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An occasional
episode of constipation is not cause for alarm. Stools seem
unusually hard. There is unproductive straining. Veterinary
assistance may or may not be needed. Here is what you need to
know:
- Straining unproductively can be a
symptom of either constipation or large intestinal diarrhea.
In either case, small amounts of mucous, gooey, or even
blood tinged stool can be passed and there is a lot of
pushing involved. Difficulty urinating can also appear as
straining. The point is that if all you have noticed is
straining, it may not be constipation. Straining to urinate
is often an emergency situation so if there is any question
about the pet’s ability to urinate, see the veterinarian
right away.
- It may be tempting to buy a
commercially prepared enema at the drug store and attempt to
relieve the pet’s problem at home. Some commercially
prepared products are toxic to pets so it is important that
human constipation products, be they enemas or laxatives,
not be used in pets without specific veterinary instruction.
Why do Pets get
Constipated?
Simple constipation can be caused by any number of reasons. Some
animals excessively groom themselves (especially if they are
itchy) and find themselves passing stools containing large
amounts of hair. This is not an uncommon cause for constipation
and often treatment for the excessive grooming is helpful.
Some animals,
especially dogs, get in the habit of eating gravel, stones,
dirt, bones, or plants. This does not usually indicate a dietary
deficiency as many owners suspect, though we do not have a good
explanation for this unusual dietary behavior. Stools produced
can be sharp or painful to pass, often leading to straining and
discomfort.
Some medications can
have constipation as a side effect (sucralfate,
codeine).
An important
potential cause of constipation to check for is an electrolyte
imbalance, especially in an older pet. This may be the only
noticeable sign of an important metabolic problem such as
kidney failure. If the constipation has been a recurring
problem, then blood tests, stool tests and radiographs become
very important..
An internal
obstruction may be causing the problem. For example, animals hit
by cars often suffer a fractured pelvis. These may heal without
surgery but can heal such that the pelvic canal through which
stool must pass is narrowed. Constipation may not result for
years after the initial trauma. An old fracture is generally
obvious with a radiograph of the abdomen.
Alternatively, an
enlarged prostate gland is a common feature of the older male
dog. The gland sits just below the colon and can press on the
colon serving to narrow it. Neutering usually solves this
problem, though sometimes something more serious like a prostate
tumor is present. An enlarged prostate is often palpable
rectally though the size of the prostate is better assessed with
a radiograph.
Treatment for
Simple Constipation:
Simple isolated
episodes of constipation are easily treated with a DSS, soap and
water, or K-Y jelly based enema. It is important to appreciate
that pets do not take kindly to enemas and this kind of a
procedure should not be attempted at home. It invites bites
and scratches, especially if the patient is uncomfortable to
begin with, plus it is a very messy undertaking. Most often,
sedation will be necessary to perform and enema and thus this
procedure is best left to an experienced professional staff.
A short course of
medication may be prescribed. This might be stool softener such
as, lactulose, or DSS or it might be a medication to increase
the normal motility (contractile strength) of the large
intestine such as cisapride or bisacodyl.
An old fashioned
remedy has been the oral administration of mineral oil. It is
best to avoid this temptation, as mineral oil, being a light
fluid without flavor, is easily inhaled accidentally into the
respiratory tract. Since it is a mineral based compound, the
body cannot ever remove it and the immune system will forever
attempt to wall it off with inflammatory granulomas.
For a single episode
of constipation, a diet change may or may be recommended. There
are two approaches that are commonly employed in this regard.
The first is the addition of fiber to the diet. Fiber is not
absorbed by the patient’s intestinal tract and passes to the
colon where it contributes to the stool volume. The result is a
larger, more bulky stool which, when passed, provides stronger
sensory stimulation to the colon than a regular stool. This
increased stimulation may result in better colon motility. This
type of diet change is achieved most easily by switching to a
prescription high fiber diet such as Hills’ W/D diet. If this is
not acceptable to the pet, fiber may be added to the regular
diet in the form of:
- Canned pumpkin
- Bran cereal
- Metamucil, Konsil, Siblin or similar
product
Your veterinarian
can instruct you as to how much you should add.
The second theory of
dietary management is that the colon would perform better with a
smaller stool. In this case, a low residue, high digestibility
diet is used. With such a diet, the patient absorbs a greater
amount of nutrients and there is less undigested material
passing to the colon to contribute to the fecal mass. Such diets
are also prescription. An example would be Hills’ I/D diet.
Recurring
Constipation
In recurring constipation, the same treatment methods as listed
above are employed but on a more long term basis. Enemas may
have to be used more frequently and medications/diet changes may
represent permanent management methods. The labwork database and
the abdominal radiographs become especially important.
Some additional
comments regarding the long term use of the above methods:
- Lactulose is a very effective stool
softener, but it is a thick, sweet liquid and many animals
find its taste objectionable. This frequently leads to the
drooling out of medicine into the fur of the chin and ruff.
This may become a grooming or cosmetic problem
- Bisacodyl works by stimulating the
pelvic nerves to increase the motility of the colon. It has
been suggested that this kind of nerve stimulation should
not be done indefinitely thus this medication typically is
recommended in a finite course.
- Cisapride has a very broad dose range
depending on individual response. Often a more conservative
dose is selected to start. If this does not appear to be
effective, there is a good chance that there is room to
increase the dose. Do not change a drug dose on your own!
If you think the cisapride dose you have been using is
ineffective, notify your veterinarian and ask if a higher
dose might be a good idea.
- While neutering usually resolves most
enlarged prostate problems, an old pelvic fracture may or
may not necessarily be helped by surgically repairing the
bones. If the above medical management is not effective, the
subtotal colectomy (see below) may become needed.
Constipation vs.
Obstipation
When constipation becomes a more permanent and continuous
problem, it is more correct to use the term obstipation. Here,
the patient is unable to effectively or completely empty the
colon on his/her own. The obstipated colon is dilated and packed
with a rock hard enormous burden of feces. The patient is
usually quite uncomfortable, with more frequent unproductive
straining, lethargy, appetite loss, and even vomiting entering
the picture.
Usually the only way
to relieve this is through a more complete de-obstipation
process, which frequently necessitates general anesthesia. The
patient is hydrated with intravenous fluid which helps to soften
the stool and correct electrolye imbalances. After this, the
patient is anesthetized and the fecal mass is milked from the
colon by hand. If the colon is severely “backed up” often a
single procedure is incompletely effective as some of the higher
stool may not be accessible at the time of the procedure.
There is no way to
predict the frequency with which this procedure must be
performed in a given individual; one must simply judge the
patient’s discomfort to determine this.
Subtotal Colectomy
A permanent resolution of this problem can be achieved by
surgically removing the diseased colon. This generally
eliminates the need for any stools softeners, pills, enemas etc.
and the patient can resume a “low maintenance” lifestyle. A
looser consistency stool replaces the constipation and, though
sometimes this firms up into a more normal consistency stool
after a couple of months, it is important for an owner expect
this change to be permanent. Patients appear much more
comfortable with this new arrangement and most owners are so
satisfied with results as to wish they had pursued surgical
treatment sooner.
Still, it is
important to realize that the subtotal colectomy is a major
surgery and there are special problems to be concerned about:
- The colon’s bacterial population is
enormous (some ten times higher than the population of the
small intestine). This introduces special concern for any
leaking from the intestinal incision. Infection could easily
progress to peritonitis and become a lethal complication.
This is by no means a common problem but it is important to
report any post-operative lethargy or appetite issues
immediately, especially if the patient had appeared to be
stabilizing and the change is sudden. Leaking after
intestinal surgery generally occurs around the third day
after surgery if it is going to occur. Fever is a sign of
infection but it is best not to attempt to take a rectal
temperature at home given the proximity of the colon
incision. Your cat will probably be going home on
antibiotics.
- Special diets are often recommended
during the recovery period (usually something highly
digestable to minimize the amount of stool produced). The
20% of cats who have persistent loose stool problems
generally must stay on this diet permanently.
- It is not unusual for a patient to
refuse food for several days after surgery. The cat must not
be allowed to go without food for more than 5 days without
some kind of nutritional support. This may require force
feeding or feeding through a special feeding tube.
- Scarring of the surgery site
(stricture) may lead to narrowing of the bowel and
recurrence of the obstipation. If this occurs a second
surgery would be necessary to remove the narrowed area.
Most cats do not
experience complications with this surgery beyond the initial
loose stool mentioned. Results are described as good to
excellent.
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