Feline Constipation-Miralax vs. Lactulose/or both at the same time?

Hi there!

Gizmo is my almost (birthday in July) 12 year old male house cat. He is neutered, indoor only, on an all wet food (Wellness Brand) diet with a water fountain.

Monday night (6 days ago) he tried to poo on my bed and when I shooed him away he tried to go my living room floor. Tried being the operative word. This was about 7pm and after watching him for a few hours we headed to the emergency vet. He tried in vain every couple minutes to poo and threw up twice after two really strenuous attempts. The emergency vet (it was 11pm at this point) manually cleared out the impacted stool, gave him sub-q fluids, gave him an enema and prescribed 1/8 tsp twice a day of Mira-Lax. He didn't poo (or even try) on Tuesday but Wednesday morning had a normal looking stool waiting for me in his litter box.Wednesday night when I came home from work I walked in on him (in his litter box) trying to go again. When he was done he skittered across the kitchen dragging his bottom........I had to get the nugget of poo off of his bottom. I couldn't tell if it was stuck in him or stuck to his fur but either way he wasn't having an easy time getting it out. I called his regular vet first thing in the morning and they got me in later that day. His regular vet said he could feel from the manual exam that he had a lot of poo still inside his body that needed to come out. They kept him over night and gave him fluids and Lactulose-they would have administered another enema but didn't want to go that far if they didn't need to and it turned out he pooed on his own. The vet actually took a picture because A LOT came out and wanted to show me why he was confident that his belly was now empty-that was Thursday around 1pm. He had a regular poo Friday and a regular poo Saturday, it is Sunday and he hasn't pooed. When we left his vet on Thursday he said to stop the Mira-lax and start him on 2-3 cc's of Lactulose once a day for 3 days and then every other day as needed. 

I have some questions-

Gizmo has never had an issue with constipation before and while I know he poo's regularly I can't say if he's an everyday kind of guy, or an every other day kind of guy-if he doesn't poo today is that ok? 

Maybe because he had an enema, a couple laxatives and lots of fluids he just doesn't have anything built up in there to be pooing out?

If he isn't showing any signs of distress how long is too long without going poo? My cousin is a vet tech and says because of his age 1 poo every 1-3 days could be normal.....other sites say everyday is normal, anything less means he's sick.What is your experience?

What do you think about Mira-Lax? Lactulose? Which do you prefer? I've read that people swear by each respectively and I don't know enough to have an opinion. I just want the most consistent and reliable option to keep things moving.

Can I give Lactulose and Mira-Lax at the same time? I would assume because I am adding another medicine I might need to reduce their individual serving sizes, is it safe to give both?

I was giving pumpkin mixed in with his wet food but his regular vet said to stop that. I also mix in a couple extra tablespoons of water with his wet food and he is peeing like a champ. No pain or straining when he urinates, goes several times a day. His litter box is extremely clean. He is eating and acting normal. 

I should have mentioned that all of his blood work is normal and his regular vet says it is not a urinary issue and that he isn't worried about his kidneys because his numbers were so good. 

Also, he is scheduled for an ultrasound and xrays on Friday the 13th, sort of fitting since he is a black cat :-)

The emergency vet didn't do xrays or an ultrasound because they treat and release so you can get to your regular vet for consistent treatment.....his regular vet delayed these tests but recommended that they happen at some point for a few different reasons. He said xrays weren't immediately necessary because they only show solid masses and would see through soft tissue like backed up poo which he could feel from the manual exam and he could tell there wasn't a foreign object because he would have been vomiting regularly (vs. the two times after excessive straining) and the ultrasound, while it could show a tumor or megacolon had to wait because they needed to schedule to off-site technician to come to their office. He sent Gizmo home confident that his belly was empty and said he'd be ok until the 13th when we could do the xray and ultrasound to determine conclusively what was causing the constipation.....if anything was causing it. He said it's rare, but not completely unheard of for cats to randomly get constipated. 

What's your input?

I wouldn't give both the lactulose and Miralax.  I have only used the Miralax so I don't know anything about the lactulose.  From what I have seen here people seem to have better luck with the Miralax.   Many people have also had good luck with a herbal syrup called Slippery Elm Bark.  The only thing with it is that it coats the digestive tract so if there are any medications being given there needs to be two hours between giving the SEB and the medicine.  The coating can affect the absorption of medication.

As long as he is still eating and not showing any distress I wouldn't be too concerned yet.  As far as added fiber it really is individual to the kitty.  Some kitties do better with a little added bulking fiber, like the pumpkin, others don't.  Since you have been giving extra bulking fiber it might be worth trying not giving it.  The Slippery Elm does have psyllium in it, the psyllium isn't as bulking as some other fibers.

If this seems to be becoming an ongoing issue, I think an ultrasound would be a good idea.  You are doing everything right as far as wet food and trying to get him to drink as much water as possible.

Hi there,

Sometimes cats will get constipated for different reasons. A change in diet or something in the diet, not enough water, stress or sometimes as a side effect of some medications. I have used Lactulose on my male cat, Max, for constipation, with good results. That said, I would also not recommend using both lactulose and miralax at the same time. They both do the same job, but some cats will show better results with one or the other.

As Denice suggested, you could try some pumpkin (puree - not the pie filling) for occasional constipation. Some kitties do not respond well to things like pumpkin or psyllium, so Slippery Elm Bark that is made into a syrup, is also very effective for constipation as well as diarrhea and nausea that leads to vomiting. I have personally used this on Max with really good results. Just an FYI, Slippery Elm does not contain psyllium, psyllium is a different material, however there may be some commercial products that will contain both. Psyllium really shouldn't be used if a cat is already constipated as it is highly bulk-forming and can make constipation worse, whereas SEB does not create bulk in the stool but coates the intestinal tract to facilitate easier transmission of feces through the colon. It is best to use psyllium as a preventative measure. 

Hope your little guy is on the mend, and feeling better.

This update is a long time coming, sorry ya'all!

Gizmo is doing great! Lots of tears and stress on my part, lot's of poking and prodding on his part.

Doc finally diagnosed him as pre-mega colon. His colon is enlarged which is providing more room for fecal matter to accumulate with not as much of the normal inspiration to move out *but* it's not so advanced that he requires surgery.

Blood work was fine, x-ray was clear, ultrasound was clear. There was no obvious reason as to what caused the constipation: we don't know if it was the slightly enlarged colon that caused the bowel movements to stop of if it was the lack of bowel movements that caused the colon to become enlarged with backed up fecal matter. Sort of which came first, the chicken or the egg.

The treatment going forward is lots and lots of extra fluids and 4ml of Lactulose twice a day. Gizmo seems to be responding well to that with zero side effects. The vet explained to me that because the Lactulose is not really a chemical medication there is no danger of it damaging his system and it can easily be adjusted should he ever need more help passing his movements. He said if this continues to be successful surgery won't be a factor for a very long time.