Help! Cat unable to pass feaces...

[moose]

My 1year old cat has a problem:

3 weeks ago- he had a blocked back exit as he is a long haired persian. I freed this area by cutting the hair away and the compact feaces, and loose feaces immediately fell out.

I called the vet as I noticed his back entrance seemed to be really open, they said to bring him in , in the morning. They put him under and discovered he had no anal tone whatsoever, however after a few days- he came home and we had noticed, despite having no anal tone, he had control and was able to pass feaces in his tray with no problem at all. He also has full control of urination (which is done in the tray also). The vet came to the conclusion that his hair had become tangled in with feaces and blocked him from going to the toilet for at least 24 hours - max 48 hours and that feaces must have been sitting in the passage which stretched it and there was about a 4mm band of necrosis inside where the anus should be and tone.

However, the second week came along, and I kept cleaning him with saline solution (by using a syringe and spraying it up the passage) and the tone has fully returned! But in the second week is when the problems started. He started straining (despite in the first week of passing feaces no problem even with a relaxed tone), he started straining all over the house, outwith the tray and little bits of soft feaces would follow, he started bringing food up as well. (I forgot to mention , he has been bright natured throughout this all and eating well). I took him to the vets that day and they brought him in as thought it was sickness and diahhrea. They gave us Fibre Response Royal Canin biscuits and peridale. I was told not to spray the syringe up his passage now as it could cause a rupture (as the purpose of spraying the saline solution was to keep the cavity of no anal tone clean- but it has now returned).

My faux pas, as I had just changed his food straight to fibre response, peridale and sometimes chicken and brown rice (encore cat food packets). He then had diarrhoea again and was straining this all over the house. I am also administering sudocream on the area to help with straining. I then took him to the vet again- who gave him an anti-sickness injection and put him back on metacam (2.5ml) for pain relief and anti-inflammatory, when he came home - he had a full day and night sleep and ate in between and woke up bright an early. The high volume of straining stopped and he was only straining in the tray. I put him back on his usual diet (to harden up the feaces) - and on xmas evening he did a long bathroom- of hard feaces to a long line of soft feaces.  I kept feeding him his normal diet, cleaning his back area (of small soft leakages) and putting sudocream on… but last night (when i expected he would go) - he was pacing and straining and I could hear gargling of diarrhoea trying to push out , which unsettled him..I put a hot water bottle out for him and he settle down for the night.. 

I woke up this morning and he was sick a little… then got up and ate lots of food and I gave him his daily dose of metacam .. he then had a strain again and I took him into the vets today… they saying that if he doesn't pass , he may have to be sedated to clear his colon… and that things don't look too good as they will have a look to see - but can only look so far, and it sounds like the nerves in part of his colon have become unresponsive or may be a rupture.. and we may need to try different types of 'sloppy diets' at home, to get the right balance to have him pass all the way through until it may heal?

I've noticed

- since stopped the spraying of saline- he has had trouble passing

-that he could pass when there was no tone, and now that it returned- he having difficulty

-that percale may have caused more straining and small feaces to come out all over the house (but on other hand he may have been straining because of diarrhoea hurt his insides)

-that he is even having difficulty passing soft feaces..

sorry for the essay.. but I'm just looking for people with ideas/ who have been through this/ other vets advice? As i've been told , this could be terminal (due to quality of life).

I work from home, so my 24hours are no problem devoted to him , and I just want him to be happy.

 

[denice]

I take it by some of the terms you use that you are from Britain.  I just say that because I know vet protocols and available foods are different from the U.S.  Are you taking him to a cats only vet.  I know here in the States metacam is not given on a regular basis.  It's an NSAID which a cats liver can't filter out so the kidneys have to do all the work.  There are cats that have gone into renal failure because of it.  When it was originally released for vet use it was for dogs and a one time shot after surgery for cats.  Vets started using it the same way in cats as dogs and a black box warning was released here reiterating its original use.

A cat can be constipated but still straining and having loose stool.  The loose stool is going around the impaction.  It sounds like your vet suspects megacolon.  What has been found to be the best protocol here is a low fiber wet diet and using Miralax regularly to keep things moving right.  You would start with 1/4 teaspoon twice a day and adjust the dosage.

For now I do thing he needs to be cleaned out and then start with the new diet and Miralax.

 

[moose]

great ! thanks so much for your reply… I am in Britain .. he has had a enema today and waiting on him passing.. if not, he will be sedated and as soon as he is home.. wet diet it is! This laxative you talk of.. is it a bulk one? lubricant etc? And avail in uK?

 

[denice]

It works by drawing water into the colon.  It's a tasteless powder that can be mixed in with wet food.  I don't know about whether it's sold in Britain though.

 

[catwoman707]

What strikes me is, this just started going on and he is a year old.

It sounds like a temporary issue in my opinion, not something that can't be straightened out.

As I was reading the original post, it popped into my head that he had some hard poop sitting in his rectum for awhile so it stretched it out, which as you said came back. I'm suprised your vet didnt think this as well.

Once he is cleaned out, I would think that a diet change appropriate for his tendencies will very possibly be his 'fix-all'. Surely an all wet/canned diet will be best.

Excellent advice from Denice.

I second the dangers of metacam. A daily dose? Gee....I hate to say it, but it makes me question some of your vet's decisions/treatments, as well as what he has going on being possibly fatal? Something doesn't settle quite right.

Not sure I should be saying that but I can't help myself......

I have certainly learned through my own experiences, having a cat rescue group we use several vets, and they definitely vary.

Good luck!

 

[raintyger]

I think it is NOT sold in the UK, but you can get Miralax on Amazon. It will only work on stool that is forming and takes 2-3 days for the results to show up. In the meantime you might ask about lactulose. It does the same thing, but most people prefer Miralax over lactulose for several reasons:

1. easier to administer because lactulose is made from a sugar and is a sticky mess;

2. Miralax seems to deliver better results in most cases

3. In the states MIralax is OTC and cheap.

4. Since lactulose is made from a sugar many worry about diabetes, though I don't know if lactulose can cause diabetes.

You might need cisapride, too. Cisapride stimulates bowel movement. Be sure to give it 15-30 minutes before meals. Cisapride does interfere with natural peristalsis (body's bowel movement stimulation), though, so try to get away without it if you can. After many years some cats lose their natural ability to have a bowel movement due to cisapride, and the cisapride will become less and less effective. At that point you have to consider a subtotal colonectomy, which is  a majorly invasive surgery.

Let us know how things go and if the diagnosis is megacolon.

 

[raintyger]

Oh, yes, forgot to add that a wet diet as Denice and catwoman707 recommended cannot be stressed enough. Stool must be soft enough to pass, and that means there needs to be water.

 

[moose]

Hey , thank you , you have all been so helpful. I'm still awaiting to find out if he has passed anything more and will know in 12 hours time in our morning. If not , he will be cleaned out and when we get him home - wet diet it is! I will ask vets about the medications, I will certainly keep you all updated , thanks

 

[white shadow]

 
........... I then took him to the vet again- who gave him an anti-sickness injection and put him back on metacam (2.5ml) for pain relief and anti-inflammatory, when he came home.....

I woke up this morning and he was sick a little… then got up and ate lots of food and I gave him his daily dose of metacam ..

Moose......

IF   you are actually giving 2.5ml (two and a half mils) of Metacam each time - at each dosing - ...........then your cat must / would need to weigh about 55 pounds, or 25kg....that weight is calculated using the dosing regimen/regulations set out by The European Medicines Agency....see page 39 of this document: http://www.ema.europa.eu/docs/en_GB...Information/veterinary/000033/WC500065777.pdf

I think it's extremely unlikely that your cat would be so heavy.

Therefore.......IF you are actually giving that dosage.......IT IS A MASSIVE OVERDOSE OF A DRUG THAT IS KNOWN TO A VERY NARROW SAFETY MARGIN IN CATS.......

From that EMA documentpage 39):

4.10  Overdose (symptoms, emergency procedures, antidotes), if necessary

Meloxicam has a narrow therapeutic safety margin in cats and clinical signs of overdose may be seen at relatively small overdose levels.

In case of overdose, adverse reactions, as listed in section 4.6, are expected to be more severe and more frequent. In case of overdose

symptomatic treatment should be initiated

(my emphases)

The signs of overdose referred to in the above quote (page 38)

 
4.6   Adverse reactions (frequency and seriousness)

Typical adverse reactions of NSAIDs such as loss of appetite, vomiting, diarrhoea, faecal occult blood, lethargy and renal failure have occasionally been reported. In very rare cases elevated liver enzymes have been reported.

These side effects are in most cases transient and disappear following termination of the treatment but in very rare cases may be serious or fatal.

If adverse reactions occur, treatment should be discontinued and the advice of a veterinarian should be sought.

To put the overdose in another perspective.......if you cat weighs 10 pounds, the maximum licensed dosage would be .45ml (decimal four five) or less than 1/2 ml............2.5ml is about FIVE TIMES that amount.

IF you determine from all this that you have indeed given this amount of this drug, my advice would be:

• stop using the Metacam immediately
• if you have a camera, take a picture of the prescription label that clearly shows the prescribed directions
• get the cat to the Vet immediately, explain that the cat has been overdosed and demand that the cat be put on IV drip immediately and kept on the drip for at least 4-5 days.....see below for a reputable recommendation for care after Metacam poisoning
• if your own Vet is closed, take the cat to an Emergency Clinic immediately
• don't let the Metacam bottle out of your hands....it's your evidence of the medical error
• find a cat-only Veterinary practice and arrange to have your cat's care transferred there
• lodge a complaint about the error/malpractice with The Royal College of Veterinary Surgeons: http://www.vetlife.org.uk/professional-issues/complaints-rcvs
• report the incident to the UK's Veterinary Medicines Directorate: https://www.vmd.defra.gov.uk/adversereactionreporting/

Here is a trusted, reputable reference for the treatment of Metacam poisoning: (the link is there too)

 Dealing with Adverse Reactions to Meloxicam
If you believe your cat has developed kidney disease as a result of using meloxicam in the form of Metacam, you should report this to the manufacturers. The number to call in the USA is 1-866-METACAM (638-2226). You will probably find yourself speaking to a Dr Carey or a Dr Grubb, who should work with your vet to devise a treatment plan. If you are in Canada, the contact number is 1-800-325-9167 but the manufacturer will only speak to vets.

Most cats who suffer kidney disease as a result of using Metacam are suffering from acute kidney injury (AKI) and their bloodwork may be extremely high, with creatinine often in the high teens. Do not give up hope! Acute kidney injury is difficult to treat, but not impossible: an aggressive treatment plan should see those numbers dramatically reduce in most cases, and in some cases a complete recovery from a case of acute kidney injury is possible. In fact, one person was told by the manufacturer that 77% of cats affected by Metacam make a full recovery with prompt and proper treatment, so don't opt for euthanasia immediately. However, I understand that the manufacturer considers a creatinine in the 3s to indicate that the cat is stabilised, and whilst this is certainly not a critical level nor grounds for euthanasia, it does indicate some residual kidney damage. 

A treatment programme which includes 4-5 days of IV fluid therapy (hospitalisation), followed by 4-6 weeks of sub-Q fluids at home, is often recommended by the manufacturers, but talk to them and see what they suggest for your cat. I would also suggest that you ask the manufacturers to pay your veterinary costs - I know they have done this for some people, although they have not necessarily paid the full costs. It would appear that they may pay more if your vet calls.

If you are in the USA, you should also make a report to the Food & Drug Administration. Apparently the manufacturers are not obliged to report any cases of kidney problems to the FDA because renal failure is already listed in the package insert as a possible side effect (see the second link above),but I believe it is very important for the FDA to be fully aware of the scale of the problem. FDA Consumer Complaints Co-ordinator has details of the relevant contacts for each state.

If you are in Canada, you should report it to the Veterinary Drugs Directorate.

If you are in the UK, you should report it to the Veterinary Medicines Directorate.

http://www.felinecrf.org/treatments_antibiotics_painkillers.htm#meloxicam_adverse_reactions_protocol 

 

[cprcheetah]

I would go with a low fiber diet (1.0-1.5%).  Canned or tinned food is best.  High Fiber can cause bigger, harder stools which make it more difficult to pass.   Miralax if you can get it there is good, I give my cat 1/4 teaspoon twice a day.  Why is he on the Metacam?  It can be very dangerous and can cause Kidney Failure.  If it is for arthritis there are other things that you can do that are safer (Cosequin, Krill Oil, Homeopathic Remedies).  You can get the Miralax online on Amazon   I just mix a little bit with my cats canned/tinned food and she eats it right up. 

 

[GemsGem]

I just hope and pray that @Moose did mean to write 2.5 kg NOT not 2.5ml.

@Moose is from the UK and so am I. So I have a bottle of metacam for cats, so I'm hoping her bottle is the same as mine. I had it from vets but never used it so just found it to have a look at instructions. This is what it says

Dosing procedure using the measuring syringe ( supplied )
The syringe fits into the drop dispenser of the bottle and has a kg body weight scale which corresponds to the dose of 0.05 mg meloxicam/kg body weight.

 

[moose]

Hi , yes I made a mistake sorry , he is 3.3kg .. The vet has prescribed 2.5 units of the syringe daily . I'm just trying to work out what a unit of the syringe is equal to?

 

[moose]

The whole bottle
Is 3ml

 

[moose]

Ah just worked it out , he is getting 0.125mg

 

[white shadow]

Ah just worked it out , he is getting 0.125mg

Well, that's at least a huge relief.

Now, do you have his exact weight? From that can be calculated what the dosage should be.

Secondly, you also need to know that this drug has been prescribed for him off-label....that is to say, for a purpose for which it is not licensed/approved for use.

The EMA document I gave you states it is licensed for:

 4.2   Indications for use, specifying the target species
Alleviation of mild to moderate post-operative pain and inflammation following surgical procedures in cats, e.g. orthopaedic and soft tissue surgery.

Alleviation of pain and inflammation in acute and chronic musculo-skeletal disorders in cats

In North America, when a drug is prescribed for a purpose for which it is not approved, the practitioner is considered to have an ethical duty to advise the patient and to obtain the patient's informed consent......I can't imagine those ethical considerations to be any different in the UK.

And, more importantly, the EMA license specifies when it should NOT be prescribed:

4.3   Contraindications
Do not use in cats suffering from gastrointestinal disorders such as irritation and haemorrhage, impaired hepatic, cardiac or renal function and haemorrhagic disorders

So, personally, I'm troubled by what's happened to Moose.

From everything I've read, a steroid is usually used for inflammation in the intestine, not NSAIDs. Here's an example with IBD: http://www.vet.cornell.edu/FHC/health_resources/brochure_ibd.cfm

Finally, a safe pain med for cats is buprenorphine....a few drops applied to the inside of the mouth 3-4 times a day: safe and effective.

 

[moose]

Thanks for this info, I'll get this info passed on at vets today. Picking him up in 3 hours , he had an enema yesterday and had passed a 'reasonable' amount of feaces.
Do you think I should still suggest a low fibre diet on wet food?

 

[denice]

I am assuming you have already talked to your vet.  Many vets are still recommending high fiber diets, my own personal experience the low fiber works better.  I would definitely switch to an all wet, canned diet for the extra moisture.  If he will eat it I would even add some water to the canned food.  That's a recommendation that is usually seen for cats with urinary tract issues but I think it would be beneficial for constipation issues as well.  The idea is more moisture which helps both issues.  http://www.littlebigcat.com/health/constipated-cats/  is a good article on the subject.  This article also differentiates types of fibre, some are better for a cats digestive system than others.

 

[raintyger]

You will have to choose between a high and low fiber diet. I can tell you that most people on the Yahoo! feline chronic constipation and megacolon group went low fiber. Some went low fiber after trying high fiber and claimed that the high fiber diet stretched out the kitty's colon, causing a chronically constipated cat to move into megacolon. With my kitty I found that there was no difference in frequency of bowel movements, but low fiber meant less poop. Most often a high fiber diet also isn't as nutritionally good because the fiber comes from plants, which increases carbs.

Megacolon/chronic constipation can be challenging until you find out what works for your kitty. It's very individualized and pretty much a trial and error process. You might want to join the Yahoo! group. They have some additional home remedies such as coconut oil or aloe vera which may help, depending on how your kitty does/what symptoms become present.

 

[white shadow]

From my own life experience, it seems that many people don't have a clue about how their own gut system works........let alone their cats'.

And, except for a couple of major differences between theirs and ours, those systems are almost identical.

I believe that the following website is a must-read, a prerequisite for anyone with guardianship of a cat, or intending to take it on....and yes, I did say read (an activity disappearing from the landscape these days)...read slowly, the better to digest the content

:

I created this site because I would have welcomed one like it when we were struggling with SEM's constipation. Not only have I learned more since then but there is more available to learn, available to us all.

My wish is to make information about gut health and constipation in cats accessible in a manner that leads to understanding. In my experience, understanding how things work helps us to help our cats better. I hope you will agree and that your sweet cats benefit.

http://www.felineconstipation.org/​

[I (WS) have no connection to that site - the "I" in the above quote is that of the website's author and owner.]