Simple Constipation

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:

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).

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 this kind of lab work database becomes especially important.

An internal obstruction may be causing the problem. For example, animals hit by cars often suffer a fractured pelvis. These usually 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 older male dogs. The gland sits just below the colon and can press on the colon serving to narrow it. Neutering usually solves this problem, though sometimes the problem is more serious, such as a prostate tumor. An enlarged prostate is often palpable rectally though the size of the prostate is better assessed with a radiograph.

Treatment For Simple Constipation

A short course of medication may be prescribed. This might be stool softener such as laxatone, lactulose, polyethylene glycol 3350 (Miralax®), or DSS or it might be a medication to increase the normal motility (contractile strength) of the large intestine such as cisapride or bisacodyl (Dulcolax®).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 messy undertaking. Enemas are best left to an experienced professional staff.

An old-fashioned remedy has been mineral oil taken orally (by mouth). 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, it cannot ever be removed by the body 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 not 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 one of the prescription high fiber diets formulated for this exact use; most manufacturers of therapeutic pet foods include such diets in their offerings. If this is not acceptable to the pet, fiber may be added to the regular diet in the form of:

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, a greater amount of nutrients is absorbed by the patient and there is less undigested material passing to the colon to contribute to the fecal mass. One of the problems in constipation is that stool becomes dry as water is absorbed by the colon, making the stool harder to pass. Fiber absorbs more water and exacerbates the problem. Low-residue diets help preserve fecal water.  Such diets are generally available only through your veterinarian.

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 lab work database and the abdominal radiographs become especially important.

Some additional comments regarding the long-term use of the above methods:

Constipation Vs Obstipation

Usually the only way to relieve this is through a more complete de-obstipation process, which frequently necessitates general anesthesia. The patient is hydrated, usually using fluids given under the skin and some enemas are given while the patient is awake. This helps moisten the hard fecal mass and sometimes helps with the fecal evacuation. 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 stool that is higher up may not be accessible at the time of the procedure.

When constipation becomes a more permanent and continuous problem, it is more correct to use the term obstipation. Here, patients are unable to effectively or completely empty the colon on their own (70% of affected cats are male, 30% female). The obstipated colon is dilated and packed with an enormous, rock-hard burden of feces. The patient is usually quite uncomfortable, with more frequent unproductive straining, lethargy, appetite loss, and even vomiting entering the picture. Small hard bits of stool are often found around the house as well as in the litter box. Sometimes liquid fecal secretions are passed around the hard fecal mass, leading the owner to incorrectly think the pet has diarrhea.

There is no way to predict the frequency with which this procedure must be performed in a given individual; you must simply judge the patient’s discomfort to determine this.

At some point repeated use of anesthesia may represent an undesirable expense or risk. At this point, home enemas may be reconsidered. As previously mentioned, this is a messy procedure that pets do not appreciate in the least. Your vet will need to show you the equipment and supplies as there are many different products available. The procedure will need to be done in an area that can be mopped or hosed off afterwards (an outdoor area, for example). Often the patient will require a bath afterwards. For many pet owners, this is simply not something they want to do but for some people, this can be a valuable management procedure that can save a great deal of veterinary expense.

High-fiber diets are not appropriate after a patient has progressed from simple constipation to obstipation.

Subtotal Colectomy – A Permanent Solution For Cats

For cats, a permanent resolution of this problem can be achieved by surgically removing the diseased colon though this procedure is not nearly as effective in dogs. This generally eliminates the need for any stool softeners, pills, enemas etc. and the patient can resume a low maintenance lifestyle. The constipation is replaced by a looser consistency stool 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:

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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