Poop problems. ay yoh...

Warning: LONG...

First off, thanks for coming over to read my kitty's situation. I hope that someone can give me a little guidance on what to do or what's going on or even words of comfort. 

A bit of background; Momo is a neutered DLH rescue who is 6 and thus far has just remained an observer in this. Thankfully he's A-OK and nothing out of the ordinary is happening with him. Mephistopheles is a 3yr old DLH rescue who is 3 and up to this point has been the picture of good health. This is the first medical problem she's had. They get along swell but not super cuddly cuddly.

Their diet has been Blue Wilderness grain free dry (chicken or salmon) with 1/2 can each Fancy Feast wet daily. This has been their diet for years now with no problems. Their litter is Sweat Scoop Multi or Premium (since forever).

The most recent change in their lifestyle was 5 months ago a friendly stray wandered into our apartment complex and myself and a few others have been taking turns caring for him. I've been giving him flea meds for 4 months and the leftovers from what my cats don't eat. I was cautiously allowing "visiting time" in my living room only (my cats are both up to date on vaccines) but while there were thankfully no fights, they avoided each other. I've since stopped the visiting, which was going on for about 3 months.

Briefly, Mephi is having poop problems! 

12/30/16 - enema

1/5/17 - enema, eating and peeing fine since here on but not acting normally, more sad than anything and on Miralax

1/9/17 - cowpie,

1/12/17 - cowpie after dose of lactulose

OK! The extended version...

On Fri, 12/30/16 I had to take her to the vet for an enema. She was visibly uncomfortable and even dragging her bum and walking funny. Since I feed both cats at the same time and they share the litter I couldn't tell at the time if she was eating, but I suspected not and definitely noticed less No. 2s the day before. The vet took an xray and said that there was no blockage, just a whole lotta poop! That evening after the enema she seemed a lot better. The next 2 days were crazy because of New Years, but she seemed well, wandering around the apartment like normal. She's skittish by nature, so her hanging out under the bed is normal for her.

Then I noticed she stopped eating. The litter was low on No. 2s. On Thurs, 1/5/17, I took her to the vet for another enema. They were concerned about her lack of eating but it was for naught (maybe?) since she gobbled down a can of Fancy Feast that night. The vet also recommended Miralax at 1/8 - 1/4 tsp daily. Since then I've been giving her 2 cans of FF/daily. I couldn't be sure if she was drinking water (I did a few tests measuring it) so I would syringe her water (30-40 mL). I was mixing the Miralax in the food at first, but then switched to syringing it. By Sun, I was freaking out again and upped the dose of Miralax. 1/4 tsp syringe + 1/8 tsp in FF. Thankfully she was eating well, meaning all FF, this time.

Monday (1/9/17)  morning she had a gloriously stinky cowpie. Gotta mention that she was peeing fine throughout this time, 2-3x daily. I flattened the litter each time I cleaned it, and I can say that she didn't go in it unless to pee, and unfortunately I down know if she's straining. She does cry when I pick her up though she always she's always done that - more often I feel it's a 'leave me alone' than 'it hurts!' But within 24hrs of that and the next poo she seems more uncomfortable, hunched in and takes more time to be receptive to petting. Sometimes she'll cry if I touch her lower belly and then later she'll let me rub it happily so I don't know what to think. After dropping the payload she noticeably perks ups.

WELL, she's eating the canned FF (which I'm mixing in with 20mL water) w/ 1/8tsp Miralax, getting and additional 1/4 tsp Miralax, peeing fine, and yet it took til yesterday night, Thurs 1/12/17,  to get another cowpie. The vet and I were concerned earlier in the day so they prescribed me lactulose for her and I gave her that. Not sure if it was the lactulose (the dosing is higher than Miralax) or it was TIME, but she had a runnier cowpie that evening. The vet told me to stop the lactulose and use it only if I see she's constipated again. Also to slowly reincorporate some kibble to bulk up the stools.

And that's were I am. I don't really know what to do except continue to monitor her and give the Miralax. But I don't know if I'm not giving enough? 3.5 days between poops seems like a long time for a cat. And then it comes out cowpie-like (so maybe too much Miralax??) Today she ate 14g of kibble (abt 1 tbsp). Poor thing hasn't been herself in weeks. She's just lies under the bed, or in my arms if I drag her out. Sometimes she struggles sometimes she 'gives up.' She likes being petted still, after a few minutes she'll loosen up, but she doesn't really want to play. She's been in isolation for 2 weeks with the occasional Momo-visit.

The vets (2 doctors at this clinic, each saw her once) don't think it's anything sinister. They don't think she has megacolon.

I read a lot on others experiences and was just hoping to here some thoughts to this specific case. My poor baby-tospheles...

Thanks for taking the time to read this!!! I'm going to try and help others too now!

Update: Found a super soft poop this morning! (Of course when I pleaded for help last night) It looked a little pale to me though and after a quick search, she may be having liver issues (?!?) or a bacterial flareup. I read earlier a member was using probiotics and so I will look into and ask the vet about it. (Hah, I use probiotics, why didn't I think they're be kitty version) 

Hopefully not liver as both vets gave her a physical exam (2 in 2 weeks) and said that her organs felt normal and she wasn't expressing pain when being palpitated.

Constipation is serious, and going days in between bowel movements is definitely not okay. If the vets aren't taking it too seriously then I would find another vet. She may not have megacolon, but megacolon can develop if constipation goes on for too long.

Something else to be wary of is that sometimes constipation can cause what looks like diarrhea when hard stool is still stuck in the colon but a little bit of soft stool is squeezed out around it.

The main problem with treating constipation is that even if you find a treatment that makes thw stool form correctly, there is nothing you can give the cat that will fix any of the already created dry stool that is sitting in the colon, and often the only way to get it out is an enema. (If it's not terrible yet, sometimes some extra fiber can help push that last bit through I think, but I don't know that that is veterinarian-recommended.)

Once the colon is clear of hard stool, then treatment will work best. Probiotics like you mentioned were the saving grace for me. Also important is hydration, so feed as much wet food as possible, exercise if your cat is feeling well enough to play, and frequent brushing to reduce the amount of hair that gets ingested and might be building up in the colon.

Are they doing xrays each time to make sure they isn't a partial blockage? 

I've had a couple of chronically constipated cats, but that was due to kidney disease.  We definitely used Miralax, and like you, used between 1/8th and 1/4 teaspoon TWICE a day, every single day or it didn't work for them.  If I missed a single dose they wouldn't have a bowel movement and I would see them straining and straining,then throw up due to the straining.  And if I gave them too much, then they would have too soft a stool, or sometime leave little "pasta shells" around where they had been lying and not even realize it.

I don't think adding in more  kibble is the answer, personally.  Kibble is DRYING, and with constipation, hydration is key.  If more fiber is needed, why not add in some pumpkin.  It's great fiber, and a good kind.  The issue may be whether or not she'll eat it.   I'd try 1 teas. per meal, up to 1 Tablespoon per day.  Now, which Fancy Feast are you feeding?  The CLASSICS, or the medleys, the roasts or what?  Again, personally, I'd just feed the CLASSICS, or the PURELY, and nothing else. All the others have wheat or corn or soy or other not so good stuff in them (carbs)  Or, if you can, try something else and see if it makes a difference.  Maybe Nutro Natural Choice Chunky Chicken (seems to be a favorite around here), or if that's not in your price range, possible SHEBA pates.  Just possibly there's something in the FF that isn't working for her anymore (if you're serving the CLASSICS) 

And definitely try her on some probiotics.  I've been them to my guys for years.  You can probably just give them whatever YOU are taking.  We all share ours   I give 1/2 capsure to them in the morning (dissolved in a little water, then mixed into their canned food) and 1/2 capsule in the evening done the same way.  I also give them a capsule of Egg Yolk Lecithin for hairballs, done the exact same way as the probiotics.

Thank you both for your thoughts! Today nothing but pee and she's eaten most of her wet food and kibble (1oz) that I left before reading your comments in the morning. Administered 1/4 tsp in 10ml water morning and night.

The fancy feast is "grilled" boosted with 20ml water.

I'm going to monitor her Sunday and call a cat only vet on Monday. Getting xrays after an enema is a good idea!