Assessment & management of constipation in cats - Key Long term management - Feline ...
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2021‐04‐12
Assessment &
management of
constipation in cats
Susan Little, DVM, DABVP (Feline)
n
Bytown Cat Hospital, Ottawa, ON, Canada
@catvetsusan
a
catvet@vin.com
u s
2
e t s
a t v
c
@ Key
assessments
Long term
management
Effective acute
treatment
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2021‐04‐12
• Infrequent & difficult
evacuation of feces with
Constipation retention in colon & rectum
• Acute & short term or chronic
Terminology
a n
• Intractable constipation
Megacolon • Poorly responsive to medical
s
therapy
t s u
e
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a t v
c
@
Radiographic
definition of megacolon
Ratio of colon diameter to L5 length
• Normal 1.5
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2021‐04‐12
Functional definition
of megacolon
• Acute dilation that responds to therapy
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• Chronically dilated colon, poorly
a
responsive
s
• Causes?
• Recurrent constipation, obstipation
u
• Generalized dysfunction of colonic
s
smooth muscle
9
e t
a t v
c Colon motility patterns
@ Propulsive Non‐propulsive
• Rhythmic
• Stimulated by segmentation that
food & activity mixes contents
• Absorption of
water, electrolytes
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2021‐04‐12
n
The work up
s a
t s u
e
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a t v
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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2021‐04‐12
Chronic kidney
disease
• Dehydration
• Hypokalemia
• Reduced gastrointestinal
n
motility
a
• Phosphate binders
s
• Amlodipine
t su
e
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a t v
c
@
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2021‐04‐12
Everyone’s favourite – the
01 enema
De-pooping
02 Manual disimpaction – oh no!
the cat
a n
s
03 There is a better way
t s u
e
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a t v
c Patient prep
@
Correct dehydration Anti-emetic
& hypokalemia Analgesic
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2021‐04‐12
Warm!
Water, saline,
lactulose
5-10 mL/kg
a n
u s
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e t s
a t v
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@
#EnemaFail
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2021‐04‐12
Manual disimpaction
(why is it always when you’re ready to leave??)
a n
u s
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e t s
a t v
c
@
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2021‐04‐12
A better way!
a n
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@
Laxative trickle-feeding
Dr. Tony Carr
Western College of Veterinary Medicine,
University of Saskatchewan
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2021‐04‐12
Colonoscopy or laxative solution
intended for acute treatment
Polyethylene glycol 3350
(macrogol)
Sodium bicarbonate
sodium chloride
n
potassium chloride
a
Brand names:
s
Golytely, Colyte, Movicol
t s u
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a t v
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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
a n
u s
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e t s
a t v
c
@
Pre-treatment
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8 hours later
a n
u s
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e t s
a t v
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@ Everybody
poops better
at home!
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Pre-treatment
a n
u s
t s
Hannah Vds, Facebook Feline Veterinary Medicine Group
e
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a t v
c
@
Hannah Vds, Facebook Feline Veterinary Medicine Group
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a n
s
7 hours later
t s u
Hannah Vds, Facebook Feline Veterinary Medicine Group
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a t v
c Long term management
@
Identify &
manage
concurrent
diseases
Hydration Dietary
therapy
Prokinetics,
laxatives
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Hydration
• Wet food
• Flavoured water
• Bottled/filtered water
n
• More water bowls
• Subcutaneous fluids if appropriate
s a
t s u
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a t v
c Dietary therapy
@
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
n
• Lactulose • Cisapride
• PEG3350 (macrogol) • Metabolized in liver
a
without electrolytes by cytochrome P450
u s
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e t s
a t v
c
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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a n
u s
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e t s
a t v
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@
catvet@vin.com
@catvetsusan
@purrpodcast
purrpodcast.net
bit.ly/CatBites
drsusanlittle.net
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