DIAGNOSIS & MANAGEMENT OF CONSTIPATION IN CATS SUSAN LITTLE, DVM, DABVP (FELINE) @catvetsusan, catvet@vin.com
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bowls designed for cats are too small; cats dislike having their whiskers touch the side of containers. Dog water bowls are larger and more appropriate. Litter box modification may be helpful for cats with arthritis. Most cat litter boxes are too small and have high sides. A winter boot tray or an under- the-bed type of storage box with low sides is a better alternative to make access easier. The litter box should also be in an accessible but private area, avoiding the need to navigate stairs if possible. Hyperosmotic laxatives include lactulose and PEG 3350 (without electrolytes, e.g., MiraLax, RestoraLAX); they stimulate colonic fluid secretion and propulsive motility. The dose of lactulose solution is 0.5 mL/kg, PO, BID-TID. The dose of PEG3350 is 1/8 to 1/4 tsp. BID in food. Cisapride stimulates contraction of feline colonic smooth muscle. A typical starting dose is 2.5 mg/cat BID, PO and it is better absorbed when given with food. Doses up to 7.5 mg/cat, TID have been reported. The drug is only available from compounding pharmacies in most countries. Surgery can be considered for cats that are refractory to medical and dietary therapy. There are various techniques available, including partial colectomy, subtotal colectomy (most common), or total colectomy. A subtotal colectomy describes the removal of the majority of the colon, excluding the ileocolic sphincter and cecum.
In severe cases, manual manipulation of the feces via abdominal palpation or per rectum (manual disimpaction) under general anesthesia with endotracheal intubation (in case of vomiting) is also required. In these cases, opioids should be administered for pain relief. An alternative to enemas is administration of an oral polyethylene glycol (PEG 3350) and electrolyte solution intended for colonoscopy preparation (e.g., CoLyte, GoLytely). A nasoesophageal tube is placed and the solution is given as a slow trickle (6-10 mL/kg/hour) over 4-18 hours. Defecation usually results in 6-12 hours. 3 LONG TERM MANAGEMENT In addition to management of any underlying conditions, long term medical treatment may involve dietary therapy, laxatives, or prokinetic agents. Dietary therapy may include high fiber diets (>20% on as fed basis), low residue diets, or biome-manipulating diets. Increased dietary fiber increases the production of short chain fatty acids which stimulate feline colonic smooth muscle contraction. Dietary fiber is also a bulk laxative and will increase fecal bulk, which will not be beneficial for all patients. Feeding a canned diet is often recommended to reduce fecal bulk and to ensure adequate water intake and hydration. A certain amount of trial and error is necessary to determine the best diet type for an individual patient. It is also important to ensure adequate water intake by various methods, such as feeding canned diets. Most water
Preservation of the ileocolic valve decreases postoperative diarrhea caused by bacterial overgrowth and decreased water absorption. Surgical complications are uncommon and include contamination of the surgical site and dehiscence of the anastomosis; both are prevented by proper surgical technique. Diarrhea normally disappears 4-6 weeks after surgery. In a minority of cats, the soft stools persist. References available on request.
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