Cat on lactulose and cisapride, still not pooping

Hi guys, 

I was hoping someone could give me some advice on how to help my cat Bandit. He's 11 years old (almost 12, really), 10-11 pounds, and neutered, with a history of urinary tract infection, so he's on dry C/D and W/D and has been doing well with no UTIs or other problems for the past ten years. However, two weeks ago, he started straining to pee (and he hadn't pooped in a while), so I took him to the emergency vet. The emergency vet told me that my cat was so constipated that the poop was blocking his ability to pee. Bandit had to stay in the hospital for 24 hours while they administered 4 enemas, none of which worked. They finally did a manual deobstipation, X-rayed to confirm the poop was all out, and sent him home with lactulose (2.5ml, twice a day).

After three days on lactulose, he still wasn't pooping, so we took him to our regular vet, who prescribed cisapride (0.5ml, twice a day), and Bandit started pooping almost immediately. He continued to poop once a day or once every two days for the past week and seemed to be recovering well. However, then this weekend rolled around, and Bandit again hasn't pooped in three days (today is the third day). He is still producing pee, eating, drinking, and generally seems like his regular energetic, happy self. Since it's Sunday, I'd like to wait until tomorrow to take him to the regular vet (if he does need to go), but is there anything I can do for him at home?

Other things that might help: he is still taking all his meds (same dosage and frequency), and in order to increase his water intake, I add water to his dry food, I feed him half a spoonful of pumpkin twice a day (also with water added in) and I also sometimes feed him some water with a drop of milk added for flavoring. He has a good appetite and generally will eat/drink all of it. I work from home, so I can observe him going to the box, and all the other times he's pooped he hasn't strained to poop. This weekend I did notice him straining one time, and the pink part of the anus kind of...bulged out a little I guess? Which is a thing that's happened before when he's pooping, and the vet's generally told me that if it goes back in on its own (which it does), it should be fine.

I've been really stressed out over this though I've been doing my best to take notes and do my own research (lots of info out there haha, adds to the stress), so any help you guys can give me would be hugely, greatly appreciated. Thanks so much.

(Quick summary: 11 yr old male cat, 10-11 pounds, on lactulose (2.5ml, twice a day) and cisapride (0.5ml, twice a day), cat pooped regularly for about a week and now hasn't pooped for three days.)

Does he seem to have arthritis in his back end? The reason I ask is my vets' office has a resident cat (Mr Oreo) who had such bad arthritis that it damaged his nerves and he was forever constipated. They had to bring in a specialist to do surgery on him to get him back on track. Even after that he still took meds to help things along. 

I don't think he does, just because he seems to still go up and down the stairs easily. Are there other symptoms I should watch out for?

The good news is, he pooped late last night, so I ended up not taking him to the vet since that stresses both of us out, haha. I guess I'll continue to observe and see what happens! Thanks so much for replying.

I had another question if it's okay -- the vet had talked to me about trying to wean him off the lactulose and cisapride, and I was going to try that, but now i think I'll wait a little and see if his pooping becomes regular again like it was last week. Do you know if there are any long-term effects as a result of staying on lactulose and cisapride for a while?

I had a cat who seemed to be constantly constipated, and I found the Lactulose lost it's potency after long term usage.  What DID work for us was Miralax.  We used it on our Sven for at least a year before he died, and now we are using it for Callie, who has developed that problem (she is almost 16, with kidney disease).  We gave/give it twice a day.   1/8th to 1/4 teaspoon dissolved in about 1/2 teaspoon water, then mixed into their food.  It's completely flavorless and odorless, and doesn't gel up, so no problems getting them to eat it.  With Miralax, the key is giving it all the time.  If we miss a dose, THEY pay the price .  It works like a stool softener, so that's why the amount given can change.  If you notice the stool getting too soft, then give a little less, or if you notice them straining, give a little more.  But not much!  Always between 1/8 and 1/4 teaspoon. 

That's what works for us.  Also, we feed wet food, and add extra water to it.  So understanding you need to feed your special diet, keep giving him as much liquid as you possibly can, and maybe give him goat's milk vs cow's milk)

Have you tried wet food and a little bit of plain pumpkin puree?  I used to feed that, along with Miralax to my older kitty girl and it helped keep her poops soft enough to pass.  If she wasn't such a carboholic, I'd have drastically reduced the amount of dry food I fed her, but she barely tolerated canned food.

I also have a constipated (controlled for now) kitty. He is on an all wet food diet with added water and he gets 1/4 tsp mirilax 2 times per day. The Miralax is, as stated above, a stool softener and can be adjusted if stools get too soft. Ask your vet about the Miralax and see what they think. It has helped a lot of constipated kitties.

I also keep a journal documenting bowel movements so I have a reference and see what my cats "normal" is. Sending you positive vibes I know how stressful this is...

I use 1/4 tsp of  miralax twice a day, cisapride twice a day, along with wet food mixed with some added water. It has helped so much.

I have an extra 'cat' calendar which I mark "P" on his poop days. Artie goes every 2-3 days...when he goes it is a foot long! No exaggeration!

Cala said:

I don't think he does, just because he seems to still go up and down the stairs easily. Are there other symptoms I should watch out for?

The good news is, he pooped late last night, so I ended up not taking him to the vet since that stresses both of us out, haha. I guess I'll continue to observe and see what happens! Thanks so much for replying.

I had another question if it's okay -- the vet had talked to me about trying to wean him off the lactulose and cisapride, and I was going to try that, but now i think I'll wait a little and see if his pooping becomes regular again like it was last week. Do you know if there are any long-term effects as a result of staying on lactulose and cisapride for a while?

Click to expand...

There are some good reasons to try to wean him off of lactulose and cisapride (esp. if your vet has mentioned this, have the vet explain to you his/her reasons why, and --if you are comfortable with the vet you use-- it's important to follow your vet's advice). Lactulose is essentially a man-made sugar that the cat cannot digest well so, long story short, it is supposed to boost the moisture level in poo and hopefully aid the cat in pooping better. Cisapride is a powerful colon motility drug, and some vets have mentioned to me that they use it as more of a last resort as sometimes once on it, the cat has trouble getting off of it.

Also, I would skip the addition of pumpkin as some studies/vets have indicated that fiber can actually make some cats even more constipated. Fiber is usually dehydrating to the system; you don't want that. (It, along with the sugary lactulose, can actually cause a kitty to have a lot of tummy discomfort.)

Many vets recommend trying Miralax, a stool softener. It can sometimes take 2-3 days to work. Follow your vet's recommendations. More moisture in the diet will help; canned/wet food usually helps. I wouldn't get any canned food that has more than 1.0-1.5% fiber in it.

Thanks everyone for your informative comments! Sorry for the late reply on my part, unfortunately I ended up with a lot of holiday and family stuff to take care of. I'll give you guys an update first and then respond to things!

So kitty has been pooping pretty regularly ever since his weekend almost-4-days-no-poop incident. We got him off the cisapride entirely, but he's still on 1.5ml lactulose once a day. Now he's been pretty regularly pooping every two days or so -- occasionally he'll poop every day or every three days, but usually it's every two days. He also pooped every two days before this whole constipation adventure, so maybe that's just his normal?

However, I've noticed some instances of straining (about once every 1-2 weeks or so, he doesn't meow or otherwise seem in pain while straining, but he doesn't produce poop at these times) and the pink part of his anus is still poking out a little bit (it's not red or bleeding, it's just a little pink nub poking out). Are these things I should be concerned about, or should I just keep observing?

mrsgreenjeens said:

 
I had a cat who seemed to be constantly constipated, and I found the Lactulose lost it's potency after long term usage.  What DID work for us was Miralax.  We used it on our Sven for at least a year before he died, and now we are using it for Callie, who has developed that problem (she is almost 16, with kidney disease).  We gave/give it twice a day.   1/8th to 1/4 teaspoon dissolved in about 1/2 teaspoon water, then mixed into their food.  It's completely flavorless and odorless, and doesn't gel up, so no problems getting them to eat it.  With Miralax, the key is giving it all the time.  If we miss a dose, THEY pay the price

.  It works like a stool softener, so that's why the amount given can change.  If you notice the stool getting too soft, then give a little less, or if you notice them straining, give a little more.  But not much!  Always between 1/8 and 1/4 teaspoon. 

That's what works for us.  Also, we feed wet food, and add extra water to it.  So understanding you need to feed your special diet, keep giving him as much liquid as you possibly can, and maybe give him goat's milk vs cow's milk)

Click to expand...

Thanks! I'll definitely ask my vet about Miralax after this last bottle of lactulose is gone. He seems to be doing okay on lactulose, but maybe Miralax will be even more effective. How soft is your cat's poop? I know that's a weird question to ask -- I usually wrap my cat's poop in a napkin and poke it so I can tell how soft it is, and while it's still possible to make an indentation, sometimes it's not really what I would call soft, particularly the bit that comes out first (which is presumably the driest from staying in the colon for so long). So maybe the Miralax would make the poop even softer.

PushPurrCatPaws said:

There are some good reasons to try to wean him off of lactulose and cisapride (esp. if your vet has mentioned this, have the vet explain to you his/her reasons why, and --if you are comfortable with the vet you use-- it's important to follow your vet's advice). Lactulose is essentially a man-made sugar that the cat cannot digest well so, long story short, it is supposed to boost the moisture level in poo and hopefully aid the cat in pooping better. Cisapride is a powerful colon motility drug, and some vets have mentioned to me that they use it as more of a last resort as sometimes once on it, the cat has trouble getting off of it.

Also, I would skip the addition of pumpkin as some studies/vets have indicated that fiber can actually make some cats even more constipated. Fiber is usually dehydrating to the system; you don't want that. (It, along with the sugary lactulose, can actually cause a kitty to have a lot of tummy discomfort.)

Many vets recommend trying Miralax, a stool softener. It can sometimes take 2-3 days to work. Follow your vet's recommendations. More moisture in the diet will help; canned/wet food usually helps. I wouldn't get any canned food that has more than 1.0-1.5% fiber in it.

Click to expand...

Thanks! At least he's off cisapride now and still seems to be pooping regularly, though he's still on the lactulose, but I'll definitely ask my vet about Miralax. The emergency vet I went to also mentioned that too much fiber can cause more constipation, but he said that for an 10-11 pound cat, 1 teaspoon of pumpkin daily should be okay. And my cat drinks all the water I add to it, so that's more moisture for him.

I'd definitely like to transition to wet food, but due to my cat's past urinary tract issues, I'm not sure if he can. Does wet C/D work as well as dry C/D for preventing crystals? Or is there an ingredient in C/D I can look for when searching for wet foods?

For the time being, I'm adding a lot of water to his dry food (he drinks almost all of it while eating the dry food) and feeding him pumpkin with water and milk-flavored water. Sometimes if I have extra chicken or meat I'll cook it with no flavorings added and then chop it up and feed it to him (with of course more water). I've also read that giving constipated cats extra-virgin olive oil might help, so I tried a drop or two, but it didn't seem to have any positive or negative effects.

Cala said:

Thanks! I'll definitely ask my vet about Miralax after this last bottle of lactulose is gone. He seems to be doing okay on lactulose, but maybe Miralax will be even more effective. How soft is your cat's poop? I know that's a weird question to ask -- I usually wrap my cat's poop in a napkin and poke it so I can tell how soft it is, and while it's still possible to make an indentation, sometimes it's not really what I would call soft, particularly the bit that comes out first (which is presumably the driest from staying in the colon for so long). So maybe the Miralax would make the poop even softer.

Click to expand...

In answer to your question about how soft the poop is on Miralax, it really all depends on how much Miralax you give.  If you give too much, it can turn into pudding.  That's why the typical dosage is between 1/8th and 1/4 teas. twice daily.  You adjust accordingly   But typically, once you find the correct dosage, it's soft enough the if you pick it up with a piece of TP, you can very gently squeeze it,   Definitely not like a rock, which it was in the past, and definitely not just little hard balls here and there, but actual formed stools.

Hey all,

(Not sure if reviving this old thread is against any etiquette rules -- let me know if I should start a new one!)

So my cat has been doing really well on the miralax (1/8 tsp per day) for the past couple months (thanks again for the suggestions) and we started adding a little bit of wet food to his diet so he can gradually get used to it. He's been pooping nice soft poops every day or every two days, until THIS week, when he started straining in the box a lot, got really constipated, and we had to take him to the vet for another enema. Fortunately the enema worked, but the vet can't give us a reason as to why he got constipated again and suggests we re-start him on cisapride and lactulose, as well as increase his wet food intake.

We're definitely going to work on increasing the wet food, but I was wondering if anyone could give me some advice on how cisapride and lactulose is supposed to help my cat now? The miralax made my cat's poop more regularly soft than did the lactulose, and for this past week, my cat's been straining to poop a lot, he just hasn't gotten much out. Last time we got the cisapride, the vet told me it was just supposed to make my cat want to poop. Does it also increase the strength of the bowel movement so that poop can come out? Is there anything else I can try that would be easier on his system? I'm afraid if he gets on the cisapride he won't be able to poop without it.

The cisapride stimulates the bowel muscles to contract. It can be kind of a jumpstart to the system if a cat isn't used to using those muscles for a few days, although I think some megacolon kitties need to be on it longterm. My cat was on it for 2 weeks and she was okay when she stopped. I'm not sure that it loses it's effectiveness like Miralax and lactulose do over time.

I'd say give the combo your vet prescribed a shot. Sometimes changing things up is enough to get a good result when whatever you've been doing isn't working.

Definitely increase the canned food, and maybe even add some extra water to it because hydration is so key with constipation. Miralax and lactulose help the stool absorb more water because for whatever reason, too much is getting leached out of the stool while it's in the colon. Sometimes they do lose effectiveness, and a small amount of pumpkin can also draw water into the stool, as can other soluble fibers like acacia fiber. Be careful with other fibers, because they can add bulk to the stool and make it more difficult to pass.

My cat's constipation has been such a mystery to me from day one, but I have noticed that if I give her the same Miralax and fiber combo everyday, it does not always work, but then if I kind of rotate it so I'm not giving them everyday they have more of an effect. It's not a perfect system, though. Slippery elm bark is also a supplement that's supposed to work by coating the intestine to make everything pass more smoothly, but with my cat it made her very uncomfortable. Probiotics seem to help a bit, and that's something you can give everyday infinitely without worrying. I might also try adding enzymes too. I'm not entirely sure what these do, other than something is off in her colon and enzymes and bacteria might help get her digestive system working more like it should.

Best of luck with your constipated kitty!

I'm not advocating that you go against your vet's instructions...

The first thing I would do would be to increase the Miralax from once a day to 1/8 tsp twice a day. (I'm not a fan of lactulose). When my kitty goes to the box and doesn't produce I increase his dosage of Miralax from 1/4 tsp 2x per day to 1/2 a tsp once and leave the 2nd dose at 1/4 tsp. I will even up it to 1/2 tsp 2x per day if necessary until his poop is productive and soft but well formed.

I've wondered about the cisapride but my vet hasn't felt it necessary. I too do not know why my cat is so prone to constipation and my vet could find no underlying cause. Since June of 2015 my cats have been fed a wet diet with added water and my kitty still has times that I have to intervene with the above Miralax adjustments. When we started with the Miralax it was at the same dose you have your kitty on, 1/8 tsp once per day. Over the last 9 months I've found what seems to work the best for my cat and that is 1/4 tsp 2 times per day. I keep track of when he poops and the times he's gotten constipated I can usually trace back to a change in his routine regarding feeding and/or the amount of water I add to his food. Luckily we haven't had to return to the vet for any intervention!
I know it's stressful!

I don't know if this is useful for not, I'm more of a dog guru than a cat, hints I joined this site for help with my kitty issues [emoji]128514[/emoji], but back when our dog was having lots of trouble pooping, I introduced raw pumpkin to his diet. It's high in fiber, natural, and it did the trick. He goes much more smoothly now and doesn't have any problems with straining. He also eats it good, as it's only a tablespoon per bowl of food.