Constant constipation

At my wits end again. Vet now thinks Pepper has IBD, but we have tests to be done to confirm that. She has been suffering from constipation since diagnosed with severe arthritis back in September. She had to have an enema on Friday. She is on 1/2 tsp of Miralax twice a day, 2 ccs of lactulose twice a day (separated by a few hours from the Miralax), a teaspoon of pumpkin in the morning, as well as canned food with extra water. Right now, she's getting polyglycan shots once a week, which will be tapered off over the next several weeks. She has not done a proper poop since her enema. Saturday she had diarrhea once. Yesterday I couldn't tell hers from Tater's poop (who also has IBD and is her littermate), so I don't know if she went at all. She hasn't gone today, but it's still early in the morning. Can any of you think of something that will make her poop? I'm running out of money. It's $300 every time I bring her in for an enema. With Tater and Pie also having health issues, I don't know how I'm going to be able to keep this up monetarily. How can I get her to poop?

I am kind of in the same position you are in. Have you or your vet tried sub-q fluids? I think that helps a lot.. 

I also feel it is kind of a wait and see game..You are giving Peeper enough meds, so it should help. Sometimes it takes a couple of days after an enema for them to poop..

The only other thing I can suggest is that you try to monitor her poops.. and see if there are a lot in the box.. if there are, then Pepper must be going. it cannot all be from one cat. 

My guy is also on cisapride ... it is supposed to help with the muscle contractions.. He went from twice a day to three times a day, and we have recently doubled his dose..'

Artie has IBD also.. and has constipation issues.. as long as Pepper is eating, that is good. 

Did she get dehydrated from the enemas? I know Artie did. and he lost his appetite, losing a ton of weight.. 

Good Luck... 

Have her kidney levels been checked?  You could also try the slippery elm bark concoction that has helped.

http://www.thecatsite.com/t/270597/slippery-elm-bark-wet-food-managing-constipation

I also meant to add that my little guy had to have an enema a few months ago and he had soft poops for several days after.  We ended up putting him on a prescription wet food (Science Diet I/d) to help firm up his poops. Now he's back to his regular food, but he still gets a small serving of the i/d to help keep his stools normal.

I know she had her liver levels checked recently, but I don't know if the latest was when I had tests run in September to have as a senior baseline or if there are any more recent. I'll have to check. She is finally pooping. Extremely runny so I have to hold back on either the Miralax or the lactulose, but not sure which. She just ate and 30 minutes later threw everything back up (all over my clothes I might add). It had the Miralax dose in it. Which would you withdraw on first? The Miralax or lactulose? I also stopped the pumpkin about 2 days ago.

BelleL,

Please ask your vet before ceasing either the miralax or the lactulose. 

Some suggestions:

1) ask vet about low-residue diet, or limited-ingredient diet, or hypoallergenic diet - this would be a first approach for IBD - a second option would be discussing a fiber-enhanced diet, particularly if she happens to be overweight.

2) ask vet if adding a small amount of laxatone (hairball remedy) to her food would be ok - it shouldn't be used long-term but it can be helpful to help produce a stool - if used as a treatment approach, it can help keep things consistent - I don't think it should be used when lactulose and miralax are also used.

3)  make sure her feeding schedules aren't sporadic or timing too long between meals

4)  inflammation is an unfortunate problem with IBD, anti-inflammatories are usually prescribed, talk to vet about this

5)  try to encourage playtime and activity for short intervals, as exercise on a regular basis helps keep the digestive tract going

6)  ask vet about omega 3 fatty acids (i.e., fish oil) supplementation - sometimes, this helps arthritic cats if used on a regular schedule (warning, some cats, particularly those with pancreatitis issues, should not be given fish oil unless specifically directed by vet) - also ask about vitamin B12 injections.

7)  if she has been on any prescribed pain medication, know that they can cause constipation, especially those of the opioid class.

8)  you may not have to do invasive testing for IBD (like the dreaded endoscope) - sometimes the preferred option is trying a trial diet (any of the three I mentioned above), adding low-dose prednisone if necessary (please get a new blood work profile done before starting any anti-inflammatory), lactulose or cisapride.  Sometimes cats have bacterial infections in the intestine (which can also cause inflammation), so antibiotics may be warranted on occasion.

The key is consistency, whether that be diet and feeding times, medication scheduling (try to keep medications spaced apart accordingly, as directed by your vet), exercise, etc.  At this point while awaiting diagnosis for IBD, it might be wise to ask your vet about an anti-inflammatory and the diet.

Guess I should've mentioned that her litter mate, Tater Tot, has IBD, so I know all the ins and outs on that. And yes, I've already talked to the vet about the lactulose and Miralax...I was just wondering which one to titrate first...I am not stopping either. By hold back, i meant titrate down, not stop. I am titrating them meaning go up or down on the amount of each dose depending on how her stool looks. She is now on the opposite spectrum: she has one bout of diarrhea a day. I stopped the pumpkin because I felt that was keeping her from pooping. She's not on any pain meds, just the meds I described above. I know buprenorphine and opiates cause constipation...she was taken off of bup last month. So which of the Miralax and lactulose should I titrate first? Vet had no answer for me there. Sorry, my brain has been quite fried lately with troubles at work and all of my cats' health issues, so I wasn't quite as descriptive as I normally am.

Reduce the miralax.  Monitor her closely in the next 24 hours, and gauge the effects.

cat-tech said:

Reduce the miralax.  Monitor her closely in the next 24 hours, and gauge the effects.

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Thanks...will do and keep y'all posted. I appreciate your advice.