Megacolon caused by old hip fracture?

Hi all! (This will be long! Just a warning! ) I am writing this about my parents kitty, not one of my own. His name is Wonka and I think he may have megacolon caused by a (very) old hip fracture he got when he was about 6 months old. He is 15 years old now.

My parents and I have gone to the vet twice for this so far. His symptoms are occasional bloody stool (that is sometimes bright red blood, sometimes black and tarry), occasional diarrhea, occasional constipation, occasional defecating outside of his litter box and crying (that is what my mom calls it, I have not heard it myself) downstairs where his litter box is. The "crying" is heard about 2 or 3 times a week. He is acting normal and is eating and drinking normally. Urinating normally. Still having bowl movements at least once a day. No vomiting. He eats only low carb, grain free canned food. (He has been on this diet for a long time, he used to be diabetic and on insulin, but he is not diabetic anymore! ).

Another important thing to note is, the "crying" in the basement where the litter box is located has been going on for a long time, probably since two years ago. We had taken him to the vet for that specific reason before, about a year and a half or so ago, and the vet did not think anything was wrong with him. At that time we did not notice any blood, diarrhea or constipation.

So...on our first recent trip to the vet he gave us weeks worth of metronidazole and it did not help (still blood/diarrhea/constipation). Also, we brought a stool sample to check for parasites and there were none. On the second trip to the vet he seemed stumped and had no idea what to do, so I had to suggest to him to do a complete blood test and urinalysis. We got the results back from that and he said Wonka's blood work looked fantastic and looked like it was from a much younger cat. While we were there on that second visit I also suggested to him the fact that he had had a pelvic fracture when he was younger and could that possibly have narrowed certain passages making it harder for him to defecate. His answer was "No, that wouldn't be an issue unless he was going to have kittens". ... I guess he was trying to be funny but I didn't really appreciate the way he automatically dismissed what I had suggested. (He has arthritis from his old injury and is taking a glucosamine/chondroitin supplement which helps him a lot). The hip fracture healed on its own and was not corrected by surgery.

That's where we left of with the vet and no x-rays or ultrasounds have been done. He just told us to call him if anything changes. (I'm thinking it's time for my parents to get a new vet). From doing some research on my own it really does sound like megacolon is a real possibility. What do you guys think?

I am going to instruct my parents to add extra water to his canned food and also have them stir in a probiotic/digestive enzyme supplement. I am keeping an eye on the amount of fiber in his canned food, currently he is eating one that is 1.5%. I'll see how he does on that and then if there is no positive changes switch it down to a 1% or .5% fiber. Or, do any of you suggest starting out low, at .5% and then working up from there? Also, I'm going to be switching him to a canned food with no fruits or veggies in it, (but still low carb and grain free), so hopefully it will be more digestible. (I am a huge fan of raw feeding and feed my own kitties that way, but my mom is ill and has a weakened immune system so raw food for Wonka is not an option unfortunately).

From looking around on here, and other sites, I see Miralax works very well for some megacolon kitties. If all of the above doesn't work than I may try adding some to his food.

Sorry for such a long post! Any advice is greatly appreciated!

I am not a vet just a human doctor but I am not sold on the correlation w megacolon and the hip fracture. I DO wonder about the vet and his very poor communication skills Imho. If they match his surgical and internal medicine skills, Oy!! Perhaps a second opinion would be wise. Megacolon can be caused by do many variables and yhr etiology can be difficult to ascertain sans much detective work in some cases. Obtrucyion tor ex. Has the Kitty had ultradound or frays to see what is going on inside? That is where I would start if all the other tests are positive and he is still ill. The ONLY connection I can think of re the hop fracture -which would be well healed bu now - is a bone impaction but you did not indicate the type of fracture, ie impacted, compression, closed, open etc. If for some reason pieces of bone are causing an obstruction, that might implicate the fracture but in most procedures where some complication like that occurs, it is typically no longer then 2 yrs post op and usually involves material other than bone. Even osteoporosis -unusual buy not unknown in cats who age - would not cause an obstruction which is what leads to megacolon. Could there be another problem with his hip? I think more radiological nerds to br fond before any conclusion reached. But he does have dome megacolon symptoms but any human or cat who had severe obstruction usually has electrolytes that are not normal and that does boy appear to br the Case Herr. If he were my cat wi would obtain another opinion from a feline specialist. Hood luck!:

Sorry for the typos. Cannot see well nor is typing my forte!

Thanks for your reply! No he has not had any x-rays or ultrasound done yet.

As for the fracture I could not tell you exactly what kind of break it was. It was so long ago and the vet does not have any record of it. If I can recall correctly some part of his hip and/or pelvis was fractured and his hip was dislocated. (I wish I could be more specific!)

He walks with an altered gait, which I had been attributing to arthritis in that hip. (And the fact that it healed naturally on its own after it was broken, so I'm sure its placement now is not optimal). Sometimes it is worse than others. If he has not had the joint supplements for a few days you can really tell a difference. His leg seems wobbly, when he puts his full weight on it it will shift back and forth slightly, but he does not seem to be in any pain.

I agree it's hard to know whether the old hip fracture is a contributing factor without more diagnostics. Honestly, the blood concerns me more. The bright red blood suggests lower GI bleeding which may be explained by the megacolon, but the dark and tarry blood suggests upper GI bleeding. I'm not sure how that would be a direct symptom of megacolon. I think something else is going on here and more tests are needed.

Yes which is why I wonder why the vet did not do any diagnostic imaging. Is there an obstruction that is caused by something more serious? And even in humans, some obstructions are even difficult to see on scans or MRIc 's etc but possibly easier in a Kitty. But I would ask for one if that is possible for you.

I would agree that more testing is needed. Especially since there has been a hip injury, x-rays would help. Any pelvis narrowing may cause feces to have a difficult passing, so maybe a cause of the meowing/straining. Black, tarry stools are indications of something wrong in the upper digestional tract; bright red ones indicate problems in the lower tract. Bowel movements once a day would go against the megacolon theory, though. Megacolon usually involves a distended colon that can't contract normally. X-rays would also show if there is any bowel backup and also any obstruction--maybe there is something foreign in the digestive tract that is irritating it?

Miralax creates softer stool by pulling water into the colon, thereby making it easier to pass and move along the colon. So use if the stool is hard.

Have you considered that maybe there are two problems here? Maybe the hip injury is causing the straining, while other digestive ailments are causing the abnormal stool.

I think it could be very possible that there are two different issues. It may be possible that he re-injured his hip? My parents or I haven't seen anything to necessarily suggest that though, other than the straining/meowing while trying to defecate.

While talking with the vet a food allergy was mentioned as a possibility as a cause for his abnormal stool. The next food I'm switching him to will be a novel protein, a canned rabbit food, so if that is the case we should see some improvement there. Also I would think probiotics/digestive enzymes should help too.

I will suggest to my parents that he should get an x-ray. In the meantime I will change his food, add more water and add the probiotics/digestive enzyme supplement. Hopefully some results will be seen from that!

Thanks for all the help. I will update this after x-rays have been done. (If my parents choose to do that, hopefully they will).
 

Poor little old guy!

Considering his advanced age, I'm guessing it may be that his arthritis is getting worse. Because he favors one side over the other, the weak side stays weak, the stronger side has to work twice as hard.

I have seen kitties with past injury to the hip area having the same problem. It is good that he is eating low-carb diet. It is the best diet for any cats, but specially for cats prone to constipation.

His arthritis is probably making it hard for him to squat and push in the litter box; the longer he stays in the box trying to defecate, more fatigued he gets. He knows it's painful, so he probably tends to "hold it", making the stool even harder.

Miralax will help with this; also...

Do ask your vet about Adequan shots.

Adequan (Polysulfated Glycosaminoglycans or PSGAG) is an injectable drug for arthritis; it has been used for horses and dogs, and for human (Arteparon) for many years. It has been used safely for cats, but by off-label. It calms the inflammation and repairs the already damaged cartridge. Often the results are very dramatic. It can be administered  by intramuscular or subcutaneous injection. The shots are given every four days for a month, followed by maintenance doses. (Vet will determine, depending on the severity-once a week to once a month) It is a prescribed medicine, but your vet might let you do it at home. (That way, it is vastly cheaper, less traumatic and less time consuming than going to the vet every 4 days!)

Other things you might try is to adjust the litter box. This depends on his body size and "style"; does he squat "high", with his front paws on the edge of the box as support? Then you might want to try filling it very high so he can push down easier. If he squats balanced on the side like a bird, you might want to make that surface bigger by adding a piece of wood level with the box. If he squats "low", litter filled too high might be too wobbly; you might want to give him one box filled low for solid and one regular for urine. (He will figure it out. You can help him by placing his poo in the "#2 box".)

If the room where he likes to sleep is air conditioned, you might want to give him a warm surface to sleep on. Heating pad set low is OK, but I think it dehydrates them, so if you use it, cover it with a towel or a blanket to take away some of the heat. There are pet blanket/bed that has "space blanket" (the shiny sheet of Mylar they give out to Marathon runners) inside, design to reflect the body heat back. If you are handy, you can make one pretty easily with an old blanket and a sheets of Mylar sold as a gift wrap.

If he prefers to sleep on the floor, foam pet bed works great. (Cover it with a towel or a blanket to protect it from "accidents".) They do not market them as cat beds, so look under "dog beds for small breeds" online. If someone is getting rid of old foam mattress pad, you can cut it to cat size and wrap it with a towel or a blanket; voilà, a foam bed for a kitty!

Also, do make sure there is no draft directly hitting him where he sleeps.

Another thing to try is kitty massage. There are excellent books out on the subject (many available at your local public library); Linda Tellington-Jones (Her TTouch method works even for feral cats) and Dr. Michael W. Fox are my favorites.

Massage loosens the knots and kinks in the tired, compensating muscles and helps to regulate circulation. It also makes him feel loved and appreciated as a member of the family. It has a calming effect on the masseur as well.  

Good luck!

Thanks so much for all that info!! Very helpful! I really didn't think much about his arthritis and how that could be causing these issues as well.

It seems getting an x-ray is the way to go. Why Wonka's vet does not think so I don't know. I suggested an x-ray and he dismissed it saying it wouldn't show anything. He said an ultrasound would be much better. Well, an x-ray would show arthritis, correct? Also it would show if there is a foreign material/blockage. And also it would show if megacolon were an issue if his passageways were too narrowed. I don't know if an ultrasound really would be better in this case. Does anyone think an ultrasound would be better vs an x-ray?

I am going to be doing all of the diet, supplements etc. changes for him in the next few days. My parents may want to see how he does with just that for a bit. Then if nothing improves move on to the x-rays. I wish they hadn't spent all that money already on tests that weren't too helpful. Oh well, that's how it goes sometimes I guess.

I believe radiograph (x-ray) does show feline arthritis. In my cat's case though, we never did any radio diagnostics. We just added up all the symptoms plus her age and decided it is most likely.

(Most middle-age and over cats seem to have some degree of arthritis in their joints.) The blood in the stool is worrying. It could be a GI issue like an allergy as the vet thinks, or it could be because he "holds" his stool (the hard stool can break the small blood vessel in the rectum), or myriads of other issues. I am too, surprised your vet did not order more tests. But for now...

Definitely do add Miralax to his food.

Here are a few more tips that can help the little guy to live his golden years a bit more comfortably: (If you haven't tried them already)

Raised food dish will also make his meal time more comfortable for him and helps to keep up his appetite. (When senior cats start to have less appetite, this can be the cause.) Pedestal style dish like Classy Cat on Amazon U.S. works nicely; same style can be found on etsy.com. If the added weight of the pedestal is an issue, you can find a small plate that fits on the top part. 

(I have tried adding two pieces of brick under a dish, but I was afraid it might fall over and break her paw or something, so I decided to splurge for the peace of mind. Maybe a piece of wood can be cut to size also?)

A step to get up and down from his favorite high napping spot is also helpful for him. It makes getting up there more secure and not so scary that he may not "make it" with his old wobbly legs - ever see him seeming to jump and changing his mind, stretching up and down a few times before jumping like he is measuring the distance and falling backwards or sitting by your bed wistfully? - and it makes getting down (jumping down) less painful. It doesn't have to be anything fancy. A cardboard box with a few books inside for weights or rubbery "feet" glued to the bottom (so it won't slide when he jumps up and down on it) and an old towel covering the top (for traction) will work.

He might appreciate and enjoy extra help in grooming also. While grooming him, check his anus for blocked anal glands-another common problem in older cats.

One more thing: is there a possibility that your parents can relocate the litter box upstairs? It must be hard for him to go up and down the stairs, with his bad hip and all. He might even be holding his stool because of the stairs.

Thanks so much for all those helpful tips Chloespriestess!
I have suggested to my parents to bring the litter box upstairs soooo many times, they're just being stubborn about it unfortunately. Not only for his arthritis but also because we need to see what's going on when/if he's straining. I am just going to do it myself for them and make a big cut out cardboard box to put it in so they don't have to see it and he won't track litter everywhere.
I am second guessing his arthritis getting worse as a cause for all this. He willingly, and with no hesitation, jumps up and down, runs (more of a silly gallop), and goes upstairs. There is nothing upstairs for him, no food, litter box, toys or people. I know cats are good at hiding pain, but jeez, you would think he wouldn't want to do those things if he was hurting a lot. There are no signs of pain from him. I'm so confused as to what could be going on with him.
Anyways, new novel protein diet starts tomorrow. With extra water, enzymes and probiotics and Miralax. Hoping this will be the solution for him!

That's great that he is very active! It's always better for cats of any age, but specially older kitties to be active in order to keep up the muscle mass. He is lucky to have a "sister" who cares about him and takes initiative.

OK, maybe it's not arthritis. Maybe it's a combination of his hip being awkward and hard stool. Miralax  and extra water should definitely help.

If he is having a litter box issue, he should appreciate the box closer by, even if it's not painful for him to get to it, I imagine. You can emphasize the problem relating to poor old guy's "age" and maybe your parents will soften up a bit. It would be helpful if you can chart his habits; day, time, quantity, quality and how he is doing it. Compared to what he is eating and what supplements he is getting, a pattern might emerge that make it easier to figure out what might be the problem. If none of these things work, you might have to delve more into the possibility that something medical is going on, i.e. polyps.

(About tracked litter: after I set up a cardboard step for my cat next to the bed, I noticed bits of litter that she used to bring up to the bed with her are now left on the towel covering the step. A little perk I haven't foreseen!)

In any case, I think a vet should take an X-ray of his bad hip, just so you have something to compare to later if problem should develop. In my experience with cats and dogs, if they have had a past injury, they almost always develop problems later, stemming from it.