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Hello. I am hoping for advice from people who know cats. I introduced myself in that forum with some of my kitty's history, so I will recap here:

- 2 year old cat, male ( Linus)
- we aquired him because he ran out onto a 4 lane highway and was hit by our car (as a kitten of about 10 weeks old )
-We rushed him to vet ; broken pelvis in the growth plate; nursed carefully until well recovered; after recovery, we kept him.
- all fine until this past March; he was constipated; to vet; he was really 'backed up'; 2 enemas did not work ( we've since found he won't go until he is home even with an enema); so he was 'manually' cleaned out. Home again. Had 10 days of cisapride; all seemingly ok until this July when 2nd bout of constipation. Repeat procedures again.
- His food had been medi-cal 'gastro intestinal' from the vet ( our other cat has that for her digestion problems; the vet said it shouldn't hurt him to eat it too when we asked) They were both changed to this food in February when our other cat ( 13 year old female: 'Tara, or Tabby' as we like to call her) had vomiting etc.
- After 2nd constipation the vet thought the food was maybe 'too high in fiber', and he has been eating 'Purina DM'.
- Now: he has a lot of trouble with the movement and passage of his stool. His stools are too hard. He has had episodes of laying on the floor and growling and moving as if he has stomach pain. Many litter box trips. I have seen him in his litter box: sometimes he makes a gagging sound as he is trying to use the litter; twice he has thrown up while trying to use the litter. He IS passing stools. I clean out small, hardish little pieces; and then a normal sized amount. It's the hard small pieces, and then the a day later ( so far). He always feels better when the lot passes.
- We have been to the vet 5 times over the past 7 days ( including a weekend emergency visit). Each time, the vet said, he has NOT been constipated. He was tested for pancreatitis, and had a urinalysis ( all normal).
- When he was first in for constipation; he had an xray in case it was the old pelvis break causing a problem. Two vets have said the pelvis is only slightly narrowed, and there is a small bone spur; but it does not look like they should interfere with his bowel movements.
- He currently has cysapride; lactulose ( just started 2 days ago; not working yet it seems); and he is finishing a 5 day course of Metronidazole ( an antibiotic and anti-inflammatory in case he had an inflammed rectum from all of the recent enemas etc). And he has laxatone.
The vet said his stools need to be softer. According to the stools I brought in; he said there can be no blockage with their shape and size as passed.

Now:
Opinions anyone?
Now my confusions that I am hoping you can help me sort out:
- Can I give him both lactulose, and pumpkin, and laxatone; or is this too many things?
- could pumpkin 'bulk' the stool and make it hard to pass ( what if his 'narrowed pelvis or the bone spur are an issue in spite of the vets' opinions ?)
- can pumpkin cause gas for him?
- if pumpkin is ok, how much? He's small ( about 10 pounds).
- Should I slowly change his food? Do you know of a good quality food from a grocery store ( sometimes I think these ones from the vets are not so good afterall)
- Does he need less fiber or more fiber? What is a good normal % on a can of cat food for fiber, and protien?
- how should I change foods when he's in the midsts of still having so much trouble?
-- should I continue the cysapride ( I'm afraid of this drug, but also afraid to stop it when things are not yet normalized)
- can the antibiotic contribute to the hard stools?
I need to get his stools soft and easy to pass. He has so many drugs and things right now; and I think a food that is not right for him; but I don't know what to change, or how to do changes that won't just cause more of the problems.
I'm afraid to 'experiment' and cause him more distress or harm.
Please help me sort this out. I am really distressed by this. We had a cat, Boris, who I loved very much; who we did our best for for many years of his problems passing stool; he ended up with megacolon, and ultimately, at 15, his bowels just quit; and we had to have him put to sleep. I am so afraid that this is what is happening here all over again. Does anyone ever actually solve, or normalize this hard bm, constipation thing?
Why is this happening after almost 2 years of him being just fine? Can he be normal again or will he always have trouble?

Thank you for your king patience and reading this through. I am grateful for any thoughts or advice that you can give me.

Most sincerely.
Mia
 

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Poor baby. It sounds like he is so distressed at times. I don't have any suggestions but I am responding to bump this thread up.
 

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Is he on 100% canned food? Dry food can cause constipation in cats because they generally need a wet diet and do not drink enough water to hydrate themselves. Purina DM is high protein but the dry and the selects canned have corn and soy in it which cats basically cannot digest. Is there a petsmart or petco near you? They have a better variety of foods than a grocery store.
 

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First, a couple of very important and informative links for you. They will teach you everything, and more, about feline constipation and its management:

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Constipation
Feline Constipation Home Page

The single most important consideration when managing/avoiding constipation is hydration. For this reason (and many others), your cat(s) should never be fed any sort of kibble - UNLESS AND ONLY UNLESS kibble is the only type of food that your cat(s) will eat. If your cat(s) will eat canned food (or a homemade/raw diet), then that is what they should be fed ... preferably mixed into a soup with warm water to further improve hydration. Stool softeners can't soften stool in a dehydrated cat.

In my opinion, both of your cats should be on a much higher quality, meat-based food than the prescription junk they're eating now. EVO 95% meat varieties are very high quality and can be purchased online if you don't have a local source. There are a number of other high quality canned brands, too, and all can be purchased online.

You will read all of this on the constipation sites I linked above, but to sum it up:

Lactulose and Miralax (I MUCH prefer Miralax) are osmotic laxatives which hold water in the GI tract to help moisten and soften the stool. They are only effective on properly hydrated cats, and they are only effective on stool that is being newly produced in the gut. They will not have any effect on constipated stool already present in the gut.

Laxatone is a lubricant that will help lubricate constipated stool so that it can be passed successfully ... unless the cat is horribly blocked up. Laxatone (and any of the other lubricant hairball remedies) should not be given regularly, because they can interfere with the proper absorption of dietary nutrients.

Fiber (pumpkin, psyllium, etc.) will bulk up and soften the stool. This can help the cat's body to properly advance and push the stool along and out of the system. However, too much fiber can cause more problems than it can solve by making the stool too large. Be careful not to overdose fiber.

Osmotic laxative, lubricant, and fiber can be used simultaneously, though such measures are rarely necessary. I have only had one cat who required both an osmotic and fiber to prevent constipation. I have had several whose constipation was reliably avoided with Miralax (and proper hydration) alone.

As far as the osmotic laxatives are concerned, Miralax is my preference for several reasons:

1) It is a crystalline powder that is nearly tasteless, so it is MUCH easier to administer by simply mixing it into a little canned food. It can also be mixed with a cc or two of water in an oral syringe, if need be.

2) Miralax is available OTC in the U.S.

3) Miralax does not have the potential to cause hypercalcemia, as does lactulose.

Both osmotic laxatives are dose-to-effect drugs, meaning that you can adjust the dose gradually to produce optimal stool consistency in your cat. Too little osmotic, and your cat will continue to be constipated. Too much, and the stool will become too loose. A little experimentation goes a long way in determining the perfect dose for your own cat.

Any food changes should be made very gradually over the course of a couple of weeks to avoid digestive upset.

Antibiotics generally cause loose stool. I don't know of any antibiotic that causes constipation.

Laurie
 

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Discussion Starter #5
It is wet food, with extra water mixed in.
Thank you all! I am printing these out to read carefully. Thank you!
Mia
 

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Just a thought--if you have municipal water, could the city have changed the mix or timing of chemicals? Your cat might be sensitive. Try bottled water for a bit. (Bottled somewhere other than your city.)
 

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So sorry that your Linus is having these issues, and I hope your vet can help you figure something out soon.

A couple of years ago one of my cats would occasionally suffer from constipation and really hard stools that would sometimes cause pain and bleeding. Our vet wasn't sure what was causing his issues, but we had some success through the use of pureed squash (essentially the same as pumpkin) and laxatone if I noticed when cleaning the box that his stools seemed really hard. He was never to the point of becoming sick to his stomach or yowling out in pain though.

Hope he's doing better soon! Let us know if something starts to improve.
 

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I am not a vet but I am really against prescription diets... It's all garbage. My one cat was prescribed this a while ago for her digestion issues and it made matters 10x worse even after the vet insisted she must stay on it(they get a commission on these foods that's why they push it so much).

I agree, if eats wet then I suggest a high quality wet food (Evo, merrick, wellness core, etc.) and add water to it. Also if you don't see him drinking much then I would maybe syringe feed him water to see if that lubricates him enough. Also try several small meals a day if you can manage, so he doesn't have to digest a lot of food at once.
 

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Discussion Starter #9
Thank you all!
Well, this morning he has been having a very hard time passing stool. Growling with the discomfort; nothing produced yet. now he's walking around, not too bad; but obviously the using his litter needs some help.

I have given him a mini sort of 'enema'; I'm so distressed; I want to help him. I'm so afraid of hurting him. I mixed warm water ( like for a baby) with some mineral oil, and a drop of liquid soap on my finger swished through the water. I used a small plastic syringe with a well lubricated tip. The amount was very small; 3mls in all; but I figured it may help lubricate just inside his little rectum. I hope. I'm afraid to do much more. I felt his colon; I can feel a hard stool in there. I tried to gently massage it toward his back end.
He has been given his lactulose. I just read on the internet that antibiotics can interfere with the action of the lactulose. He finished his antibiotic/antiinflammatory the day before yesterday.
Any other suggestions of how to help him?
Thank you all. It is so good to have people who can give thoughts and suggestions.

I have to say; I feel a bit from the last visit that the vet can't help me much here ( they seemed at a loss as he was not constipated). They suggested he is stressed from so much going on lately, his rectum was probably iritated, and he needs softer stools. If he's 'not constipated', but needs softer stools so he can pass them without pain; I need to figure this out.

How long before the lactulose works?
I mix in extra water into his wet food ( all wet food; several times a day), but how can I get more water into him ( I follow his lactulose with a syringe of water too). I don't want to stress him out from all I'm doing too. I'm a coward too.

Your thoughts are so welcome.
Mia
 

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Now, I don't have any experience with it, so I can't make a guess to whether is would help or not, but what about trying some Feliway. Aren't the diffusers supposed to help relieve stress in cats? If your vet thinks it's stress related, perhaps it would be something to try to help him de-stress?
 

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You are a good cat parent. Have you thought of getting a second opinion, or even taking him to the closest vet college? They may be able to give you some better suggestions to help your kitty.

Btw, your kitty is amazing to allow you to do all these things to him.
 
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