Feline Defecation Dr. Serena Mills

Terms Diarrhea Constipation Obstipation Megacolon The passing of loose or liquid stool, more often than normal. Constipation The infrequent or difficult evacuation of feces, which are typically dry and hard.  Obstipation Inability to evacuate the mass of dry, hard feces Impaction extending from the rectum to the ileocolic valve can result.  Megacolon A pathologic condition of hypomotility and dilation of the large intestine that results in constipation and obstipation Generalized dysfunction of colonic smooth muscle

The four C’s of Poop COLOR CONSISTENCY COATING CONTENTS Happy healthy color = chocolate brown Comes from bilirubin, a pigment in bile, from the gallbladder that is used to help digest food Red = bleeding large intestine or rectum Tarry black/maroon = bleeding in stomach or small intestine Clay/pale yellow = problem with liver, gallbladder, or pancreas CONSISTENCY Fecal scoring system (next page) COATING Happy healthy coating = none Mucus coating = large intestine problem CONTENTS Worms Excessive grass Hair Etc.

Note that everything else we monitor at OHS uses a 1-4 scale and this is a 1-7 scale

What’s in a fecal? Normal to have some bacteria in poop! Clostridium is not normal. Neutrophils are not normal.

Causes for diarrhea… Diet Infections Other Parasites Allergy (S) Viral (S) IBD (S/L) Rapid change (S) Panleukopenia SIBO (S) Poor quality food (S) Coronavirus Lymphoma (S/L) FeLV/FIV Parasites Liver disease Bacterial (S) Hyperthyroidism Roundworms (S) Salmonella Renal disease Hookworms (S) Clostridium Pancreatic disease Tapeworms (S) E-coli Stress (L) Whipworms (L) Campylobactor Coccidia/giardia (S) S = small intestinal diarrhea L = Large intestinal diarrhea IBD = inflammatory bowel disease (allergic to component of food, bacteria, or parasite) SIBO = small intestinal bacterial overgrowth (overgrowth of normal bacteria)

Small Intestinal diarrhea Large intestinal diarrhea -Large amount of stool -Small amounts of stool -Increased frequency (3-5 x per day) -Increased frequency (>5 x per day) -No straining/difficulty passing stool -Yes straining/difficulty -May vomit and lose weight -Does not usually vomit or lose weight -Excess gas production sometimes seen -May be slimy w/mucus -If blood in stool = digested and black in color -If blood in stool = red in color

History and r/o other causes Most at risk Diagnosis Treatment Diet change Any History and r/o other causes Bland diet and then slowly back to normal diet Food allergy Food trial/elimination diet Feed appropriate diet Worms Kittens Fecal flotation Pyrantel or droncit Coccidia Kittens + immunosuppressed Marquis paste Giardia Fecal float + microscopic exam of feces +/- ELISA Metronidazole (25mg/kg) Bacterial infection Microscopic slide exam of feces Antibiotics Panleukopenia CBC and parvo snap test Supportive care and antibiotics FeLV/FIV Outdoor cats/kittens Snap test and r/o other causes Supportive care (poor prognosis) IBD Middle-age cats Can occur in kittens Biopsy and r/o other causes Modify diet, probiotics, canned pumpkin, Metronidazole (15mg/kg), prednisolone SIBO Biopsy +/- GI panel (folate/cobalamin) Antibiotics, modify diet, give vitamin B12 injection Note the 2 different doses of metronidazole

A few notes on diet… Beef, wheat, and corn are the top 3 allergens for cats Cats with IBD Highly digestible (Hill's i/d, Iams Low Residue, Royal Canin GAstrointestinal, Purina EN, canned and dry)  Cats with food allergy or IBD Highly digestible + novel ingredients (Hills d/d, Royal Canin select protein)  Highly digestible + hydrolyzed protein sources (Hill's z/d, Royal Canin HP, Purina HA)  Cats with large intestinal diarrhea High fiber (Hills w/d, Royal Canin GI fiber response). High fiber diets are usually low on energy density, so cat might lose weight because the effect on the diarrhea is only cosmetic or because it cannot eat enough Why don’t we do more diet trials in the shelter? Inconsistent supply of food Treats Rapid adoption rate

Causes for constipation… Diet Behavioral Other Excessive fiber Change in routine Hypercalcemia Ingestion of hair “Bad box” Hypokalemia Obstruction Inactivity Nerve damage Pain Obesity Perineal hernia Stress Dehydration (renal dz) Foreign body Drugs Megacolon Tumor Pelvic fracture Abscess Opiates (buprenorphine) Stricture Sucralfate *Note: typical feline patient is middle-age and male

A note on radiographs… Colon >1.5x length of L7 = megacolon

Why is constipation a problem? Job of large intestine/colon and rectum = reabsorb excess water, collect and retain feces in preparation for defecation If fecal material is not passed it becomes extremely desiccated (dried out) making it even more difficult to pass Can lead to megacolon Decrease in peristaltic contractions and smooth muscle degeneration from over distention Often permanent Can result in systemic toxicity Over absorption of toxic intestinal products

Treatment options… Removal of impacted feces Laxitaves Prokinetics Enema or rectal suppository Laxitaves Only in well hydrated cats Lactulose, Miralax, DSS Prokinetics Usually only work if acute not chronic Cisapride, ranitidine High fiber diets (Royal Canin GI fiber response, canned pumpkin) Canned diet (increased water intake) Acupuncture Megacolon – subtotal colectomy if refractory to medical or dietary therapy

Questions??