2021‐04‐12

Assessment &
management of
constipation in cats
Susan Little, DVM, DABVP (Feline)

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Bytown Cat Hospital, Ottawa, ON, Canada
@catvetsusan

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catvet@vin.com

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@ Key
assessments
Long term
management
Effective acute
treatment

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• Infrequent & difficult

evacuation of feces with
Constipation retention in colon & rectum
• Acute & short term or chronic

Terminology

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• Intractable constipation
Megacolon • Poorly responsive to medical

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therapy

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Radiographic
definition of megacolon

Ratio of colon diameter to L5 length

• Normal <1.3
• Megacolon >1.5

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Functional definition
of megacolon

• Acute dilation that responds to therapy

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• Chronically dilated colon, poorly

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responsive

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• Causes?
• Recurrent constipation, obstipation

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• Generalized dysfunction of colonic

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smooth muscle

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c Colon motility patterns

@ Propulsive Non‐propulsive

• Rhythmic
• Stimulated by segmentation that
food & activity mixes contents
• Absorption of
water, electrolytes

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The work up

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c Look for contributing factors

@ Drugs Stress

• Antacids Dehydration • Resource-poor

• Opioids environment
• Antidepressants • Intercat conflict
• Diuretics • Underlying disease • Changes in routine
• Opioids • Vomiting, diarrhea
• Sucralfate • Impaired mobility, pain

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Chronic kidney
disease
• Dehydration
• Hypokalemia
• Reduced gastrointestinal

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motility

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• Phosphate binders

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• Amlodipine

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@

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Everyone’s favourite – the

01 enema

De-pooping
02 Manual disimpaction – oh no!
the cat

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03 There is a better way

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a t v
c Patient prep

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Correct dehydration Anti-emetic
& hypokalemia Analgesic

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Warm!
Water, saline,
lactulose

5-10 mL/kg

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@
#EnemaFail

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Manual disimpaction
(why is it always when you’re ready to leave??)

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@

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A better way!

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Laxative trickle-feeding
Dr. Tony Carr
Western College of Veterinary Medicine,
University of Saskatchewan

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Colonoscopy or laxative solution

intended for acute treatment

Polyethylene glycol 3350

(macrogol)

Sodium bicarbonate
sodium chloride

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potassium chloride

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Brand names:

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Golytely, Colyte, Movicol

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@
6‐10 mL/kg/hour

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Defecation in median 8 hours

(range 6-14)
Median total dose 80 mL/kg

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Pre-treatment

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8 hours later

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@ Everybody 
poops better 
at home!

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Pre-treatment

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Hannah Vds, Facebook Feline Veterinary Medicine Group

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@

Hannah Vds, Facebook Feline Veterinary Medicine Group

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a n
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7 hours later

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Hannah Vds, Facebook Feline Veterinary Medicine Group

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a t v
c Long term management

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Identify &
manage
concurrent
diseases
Hydration Dietary
therapy
Prokinetics,
laxatives

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Hydration
• Wet food
• Flavoured water
• Bottled/filtered water

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• More water bowls
• Subcutaneous fluids if appropriate

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a t v
c Dietary therapy

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Type of diet

Low residue

Increased fiber
Characteristics
Highly digestible
Decreased fecal bulk

Soluble & insoluble fiber:

• Increased fecal bulk & water
Examples

• Hill’s Prescription Diet i/d Feline

• Royal Canin Feline

Gastrointestinal Fiber Response
• Hill’s Prescription Diet w/d
Feline or r/d Feline
Soluble & insoluble fibre:
• Increased fecal bulk & water
Specific prebiotics:
Modulation of • Hill’s Gastrointestinal Biome
• Increased postbiotics that
microbiome improve motility, provide energy,
Digestive/Fiber Care
anti-oxidant & anti-
inflammatory effects

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When dietary therapy isn’t enough

01 Add a laxative 02 Add a drug

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• Lactulose • Cisapride
• PEG3350 (macrogol) • Metabolized in liver

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without electrolytes by cytochrome P450

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Top tips for managing constipated cats

@ Identify
Underlying factors,
concurrent diseases

Evaluate
A D
Provide
Effective acute
management

Recommend
Hydration,
electrolytes
B E Dietary therapy for
long term
management

Radiograph Add
GI obstruction,
masses, pelvic
C F Laxatives, drugs if
needed
fracture, colon size

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@
catvet@vin.com

@catvetsusan
@purrpodcast
purrpodcast.net
bit.ly/CatBites

drsusanlittle.net

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