Cat having trouble with bowel movement

[ugurcan]

Hello Tracy,

My other cat is sick now. She is 7 years old and started vomiting recently. I also noticed a little bump on her back right next to her tail ends. I took her to the vet and after an x-ray they realized her bowel was full and there was a bigger piece at the end and was not coming out. So it was blocking everything else to come out (that bump was the blocked stool right before her anus). Since there was no room left in her intestines anything she ate had to come out through the other end hence she was vomiting. She went through an enema and vet prescribed her Cisapride (oral 0.5ml twice daily) and Kristalose (1 tea spoon daily).

Well she had the exact same problem again and I had to take her to the vet last week. It was the same thing vomiting not being able to have bowel movement (some very little stool comes out like toothpaste every time she tries for it). Again she had her bump by her tail.

She went to the vet again. She got an enema again. Vet thinks she is constipated but her stool is not hard it is actually how it is supposed to be not watery nor rock like. He suggested to continue to use the prescriptions.

Now she has the same problem again. I had to keep her separated in a bathroom because she will vomit again and her back is not clean.

Did you have any experience with something like this. She keeps getting blocked but her stool is not hard so she is probably not constipated? She is urinating well though she does not have a problem with that. Also she is lively playing and eating. Vet also tested her for instestinal parasites and she was negative.

I appreciate your help very much!

[Tina B and crew]

I'm not expert, I'll leave that to Traci, but my first thought was did the check for an obstruction?

Hoping kitty gets better and you find some answers soon!

[ugurcan]

They did an X-ray and it showed no obstructions. After enema she was able to do bowel movements for a couple days but she got blocked at the same location again.

[Traci]

When was kitty's last bloodwork done? If over a year, please get bloodwork done for her (a CBC and chemical profile - the CBC might show some dehydration or electrolyte imbalances and the chem profile might show some potassium or calcium deficits). A urinalysis could be helpful to rule out bacterial infection.

When was the first episode of the vomiting/constipation? How much time passed between the first and the second and third episodes?

What food are you feeding her?

Is she drinking normal amounts of water on a daily basis? (this is very important!) - if she isn't drinking a normal amount daily, consider getting a kitty water fountain dish for her.

If the vet is only giving kitty repeated enemas, then I would suggest asking him to do a barium enema, the barium enema can help determine/show on xrays where a potential blockage might be. Remember, even though the first enemas may have relieved some of the feces, a partial obstruction could still be present. Sometimes an enema solution isn't enough because a blockage could be occurring further in the colon - a barium enema can help locate such a blockage, and if meds and high fiber diet aren't resolving it, then manual extraction (if low enough in the colon to reach), may be necessary. Manual extraction of impacted feces requires anesthesia, so this is another good reason to get a full bloodwork panel done PRIOR, to determine her overall health status and determine anesthesia candidacy.

That said, if for some reason you don't trust your current vet or his competence/experience level, then see a NEW, more experienced vet (preferrably feline-only), RIGHT AWAY to get the vet's opinion on the barium enema and/or manual extraction potential.

In lieu of manual extraction, you could continue the cisapride and kristalose, but it's also very important to get kitty on a proper diet, such as a high fiber diet (example: Hill's Rx W/D or R/D), make sure kitty is drinking a sufficient amount of water every day, encourage her to exercise daily (but don't overdo it on the exercise). Combined with the high fiber diet, you can also try adding canned pumpkin mixed in her food daily (about a teaspoon or do, your vet will direct you), or you could try sprinkling a small amount of metamucil over her food (again, vet will direct you on how much to use, do NOT ever use more or less than what the vet recommends), or you could try giving her hairball remedy once a week or so (again, as your vet recommends - if you use hairball remedy, I would suggest Laxatone for cats).

If she tends to groom a lot, or has hairballs often, or you see strands of hair in her feces, then please do regular brushing of her fur at least once a week to help minimize hairballs.

The thing is, especially if your vet doesn't have much experience with this, you should really shouldn't wait long after a course of medications if the condition keeps occurring with no resolve - I strongly suggest getting a second opinion from a more qualified, experienced vet, to rule out megacolon, which I suspect could be what's going on with kitty. I'm not saying it definitely is megacolon, but it should definitely be investigated. Beyond diagnostics for megacolon, I would also rule out IBD.

Do you know if kitty ever had a pelvic injury when younger? Is she a manx breed? Is kitty overweight? These things, and even prolonged constipation between episodes can increase the potential for megacolon.

Some cats require surgery (subtotal colectomy) if the condition worsens or progresses or does not respond to diet and medications. Likewise, in some cats, surgery is not a guarantee, as the cat's stool could be very soft or even runny, and constipation could reoccur. Hopefully, this would not be something you'd ever have to consider.

So, essentially, I'd get a new opinion for kitty, with a feline-only vet, get kitty's current records faxed to the new vet for review and take it from there - ask about the barium enema, new high-fiber diet, the current meds and ruling out megacolon.

Please update us when you know more. Kitty is in our thoughts and prayers for an excellent recovery and hopefully it isn't megacolon. Even if it were, it can be treated and manageable.

[slvrwhispr]

Traci, just reading through with my untrained eye, my first thoughts were nerve damage. Since the bowels appear to be working properly, but the cat isn't voiding on its own and is otherwise acting normally, maybe the signal to have a bowel movement isn't reaching the brain for some reason? Not intended to be alarmist, just wondering if this could be a cause.

[Traci]

Slvr, sometimes megacolon IS caused by some types of nerve problems, like spinal, etc. There can be various suspected causes, but most diagnoses are idiopathic. Neurological would probably be a last rule-out, and the xrays didn't show a spinal problem or pelvic abnormality (thus far). Strictures are another problem in some cats, but can usually be detected via endoscopy, another diagnostic that would probably be last considered. Yes, diagnostics could end up being extensive, but megacolon is relatively easy to rule in or out with few diagnostics.

Also, even though kitty has produced stool, one cannot totally rule out an obstruction or a partial obstruction.

[ugurcan]

I took my cat (her name is Biber) to a different vet after work today. I asked my original vet to fax her records to this new vet and they did but they didn't include the X-Ray. New vet examined Biber and even though he likes to see the X-Rays and talk to my original vet first, he is pretty confident the lump (bump) on her back end by her tail is a perineal hernia. He explained that her colon became like an horse shoe shape and that's why he is getting blocked.

He explained to me that Biber probably did have difficulties with bowel movement for a long time (he is thinking she might have mega colon) (it is my fault I should have recognized it earlier because I knew she was vomiting but she was vomiting by her food bowl and I was thinking other cats were harassing her while eating).

He thinks Biber has mega colon and she strained herself too much for bowel movements and over time that started to tear up her muscles by her anus.

I will take her X-rays to this new vet tomorrow. He will call my old vet and let me know what his final opinion on Friday.

He says if he can't see what he wants to see from the X-ray he will do a barium enema and will do a surgery to repair the muscles and reposition her colon. He likes to do both at the same time since she will already be under anesthesia. He says muscles might be too damaged (even shredded) to be repaired and in that case he will try to make a rigid wall by her anus wall so that her colon won't take that horse shoe shape again.
After her colon is fixed we're going to start treating her for mega colon.

Traci, I did not mention your comments to him. However the procedures he recommends to be taken (bairum enema) and what he thinks the problem is (mega colon) is exactly what you predicted without seeing Biber. I thank you very much for your help and will keep you posted with her progress.

I forgot to add she eats and drinks fine and she is playful. But her back is always dirty so I keep her locked in the bathroom for now.

[Traci]

You should know that perineal hernias are fairly rare in cats, so it's imperative the new vet reviews the other vet's xrays, and, ideally, takes new xrays of his own. That said, the barium enema actually requires xrays after the barium is given, so that will be covered.

Is the new vet a qualified vet surgeon? I ask, because you want to make sure he isn't rushing into surgery without a great deal of surgical experience and definitive diagnosis.

Again, if surgery is required, you want to get full bloodwork done on Biber FIRST to determine her overall health status and anesthesia candidacy. Also, make sure the vet explains to you in great detail about the surgery and after care - after care can take upwards of 6 weeks to heal, so the recovery time requires medications, restricted exercise, and your very careful monitorization of the surgical site, her bowel habits, stool consistency etc.

Do you know if Biber was also straining to urinate during any of the three episodes?

Please keep us updated, and know Biber is in our thoughts and prayers.

[ugurcan]

He said the same thing. It usually happens in dogs but not in cats. He did this surgery before on dogs.

He is recommended to me from a friend I work with. She trusts him for a long time with her 5 dogs and 3 cats.

When she urinates it comes out pretty quick. I don't think she has any problems with urinating. However when she tries to do number 2 either nothing comes up or it comes out just a little like toothpaste.

I will let you know what he recommends after seeeing the X-ray. They are not open today so it will be Friday.

Thanks for all the help!

[ugurcan]

Sorry it's been a while since my last post. Last Friday night Biber was able to pass a large one and started having regular bowel movements during the weekend. I talked to the vet and decided to wait and see how she would react to her prescription before deciding to have a surgery for her perenial hernia.

She is still on Cisapride 0.5 ml twice a day and she is prescribed Lactulose 2ml three times a day.

She is doing better. Her back is clean. I let her out of the bathroom last weekend. She did not have any accidents or vomiting so far. She eats good (actually she only likes to eat hard food, she would lick can food but does not eat that. Because of that twice a day I feed her orally with a syringe with Hills prescription diet a/d can food. Yes that's the very same food prescribed for my previous sick cat who would eat anything but this. He is doing great now by the way.)

I will keep you posted with Biber's progress. Thanks for all your help.