Still battling the "defecating outside the box" problem

Yes, he told me he expressed her anal glands.  I got a stool sample yesterday morning and took it in so the vet could see it.  He agreed that it was nice and soft (I still can't believe we have these conversations about the color and texture of this), and wants to make sure that Brownie is the one that gets the Fortiflora each day. 

I"m not sure why they wouldn't have given her an enema either now that you ask.  Part of the problem is, like most people, I suspect, I'm reliant on what the vet does since I don't have the knowledge base to ask about rectal exams and enemas and such.  I'm not sure I even would have thought of that with a person, much less a cat...

But, she (in theory) should be cleaned out now 'cause she went yesterday.

We ALSO re-confirmed that the problem is Brownie, but segregating them in separate rooms.  Doesn't mean there ISN'T a problem with Skyy, but there's been no droppings in the areas Skyy had access to, and there were DEFINITELY droppings in the area where Brownie was confined (just wanted to be sure again so we're not treating the wrong cat). 

Anyhow, we'll all be leaving in about an hour, and we'll have the next week to see how things go.  We've got lots of throw rugs to cover areas, a small rug scrubber, and other stuff so if she doesn't use the litter box we can hopefully keep it from becoming a crisis.  AND, since we'll all be in the 5th wheel, with luck if she squats when we're up, one of us will catch her and put her in the box...

The vet says when we get back we'll talk about where we are and where we go next.

He's having the blood work checked by a specialist and he's posted the x-rays somewhere so their radiologist(s) and specialists and take a close look.  He's not ready to claim megacolon, and his physical exam didn't reveal a large, distended colon, but his rectal exam showed "lots of material and gas".  So, maybe (HOPEFULLY, if it's something that can be treated) poor Brownie has that...

I"ll check in periodically from the road, so if anybody has any ideas, throw 'em out there.

OK, I have a little more anecdotal info........

We've been adding the Fortiflora to Brownie's food for the last 4-5 days.

We're on the road in the 5th wheel.  We've had two instances of droppings near the litter box.

BUT, we've got the litter box in the area where we usually are, and this afternoon I WATCHED Brownie get into the litter box.  She rummaged and arranged for a few seconds then squatted.  And waited...  After 15-20 seconds she put her front paws on the side of the box and continued squatting...  This went on for at LEAST 60 seconds.  Then  she jumped out of the box.  And walked a foot and squatted again.  I immediately grabbed her and put her BACK in the box.  Sat for another 10 seconds then jumped out and ran to the corner where she started to squat again.  This time my wife picked her up and put her back in the box. 

AGAIN, she squatted and you could see her pushing and so on.  This went on for at least 30 seconds - I think it was actually more like sixty seconds and FINALLY she passed a large feces... 

This CAN'T be normal...  We're still giving them the broth and Miralax because the vet didn't wan us to change ANYTHING other than adding the Fortiflora while we're on the road.  The dropping was soft, so it doesn't seem like she should have been struggling because her feces are hard.  But it took her a LONG time to pass the dropping and it sure SEEMED like there was a log of squeezing and effort...

So, tomorrow I"ll call the vet and pass on the information...  Again, we don't know if this happens every time, but if it is taking her that long and that much work to go, that seems like it should point to SOMETHING physical, right?

It sounds to me like she has poor motility. Cisapride, along with the miralax, is prescribed for that, and is very effective.

As I said before, this is classic megacolon symptoms. Straining, moving around, passing over large stool. Cisapride and an effective laxative (such as miralax) is a long term, for life, treatment. The only cure for megacolon is surgery.

I got a call back from the vet today.  Went through the same thing I posted in here.  He's still not calling it megacolon, but he did recommend we add Laxatone to make it easier to pass stool.  This afternoon we watched Brownie in the litter box again.  Again, she took at least 30 seconds to pass and seemed to be doing some straining, but she stayed in the box and finally passed a large movement. 

The vet indicated that we may be stopping the Miralax at some point, but we'll see what's happening when we get home. 

Is there some specific indicator for megacolon?  Does there have to be significant distension or some other thing that can be seen in an x-ray?  'Cause the vet posted her x-rays and had them checked by a radiologist who found nothing unusual?

Are there other tests we should have done to determine exactly what's going on?

Laxatone is not going to help. The excessively large stool is a classic indicator of megacolon. No matter how many laxatives you give her, if the stool isn't being moved the way it should, it's going to cause trouble. I would find another vet, frankly, this sounds too much like what I went through with my Ootay . the vet just kept prescribing more and more laxatives and bulk fibers.

It wasn't until I finally got smart and switched vets that my poor little girl got some relief, with the cisapride. She still had to take the laxatives too, but it was the lack of motility that had caused the problems in the first place.

I'm not a vet, nor a radiologist. But, I think I remember my vet saying, if the colon isn't full at the time of the x ray, it may be difficult to tell that it is stretched out of shape.

I'm running out of vets...

And this one ISN'T saying it's not megacolon, only that it didn't appear to be when they checked.  But he DID say there was a "lot of feces in the colon, along with gas".

The Laxatone was to make it easier for Brownie to go while we were traveling.  I'll call him Monday to see where we go next.

Frankly, I'd like to get away from ALL the stuff we're adding - wet-food-only, broth, Miralax, Fortiflora, Laxatone - and give Brownie what she needs to treat her problem.  But we've now been to two different vets, had a ton of different tests, and been screwing with this for months.  At LEAST, at the moment she's using the litter box and appears to be straining less. 

I'll bring up megacolon and cisapride on Monday.

Back home...  We didn't have any more occurrences of dropping outside the box for the rest of the week while traveling.  On the one occasion we SAW Brownie using the box, she APPEARED to be straining less and went sooner when using the Laxatone in addition to the broth and Miralax.

But, now at home where we can't see her, she went next to one of the boxes last evening.

I'm going to call into the vet and let him know where things are, and see what he says...

BTW:  if large stool is a symptom of megacolon, HOW do I know if it's "large"?  It SEEMS large to me, but I don't have anything to compare it to except Skyy, and she's only 6 pounds, so how large is large?

Normal poop for a healthy cat on a canned diet should look like 3 or 4 (or even 5-6, if smaller pieces) little tootsie-rolls, either linked together, or separated. Each piece should be between 1/4 inch and 1 inch long and should be no bigger around than a...tootsie-roll. They should not be thick, or in long solid logs, or several long solid logs, or looking like "soft serve" ice cream.

Stool sections should be firm but not rock-hard, and not crumbly. (when you press on a stool, you should be able to flatten it slightly)

PS here is a terrific website on feline constipation

http://www.felineconstipation.org/index.html

Thanks for the pointer.  I'll go out and give it a read, too........

Vet just called me back.

First, he wants to do a more thorough rectal exam under sedation.  He says the last time he did examine her and expressed her anal glands, but she was awake and not the LEAST bit happy about him poking around her back end.  This time they'll do the exam under sedation to make sure where they can check that there's no problem.

He wants us to discontinue the Forti-flora and the Laxatone since neither helped. 

If the exam is good we'll start her on Cisapride and continue the Miralax.  He says they typically use BOTH Cisapride and a stool softener in cats with poor motility.

I asked about fiber and he indicated that we could try something like the canned pumpkin to increase fiber because the i/d, which he wants us to continue, is the OPPOSITE of fiber.  We can also try Metamusil if the cat won't eat the pumpkin. 

One of the things that would make this easier would be if I could predict when she'll have a movement...  When we were traveling we got to SEE her straining (BTW:  the droppings were 4-5 inches long and at least the diameter of a full-sized Tootsie Roll) because she was going in the late afternoon/early evening.  At home, she seems to go at night after we're in bed, so we can't see what's going on.

I asked about using milk to get her to have more predictable movements.  One of the sites recommended in here talked about adding 2-3 ounces of milk and the cat would have a movement within 2 hours.  That would make it a LOT easier to see what's going on.

Anyhow, presuming the exam is good, we'll stop the Fortiflora and Laxatone, and add Cisapride.  See how it goes.

If all else fails we'll be referred to a vet that can do a full colonoscopy, but since the cost on that will be around $1500, he recommended the local exam first, holding the colonoscopy if these changes fail.

PLEASE don't use metamucil (psyllium) it is a bulk forming fiber and absolutely the worst thing you can give a cat with constipation problems. It works by drawing water to the colon, making the stool incredibly large. ALL the water in the cat's body is drawn to the colon, not only increasing the stool size until it is almost impossible for the cat to pass (worst case scenario, and I've been there) it causes the cat to become dehydrated. And as you probably know, a dehydrated cat is not a good thing.

I think the miralax and the cisapride is an excellent plan. I am not a vet but having dealt with these things so much over the years (I wish that website had been around for my little Ootay ) I am almost positive your kitty is having a problem with motility.

I think I'm starting to hate the Internet............

One site says "use pumpkin or Metamucil".  Another says it's the worst thing.

A site says Hill's is great.  Another says it's terrible.

At this point, the vet is at least determined to try one thing at a time...  So, We STAY with i/d, continue the broth with Miralax, and she's now on 2 1/2 mg (half a tablet) of Cisapride every 8 hours...  No more Fortiflora or Laxatone.

If this doesn't work he figures we'll try going to 5mg.  He says most cats get 5mg twice a day. 

Unfortunately, Brownie REALLY liked the Fortiflora and/or Laxatone, and would take them with a small spoonful of food.  She did NOT want to take the pill in food.  We finally resorted to a bit of tuna.

For food, try a raw diet, preferably something she has to chew. First, cats are obligate carnivores and they eat raw in the wild. All these additives, dry food, etc. are not what a cat would normally eat. Diet is the number one step, and avoid dry food entirely. 

Try whole prey or even a raw formula (meat, bone, organ) as a balanced introduction to raw. The other thing about chewing is that it sets up a cat's digestive system to properly (and fully) digest food, and this should make for easier-to-pass stools. More organ meat will generally soften a stool, where more bone will harden it. I noticed that on my cat's raw diet (mostly primal formula supplemented with raw meat), my cat's stools are firm and small. With regular canned food, they're a little softer. Sometimes just for a change of pace I throw in canned food, but the raw has all the nutrients that won't be cooked out (Taurine being one of them). 

Also, your cat will get more water from raw meat since cats naturally have a low-thirst drive. More moisture=proper stool formation and less chance of UTI. 

I would *never* suggest an enema for a cat unless it was medically-prescribed. Enemas are not necessary for humans and likely not for cats unless there's some extenuating circumstance. 



 

This is going to sound silly, but are you scooping the litter box every time they go to the bathroom, and cleaning it at least once a week to remove any old odor's. Also the spots that they tend to favor defecating in, have you disinfected it where as no odor could be trace through your kitties highly sensitive nose's.

Yup, the boxes are cleaned at least twice a day.  Our other cat, Skyy, LOVES the litter boxes.  She gets in and has a GREAT time, flings litter all over the place, digs like she's going to China, and so on.  We actually have SIX litter boxes in different places with two different types of litter because we thought maybe Brownie didn't like the Tidy Cat...

So, Brownie has boxes with Swheat Scoop that she likes, and Skyy uses the other litter boxes with the Tidy Cat (Skyy doesn't seem to like the Swheat Scoop especially...).  Maybe it doesn't fling well or something......

Anyhow, yes, they're scooped and scraped a couple times a day.  They get scrubbed and new litter at least every two weeks - we've tried weekly, but it didn't make any difference.

Brownie USES the box(es) to urinate, just not to defecate, so she's USING the box.  She just isn't defecating in there..

As far as rugs - we're using throw rugs.  We had mats in the laundry room, but they weren't very washable so we got rid of them.  Now, when she goes on one of the throw rugs it get cleaned and every couple days we put the throw rugs through the washing machine.  Since she doesn't go in the same place, I don't THINK it's an odor problem on the rugs........

AND, we just got a new floor shampooer, and I did the whole carpet in my office this morning.  With rug shampoo and Natures Miracle and the rug shampoo is specifically to deodorize pet odors and all that.....  I"m not happy, but the carpet in my office has NEVER been so clean! 

I don't THINK it's a box problem or a litter problem or a throw rug problem... 

What's REALLY odd at the moment is I called the vet this afternoon to ask how soon we could expect the Cisapride to kick in...  They told me it should start working within an HOUR...  Told me to give her a dose of the Cisapride an hour before feeding, then feed.  She SHOULD have a movement within 15 MINUTES of eating...........

Gave her a dose at 05:30.  She had dinner at 06:30.  I WATCHED her eat a bown of food - this was a whole can of i/d with two tablespoons of chicken broth and Miralax.  She had ANOTHER dose of Cisapride (she gets three doses per day) at 10:30 (which is when we'd normally go to bed).  It's not 11:10 AND SHE STILL HASN'T HAD A MOVEMENT...................

Either we're not giving her enough Cisapride, or this cat just isn't moving ANYTHING through her digestive tract.  The problem is that if I go to bed, when I come down in the morning, she'll have gone on one of the rugs NEAR the litterboxes...

I was always instructed to give the cisapride 15 minute before feeding, and in reading this link:

http://www.wedgewoodpetrx.com/learn...-monographs/cisapride-for-veterinary-use.html

^This info sheet also says give 15 minutes before a meal. What I recommend is giving the cisapride, then a small meal, then an hour later another meal with the miralax in it. Small meals more frequently will be better than one or two large meals a day.

It can take time to find an effective dose. My little Ootay was taking, by the end of her life, 5 mg Cisapride three times a day, and mineral oil twice a day. Mineral oil of course has to be given on an empty stomach (I gave it with a tiny amount of food) and wait at least an hour before feeding a real meal, because mineral oil interferes with nutrient absorption.

She didn't start on such a high dose though, when she started she was on 2.5 mg twice a day, and it gradually had to be increased.

I was hoping I wouldn't need to come back to this problem, but.......

If you read through all the previous entries, you'll see that we've got a 5 year old female cat that doesn't defecate in the litter box.  she's bee checked, tested, poked, prodded, and all that.  We've added litter boxes, have different litters, have changed her diet, and on and on....

She's now on Cisapride, even though she showed few symptoms of megacolon.  She gets 2.5 mg, twice a day.  She's now defecating without problem, and her droppings are solid but soft.  So, whatever the problem was before, I think it's now been addressed.

EXCEPT THAT SHE DEFECATES NEAR THE LITTER BOX INSTEAD OF IN IT...  Typically she goes on the throw rugs we've got around the boxes.

At night, we're confining her to a bathroom with a litterbox, bed, food, water, etc.  No carpet or rugs.  She always URINATES in the box, and once in a while defecates there, but MOST of the time she goes NEXT TO, OR NEAR THE BOX.

She's also gotten sneaky about going near the boxes in the rest of the house.  I have TWO boxes in my office, where she spends most of her time, one with Tidy Cat and one with Swheat Scoop.  Doesn't seem to matter.  As near as I can tell, she'll urinate in them but I've only seen her defecate in the box ONCE in the last couple months.  What she WILL do is wait until I leave, then go to the box in the laundry room and defecate on the rug next to it.  She's done this repeatedly on the carpeted mats next to the litter box.  My wife has followed her a couple times and the cat will look, back and forth, up at my wife and eventually get in the box and defecate.

Otherwise, if noone is there, she doesn't use the box.

We've now been screwing with this for A YEAR.  We've spent a fortune on tests, vet visits, changing diet, litter boxes, different litters, buying Cisapride, and all the rest of this.  My wife ran out of patience a while ago, and I"m about there too.  I don't know what is wrong with this cat, but if we don't come up with something that'll DEFINITELY keep her using the litter box regularly and consistently, we're going to wind up putting her down.  I'll hate it but this CANNOT go on indefinitely.

So, I need ideas.  Do NOT tell me to clean litter boxes or change litter boxes or add more litter boxes or change litters again.  We do daily, we do regularly, we already have SEVEN boxes, and we've tried 8 or 9 different litters, keeping the ones the cats seemed to prefer.  And there's NO straining or extended time when we've SEEN HER defecate, so if there WAS megacolon, it's being handled.

Ideas?

How about a box with NO litter in it, next to the regular litter box?

A low sided box, with a paper towel laying in it, to resemble a rug, is what I am envisioning.

Something other than rugs around the litter boxes. Something not so pleasant to squat on, like those astro-turf door mats maybe.

Gosh, I can understand your frustration.

I wonder...if it's a spatial issue? Aside from what seems like an aversion to litter when she poops, perhaps she feels she needs more room when pooping. A big open low sided tote box for her litter box maybe?

Hm.  It'd be easy enough to try.  I can move the current litter box out of the bathroom to the hallway (where it previously was), and put a box in the bathroom with paper toweling in it.  I don't think it'll fly long-term because of the problems with cleanup, but it'd be worth a try for the short term to see if we can get her back into the box...

What I DON'T understand (if there is any understanding cats), is she's perfectly happy urinating in the box(es).  I've seen her use both the boxes in my office to urinate. 

The other day, I watched a video by Jackson Galaxy [sp?], the guy that does the tv show, My Cat From Hell.  He says we clean the litterboxes TOO MUCH, scooping and all such.  And that he only changes the litter twice a year.  He insists his boxes don't smell and so on...  I"ll agree that our boxes don't smell either, even the ones sitting 6 feet away here in the office, but we also scoop them every morning (and sometimes additionally if there's something particularly fragrant deposited by the other spoiled princess)...  I don't know if anyone else has watched what he's got to say, but I'm curious about how much cleaning is too much, how much scooping should really be done, how often we should change the litter and wash the boxes, etc...

Well, it may have been a good idea, but it didn't work.......  We moved the Littermaid with Tidy Cat OUT of the bathroom and replaced it with two litterboxes.....  One with a regular amount of Swheat Scoop in it - she seemed to like that originally.  The other we've tried paper towels - ignored, a LITTLE paper - ignored, and a regular amount of shredded paper - IGNORED.  We've ALSO tried adding Cat Attract to both boxes. IGNORED. 

Again, she URINATES in any of the boxes just fine.  But, she refuses to defecate in any of the boxes (usually overnight)... 

I even got a bag of the Blue Buffalo stuff - I believe it's walnuts or something, and I'm trying THAT in a box with some Cat Attract in one of the boxes in the laundry room...  So far, BOTH cats seem to be ignoring that.  Maybe they don't like nuts?

Again, we've GOT to find a way to get her using the litter box - ANY litter box (of which we now have EIGHT!!!!!!) in various places and with a couple different litters...

I had one recommendation to get a crate that's just large enough for the litter box and a bed and put the cat in that...  As I understand it, that'll basically FORCE the cat to use the litter box to avoid going in her bed, but you may have to use it for MONTHS.  But, my current vet, who's been really good at testing and trying things and has come up with some ideas, does NOT like this idea.  He thinks it'll cause more problems than it'll solve, causing the cat to use the litter box but creating a lot of stress...

SO, AGAIN, we've GOT to find a way to get her to consistently use a litter box...  Ideas?

My cat had this problem for 2 years. For 2 years he pooped everywhere around the house and not in the box. It drove me crazy, I almost gave up on him. We tried everything. We thought he had arthritic. He is now 11 years old, he has long hair.

One day I took him to the groomer to have his butt hair shaved. And he has been going in the box ever since! Now I keep his butt hair shaved 2 times a year and he's good to go.