Hello all,

My two cats, Christopher Robin (we call him 'Nub' because of his nubby tail) and Squishy Squish (we call her 'Squish' for short) have their 10th birthday coming up on Feb. 10th. 

They are currently eating Trovet Hypoallergenic Quail food, because they have been having allergy symptoms for the last year or so (itching, licking, and head shaking). The allergy food hasn't seemed to alleviate the allergy symptoms, so I'm pretty sure the allergy is environmental. 

Meanwhile, Nub has recently started suffering from repeated bouts of constipation, escalating last week to near-obstipation. The Trovet food is just Quail and (presumably white) rice, so I don't think they're getting any fiber whatsoever at this stage. I would like to switch their food to something that has some fiber, that can also support optimal health at this age.

Nub also has some mild arthritis in his spine and tail, so ideally I'd like to feed them something that also could help with that, but the vet said I could add things to the food to address that separately, so the constipation is the primary issue, as well as just encouraging healthy kidneys/liver/etc. 

Both cats eat mostly wet food mixed with water, with a little bit of dry food as a snack. The vet has recommended Hill's Prescription Diet, w/d or another one which I can't remember, but I would prefer to feed a higher quality food with no byproducts/etc. Unfortunately I've had bad experiences with vet recommendations, they usually seem to push whatever brand they sell at the office.

We currently live in Amsterdam so the selection here is more limited. The prescription brands I know I can get include Eukanuba, Hill's,  Royal Canin, Forza10, Sansimed, Specific Cat, Trovet, and Virbac. Non-prescription, I know I can also get Almo Nature brand which is considered good quality, but I don't think I can obtain Wellness brand here (which I've seen recommended).  

I am unfortunately not in a position where I think I could regularly cook for the cats or feed a raw diet, so I would prefer recommendations that I can purchase. Any suggestions are incredibly helpful, even if they include tips or what to look for or anything else. 

Thanks very much!

Treating constipation is a trial and error process. There are two paths you can take: high fiber or low fiber. I used to belong to the Yahoo! feline chronic constipation and megacolon group, and most people there felt they got better results going low fiber. The theory behind this is that cats don't handle fiber very well, so don't give them much. The owners in the low fiber camp that previously fed high fiber also felt that high fiber foods may have made their kitty worse and bumped them from chronic constipation to megacolon. Whichever way you go, you're looking for wet food.

Low fiber feeders also recommended low starch/no grain. There's a brand in the U.S. called Tiki Cat whose chicken flavors are good if you're feeding low fiber.

Arthritis can be addressed with Cosequin, krill oil, or coconut oil. In another thread another member is trying tumeric for a different treatment, but I remember tumeric is also used in people to treat inflammation.

Thanks very much for the input Raintyger. I definitely am concerned about over-fiber-ing him too, as I think his near-obstipation incident was triggered by being given too much Metamucil (psyllium husk). 

I admittedly am no expert at nutrition, but I'm wondering, isn't what he is eating right now considered 'low fiber'? 

The ingredients are listed as:

Trovet Hypoallergenic ( Quail ) Canned Food :
Meat and animal derivatives (quail ) , rice , oils and fats (sunflower oil, olive oil) , vegetable products (guar gum), minerals.

It is my understanding that the food is essentially just quail and rice, for the purposes of reducing possible allergens, but as far as I know white rice does not contain any fiber? 

The reason why I thought fiber should be added is because I was under the assumption that he wasn't getting any fiber at the moment. Please correct me if I'm wrong, though, as I said I don't know much about this. 

I agree with Raintyger.
Cats don't need a lot of fiber; they do need more water than they think they do
Do definitely go with wet food. Read the ingredients, the first two or three should be meat based. The Trovet Hypoallergenic ( Quail ) Canned Food doesn't seem bad, try adding water to it.
PS: have any friends who could mail you canned food from Baltimore !

He is having recurrent constipation on the Trovet food, this is why I need to switch foods. Since it doesn't seem to contain fiber (unless I'm wrong about rice?) I was wondering whether a diet with fiber would yield better results, which is what the vet has also suggested. 

He is already on an almost all wet diet with lots of water mixed in, and has been on that for years, but is still having constipation. If anyone has other food recommendations, that would be very helpful. 

Thanks!

I'm sorry I missed that important part. I'm hoping someone else will post with more helpful information.
Good Vibes to you and yours.

A lot of people here in the U.S. have had good luck with using Miralax daily.  I don't think Miralax is available in Europe but I think there would be an equiv.  It works by drawing water in the colon.  http://www.miralax.com/pdf/MiraLAX_ProductLabel.pdf  is the label from the Miralax.  Many people give it twice a day to keep thinks moving.  It's a tastless powder that can be mixed with food.  Normally people start with 1/8 teaspoon twice a day and adjust the dosage.

The fiber versus no fiber really depends on the cat.  One of my cats has constipation issues as part of IBD.  The vet told me a little fiber such as plain pumpkin can help until a cat goes into megacolon.  With megacolon it is best to get as much fiber as possible out of the diet.

Since your kitty has a stubby tail and has developed arthritis in the area I wonder if he has what is commonly called Manx syndrome.

Thanks very much, Denice. I will ask my vet about Miralax or an equivalent, or at worst maybe try to order it from the US. 

I was worried about Manx Syndrome too, but from what I've read, I don't think he seems to have most of the symptoms. It also seems like those are usually seen earlier on in a cat's life, and more common for 'rumpies' than for 'stumpies'.

While the arthritis may be an issue, that was only discovered accidentally last year when he had another issue and they had to take an xray. In practice I have always known he didn't seem to like having his nub touched too much, but he still runs around and jumps on furniture/shelves, etc., so I hope it is not too much of an issue for him. 

With regards to fiber, since his constipation issues only started in the last month or 2 and he's been on the no-fiber Trovet food for maybe 10 months or so, I was hopeful that if I switched to a brand with some fiber he will do better. We'll see how it goes.

I'm not really familiar with most brands in Europe, though, so I just don't know what's considered high quality food here. I can feed Hill's or Royal Canin but I know that there are probably better quality products, and the vet only ever recommends Hill's because that's what they sell.

White rice has fiber, just low amounts. It does have starch, though, which is not supposed to be good. I couldn't find much information on it, so I can't tell how much rice is in it. I re-read your initial post, and if the food has brown rice, that is quite a different matter, brown rice has lots of fiber.

For a low fiber diet you want 1%-1.5% fiber in a canned food.

Did the vet give any indication as to why Nub is constipated? Is he a Manx? Manx have a tendency to develop constipation.

Thank you, Raintyger. The label doesn't indicate whether it is white or brown but I assumed it was white based on how it looks in the can. I just checked their website and that doesn't indicate either, but it does say the composition and it is as follows: 


So it appears that fiber is at 1% which you indicated was low. I'm not seeing a reading for starch so not sure how to evaluate that, but I imagine you're right about white rice being high in starch. 

Since he's been eating this food for a while and now has constipation, based on what you guys have advised I think I'd like to try something with more fiber, not a high fiber content but maybe what's normal in the average cat food, and see how he does with that. 

The vet didn't give any indication as to why he's constipated. They did an ultrasound and xrays and said everything looked normal, they didn't see megacolon. They theorized that it could be from the arthritis, but I asked them to compare the xray against the one they took a year ago to see if the arthritis looked any worse and they said it looked the same, and he wasn't having any constipation issues last year. That coupled with the fact that he's still quite active and jumping and stuff makes me think that it might not be arthritis related. 

I don't know him to be a Manx, he's a domestic shorthair mutt, and I was under the impression that his tail was a birth defect. Neither his mom nor any of his siblings had stumpy tails, but his dad is unknown so I suppose it is possible that he has Manx genes somewhere in his background.

Otherwise the vet just seemed to think that he needed more fiber, but I guess that's a common recommendation. In the meantime I'm giving him 2ml of lactulose per day, but from what I've read it seems like it's not a great idea to keep them on that for life because you need to gradually increase the dosage. I'd like to try to switch to a good food first and if that doesn't work to try adding the Miralax. 

Maybe if anyone is able to give recommendations on what composition I should look for in the food, or point me to a good resource (since I have no clue about nutrition, I can then read the labels and find something good.

So things like what normal fiber levels should be (not high but not low), how much protein/fat is good for a 10 year old cat, if there are any vitamin or mineral levels I should be looking out for at his age, ingredients to avoid, etc.

Most canned food in the U.S. is 1%-1.5% fiber. I guess it is considered "low fiber" in comparison to a few brands that are 2% or 3%. Offhand, Ziwipeak is 2% and Nature's Variety is 3%. But Nature's Variety has clay in it (for detox purposes), which can constipate.

The high fiber foods I have heard of are prescription. Unfortunately, they derive most of their fiber from grain/carb sources and are often dry food. They are REALLY high fiber. I remember seeing figures like 23% or 30%. Most of the people in the Yahoo! group did state that the food worked. But there were also quite a few that said it worked for a while. Some felt that the high fiber food stretched out their kitty's colon, so personally I would try to see if there's other solutions first, which is why I asked if the vet knew anything.

Here are some other remedies that I've heard of:

Coconut oil increases metabolism, so waste gets moved along faster.

Aloe vera is a mild peristalsis (bowel movement) stimulant, but you have to be careful because you need something made from the inner leaf and no preservatives. Outer leaf is poisonous.

Probiotics create the correct body pH for peristalsis.

Digestive enzymes reduce stool volume so that kitty doesn't have as much to deal with.

Miralax softens the stool by drawing water into the bowel. Soft stool is easier to pass.

Cisapride is a medication from the vet that stimulates peristalsis. Unfortunately, it can also interfere with kitty's natural peristalsis ability.

Sub-Q's hydrate kitty

B12 injections stimulate the nerves

Most of these can be discussed with a holistic or integrated vet. Always try one remedy at  time so you'll know which remedy caused what.

If there's been anything like appetite problems you might want to check for IBD. That was behind my kitty's constipation.

Of course, it is your choice to go for the high fiber, too. It's just that once the colon stretches, it might not go back. So if Nub's not too severe, there might be a different path to take.

DUH! Forgot to write about the Trovet food. It does look like a decent food--only 1.8% carbs. (Wow! You guys just get told what percent carbs. In the U.S. the companies get to hide the number and we have to figure it out mathematically.) You generally want 10% or less. Protein's a little low at 43% (ideal about 50%). I don't know a whole lot about the individual nutrients (calcium, phosphorus, etc.). High calcium can constipate (just as when we eat cheese), but I would think a commercially made cat food would stay within reasonable values.

Thanks so much Raintyger, that's very helpful. Maybe I'm missing something really obvious, but how did you calculate the protein? 

Correct me if I'm wrong, but it was my impression that maybe I should switch both cats to a 'senior' formula at this stage (since they're both about to be 10), so I was hoping that maybe I could find one of those that has a slightly higher fiber content but not crazy high, and that maybe also there would be added benefits to a senior formula for them (I don't actually understand what the difference is)..
 

I'm definitely going to look into Miralax in the meantime, as switching the food will be a slow process regardless, and your other tips are great too so I will look into those. 

Mayadot - I can vouch for the following for constipation: 

 

(1) Slippery Elm Bark Syrup

Make your cat a homemade slippery elm syrup. Add 1 to 1 1/2 tsp. of the powder to 1 cup of cold water. Dampen the powder by stirring, which helps avoid lumps. Boil the mixture in a stainless steel or glass pot for about 3 minutes, stirring continually. Allow it to thicken to the consistency of maple syrup or molasses. Store in a dark colored dropper bottle in a cool place for one day or in the refrigerator no more than five days. Label and date the bottle. Give your cat 1/4 to 1/2 tsp. mixed with her food or straight if she'll drink it. You can administer up to 4 doses a day. For the most difficult cats, squirt onto their paws during their bath time and they will lick it off.

Learn more: http://www.naturalnews.com/035014_kidney_disease_cats_Slippery_Elm_Bark.html##ixzz2sgJe3qYM

- This definitely helped clean him out. Think of it as greasing the pipes.  My guy now poops once daily again. 

(2) Coconut Oil - teaspoon a day mixed into his food.  Couldn't tell you if it works, but I do give it once in awhile. Plus I enjoy it too. 

(3) Probiotics - I drop ~ 10 Billion CFU per day into his wet food.  Since I've started doing that, he hasn't puked any more.  Could be coincidence but I'll take it.   The pills I have are 30 Billion CFU so I unpop the capsule and give 1/3 of it, for 3 days. So, it can be pretty feasible. 

Slippery Elm Bark powder should be found at your local health food store. After I made the syrup, I used a syringe to suck up 2.5 ml / twice a day and inject into his wet food.  It's that slippery that I couldn't just use measuring spoons.  It would roll right off the spoon.  That's your 'natural' alternative to Miralax.  Either should work. 

mayadot said:

 
Thanks so much Raintyger, that's very helpful. Maybe I'm missing something really obvious, but how did you calculate the protein? 

Correct me if I'm wrong, but it was my impression that maybe I should switch both cats to a 'senior' formula at this stage (since they're both about to be 10), so I was hoping that maybe I could find one of those that has a slightly higher fiber content but not crazy high, and that maybe also there would be added benefits to a senior formula for them (I don't actually understand what the difference is)..
 

I'm definitely going to look into Miralax in the meantime, as switching the food will be a slow process regardless, and your other tips are great too so I will look into those. 

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For canned food you have to convert the percentages given to what is called dry matter basis. That means you're finding out what percent of the dry matter is a protein, carb, or whatever it is you're interested in. Your food is 79% moisture, so that means it is 21% dry matter (100%-79%). Divide your protein percentage by dry matter percentage, and you get percentage of protein on a dry matter basis. (9% / 21% = 42.85%)

Cat nutrition and how to read a pet food label is found on these websites:

http://www.fnae.org

http://www.catinfo.org

The first is a summary of the second. The catinfo.org is a bit long, but is the first hand information from a leading vet in cat nutrition. You will find Dr. Pierson's work referenced frequently on this The Cat Site.

Special formula food like senior food or weight management usually just have more carbs in them and are a gimmicky way to sell food that is in reality less quality. This website has a discussion on senior food. It basically says that there may be some extra vitamins, but nothing is really proven to of benefit.

http://www.2ndchance.info/oldcat.htm

If you want to add a little bit of fiber you could try Metamucil or Benefiber, maybe ground flax seed. That way you can add it to Nub's food without having to buy something full of carbs. Metamucil is psyllium husks (insouble fiber) and Benefiber is soluble fiber. The flax seed is insoluble fiber. Insoluble fiber helps with constipation, but bulks up stool. This is important if your kitty has a narrow pelvic opening (this happens sometimes if they've been injured-car accident is a common scenario) because the increased bulk will tend to cause constipation blockages when it physically can't go through the pelvis. Soluble fiber will slow down digestion, but block absorption of certain cholesterol-creating fats and sugar. It can help by softening the stool because it attracts water and forms a gel, making stool soft and easy to pass. Foods will have both insoluble and soluble fiber in them, but in high-fiber foods one or the other will dominate. Pumpkin has reasonable amounts of both and for that reason can help with both constipation and diarrhea. I found pumpkin to be helpful in mild cases, though. The slippery elm that Marc999 has recommended is mainly soluble fiber which has some gut soothing properties.

http://www.webmd.com/diet/fiber-health-benefits-11/insoluble-soluble-fiber

Forgot to mention krill oil and l-carnitine in my previous remedy list. Krill oil keeps food moving down the colon by oiling the tracks, so to speak. L-carnitine has been shown to help in human babies. It increases metabolism.

Edit: I keep forgetting to discuss things! One of the most important things you can do is keep a journal. You'll likely be experimenting quite a bit, so write down things like what food you gave, what meds/supplements, and notes on the bowel movement (time/date, approximate volume, softness). Softness can be rated by the Bristol Stool Chart.

Metamucil and Benefibre are sources of soluble fibre, not insoluble fibre. Flaxseed is a bit of both.

Psyllium works with water to expand and create bulk, so it is very important that when this is given, that sufficient water is consumed. If not, the consequence can be that psyllium will use up whatever water is available and you end up with a bulking stool but likely a dry stool and possible impaction.

Nub was prescribed a psyllium product recently for his constipation but the feces still took quite some time to move along and clear out, based on what Mayadot reported. This suggests to me that fibre might not be the best route to go, but rather a low fibre, high protein diet, and supplements like Slippery Elm which along with soothing the gut lining and addressing any IBD issues, can have the benefit of improving motility in that it stimulates nerve endings.

It is important to check the ingredients in dry food diets, as there may already be some form of fibre such as psyllium or veggies such as pumpkin, squash, etc.

I would stay clear of prescription diets such as the Hill's, Science Diet and Royal Canin. Some of the diets use a lot of corn and wheat ingredients which in general are not good for cats. Better to go with a grain-free dry if necessary, although some are quite rich and may not be suitable either. The best diet for constipation is a wet food diet. If there is a need for fibre, then it is better to get this from a supplement or soluble sources such as pumpkin.

On the subject of laxatives, I believe that you are already using Lactulose, which works the same way as Miralax to draw water into the stool, and keep it soft. Some people prefer Miralax, but in my personal experience, Lactulose is just as effective.

Hope Nub is doing well ...

I don't recall any lactulose mentioned, but it does do the same thing as Miralax, so don't use both. In my experience with the Yahoo! group, however, the preference for Miralax was overwhelming. Of the actively members, only one or two preferred lactulose. There were even some members living outside the U.S. who were asking if someone could mail them Miralax if they reimbursed. The reasons why they preferred Miralax were:

1. More effective - I can vouch for this. On lactulose I was wondering if the medication was doing anything. Within a few days after switching to Miralax I was happy with the results.

2. Not made with sugar, as lactulose is. (Lactulose is made from an indigestible sugar.)

3. Not sticky like lactulose

4. In the U.S. Miralax is over-the-counter and cheap. I got economy size bottles for $15.

Mayadot mentioned that she was giving a Lactulose-based product that the vet prescribed, in her initial thread when Nub was experiencing a bad bout of obstipation.

It really is a matter of personal preference and experience when it comes to these two laxatives. For reference, I have heard people with pets who tried Miralax and experienced the same lack of results, while others have had good results. When we switched from Cisparide to Lactulose, when the Cisapride was proving ineffectual, the Lactulose worked on the first dose. Given the difference in ingredients, it makes sense that both will work (or not work) differently from cat to cat.

Raintyger said:

 
I don't recall any lactulose mentioned, but it does do the same thing as Miralax, so don't use both. In my experience with the Yahoo! group, however, the preference for Miralax was overwhelming. Of the actively members, only one or two preferred lactulose. There were even some members living outside the U.S. who were asking if someone could mail them Miralax if they reimbursed. The reasons why they preferred Miralax were:

1. More effective - I can vouch for this. On lactulose I was wondering if the medication was doing anything. Within a few days after switching to Miralax I was happy with the results.

2. Not made with sugar, as lactulose is. (Lactulose is made from an indigestible sugar.)

3. Not sticky like lactulose

4. In the U.S. Miralax is over-the-counter and cheap. I got economy size bottles for $15.

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With regards to this list, from what I've read the fact that it's sugar doesn't matter and isn't connected with diabetes because it's indigestible, but maybe that's incorrect? I have not found the stickiness to be an issue since I mix it into his wet food, and honestly I despite being broke and spending thousands on this cat already, I can't let cost be a factor, I would like to do whatever is best for him. 

From reading various threads on lactulose, it seemed to me that the chief complaint that worried me was that it was necessary to increase the dosage over time, though maybe this is also true for Metamucil or not that big a deal?

Right now I am mainly frustrated since the lactulose seems to be hit or miss, and the stress of constantly following him to the litter box and being worried whenever he doesn't poop is taxing. 

oneandahalfcats said:

Metamucil and Benefibre are sources of soluble fibre, not insoluble fibre. Flaxseed is a bit of both.

Psyllium works with water to expand and create bulk, so it is very important that when this is given, that sufficient water is consumed. If not, the consequence can be that psyllium will use up whatever water is available and you end up with a bulking stool but likely a dry stool and possible impaction.

Nub was prescribed a psyllium product recently for his constipation but the feces still took quite some time to move along and clear out, based on what Mayadot reported. This suggests to me that fibre might not be the best route to go, but rather a low fibre, high protein diet, and supplements like Slippery Elm which along with soothing the gut lining and addressing any IBD issues, can have the benefit of improving motility in that it stimulates nerve endings.

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Thank you also for the detailed description, Marc999. As for the slippery elm, I certainly have seen numerous recommendations for that and it's something I'm considering, but I guess I'm a bit scared about long term effects since it seems to be a relatively new treatment in use with cats and I haven't seen many veterinary sources recommending it. Please correct me if I'm wrong here because it definitely sounds like a good choice otherwise, I am just always suspicious of new treatments.

mayadot said:

 
With regards to this list, from what I've read the fact that it's sugar doesn't matter and isn't connected with diabetes because it's indigestible, but maybe that's incorrect? I have not found the stickiness to be an issue since I mix it into his wet food, and honestly I despite being broke and spending thousands on this cat already, I can't let cost be a factor, I would like to do whatever is best for him. 

From reading various threads on lactulose, it seemed to me that the chief complaint that worried me was that it was necessary to increase the dosage over time, though maybe this is also true for Metamucil or not that big a deal?

Right now I am mainly frustrated since the lactulose seems to be hit or miss, and the stress of constantly following him to the litter box and being worried whenever he doesn't poop is taxing. 

Thank you also for the detailed description, Marc999. As for the slippery elm, I certainly have seen numerous recommendations for that and it's something I'm considering, but I guess I'm a bit scared about long term effects since it seems to be a relatively new treatment in use with cats and I haven't seen many veterinary sources recommending it. Please correct me if I'm wrong here because it definitely sounds like a good choice otherwise, I am just always suspicious of new treatments.

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Slippery Elm is one herb that has been found to be a natural, safe supplement for constipation in cats. Most conventional vets likely won't know about it unless they prescribe to holistic or naturopathic therapies in their practice. I use a holistic vet for my cats, and she is quite familiar with Slippery Elm.

The only concern with Slippery Elm is for possible malabsorption problems with medications. As Slippery Elm coats the intestinal tract, it can prevent some medications from being absorbed, so the solution is to give medications at a separate time. Either a few hours before, or after giving Slippery Elm. There has also been some speculation of possible issues with nutrient absorption over time, but there are no current studies that support this.