Samantha - leaking poop after colon resection

missko

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Hi all, our 6 year old DSH underwent surgery to remove masses in her colon at gulf coast veterinary specialists in Houston. The surgeon removed 7 masses from her colon and 1 mass from her lymph node on 9/17/2021. The surgeon performed a resection to rejoin the remaining pieces of her GI tract. She came home on 9/21/2021.

She is on gabapentin twice daily to keep her calm and for pain management. She was on clavamox, which she stopped on 9/26/2021. We are keeping her in a crate while she recovers. She has not moved much and has been lying in her litter box. Sometimes she tries to use her litter box, but mostly she is leaking poop all over the crate.

Does anyone have experience with fecal incontinence after bowel surgery? How long did it last?

Also, we just got the biopsy results. No cancer detected. Sam has Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia (FGESF). It is very rare and we are learning more about it.
 

Stargirl0623

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I'm glad your baby is home safe, and cancer-free!

It was not bowel surgery, but my cat did just have a PU surgery and was leaking poop for the first three days. In his case we think it was diarrhea from the antibiotics, stress, and not wanting to strain an already-painful area to hold it in, and it did resolve once his poop firmed up and he had more control in general over what was going on in that whole part of his body.

That said, please contact your surgeon ASAP to make sure this isn't something to worry about in your case, given how the bowels are more directly involved!
 

fionasmom

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FGESF – IBDKitties
Ragdoll Cat Addie's Story of Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia Discovery

The above are quick reads when you get the time. Most research related to this condition is not covered on popular veterinary/cat care websites as it is rare.

Search Results for Query: fgesf

Search of TCS threads about it.

Having said all this, I agree with Stargirl0623 Stargirl0623 that you need to stay in close contact with the surgeon. Her surgery and homecoming are both so recent that he needs to be informed of all your concerns and needs to advise as to how to proceed and what is normal after this surgery. There are reasons that fecal incontinence can happen after bowel surgery but these are mostly beyond home management and need to be brought to the surgeon's attention.

I am sure you paid a fortune for your cat's surgery and care and follow up is expected.
 
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missko

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Thank you so much all. Really appreciate hearing about the recovery period and the links to FGESF.

We did spend a fortune at Gulf Coast Veterinary Specialists - $2k for the ultrasound that detected the growths and $7k for the surgery. We go back for a 2 week recheck on 9/30/2021. The surgeon’s response to our question about whether Samantha would regain control of her bowel movements was that she didn’t know. She did not offer a solution surgical or otherwise. She did tell us to stop clavamox on 9/25/2021 (8 days post surgery) to firm up the stools. That has helped marginally. The IM vet says she had major surgery and is still recovering. He said he could not comment on post surgery bowel incontinence.

Sam squats over her box but often nothing comes out. Then she exits the box and there is poop on her rear and dropping onto her crate. I see soft poop in the box, so she is hitting the box at times, but there is always poop on her and in her crate. The frequency of the poop is also high. The hospital shaved her rear so we can help clean it. It is red, raw and painful from having so much soft poop on it. Sam has always been such a lap cat.

The surgeon highlighted infection as a very serious risk of bowel surgery. She did not mention fecal incontinence as something to expect in the post operative period.

I would appreciate any guidance on how other owners, cats and care teams have managed fecal incontinence. Does this happen with bowel surgery? How long will this last? What are the surgical treatments if it does not improve with time?

thanks for all your support.
 

Stargirl0623

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Thank you so much all. Really appreciate hearing about the recovery period and the links to FGESF.

We did spend a fortune at Gulf Coast Veterinary Specialists - $2k for the ultrasound that detected the growths and $7k for the surgery. We go back for a 2 week recheck on 9/30/2021. The surgeon’s response to our question about whether Samantha would regain control of her bowel movements was that she didn’t know. She did not offer a solution surgical or otherwise. She did tell us to stop clavamox on 9/25/2021 (8 days post surgery) to firm up the stools. That has helped marginally. The IM vet says she had major surgery and is still recovering. He said he could not comment on post surgery bowel incontinence.

Sam squats over her box but often nothing comes out. Then she exits the box and there is poop on her rear and dropping onto her crate. I see soft poop in the box, so she is hitting the box at times, but there is always poop on her and in her crate. The frequency of the poop is also high. The hospital shaved her rear so we can help clean it. It is red, raw and painful from having so much soft poop on it. Sam has always been such a lap cat.

The surgeon highlighted infection as a very serious risk of bowel surgery. She did not mention fecal incontinence as something to expect in the post operative period.

I would appreciate any guidance on how other owners, cats and care teams have managed fecal incontinence. Does this happen with bowel surgery? How long will this last? What are the surgical treatments if it does not improve with time?

thanks for all your support.
Unfortunately I can't speak too much on bowel-specific healing--my cat had his PU the same day she had her operation, but he only had fully liquid poop for the first few days afterwards. It was a lot of monitoring him with a clean, warm cloth to gently dab at the area around his incision and keep it clean, at one point I had an alarm set to check him every two hours overnight.

His poops are still softer than we'd like to see, but a combination of taking probiotics and coming off the antibiotics made it firm enough for him to at least hold in.

For what it's worth, a repair to a cat's urinary tract resulted in him having zero ability to hold it--when he needs to go, he needs to go NOW, and I was told the frequency of it is due to him interpreting pain and pressure in the area as an urge to pee regardless of how full his bladder is. It would track to me that a sore bowel could result in a similar situation, interpreting discomfort as a need to expel something when she may just not have poop ready to go?

That said, I am 100% not an expert--please stay in close contact with your surgical team! It's always better to bother them with too many questions than too few.
 
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missko

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Hope your guy continues to recover smoothly! Thanks for your note and the reminder that the squeaky chair gets attention. Going to hold the surgical team to some accountability.
 

fionasmom

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There have been a number of threads on TCS regarding fecal incontinence, but in all cases that I checked, members were trying to figure out why their cat was having that issue, not referencing a previous surgery.

Your doctors are going to have to help you with this since you know the cause already. They are also going to have to help you address the painful bottom issue as that will be the next infection if the skin becomes abraded enough.

Caring for an Incontinent Cat

This article may have some pointers that will help you with management. Only do what seems appropriate for your cat given that surgery was performed and there is an incision. If your cat is pooping outside the box, get pee pads and put them near the box and around it. Best Friends does not recommend diapers for reasons with which I completely agree, especially in your case.
 
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missko

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Thanks so much to this wonderful community. It is so good to know there are good people like you all to support kitties and their families.

this is from the surgeon:
“A large portion of her descending colon was removed to ensure excision of all palpable masses, and we attempted to spare the neurovascular bundles that supply the colon and rectum to control continence. However, we did have to remove some of the nerve supply that assists with continence. While I hope that the remaining nerve supply will take over fecal continence, she may continue to 'leak' for the next few weeks as she recovers.”

I’m encouraged to see the word “recover!”

Hopefully Sam will soon be on the path to recovery. Many things remain off versus presurgery - low energy, no appetite (the little creature has always had a tremendous appetite so seeing an untouched dish of food breaks my heart), lying in her litter box all day and of course fecal incontinence.

we have to keep her incision dry, which makes keeping her rear clean a challenge. The baby wipes hurt her - she growls when we use the wipes. She can get to her rear with her e collar, so we have been using coconut oil to soothe the rear and create a barrier. I wish we could slather Boudreaux’s on her rear - it works wonders on our human baby!
 

fionasmom

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Yes, it is encouraging that they expect a recovery which includes a return to continence. This has to have been a huge stressor to her entire system and it will take a while for her to return to normal. As I said before, this surgery is very recent; just 10 days today, so she is clearly exhausted. Keep in touch with the vet on anything that worries you. Is she eating enough to keep her going even with a reduced appetite?
 

BlackCatOp

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Omg! What an ordeal for you and Sam. Several thoughts, the colon’s main purpose is to reabsorb fluid/dehydrate stool so it sounds like to me that loose stools may be expected but hopefully the incontinence will subside.

In the vet ICU, we commonly used Boudreaux's Butt Paste. If she cannot lick it, I don’t see the harm but follow your vet’s advice. Also, to help firm up those stools: RX VITAMINS Rx Clay Powder Digestive Supplement for Dogs, 100-g - Chewy.com

The change in appetite is concerning to me. I would definitely keep a close eye on her intake and try offering her different options especially if what she is being offered is the same food as at the hospital as cats can develop food aversions due to stressful situations and/or pain. Lastly, gabapentin can cause diarrhea so maybe a change of pain med is in order??

Best wishes for her recovery!
 
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missko

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Thanks so much for all the advice and support. This is such a wonderful community.

Sam has been much perkier today. I’m happy to report her appetite is getting back to pre surgery levels and she is now walking around. I think it helped that we took her out of the crate. She is a social kitty and became very listless in the crate.

her stools are still very soft and loose but the frequency of her poop leakage seems to have decreased. Her rear is still red, raw and swollen. When we clean it, there is pink fluid. I don’t think it’s infected. I love Boudreaux’s and we use it on our (human) baby, but Sam would eat it when she cleans the business end.

We continue to hope and pray for her recovery. She has an appointment with the surgery team on 9/30 to remove her stitches, at which point she won’t have to wear the much hated e collar. The following week we meet with the internal medicine team to discuss her FGESF.
 

fionasmom

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I am so glad to hear that you are rounding the corner on this and hopefully you are headed to a full recovery.
 
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missko

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Friends, update on Samantha ...

It has been five weeks since Sam had surgery on 9/17/2021. She is S L O W L Y getting better control of her bowels. During the day, there are some deposits in her litter box and she does not soil her bedding. Overnight, it is still a disaster. My fastidious, beautiful kitten poops all over her bedding each night.

She still has some blood in her poop, but we are seeing that less and less. Hopefully that trend continues.

She is still not herself. Pre-surgery Sam loved to stretch out in the sun, always curled up on us and ate like a horse. Now, she spends her days isolating herself in a cat shelter we have made for her (naturally with a heated cat bed). She does magically appear when we are preparing the cats' meals, but she no longer tries to steal the other cat's food.

Dr. Michael Linton, the Sydney based expert on FGESF, kindly had a video conference with us to discuss his experience in being involved in the treatment of 40+ cats with FGESF. The good news is Samantha's growths were in the lower part of her intestines (mainly in her colon), FGESF in this location has a fairly good prognosis. We started Samantha on prednisolone - it's definitely increased her appetite! The bowel surgery required the surgeon to crack her pelvis; there was some concern that steroid treatment might slow the healing process. However, the internal medicine specialist felt the dose Sam is on will not interfere with her pelvis healing.

Meanwhile, we got a scary diagnosis about our other beloved cat. I'll post about him separately. This has not been a good year for the animals...
 

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Thank you for posting this update. This has been long struggle for all of you but you have done absolutely everything that you could to make sure that Samantha makes it through and returns to good health.
 
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missko

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I'm trying to respond to a post by J jssatx , but I can't find it in this forum . . .

I hope Ollie's chemo is going well. I'm sorry to hear that you have experienced similar frustration with Ollie's veterinary care as we have with Samantha.

Samantha is 5 months post surgery and the fecal incontinence has not improved markedly. We spend 1-2 hours each day cleaning up after her. Her attitude is perky, lively and her appetite is ravenous, like her old self. We cannot bear to keep her locked up in a bathroom. She is my husband's baby, and she spends the days with him in our second bedroom / his office. The fecal incontinence is worse at night, and we have to keep her in a bathroom, which she destroys by morning time. Her stools have gotten firmer better over time but they are still very soft. The surgeon removed a big section of her colon, including much of her descending colon and part of her anus. She does have anal sphincter tone and she is physically capable of holding her poop in (during follow up ultrasounds for her FGESF, the vets have noted poop in her bowels, which didn't slide out). Sam is one prednisolone and cyclosporine for her FGESF; vets have not commented on whether this impacts poops.

The surgeon, Kristin Coleman at Gulf Coast Veterinary in Houston, has long since moved on from Samantha's care. She told us that what we see at six months post surgery is what we should expect long term. I'm not giving up hope. Samantha is a fighter - she survived an acute kidney injury from taking Pepto Bismol when she was six weeks old (thanks to the terrible advice of a country vet). Her numbers were "incompatible with life," yet she survived and thrived.

J jssatx , take care to keep Ollie's business end clean. Sam's diarrhea was 1) painful and 2) caused a UTI (Sam's a little girl kitty so she's more prone to them than the boys). Antibiotics aggravate the diarrhea, so the UTIs, antibiotics and more diarrhea have been a setback for Sam.

We have consulted with the nutrition team at Colorado State to help manage her FGESF through dietary intervention. They suggest Hills z/d as part of a low inflammation diet. This diet excludes chicken, which is Samantha's favorite. I'm going to ask about clay to firm her stools. If her poops were solid, the bowel incontinence would be easier to manage. Her FGESF tumors haven't grown back (thankfully), but her quality of life and ours has been destroyed. Sam used to sleep with us every night and nap with our baby. Now she spends her nights alone in a bathroom. We got her a small heater to keep her warm and cozy in there. We are looking moving to a new home to accommodate Sam.
 

fionasmom

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Thank you so much for responding and for updating us about Samantha. I have never had a cat/dog with the procedure, but am sorry that you and Samantha are still facing issue from the surgery. Once when Chelsea (intestinal lymphoma) had diarrhea, the vet gave us the clay. Rx Vitamins for Pets. Rx Clay. It is a very fine powder (there may be different formulations though) and you might have to work with administering it. This is so labor intensive for you and your husband; Sam is very lucky that she found you.
 

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I'm trying to respond to a post by J jssatx , but I can't find it in this forum . . .

I hope Ollie's chemo is going well. I'm sorry to hear that you have experienced similar frustration with Ollie's veterinary care as we have with Samantha.

Samantha is 5 months post surgery and the fecal incontinence has not improved markedly. We spend 1-2 hours each day cleaning up after her. Her attitude is perky, lively and her appetite is ravenous, like her old self. We cannot bear to keep her locked up in a bathroom. She is my husband's baby, and she spends the days with him in our second bedroom / his office. The fecal incontinence is worse at night, and we have to keep her in a bathroom, which she destroys by morning time. Her stools have gotten firmer better over time but they are still very soft. The surgeon removed a big section of her colon, including much of her descending colon and part of her anus. She does have anal sphincter tone and she is physically capable of holding her poop in (during follow up ultrasounds for her FGESF, the vets have noted poop in her bowels, which didn't slide out). Sam is one prednisolone and cyclosporine for her FGESF; vets have not commented on whether this impacts poops.

The surgeon, Kristin Coleman at Gulf Coast Veterinary in Houston, has long since moved on from Samantha's care. She told us that what we see at six months post surgery is what we should expect long term. I'm not giving up hope. Samantha is a fighter - she survived an acute kidney injury from taking Pepto Bismol when she was six weeks old (thanks to the terrible advice of a country vet). Her numbers were "incompatible with life," yet she survived and thrived.

J jssatx , take care to keep Ollie's business end clean. Sam's diarrhea was 1) painful and 2) caused a UTI (Sam's a little girl kitty so she's more prone to them than the boys). Antibiotics aggravate the diarrhea, so the UTIs, antibiotics and more diarrhea have been a setback for Sam.

We have consulted with the nutrition team at Colorado State to help manage her FGESF through dietary intervention. They suggest Hills z/d as part of a low inflammation diet. This diet excludes chicken, which is Samantha's favorite. I'm going to ask about clay to firm her stools. If her poops were solid, the bowel incontinence would be easier to manage. Her FGESF tumors haven't grown back (thankfully), but her quality of life and ours has been destroyed. Sam used to sleep with us every night and nap with our baby. Now she spends her nights alone in a bathroom. We got her a small heater to keep her warm and cozy in there. We are looking moving to a new home to accommodate Sam.
Can you say how she is today? My cat had a Subtotal Colectomy a week ago and she is experiencing the same exact thing. The surgeon doesn’t understand why. I just don’t think it will improve. She’s oblivious and sleeps right through it. I’m going though everything you’ve described. I can’t imagine my poor baby spending her life this way and all I do is cry watching her. I can’t keep collars or suits on her and she destroys all of her bottom skin constantly cleaning. This is breaking my heart. I believe I’ve may have made the wrong decision and no one has information to help.
 

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T ToniR - missko missko has not been back on this site since their last post, so I am not sure you will receive a response. And I can't be of any help due to no experience. I also had no success finding any similar posts on this site beyond the one you found.

Have you considered asking your vet(s) to consult with a vet university who might have additional knowledge/information on various short- and long-term issues/solutions from/to this procedure?
 

ToniR

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T ToniR - missko missko has not been back on this site since their last post, so I am not sure you will receive a response. And I can't be of any help due to no experience. I also had no success finding any similar posts on this site beyond the one you found.

Have you considered asking your vet(s) to consult with a vet university who might have additional knowledge/information on various short- and long-term issues/solutions from/to this procedure?
Yes, she had surgery at Auburn University Bailey Teaching Hospital and they are awesome. But her surgeon hasn’t had this experience. She’s done a few of these surgeries with no problems. She says there’s no reason she should be doing this and I’m taking her back there tomorrow for her to look her over and see if she can figure it out. It just sounds like no one has seen this before and has no answers. I’m so upset because I won’t force what once was the sweetest cat who loved me so much to a cat that can’t stand me or herself to live this way. She’s living in her filth under places I can’t get to her. I’m so emotional and negative right now. Thank you so much for responding.
 

fionasmom

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Please let us know what you are told.

Fecal consistency
The medical records of 144 cats described the patient’s fecal consistency immediately after surgery as either liquid (60 [41.7%]), soft (43 [29.9%]), or formed (21 [14.6%]) or indicated that the patient had not defecated between surgery and hospital discharge (20 [13.9%]). Postoperative tenesmus was observed in 25 of 111 (22.5%) cats.

The final fecal consistency reported during a follow-up interview with the owner or the last veterinary evaluation was soft or formed for 100 of 121 (82.6%) cats or liquid for the remaining 21 (17.4%) cats. Cats from which the ICJ had been removed had significantly (P = 0.014) greater odds of long-term liquid feces (OR, 3.45; 95% CI, 1.29 to 9.28) than did cats from which the ICJ had not been removed. However, the median follow-up duration was significantly (P < 0.001) shorter for cats with liquid feces (64 days; IQR, 20 to 503 days) versus cats with either formed or soft feces (740 days; IQR, 145 to 1,908 days).

From the Journal of the AVMA.

I am hoping that what you are seeing might be from the recent procedure of a week ago and that more healing will occur.
 
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