Cat Megacolon and All That Jazz...

Hi all, 

I've been reading up on this site for a couple of days during our cat's Megacolon saga, and you all seem very nice and knowledgeable. So I have a couple of panic tinged questions.

A little background--our boy is a 10 year old, overweight domestic short haired kitty, and he had a bout of megacolon four years ago. They deobstipated him, and put him on a high-fiber diet which worked for four years. He'd have these INCREDIBLY large bowel movements, usually a normal with the occasional firm lump of poo followed by a soft, mushy pile. He's a large cat, not just width wise but also length wise, so we figured a large elimination was normal for him (stupid in hindsight, I know. We've been kicking ourselves since). 

So last week, we noticed he was having trouble eliminating, straining in the box, and took him to the animal hospital. They found he was constipated, borderline obstipated, gave him a few enemas; he passed an enormous amount of stool again (par for the course), sent him home with lactulose and instructions to continue putting metamucil in his diet.

Well, when we called our normal vet, he said to up his usual 1/8 of a  teaspoon to 1 teaspoon per meal. And, stupidly once again, we followed his instructions--only to have our poor boy become so incredibly compacted by the end of the week that our normal vet suggested to euthanize him. We sought out a second opinion and found an angel in an internal medicine vet at the animal hospital, who deobspiated him for 1.5 hours. She managed to get most of the fiber enriched poo out, except for a few pieces. Sent him home the next day on lactulose, cisapride, and a low-residue diet (which apparently he should have been on all along. I'm fuming by this point). 

Our cat was sent home Tuesday; our vet told us he'd eliminated on his own before he was sent home. We're not sure if this was helped along by an enema or not. He didn't eliminate the rest of the day Tuesday. Had terrible gas, cramping, yowling--really terrible stuff. By Wednesday he'd stopped smelling like a Parisian sewer and his cramping stopped as well. We noticed him straining in the box a couple of times and then, finally, he eliminated a good sized stool. Had a second bowel movement with another good sized stool later in the day. Thursday he didn't eliminate at all again, and today, we noticed him straining in the box a couple of times, no stool production. He's peeing fine. 

So I suppose my question is--should I contact the vet? She said it could take a few days for the cisapride to work. Am I just being impatient? Can cisapride work for a couple of days and then fail? Is there anything I can give him to make him more comfortable? Or his low-residue food palatable? I'm so afraid of him becoming backed-up again and damaging his colon even further. I'm afraid that our normal vet's suggestion to bombard his system with fiber may have caused even more damage than our lack of knowledge caused. 

Thanks in advance, 

-Cathulu 

Oh, and I forgot to add he's on 1/8th of a teaspoon miralax twice a day. He's not eating a whole lot of his food, though. 

So sorry to hear about your cat! Our cat had two really bad constipation/obstipation episodes, a little over two years apart. After last year's, I did a lot more research on constipation and transitioned both cats from a primarily dry-food diet to a canned-food diet, as both vets that cleaned him out remarked on how hard and dry the stool was, and that his constipation was likely due to dehydration.

If you haven't already, please read these sites:

• http://www.littlebigcat.com/health/constipated-cats/
• http://www.felineconstipation.org/
• http://www.catinfo.org/ (no real discussion of constipation, but good info about feeding cats)

I am also on "poop watch" as I am weaning our cat off cisapride, after being on it daily for nine months and gradually tapered doses for the past three. What dose is your cat on? Sometimes the dose has to be adjusted, but you should keep your cat on the lowest possible dose that will work. And it sounds like he's on both lactulose and miralax? We never used those, so cannot comment. And what is the low-residue diet the cat is on?

Now to the litter box. If I understand correctly, your cat has eliminated a couple of times since returning home, the most recent on Wednesday. And he appears to be straining in the box? Well, if it were me, I'd call the vet and describe all of this, just for peace of mind. It might be normal, under the circumstances:

• He had enemas and manual removal, which mostly cleared him out.
• He is on a bunch of new medications, each of which can cause stomach discomfort that may mimic the urge to go.
• He's on a new diet, which could also be causing stomach discomfort.
• He's not eating much, and his diet is low residue, so he's likely producing less waste, so will quite likely poop less.

I've had cats on dry food that pooped multiple times a day. Switching to a better-quality food reduced the frequency. Switching to canned reduced the size and smell. Switching to a better-quality canned with not many fillers really reduced the size and my cats go anywhere from 20-40 hours.

But, truly, I would call the vet and discuss all of this. If nothing else, to ease your mind.

You may have to experiment with the cisapride dose and perhaps go with either lactulose or miralax, but that would be a discussion with your vet. And you might have to experiment with food and possibly fiber. Too many vets are quick to suggest ever increasing amounts of fiber, thinking a big poop is the way to go for a cat. I believe smaller is better for cats. I was terrified of any fiber until our holistic vet explained that some fiber may be necessary to feed the intestinal bacteria and aid digestion. My guy is on a tiny amount of psyllium, but I am watching his poops very closely to make sure they don't get too big. I am terrified of a stretched-out colon, as well.

Don't beat yourself up over this. What's done is done (I have my own anger issues over things we did and didn't do regarding our guy). You need to do the best you can, moving forward. Educate yourself. Keep records of what you do in terms of food, medications, supplements, stool frequency, and, yes, size. I started doing this several months ago and it's really been helpful. I think our holistic vet appreciates the detail I provide (I send detailed spreadsheets that include stool size).

And you have other questions:

• Low residue food more palatable. I am assuming it's canned. If not, it should be. I had a little trouble at first with the new canned diet and cooked up turkey breast, which I shredded and added to the food. I also added homemade turkey broth, which helped make it smell yummy and add moisture, very important for cats prone to constipation. Now the cats eat the food without this extra stuff. My guy can't eat chicken; if yours can, you can use that.
• Tummy discomfort. Talk with your vet about this, as there are several medications depending on what the cause may be. Our cat exhibited slight nausea and had some episodes of excess stomach acid, which the holistic veterinarian diagnosed. We used 1/4 tablet Pepcid AC for a while and have since transitioned to a tiny amount of slippery elm to deal with tummy issue.

I know how scary this is. I do hope things improve. Call your vet and discuss.

Hi AbbyNTim

Thank you so much for your response! It's been quite a hectic week, so I haven't been able to respond until now--thankfully I come bearing good news.

Our cat's done phenomenally on a combination of .5 mls cisapride 3x a day, 2 mls lactulose 3x a day, and 1/8 of a teaspoon miralax twice a day. He's eliminating smoothly, no straining. You're completely right about the size of eliminations--he's much more comfortable with a poo of a longer length and a smaller width. I'm hoping we'll eventually be able to wean him off both the cisapride and the lactulose.

I've been keeping records of his stools, just as you suggested, and we'll have a spreadsheet ready for when we switch regular vets, which should be in a couple of weeks. Our cat is currently on the Iams low residue diet, but I'm wondering if we could eventually switch him to a higher quality food, such as Blue Buffalo. May I ask what brand you're feeding your cats?

Thank you again for your reply--I'm just so happy to be able to share good news

Great news! Happy to see your cat is doing well. It would, indeed, be great to get him off some of the medications, but that's something you should definitely do with the guidance of a veterinarian.

Tim has a lot of other issues, including a very sensitive stomach. I am beginning to fear he may be an IBS/IBD kitty and his constipation episodes are part of that. He's going through a little "flare" right now, with nausea and excess stomach acid. Because he recently reacted poorly to chicken, fish, foods with carrageenan, and possibly guar gum and xantham gum, we're feeding him primarily Nature's Variety Instinct canned rabbit. He was also eating their LID turkey until early May when he had a bad case of diarrhea. We've tried to increase turkey, but he seems to react badly every time and now I fear he may have a poultry sensitivity. I am still giving him a tiny bit of the turkey, however, because he likes it, plus I give him a little Lotus Just Juicy turkey or pork. Because he's having a flare, I may need to just stop the turkey entirely, as that may be the cause. Once he's weaned off cisapride and we are certain he's pooping regularly on his own, we will slowly add raw. Brand and proteins TBD, depending on how he does.

Glad to see you are keeping records. It's been a life-saver for me, especially as I've tapered Tim's doses of cisapride to once per week. And it's nice to go back and confirm things or have the information available to share when speaking with the vet.

Congrats on the success so far. I hope it continues!