HARPSIE'S WEBSITE -

HOME OF THE

 

WALKING VETERINARY ENCYCLOPAEDIA

 

 

 

CONSTIPATION

 

Home

 

Contact Us

 

 

Introduction

 

How I Met My Family and Got My Name

 

My Personality

 

My Siblings

 

 

Medical Problems

 

Arthritis and Acupuncture

 

Asthma

 

Cancer

 

Cat Flu  - Feline Herpes and

Feline Calici Virus

 

Colitis

 

Constipation

 

Dental Problems

 

Epilepsy

 

Feline Lower Urinary Tract Disease (FLUTD)

 

Food Allergies

 

"Gunky" Ears and Ear Infections

 

Inflammatory

Bowel Disease

 

Kidney Infections

 

Polycystic Kidney Disease (PKD)

 

Skin Problems

 

Sunburn

 

Torn Trachea

 

Undescended Testicle

 

 

My Near Misses

 

Hypertrophic Cardiomyopathy

 

Meningioma

(Brain Tumour)

 

Pancreatitis

 

 

Behavioural and Lifestyle Issues

 

Feline Introductions

 

Inappropriate Elimination

 

Indoor/Outdoor Cats

 

Travel

 

 

 

 

 

 

 

Symptoms

Treatments
Hairball Remedies Slippery Elm Bark Lactulose Miralax
Vitamin B12 Methylcobalamin Fibre Suppositories Enemas
Links

 
Cautions
Propulsid/Prepulsid Hairball Remedies Mineral Oil Enemas

Harpsie's Experiences

 

Introduction

 

Most cats will be constipated at some point in their lives, and whilst this is uncomfortable, it is usually a short-term problem which can easily be resolved. However, if the constipation is severe enough that toxins back up in the cat's system, the condition can actually become lifethreatening. Plus some cats suffer from recurrent constipation known as megacolon. So whilst it may be a popular topic for comedians, constipation should be taken seriously.

 

Symptoms

Obviously the primary symptom of constipation is straining in the litter tray and/or not producing stool. If you see this, you do need to be absolutely sure that the problem really is constipation: on one occasion Harpsie was straining and we thought he was constipated, but in fact he had a lifethreatening urinary tract blockage, which was a medical emergency.

 

Other symptoms of constipation which may be less obvious include pooping next to the litter tray, vomiting immediately after using the tray, dry stools or ungainly walk.

 

Occasionally a cat may urinate outside the litter tray when s/he is constipated - our Karma peed on the sofa so we took her to the vet for a suspected urinary tract infection, but in fact she did not have one, her problem was constipation. Once the constipation was under control, her inappropriate elimination ceased.

 

Sometimes a cat will appear to have diarrhoea but in fact has constipation, and the runny stool is simply what can squeeze around the solid dry stool.

 

Meower Power has information on the different colours of cat poop. 

Columbia Animal Hospital has a diagram of a cat with an impacted colon.

 

Treatments

It is important to keep a close eye on your cat's litter tray and to deal promptly with any signs of constipation or straining (see Symptoms). If at all possible, you want to avoid the need for an enema or manual evacuation of the bowel by your vet. 

 

Hairball Remedies - Laxatone or Petromalt

Many vets seem to routinely prescribe Laxatone or Petromalt for constipation, but these products are really intended for the treatment of hairballs. Such a product may be of use if given for a short period to try and soften the hard stool that may be seen at initial diagnosis. However, these products are not ideal - or particularly effective - for ongoing constipation problems; plus, as mentioned by the Merck Veterinary Manual, they may interfere with the absorption of nutrients if used longer-term. 

 

Slippery Elm Bark

Slippery Elm Bark (ulmus rubra or ulmus fulva) is a herbal remedy used for most kinds of digestive or intestinal problems - it can be used for nausea, vomiting, diarrhoea or constipation. It soothes and coats the stomach lining and intestinal walls and reduces irritation, and can be sufficient to keep some cats regular.

 

Slippery Elm Bark Dosage

Ideally, you want organic or wild-crafted Slippery Elm Bark powder from most good health food shops. If you cannot find this, you can usually find capsules in a 350-400mg size, but try to make sure the capsules contain only pure Slippery Elm Bark, no fillers. If all else fails, you can use capsules with fillers as well as Slippery Elm Bark.

 

The usual dosage is 1/8 to 1/4 (0.125 - 0.25) of a teaspoon of the organic or wild-crafted Slippery Elm Bark powder once or twice a day, or one capsule per day. You can sprinkle it onto the cat's food and mix it up, but Slippery Elm Bark  has a bitter sweet flavour which some cats do not like. In that case, try giving it in a capsule, either the one it came in or, if you are using organic or wild-crafted Slippery Elm Bark, purchase gelcaps separately for this purpose. Some people have found their cat will eat Slippery Elm Bark if it is mixed in a little baby food (make sure the baby food does not contain any onion).

 

Slippery Elm Bark Cautions

Do not give Slippery Elm Bark at the same time as any other medications or supplements - it can inhibit the absorption of the medications.  It is best to give it an hour before or after any other medications (especially antibiotics), and ideally on an empty stomach, although it is safe to sprinkle it on food if you wish. 

 

Slippery Elm Bark also contains calcium, so it is probably safer not to use it if your cat has hypercalcaemia (high calcium levels).

 

Slippery Elm Bark Sources and Information

1001 Herbs has more information on slippery elm bark.

Little Big Cat has an article about slippery elm bark by Jean Hofve DVM.

Southwest School of Botanical Medicine has a breakdown of the components of Slippery Elm Bark.

University of Maryland Medical Center also has information on Slippery Elm Bark.

 

UK

Holland and Barrett sells 100 370mg capsules for 6.99.

Green Life Direct sells  loose slippery elm bark for 2.99 for 50g.

Applejacks in London sell slippery elm bark in the UK, it's not mentioned on their website but you can call them or e-mail them.

Capsules are also available at most health food stores, and the ones I bought (400mg size) cost 4.99 for eighty. 

 

USA

Drugstore sells 100 370mg Nature's Way slippery elm bark capsules for US$6.29.

Vitamin Shoppe sells a number of brands of slippery elm bark in the USA.

Frontier Herb - sells a variety of types of slippery elm bark within the USA - type in slippery elm in the search facility.

Affordable Natural Supplements sell a variety of brands of Slippery Elm Bark, shipping is US$6.95, but free for orders over US$100.

Glenbrook Farm sells slippery elm bark in various quantities online.

Whole Foods Market sells slippery elm bark in bulk in its stores in USA and Canada.

Swanson Vitamins sells its own brand 400g slippery elm bark capsules for US$2.99 for 100.

 

Lactulose

Lactulose is an effective treatment for preventing constipation on an ongoing basis. It is a syrup of long chain indigestible sugars (derived from lactose, a milk sugar) that pulls water into the colon and softens the stool. Lactulose is available OTC in Europe and Canada, but requires a prescription in the USA. 

 

Lactulose is a "dose to effect" treatment, so you should start with a low dose, and work your way up only if necessary (so as not to cause the opposite problem of diarrhoea). A possible starting dose is 0.5ml once a day, but this may need to be adjusted with your vet's approval; Plumb's Veterinary Drug Handbook says that cats may be given up to 1ml per kg (0.5ml per lb) of bodyweight per day. It does take a couple of days for lactulose to work, so do not give too much too soon. I found out the hard way that, if you syringe it in to your cat's mouth, it's a good idea to wipe your cat's chin with a damp cloth after using it, because, being sugar-based, it is incredibly sticky. You may find it easier to mix the lactulose with food.

 

Since lactulose is a prescription item in the USA, it can be rather expensive, but Walmart and Target both sell it for US$4 a bottle.

 

Since lactulose is so sticky, you might wish to ask your vet about a new form of it called Kristalose. This is a powder which can be dissolved in water, and which therefore eliminates the stickiness problem. I do not know anybody who has used it for a cat yet, but it is available from Drugstore in the USA.

 

Lactulose Cautions

Some people have found that their cats developed hypercalcaemia (high calcium levels) after using lactulose regularly, which then improved when they stopped using lactulose. You may therefore wish to avoid lactulose if your cat is already hypercalcaemic.

 

Lactulose is usually of limited use if a cat is so constipated as to have impacted stool; this may need to be removed by the vet before starting lactulose. Antibiotics may reduce the effectiveness of lactulose. 

 

Antibiotics may reduce the effectiveness of lactulose. 

 

Lactulose may not be suitable for cats who also have IBD.

 

Lactulose may exacerbate the effects of diuretics. Drugs.com has more information about this.

 

Mar Vista Vet discusses lactulose.

Drs Foster and Smith have some information about lactulose.

West Shore Endoscopy Center also has information about lactulose.

The British Medical Journal reports on a recent study of human patients that indicates that lactulose may also help to prevent urinary tract infections.

 

Miralax

Miralax is a human constipation treatment containing polyethylene glycol 3350 which was recently made OTC in the USA, and perhaps as a result more people are gradually starting to use it on their cats, although I am not aware of any veterinary links about Miralax as yet.

 

Miralax is an osmotic laxative like lactulose, but unlike lactulose, which is a sticky syrup, it comes as an odourless and tasteless powder which can be mixed with water. Another advantage is that it does not have the potential to cause hypercalcaemia (high calcium levels) like lactulose does. In addition, since Miralax is now OTC, you do not need a prescription for it, though please do not use it without your vet's knowledge and approval.

 

A common starting dose is 1/8 of a teaspoon, though you can increase to 1/4 of a teaspoon if necessary.

 

Vitamin B12 (Methylcobalamin)

is helpful. Vitamin B12 in the form of methylcobalamin  is the neurologically active form of Vitamin B12, and is used by the body to correct neurological problems. It appears to help cats with diabetic neuropathy, and in addition has been found to be very helpful for various other problems, including incontinence and constipation, particularly megacolon (a bowel disorder which causes severe constipation).

 

You need methylcobalamin rather than the more commonly available form of Vitamin 12 called cyanocobalamin. A possible starting dose would be 500mcg (0.5mg) a day, though some people give twice as much. Be guided by your vet. Methylcobalamin is often sold in the form of fruit-flavoured lozenges which some people do use to pill their cats successfully, though plain methylcobalamin tablets are also available, though less easy to find.

 

B Vitamins are sensitive to heat and light so are best kept in a cool dark place.

 

PDR Health has some information about methycobalamin (this is a human site).

Vitacost sells 200 plain methylcobalamin 500mcg (5mg) capsules for US$11.99. I ordered these myself on a Sunday evening, and received them on the following Tuesday.

Bayho sells 180 1000mcg (1mg) plain methylcobalamin tablets for US$26.81. Although the site states that it only sells to health professionals, they will normally sell to individuals if you tell them it is for veterinary use.

Vitamin UK sells a number of different types of methylcobalamin, click on Search, then type in methylcobalamin.

Methylcobalamin Resources has details of suppliers in USA, UK, and New Zealand, some of whom will ship worldwide. Please note this site is recommending methylcobalamin for cats with diabetes, and the doses given may be too high for a CRF cat; ask your vet.

 

Fibre

Sometimes it is also necessary to add fibre to your cat's diet in order to bulk up the stool so that it moves easily through the cat's system. Some  form of vegetables such as baby or tinned peas or pumpkin (not the pie filling) may suffice - tinned pumpkin is harder to find in the UK, but apparently some branches of Waitrose sell American canned pumpkin with no additives in the canned vegetables aisle.

 

Alternatively if you are in the UK, your vet may offer you a standardised pharmaceutical-grade fibre called Nutrifyba. A popular fibre-based treatment which is available OTC in the USA is psyllium, commonly sold under the name of Metamucil. You only need to give a tiny amount - the maximum dose is 1/8th of a teaspoon, but you should start with an even smaller dose. With fibre-based treatments, it is very important to ensure that the cat drinks plenty of water, otherwise the fibre can bulk up in the body and make the constipation worse. Please note these fibre-based treatments are intended to help prevent constipation, but they cannot cure it  once it is present.

 

Suppositories

I attempted to give Harpsie a suppository when he was struggling with severe constipation. I purchased infant glycerin suppositories, which are roughly the size of a birthday cake candle. I held the suppository in my hand for a short time beforehand, which warmed it up so I didn't need to use a lubricant. I then inserted it gently wearing latex gloves. You then have to keep the cat away from the litter tray for a little while so the suppository has time to melt. It was actually much easier than I thought it would be for both Harpsie and myself, but unfortunately it had absolutely no effect for poor Harpsie.

 

Enemas

If your cat is severely constipated, your vet may give the cat an enema. These are not particularly comfortable for the cat, but can provide much needed relief. Below is information about Harpsie's enema.

 

If your cat is prone to constipation, your vet may teach you how to give an enema at home, but you should never attempt this without veterinary input, not least because some types of enema sold in pharmacies are toxic to and can kill a cat (see enema cautions).

 

Cautions

 

Prepulsid/Propulsid

You may be offered Prepulsid or Propulsid, which is a drug called cisapride, but I would suggest only using this as a last resort since it has been withdrawn from the human market because of serious heart-related side effects which have caused some human deaths. Rx List has more information about this issue in humans, while Pet Education has some information about the implications for animals.

 

Hairball Remedies

As mentioned above, hairball remedies are best avoided for ongoing use to treat constipation, because, as mentioned by the Merck Veterinary Manual, they may interfere with the absorption of nutrients if used longer-term.

 

Mineral Oil

Mineral oil should not be used, because, being odourless and flavourless, it can easily be aspirated and cause pneumonia. If given regularly, it may also interfere with the absorption of nutrients. Merck Veterinary Manual explains more about this.

 

Enema Cautions

Enemas containing sodium phosphate (one common US brand is Fleet) should also be avoided because they are extremely dangerous for cats.

Electrolyte abnormalities induced by hypertonic phosphate enemas in two cats (1985) Jorgensen LS, Center SA, Randolph JF, Brum D, Journal of the American Veterinary Medical Association 187 pp1367-8 reports on two cats who suffered severe problems after such enemas, and advises against their use for cats with renal problems in particular.

The Merck Veterinary Manual also advises against the use of such enemas.

 

Links

Feline constipation, obstipation, and megacolon: prevention, diagnosis, and treatment Washabau RWorld Small Animal Veterinary Association World Congress 2001 has information on constipation. It mentions that ranitidine (Zantac) may help with constipation caused by low motility in the colon.

Mar Vista Vet has information on both constipation and megacolon.

Feline Advisory Bureau has information about constipation.

Feline Megacolon List is a support group for people with a cat with megacolon.

 

Harpsie's Experiences

 

Harpsie was not particularly prone to constipation, though he did suffer from it occasionally. This page was prompted by a particularly bad experience in February 2006.

 

We are not entirely sure what happened to Harpsie at that time, but it appears that his problems may have been caused by phenobarb toxicity (one possible symptom of this is constipation). On the last Saturday in February Harpsie suddenly began staggering around restlessly and breathing very fast. We rushed him to the vet, who acertained that Harpsie was anaemic (HCT was 25%, this lab's range began at 30%), and had a heart rate of 230 and blood pressure of 200. A chest x-ray was clear, but it showed a massive amount of stool. Harpsie could not walk properly (he was walking like John Wayne). This despite the fact that Harpsie had seen the vet five days earlier with only mild constipation at that time, and had been on lactulose ever since. 

 

The vets suspected a neurological problem. Harpsie's vision appeared a little off, which happened when he first had neurological problems (he can still see, but it seems as though he cannot). He occasionally tugged at his bedding, similar to a compulsive movement he was exhibiting before his first seizure in October 2004. The vets did not know how a neurological problem could explain the anaemia, strange gait, fast heart rate and hypertension though.
 

The vet said Harpsie was too ill to endure an enema, and that she expected him to die in the night. We were devastated. They could not recommend any treatment other than a Vitamin B shot. They said we could take him to a hospital and leave him for monitoring but they do not think the hospital could actually do anything to treat Harpsie other than put him on a drip, but he was not dehydrated and a drip could have been risky for his heart, so they left the choice to us. So we brought him home. If he was going to die, he was going to do so surrounded by those who loved him.

 

When Harpsie got home, he promptly ate two platefuls of food. He then got into bed for a rest, rather than staggering around restlessly. I paged the neurologist and he called me back and said Harpsie couldn't have a brain tumour, he used to see Harpsie every two weeks and had seen him only 10 days earlier, and he would have seen the signs before now. We could take Harpsie to his hospital (outside the city) but no neurologist was on duty until Monday, and we didn't see the point of leaving Harpsie in a hospital when he could be with us, particularly since no treatment was available at this point anyway.

 

Fortunately Harpsie was still with us on the Sunday. He was still eating, but he was also sleeping very deeply, was terribly wobbly and he had constipation. These latter three symptoms often occur when a cat first begins phenobarb i.e. when the cat's body is still getting used to the medication. So we began to wonder if Harpsie's phenobarb dose was not right and needed adjusting. 

 

Harpsie's walking was really dreadful, and he was still breathing too fast. Unfortunately he did nothing in the litter tray despite all the food. We bought some laxatone, which had little effect. Poor Harpsie struggled into his litter tray, where he took 15 mins to produce two tiny, tiny pieces of poop, during which he fell over several times, and therefore he ended up covered in litter. He then promptly puked up everything he's eaten because of the strain of it all. We were thinking we would need to take him to a hospital and get some intern who's never done an enema before to give Harpsie one - but he staggered out of his litter tray, and astonishingly he wobbled over to his food bowl, and began to eat! So we decided to wait until the next day, because the neurologist was also an internist, so we felt he should be able to give up some idea of the risks of an enema and perform it if he agreed it was necessary.

 

Later that day Harpsie was no better. He did not eat for several hours, he was wandering around restlessly as if he could not get comfortable, he couldn't seem to lie down comfortably (though the x-ray 23 hours earlier had showed that his lungs were clear) and his gait was really bad. He went to the litter tray but just lay in it.

 

Harpsie was so weak I was in two minds, but I decided to give him half of a  Fleet Child Suppository, active ingredient Glycerin 1g. The pharmacist suggested using half of one, which I did. It was less stressful giving Harpsie this than I had feared, but unfortunately it had no effect at all. We also got methylcobalamin, I could only get 1000mcg ginormous tablets which were fruit flavoured. I gave Harpsie a  quarter of a tablet in the evening.

 

We decided that, come what may, Harpsie simply had to have an enema the next day. All that poop had got to come out somehow, and surely him straining in the litter tray with such wobbly legs could kill him too. I was not entirely clear why the enema was not done the previous day, because they did do a rectal exam (and surprise, surprise, found lots of dry poop), but perhaps the vet didn't want to be blamed if the enema killed him.

 

The only thing that made us smile in the midst of all this was Indie's response to the laxatone. She shot over and tried to steal it from Harpsie! We had to give her some of her own to keep her quiet (she licked it off my finger). But then Indie will eat anything (she used to try to steal Thomas's peppermint-flavoured phosphorus binders too).

 

On the Monday morning we saw the neurologist. He suspected phenobarb toxicity (Harpsie was on phenobarb for his epilepsy), but felt the constipation could also be causing some of Harpsie's problems. He said Harpsie was very sick, but he was certainly not going to feel better while all that poop was in him, and his feeling was that Harpsie could cope with the procedure, and that he would be  uncomfortable while the enema worked, but that he'd then feel so much better. So we agreed to that, we knew we had to do something about the obstipation.

 

The neurologist gave Harpsie an enema which he coped with pretty well. We waited a bit to see if the poop came out but none did and the vet said it could take up to two hours for the enema to work, so we decided to take Harpsie home. It was most embarrassing as the private car we'd booked filled with the overwhelming stink of cat poop! Poor Harpsie had a dreadful time, both vomiting and passing some largely liquid and extremely smelly poop (more of the former than the latter). Fortunately I'd put puppy pads in his carrier, so the car was unsoiled. We all sat there with stiff upper lips, pretending everything was normal and we couldn't smell a thing! Needless to say, the driver got a very large tip which put a smile on his face, so I think we were forgiven.

 

Upon returning home Harpsie puked and pooped simultaneously once more. Then he pooped once more. Much of it was liquid, but not all. He looked pretty rough, but inbetweentimes he did actually eat, so I think he was probably feeling a bit better already. His respiratory rate had certainly improved, to 32.

 

Over the next couple of days, on a reduced dose of phenobarb, and with the aid of the residual effects of the enema and regular lactulose, Harpsie's constipation resolved and the accompanying vomiting ceased, thank goodness. Whilst most of his problems were caused by phenobarb toxicity, there is no doubt that the constipation also played a major role in him feeling so ill. In retrospect, I wish we had insisted on an enema on the Saturday, rather than making poor Harpsie wait another two days for relief.

 

This photo was taken six days after Harpsie's visit to the neurologist and the enema. As you can see, he recovered pretty well, though he was still a little down.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Back      Home      Next

 

 

 

This page last updated: 9 February 2008

 

Links on this page last checked: 2 February 2008

 

Copyright Harpsie's Site 2005-2008. All rights reserved.