and how she "fixed" them. They did all have diarrhea though, that's how she knew there was a problem.

Take it for what it's worth: Trouble in Raw Paradise - Clostridium perfringens and my cats
 
  • Thread Starter Thread Starter
  • #7

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
S. Boulardi needs to be given every 12 hours to be effective. I'm going to attached a link to an old thread made by a former member whose cats got clostridium perfringens from eating raw food, and how she "fixed" them. They did all have diarrhea though, that's how she knew there was a problem.

Take it for what it's worth: Trouble in Raw Paradise - Clostridium perfringens and my cats

Yeah, reading that thread (plus the pages on Raw Feeding for IBD Kitties and the one from Food Fur Life) back in December encouraged me to give Cosmos S Boulardii twice a day. He'd have some with breakfast and then again before bed. I also read the studies about it being used to help treat Clostridium in other animals and humans. The vet hadn't heard about it before when I took Cosmos in for the Jan 4th prolapse. He said he didn't know if the S Boulardii was helping or not and said to stop it for now since we needed to get the inflammation under control. Everything I've read about it says its anti inflammatory, but I stopped using it anyway just in case. I was leery of giving Cosmos the second round of Metro since I've read how destructive it can be. But the vet insisted that he take it because of its anti inflammatory effects. The vet said Cosmos's inflammation was burning and he needed to have it with the prednisone.

Was there anything else you could think of that I could request from the vet? Cosmos didn't have any of the issues that tend to be listed when looking up info on rectal prolapses. The weird bleeding/clostridium has been the only problem he's had. He hasn't been constipated, straining, or having diarrhea prior to the prolapse.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
On, and I forgot to mention that Restoralax IS the same thing as Miralax.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
Was there anything else you could think of that I could request from the vet? Cosmos didn't have any of the issues that tend to be listed when looking up info on rectal prolapses. The weird bleeding/clostridium has been the only problem he's had. He hasn't been constipated, straining, or having diarrhea prior to the prolapse.
It could be the metro that is causing the intestinal issues like the diarrhea, even though it's often given FOR diarrhea. That doesn't explain the other issues though. Have you considered talking to another Vet? Not reallly for a 2nd opinion on what is wrong, but maybe for another opinion on how to treat? We love our Vet, but if we disagree with something she tells us, she listens to what we have to say and researches it and then gets back with us before actually dismissing us. We actually convinces her that feeding raw food was a good thing!
 
  • Thread Starter Thread Starter
  • #10

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
He's finished the Metro, thankfully as there was only one weeks worth of it. I can certainly talk to another vet. The clinic he goes to has different vets there on different days. Hopefully a secondary vet will have different ideas on how this can be treated. Cosmos is so much better today without the lactulose. He's active instead of sleeping almost all day. He's enthusiastically eaten all of his meals so far and hasn't desperately tried to groom his bottom through the cone after his poop attempts. None of said attempts have produced any poop (yet?), just a small glob of jelly blood. The amount of anal protrusion with each attempt has been less and less, with his after dinner poop attempt having minimal. His bottom wasn't painful when I dabbed at it either (yesterday it was painful after all of his poops/attempts and he didn't even want me to turn him over to see it, let alone dab it clean). Cosmos has eaten a small Pumpkin Patch Up packet today as well for a gentler alternative to Lactulose.
 
  • Thread Starter Thread Starter
  • #12

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
We ended up going to the clinic last night. Everything was good until almost 11pm. Cosmos kept trying to poop but wasn't able to squeeze any out. At one point he was straining so much that his body was trembling. He was meowing in distress, his bottom was protruding, and all he squeezed out was some bloody globs. I brought him in and he saw a different vet, one who hadn't seen him before.

She agreed that there is clearly a problem and that he shouldn't be struggling this much. The vet went over his records from November to now and said she's seen some similar cases where normal stool was being passed but blood was being left behind on the bottom. She said in those cases it was due to a tumor or some other kind of growth in the colon. She also said it could be that the clostridium is still around and causing inflammation, despite the two previous courses of Metro and current tapering prednisone. So the vet sent Cosmos home with a weeks worth of Tylosin, instead of more Metro, some pain medication for as needed use, and a written dosage for using Restolax instead of Lactulose.

The vet is going to speak with the doctor who has been seeing Cosmos about having an ultrasound done. I asked if a tumor/growth would have been visible on the x ray that he got and she said not it its very small and in its early stages. If I dont hear anything from them by Tuesday, I'll give them a call and ask if the ultrasound can be done on Wed when Cosmos returns for his recheck. While he was there, the vet gave him an exam and said everything looked normal and his bottom was good. She was able to stick a thermometer in there and removed it without any blood.

This morning, I sprinkled Restolax on his breakfast which make him not want to eat it. :sigh: The tylosin is also significantly larger than Metro or Prednisone. The technician said to crush the tablet and put it in his food, but that was a mistake. Crushing it must have released the smell or taste, and Cosmos refused to eat it. I ended up having to break apart the pieces of food I'd mixed it with and manually put it in his mouth. He eventually swallowed said pieces after many attempts. He ate most of his homemade breakfast (with the Restolaxin it) and then ate the remaining breakfast amount of Big Country Raw, which is what his sister was having. So he did end up eating a full meal amount, just not all of it being his own homemade food.

I am concerned about the size of the Tylosin tablets. I'll try hiding his next dose in his food w/o crushing it and hope he eats it. He's had no issues with taking Metro and prednisone hidden in his food since those two are so small.

Also, no poop this morning. He tried before breakfast but only produce poop smelling gas. Thankfully his bottom didn't protrude and he wasn't in pain or discomfort when I picked him up to check to see if he needed cleaning off.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
You need to dissolve the Restoralax in water before giving it to him. Then mix it into his food. Don't just sprinkle it on the food. As for the Tyosin, you can get it in other forms. Do you have a compounding pharmacy near you? Your Vet may even have it in other forms, possibly a liquid? Did you ask about using the S. Boulardi again?

Let's hope it's not a tumor.

:vibes: :vibes: :vibes:
 

fionasmom

Moderator
Staff Member
Moderator
Joined
Jun 21, 2014
Messages
9,094
Purraise
12,504
Location
Los Angeles
If you have access to something like Hartz Delectable Stews, or any other very liquid cat food, you can dissolve Restoralax in that. Stir it and make sure that it is dissolved. As was stated, don't use it dry or as a sprinkle.
 
  • Thread Starter Thread Starter
  • #15

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
Oh, thank you! I hadn't realized I was supposed to mix the Restoralax with water first. In that case, I'll mix it with water and some of the Stella & Chewies freeze dried food topper and can offer it as a treat. As for the S Boulardii, neither vet knew anything about it. I'm considering giving it to him anyway. I've read that it also has anti inflammatory properties, so hopefully it shouldn't make that worse. I do have a question though. I know S Boulardii is excellent at stopping diarrhea, but I dont know if it would work counter to the stool softener. Would Restoralax and S Boulardii cancel each other out in terms of poop softening?

I also bought a bag of salmon flavored pill pockets to see if Cosmos would eat them I was expecting an immediate rejection, but he snapped one right up and looked for more! I dislike the ingredients for the pill pocket, but I'm hoping using them for a week of antibiotics wont hurt him. His enthusiasm for the sample offered is much simpler than having to syringe a liquid form of the Tylosin, especially after so much syringing of Lactulose for the past few weeks. Fingers crossed he'll be that happy about eating one when it actually has a tablet inside.

Thanks a bunch for the well wishes and help too! I also really hope it isn't a tumor!
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
I think it's fine to give S. Boulardi along with the Restoralax. S. Boulardi is really a form of probiotic so helps with diarrhea because it helps the gut flora so doesn't really have anything to do with pulling water into the colon to help soften the stools( what Restoralax does). But the good thing about it is, even though it's a form of probiotic, it can be given the same time as antibiotics, unlike most probiotics.
 
  • Thread Starter Thread Starter
  • #17

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
Perfect! Cosmos just finished his dinner with some Jarrow S Boulardii sprinkled on top. I'll post more updates when I have any. So far he's been sleeping all day, which I think is due to the Tylosin. Taking Metro made him tired as well back when he was on it.
 
  • Thread Starter Thread Starter
  • #18

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
This morning has been rough. Cosmos spent an hour or so going back to the litter box to try to poop. He got a few squirts into the box and I wiped more off of his bottom w/ toilet paper and q tips. He was clearly uncomfortable and there was a little blood mixed into some of the wet poop. More desperate grooming through the cone. I went to put it in the washing machine and saw that he's wearing away a patch on the cloth from the furious grooming attempts.

Once he finished going back and forth to the box, being cleaned up each time, he layed on my bed and kept trying to groom. I gave him some of the pain medication (Gabapentin) since he still seemed quite uncomfortable. Not meowing loudly in pain like Friday night, but not wanting to move very much. It seems like the amount of straining he goes through is worse. His legs tremble with the effort and he was exhaling forcefully from exertion. This seems like the complete opposite of what's needed for his prolapse to heal.

I've emailed all of this to the vet along with photos of his bottom from multiple angles and a photo of the small squirts in the litter box. I told them about there being a little blood mixed in as well. I reiterated the desire for an ultrasound and said we need to figure out why he's having such a difficult time.

So far Cosmos hasn't wanted to eat this morning either. He's currently asleep since the pain medication causes drowsiness. Hopefully he will want to eat some food when he wakes up, since as of right now he hasn't eaten anything, taken his Tylosin or Restoralax.
 

mrsgreenjeens

Every Life Should Have Nine Cats
Staff Member
Advisor
Joined
Aug 13, 2009
Messages
15,653
Purraise
5,760
Location
Arizona
Oh dear :frown: One step forward, two steps back. Poor baby. Hoping he perks up. I agree that it is the complete opposite of what is needed for that prolapse.
 
  • Thread Starter Thread Starter
  • #20

Jabzilla

TCS Member
Thread starter
Young Cat
Joined
Jan 19, 2023
Messages
20
Purraise
12
Thanks MrsGeenJeans, I hope so too! I have another update as well. I took him back to the vet since he was continuing to be very unwell. I took photos of his red, swollen looking bottom, and recorded a video of him straining to poop. I showed it to the technicians and to the vet. Cosmos ended up seeing the same doctor from Friday. She gave him an exam and said the area around his anus (the swollen looking part) felt firm and that she suspects there's a large piece of poop thats stuck. Cosmos is going to be staying there overnight so they can give him an IV. He was quite dehydrated from not having eaten or drunk anything today. While he's there, they're going to do some x rays to see how far the blockage goes and to determine whether he needs a partial or full enema. The purse string suture is going to be removed as well. In the morning, they're going to do the ultrasound.

I have all of my fingers and toes crossed that the source of his straining is something as simple as a larger piece of poop that couldn't get past the sutures! That's vastly more preferable than something as awful as a tumor! I also hope that he doesn't prolapse again once the sutures are removed. It's possible that the protrusions that kept happening were in fact from said stuck poop and not attempted prolapses like I thought they were. The vet will give me a call once the x rays are done to let me know the results. I'll update here when I've heard back from them. I'm grateful that Cosmos goes to a clinic that's open 24 hours. He should be in good hands tonight.
 
Top