Constipation in cats: the secrets of a holistic veterinarian for prevention and treatment

A surprising number of cats have problems with constipation (abnormal accumulation of feces and difficulty defecating) and similar but more serious conditions such as constipation (complete obstruction of the colon by feces) and megacolon (damaged nerves and muscles in the colon that cause an inability to defect). Constipation is uncomfortable, even painful. Constipated cats may defecate (or attempt to defecate) outside the litter box because they associate the pain or discomfort with the litter box itself. Other signs of constipation include irritability, abdominal pain, lethargy, and lack of appetite or even loss of appetite.

The colon, the last part of the intestinal tract, is a large muscular structure that ends in the rectum. It contains most of the intestinal bacteria that reside in the gastrointestinal (GI) tract. These bacteria finish the digestion of proteins. Byproducts of this process include short-chain fatty acids that nourish the cells lining the colon. Some of these lining cells absorb water, while others secrete mucus to lubricate stool and keep it moving.

Most cats defect once a day. A constipated cat may only defect every 2 to 4 days, or even less. In general, stools are hard and dry, because their long stay in the colon allows the absorption of most of their water content. Occasionally, however, a constipated cat may appear to have diarrhea, because liquid stool is the only thing that can bypass the stuck mass of feces.

Causes of bowel problems include neurological problems, pelvic injury, obstruction (by hair, bone, etc.), and inflammatory bowel disease (IBD). A dirty litter box can cause a cat to avoid the box and become constipated from holding feces in too long. Hooded litter boxes are a particular problem because they trap odor, which can make the box environment extremely unpleasant for the cat.

In over 15 years of experience as a feline veterinarian, I know of only 2 cats that had constipation issues that would not eat dry food. It is logical, therefore, to think that diet plays an important role in the development of the problem. Some cats may need more fiber than is present in very low fiber diets, such as most canned, raw and homemade diets. You can always add a dash of fiber (ground flaxseeds and ground chia seeds, also known as Salba, are reasonably palatable and work great).

In fact, the initial treatment for constipation is usually a change in diet. Historically, these cats have generally been fed high-fiber dry foods. Fiber modulates intestinal motility. Depending on the type of fiber and the circumstances, fiber can speed up or slow down digestion. Therefore, it is used for both constipation and diarrhea. Light, senior, and hairball foods contain more fiber, and there are several high-fiber medical diets as well.

Usually changing your diet helps, at least initially. However, eventually these foods often seem to lose their effectiveness over time. More fiber can be added, such as canned pumpkin. Again, sometimes this produces a temporary improvement. However, most of these cats continue to have problems.

Since fiber encourages water absorption and increases the amount of stool produced (because it can’t be digested), many experts have leaned the other way and recommend “low residue” diets to minimize stool bulk. “Low residue” means that the feed is highly digestible and produces minimal waste. Cats digest protein and fat better, but carbohydrates are controversial; it is clear that many cats are intolerant to carbohydrates. According to this theory, the best food would be high in fat, high in protein, and low in fiber, as well as high in moisture. One would think that such a food would also be low in fiber, but that is not necessarily true. Eukanuba Low Residue dry food contains 4% fiber, which is quite high. Most canned foods fit this description, as do most homemade foods. However, Eukanuba Low Residue manages to incorporate a large amount of carbohydrates, even in its preserves. Reading the label is an important skill to develop.

Water balance is crucial in constipated kitties. Most vets will give constipated cats subcutaneous (or even intravenous) fluids to increase their hydration.

Treatment for constipation depends on the severity of the problem. For mild cases, occasional enemas may be all that is needed. For severe blockages, the cat must be anesthetized for manual removal of feces (a process graphically but accurately called “excavation” by my favorite tech).

Once the cat is “cleaned” by any means, it is advisable to take steps to prevent the problem from recurring. There are several options available; an individual cat may need only one of these, while others need several or all of them.

  • Canned or homemade diet. Moisture-rich diets keep the cat hydrated, and these diets are much more digestible and produce much less waste than dry food. Because canned and homemade diets tend to be extremely low in fiber, adding a small amount of rice bran or powdered psyllium (available in bulk at most health food stores) is helpful.
  • Water source. Many cats will drink much more plain water than they will from a bowl. There are various types of pet fountains, from “waterfalls” to “waterfalls” and models that could be from Rome! They are easily available online. Make sure to keep the fountain clean so your cat will continue to drink.
  • Lactulose. This is a sugary syrup that retains water in the stool and keeps it soft; therefore it is easier for the cat to pass. Cats generally don’t like the taste. Fortunately, lactulose now comes in a mild-tasting powder (Kristalose) that can be encapsulated at a compounding pharmacy or simply added to canned foods.
  • Other stool softeners, such as DSS (docusate sodium). Your vet can prescribe them.
  • Petroleum jelly. The main ingredient in most over-the-counter hairball remedies (Laxatone, Kat-a-lax, Petromalt), petroleum jelly can be given to the cat orally. Most cats tolerate it, many cats like it, and some even enjoy it. The Vaseline brand is, according to my cats, the best; but other cats prefer one of the flavored hairball types. Give 1/3 to 1/2 teaspoon per day. It can also be mixed with a small amount of canned food. However, it can interfere with nutrient absorption, so it is best given on an empty stomach.
  • Cisapride (Propulsid). This medication was withdrawn from the human market due to dangerous side effects, but is considered safe for cats. Your vet can order it at a compounding pharmacy. It seems to work best in combination with stool softeners.
  • Pediatric glycerin suppositories. Although they may not appreciate having a suppository inserted into their rectum, most cats tolerate it. Your vet can advise you on technique and frequency.
  • enemas Many cat guardians have gotten good at doing enemas at home. Mineral oil, KY jelly, soapy water, and plain warm water are fine; you may have to experiment to see which works best for your particular cat.
  • Slippery elm bark or marshmallow. These herbs can be added to canned foods (add additional cold water) or made into a syrup. Its mild flavor is well tolerated by most cats. They form mucilage, a slippery substance that helps move intestinal contents. There are many herbal formulas available to people, but many herbs, such as holy shellthey are too tough for a cat.
  • Exercise. Staying active helps stimulate your intestines and keep things moving. If your constipated cat is also addicted to television, try play therapy for cats.
  • Stress management. There is always an energetic or emotional component to any chronic illness, and stress plays a role in many gastrointestinal conditions. Flower essences are helpful in changing the energetic underpinnings of constipation and other gastrointestinal ailments.
  • Fluid therapy. Some cats do very well with occasional (daily or weekly) infusions of subcutaneous fluids. Your vet or vet tech can show you how to do this at home. Give fluids whenever you notice that your cat’s behavior indicates that constipation is coming.
  • Surgery. If there is damage to the nerves and muscles of the colon, a “subtotal colectomy” is the last resort. This surgery removes the colon and joins the small intestine to the rectum. Unless and until the small intestine develops more colon-like functioning, the result is chronic diarrhea. However, the cat will be much more comfortable.

If your cat is chronically constipated, the most important thing you can do is be vigilant. Look for early signs of constipation; exertion, abdominal discomfort, decreased appetite, etc. Note how often the cat defecates. If he doesn’t produce adequate stool for more than 2-3 days, call your vet or start home treatments if you have established this routine. Cat constipation is much easier to treat when caught early. If you wait, the treatment will be much more expensive and there is a greater chance of irreversible damage to the colon.

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