Recurring constipation despite multiple vet visits - Any ideas?

[VadGTI]

New member, looking for some help.

The X-rays described below are here https://imgur.com/a/pMYHRo9

In February, we started noticing that one of our cats (a 12 year old female in a multi-cat household) would walk around the house meowing. In early March, we noticed that this behavior was now transferred to the litter box, with lots of spinning, meowing and digging, but no poops.

On March 14, we saw a vet. The following was done: Multiple X-rays (linked above), a full blood panel and a urine panel. The blood tests came back excellent (the doctor even noted that she was surprised by how good the results were for a cat her age) as did the urine test. The X-rays showed lots of stool backed up in her colon. An enema was performed and "copious amounts of hard stool" were released over the next few hours. She was given an opioid during the enema which really messed with her so the doctor believes she may have an opioid allergy.

The X-rays also showed hip arthritis. The doctor thought this may be causing her to have difficulty getting into position and prescribed gabapentin (0.1cc to 0.3cc by mouth every 12 hours) but noted that it should be used when needed, not daily.

Additionally, lactulose was prescribed (0.3 to 0.5ml every 8-12 hours).

The first few weeks after this visit seemed fine. Then, the same behavior began again. Digging and spinning in litter box, vocalizing, etc.

On April 19 (Tuesday), we took her in again. X-rays again showed a backup of stool in her colon. Another enema was given and again "copious amounts of hard stool" were released. She was then sent home.

At home, she pooped diarrhea the next day, then had no bowel movement at all. On Friday, I called the doctor and was told that the Lactulose dose was way too low and that it should be 2ml per dose, 3 times per day, for a total of 6ml. We were also told to use Miralax.

That Friday, soon after she received her 2ml dose (along with Miralax and some olive oil), she had a very large soft movement on Friday evening. Since then, we have not seen her poop, despite her getting at least 4ml of Lactulose daily, Miralax, a bit of olive oil and gabapentin. She is drinking a good amount of water. Last night (or, more precisely, around 2 a.m. this morning, she again started to vocalize and spin and dig in the litter box.

I ordered some PRN enemas (the kind used by our vet) and they should be arriving tomorrow, but I'm wondering if something is being missed? I asked the doctor if this could possibly be megacolon but was told it was not and, even if it was, it was in the early stages.

Any ideas?

I should add, she is eating normally (excellent appetite), which allows her to take all of the medicine given to her. None of the above described issues have affected her appetite in any way, going all the way back to February. No vomiting (except for soon after the first enema in April, when she drank so much water that she vomited it up soon after).

 

[fionasmom]

Welcome to The Cat Site! If this is megacolon, which I would personally not rule out (although I am not a vet), your doctor does not want to move to the next step, which is surgical, if this is an early or controllable case.

You are okay handling enema's for your cat? Or, more to the point, is the cat willing to let you give her one? You may be very adept at this, so please don't think that I am discouraging you from doing this. Pet-Emas are safe, of course, but remember never to use a human enema like Fleet on a cat as it contains ingredients which could be lethal.

There are other medications like Cisapride which is a colon wall stimulant which you might discuss with your vet.

Megacolon in cats - Need information
Look through this entire thread, although we don't know that your cat does have megacolon, and see if any of this information is helpful.

Can you consult with another vet, not in the same practice? There are specialty hospitals in the area where you may or may not need a referral. All imaging and diagnostics are your property and can be taken with you.

 

[VadGTI]

We've never giving her an enema before but she's a very loving cat so it should be fine (hopefully). I asked about Cisapride during last week's visit, but the vet said there's no need for it at this time.

 

[VadGTI]

I forgot to mention, as far as the enema I ordered, it's the PRN Pet Enema (12ml). They also had a PRN Feline Enema but the ingredients are exactly the same, it's just a smaller size (6mL), so I went for the larger version.

 

[Nebaug]

Is there any other diagnosis except X-ray? X-ray is saying that she is full of…… but not why. What is she eating? There are other laxatives out there. olive oil ,eggs ,pumpkin, coconut oil… The amount of water she is taking. Those are things that are very important and can make a huge difference.

 

[VadGTI]

No specific diagnosis, bloodwork and urinalysis came back completely fine. Just constipation, relieved by enema. She's currently on lactulose, Miralax, olive oil and pumpkin and is drinking plenty of water.

 

[LTS3]

Are you dissolving the Miralax in water first? Lots of people,even vets, don't realize that even a cat sized dose of Miralax has to be dissolved in a little bit of water and then mixed into canned food or a moist treat. What is your cat's dose? I think the max recommended cat dose is 1/2 teaspoon twice daily.

 

[VadGTI]

Are you dissolving the Miralax in water first? Lots of people,even vets, don't realize that even a cat sized dose of Miralax has to be dissolved in a little bit of water and then mixed into canned food or a moist treat. What is your cat's dose? I think the max recommended cat dose is 1/2 teaspoon twice daily.

Funny you ask this. My partner is in charge of the Miralax. A few hours ago, while reading various posts on here, I decided to ask if she was dissolving it. Nope, she was just stirring it into the food! So the cat just got the first properly prepared Miralax dose an hour or so ago.

 

[LTS3]

Oh good. The dose should work soon. By dissolving the Miralax, you prevent dehydration in the cat which can cause constipation. Miralax works by drawing water from other parts of the body into the digestive tract. Dry powder is like a thirty sponge so once it's in the tummy, it starts pulling water like crazy from other parts of the cat. The instructions for Human says to dissolve a Human sized dose in a full glass of water before ingesting. The same is true for pets and their appropriately sized doses.

What do you feed the cat? Dry food can contribute to constipation, too.

 

[VadGTI]

She eats mostly wet, with several morsels of dry (because she loves dry food as well) as snacks during the day. Since this started, she's been getting much less dry (just a few pieces).

 

[Nebaug]

Not all wet food is equal. What are you feeding that can make a huge difference. There are pâtés out there that are on the dry side and then there are some wet foods that are soupy. That would probably help your cat

 

[Jcatbird]

I am going through something similar but the cause may be different? Banjo, my female tux did just as you describe with your kitty. X-rays, enema, later an ultrasound. Nothing showed on either except for stool being present but, her regular vet felt a mass in her lower colon. A biopsy was attempted at the time of the ultrasound and “abnormal” cells were found but not conclusive. No mass could be seen on the ultrasound. She is on lactulose and is eating her normal wet foods, Fancy Feast classics ( some water added)! but also Weruva with pumpkin and a couple of Fancy Feast broths per day. She is having small bowel movements twice a day at fairly set times. Not straining except for one incident and her lactulose was increased to 1.5 ml every 8 to 12 hours. Because my vet had to get the cell sample by “feeling” where to draw them, we are unsure of anything at this point. Banjo is going to have a colonoscopy next. Maybe we will learn more then. The broths and pumpkin laden food along with lactulose have worked well to this point.

 

[VadGTI]

I wanted to provide an update. The enema arrived this afternoon and we just gave it to her about 15 min ago. She immediately had a large bowel movement. Here's the strange part: It was soft. The previous visits to the vet noted the presence of large amounts of hard stool after the enema. This was nowhere near hard. Almost too soft, as one would expect given the various laxatives and broths she's been consuming. So the question is then why is she not doing this on her own? Why does she need an enema to push out soft stool?

 

[VadGTI]

I can't find an edit button, so I just want to also say thank you for your help to everyone who posted. We're going to take all the advice to heart.

 

[fionasmom]

You can't edit because you are a very new member. You need 20 posts and 5 days membership on TCS. After that, there is a 2 hour window in which you can edit.

Thank you for the update; glad that she is responding to the enemas. If this is megacolon ( which I certainly don't mean to imply that it has to be), it is possible for a cat to have sufficiently weakened intestinal walls to push anything out. Just one theory but it might explain why soft poop is not coming out on its own.

Feline Constipation
This article lists numerous causes of constipation which is not to say that your cat has any of them, but it might be a "rule out" list.

How often were you told to give the enemas?

 

[VadGTI]

How often were you told to give the enemas?

There was no specific instruction by the vet. There was one in March and one in April. During the April visit, the vet told us what enemas to use but did not actually specifically explain when to use them. The vet actually reached out to us for a check-up and we told her we will be doing an enema but again did not receive any specific instructions.

Since the initial movement, she has had several others, all part solid/part liquid. The one this morning was essentially all liquid.

My understanding is megacolon is diagnosed via X-ray and the vet did say that it isn't megacolon, so hopefully she was correct, since I am very concerned it could be. We reduced her lactulose and Miralax today given the diarrhea, but will go back to normal doses tomorrow. Hopefully she's regular within a few days.

 

[fionasmom]

I certainly hope that you are not dealing with megacolon either! The only reason I asked about enemas and their frequency is that they cannot be used overly often without getting into other problems, like dependency on them, liquid introduced etc. It sounds as if you have this under control though.

Let us know what happens over the next few days.

 

[VadGTI]

So, an update, chronologically:

Tuesday, April 26 - We administer an enema (per the post above) - multiple bowel movements
Wednesday, April 27 - Another small, runny bowel movement

... Then nothing...And more nothing...We start getting worried. She's on the following during this time period:

* Breakfast: 2ml lactulose, 1/2 teaspoon Miralax
* Lunch: Antinol, gabapentin, 2ml lactulose
* Dinner: 2ml lactulose, 1/2 teaspoon Miralax

... And yet nothing... At least not that we know of (there are 4 litter boxes and she is the only one that doesn't cover her poop, but others sometimes do, so it's hard to tell).

She does a couple of the "cry in the litter box and spin around" things on Friday, but no poops. We start getting worried and plan to take her to the emergency vet over the weekend.

Saturday, April 30 - Suddenly, she poops. A very long and large poop, soft, although weirdly black on a small (3/4-1 inch) portion of the end that came out first. The remainder of it is totally normal in color.

... Then nothing... And more nothing, with some spinning in the box and meowing. She's on the same regimen described above.

Tuesday, May 3 - We catch her pooping in a litter box she does not usually use. Large poop, almost diarrhea consistency for the most part, with some solids.

Wednesday, May 4 - Despite the Tuesday poop, she spends a lot more time spinning in the litter box and meowing. We start getting worried.

Thursday, May 5 (yesterday) - The spinning in the litter box continues. She also feels bloated. We decide on another enema (it has now been 9 days since the last one). The enema works within minutes. Large amount of completely normal looking stool, soft in consistency. She poops several more times thereafter throughout the night, including runny stools. She also passes gas, loudly.


So, here we are. She's still on the same regimen described above. Could it be that we are giving her too much lactulose or Miralax and the bloating (and her seeming desire to poop without actually pooping) be caused by too much of this stuff and possible resulting gas?

Also, forgot to mention, after the Tuesday, May 3 runny poop, we discovered a "rice grain" of a worm on her butt, so she somehow picked up a tapeworm. We gave her Bayer tapeworm treatment the next day (Wednesday, May 4).

 

[fionasmom]

This is certainly not medical advice, but it is possible to administer more laxatives than are needed. Not that you are being careless at all, but it might be one theory. The spinning in the box is still a mystery, but if she feels stimulated to poop but does not have enough to produce anything it might cause the spinning.

 

[msserena]

I can identify with this. My cat walked around yesterday meowing, wouldn't let me touch her, side chewing, she was hissing & swatting at my other cats & then when she went to the litter box, she stood there for longer than normal & out came a little black chunk. She was having pain & couldn't go poop. I have been giving her psyllium each morning, about 1/8 tsp. She eats only wet food (Weruva). I am seriously considering the enema thing just to clean her out & give her some relief. I loaded her up yesterday with egg yolk powder & then got a bottle of Miralax. I guess I'll see how she does but even if I did give her the enema, I would think it would clean her out & provide some relief.