To Enema or Not to Enema - That is the Question.

[Nevergiveup]

My 16 yr old kitty has kidney disease for a couple of years now. Recently we've been battling constipation. Unfortunately it took about 3 months to figure this out. Her symptoms presented as her waking me up at night meowing (screaming) in my face, humping my arm & ripping out her hair on the right side of her body. The Dr. thought it might be a UTI and prescribed antibiotics. 10 days later and she was no better I noticed her pooping wasn't daily so we tried laxatone (she hates) then miralax. She was receiving hydration 200 cc a week at the Dr. office. We asked the Dr. to give her an enema but she said she didn't feel backed up. We sought a 2nd opinion and was prescribed miralax (up to 1 tsp/day), cobalequin, SQ fluids 200 ml 2x/week, epicatin, gabapentin 100 mg x/day for nerve pain, cerenia for nausea and mirtazapine (appetitie stimulator). Most of those she did not tolerate well. With the gabapentin she couldn't walk straight for almost 12 hrs. Most others knocked her out as well including miralax. After a few enema's and changing meds to Cisapride 2.5mg 2/day & Lactulose 10 mg 2/day she was doing way better. Her weight had gone from 10 lbs to 6 lbs. We went from dry food to wetting the soaking the dry food to Science Diet W/D to Delectables stew senior 15+ kidney support with added water. For the past couple of weeks she's been getting out of bed, coming downstairs and being more alert. Recently we tried vitamins and she got constipated again. So the question is should we be hydrating 2/weekly and should we give enema's if she hasn't pooped in a few days or try to change meds to help her. Are enema's bad for her or is letter the stool build up worse?

 

[Furballsmom]

For the past couple of weeks she's been getting out of bed, coming downstairs and being more alert.

So, I'm reading that on the wet food she was improving. Changing things such as giving vitamins sets her back.

Does this answer the question regarding what works for her without her getting constipated? Can you stick with that and avoid the issue of enema vs constipation?

By the way, are you saying you are giving her subq fluids too? Although I'm not a vet, but to my mind, whatever methods and foods work for her so her digestive system is able to function is what needs to happen, --no changes, no additions.

However, I'm not clear why she lost all that weight. Is something else going on?

 

[Nevergiveup]

So, I'm reading that on the wet food she was improving. Changing things such as giving vitamins sets her back.

Does this answer the question regarding what works for her without her getting constipated? Can you stick with that and avoid the issue of enema vs constipation?

By the way, are you saying you are giving her subq fluids too? Although I'm not a vet, but to my mind, whatever methods and foods work for her so her digestive system is able to function is what needs to happen, --no changes, no additions.

However, I'm not clear why she lost all that weight. Is something else going on?

She was diagnosed with chronic kidney disease (CKD). I believe this is why she lost the weight - having difficulty with constipation - possible having megacolon now (not diagnosed but taking meds for it). It seems like most things we've tried to help her CKD makes the constipation worse. My question was -does giving an enema hurt the colon in any way or is it worse to leave stool in there why trying different meds to have it come out naturally.

 

[Furballsmom]

Without all the information about your cat I don't believe it's possible for us to say much beyond what I mentioned above regarding subq fluids, if I understood correctly that you're giving her those, and wet food and water. I was under the impression that you had her stable, ie not constipated (except for the stumble with the vitamins)?, and that basically you were discovering that changes outside of the wet food caused her to be constipated.

Since I'm apparently wrong, this website below but mostly your vet or a different vet if you're still not happy with your current one, may have more information to help you keep her digestive system stable including her kidneys, so that you don't have to walk that tightrope so much between constipation and enemas. The website has a support group.

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat

 

[stephanietx]

Constipation is extremely common in kidney kitties. Adding plain canned pumpkin to wet food can help as well as adding slippery elm bark. The key is water.

 

[Nevergiveup]

Thanks - is there any food that is better for her? She's extremely picky and is very hungry. She just lost another lb :-(

 

[Furballsmom]

She's extremely picky and is very hungry. She just lost another lb

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Persuading Your Cat to Eat
This page has helpful information, plus you need to look at some of the other pages on that website that discuss canned food and if she still won't eat even the foods mentioned on this page on her own, you need to consider handfeeding her, with your finger, a syringe, popsicle stick, feeding tube...

 

[KatherineE]

We tried a lot of tricks to get our CKD to eat in the last couple years of his 19 year long life. Here are some of them. He preferred freshly opened canned of food and often preferred to eat it straight out of the can. He would sometimes eat the food if we topped it with a Temptations treat or a treat on its own would spark him to eat his food. He’d sometimes eat if we sprinkled his food with Fortaflora. When things got harder, we used a small dose of Mirtazapine every few days. Miralax was crucial in keeping him regular and irregularity had to be avoided as much as possible because he would stop eating and/or throw up. B12 injections really perked him up the last few months of his life. He did continue to eat his favorite kibble, a higher protein option that Innova used to make. I do not generally subscribe to low protein diets for CKD cats. I mostly made sure it was low in phosphorous.

I presented him with wet food many times a day and learned to be persistentit often felt like a full time job to get him to eat. He refused most wet foods except Friskies but it was better than nothing. We kept him at 11 or so pounds until he passed, which was close to his normal weight.

I know what you’re going through is hard. I hope you find some things that work. But to answer your original question. I would opt for an enema over bad constipation.

 

[Furballsmom]

This is another website that may have information for you and/or your vet if they aren't familiar with it;
IRIS Kidney