DIAGNOSING CONSTIPATION,
OBSTIPATION, & MEGACOLON IN CATS
Glenn A. Olah, DVM, PhD, DABVP (Feline)
Winn Feline Foundation
Albuquerque Cat Clinic
Albuquerque, New Mexico
TENESMUS & DYSCHEZIA EVIDENT
INVESTIGATION
Obtain signalment and history and conduct physical examination, including:
h
U rination and defecation habits, including potential decrease in stool or urine output
h
H istory of dysuria, stranguria, hematuria, or periuria
h History of vomiting
h
A bdominal palpation (hard stool in colon, urinary bladder size and turgidity)
h Painful bladder
h Protrusion of tissue at the rectum
h Rectal or penile discharge
h
Penile tip discoloration (eg, dark red) and/or small crystalline grain present
Urogenital disease suspected First episode of constipation suspected Recurrent episode of constipation suspected
Diagnostics pursued to determine cause?
YES NO
INVESTIGATION Make diagnosis based on TREATMENT
Obtain minimum database, including: diagnostic test results h
R ehydration (SC or IV) to
h CBC correct deficit and provide
h Serum chemistry profile maintenance
h
Total thyroxine (in patients >7 years of h ± enema
age) •A void sodium phosphate
h FeLV/FIV status enemas due to potential
h Urinalysis ± urine culture
DIAGNOSIS DIAGNOSIS life-threatening electrolyte
h Abdominal ± pelvic diagnostic imaging imbalance
Urogenital disease Constipation, with
h ± rectal examination (under sedation) h •W arm water (5-10 mL/kg)
F eline idiopathic potential progression
h
± orthopedic examination with lubricant gel (5-10
cystitis to obstipation and
h ± neurologic examination h mL/cat), DSS (5-10 mL/cat),
U rogenital neoplasia megacolon
h
U rethral obstruction or lactulose (5-10 mL/cat)
h UTI is recommended
h Urolithiasis h
± polyethylene glycol 3350
h
P rostatic disease (rare) solution
•T rickle via NE tube (6-10
mL/kg/hr)
•D efecation usually occurs in
6-12 hours (median, ≈8 hr)
DSS = dioctyl sodium sulfosuccinate TREATMENT h ± removal of impaction
Treat appropriately for concurrent h
± treatment of any other
FeLV = feline leukemia virus diseases and/or urogenital disease concurrent diseases
FIV = feline immunodeficiency virus
NE = nasoesophageal
18 cliniciansbrief.com September 2018
, DIAGNOSTIC/MANAGEMENT TREE h FELINE MEDICINE h PEER REVIEWED
Bowel movement within 24 hours of treatment?
YES NO
TREATMENT
Repeat therapy
h
R ehydration
h
E nema (see previous page)
h
Manual deobstipation under
anesthesia
h
Treatment of any other concurrent
diseases
TREATMENT
L ong-term management
h Maintain hydration
h A djust diet to canned foods with water or low-residue or psyllium-enriched diets
h P reventive laxative (psyllium, wheat bran, pumpkin, polyethylene glycol 3350, lactulose)
h ± prokinetic agents (eg, cisapride, mosapride, tegaserod, prucalopride)
Patient refractory to medical or dietary management?
YES NO
INVESTIGATION TREATMENT
Repeat or conduct physical Continue medical
examination and minimum database management
as needed
DIAGNOSIS
Constipation, with potential progression
to obstipation and megacolon
TREATMENT
To determine cause and
treatment, proceed to next page
September 2018 cliniciansbrief.com 19
OBSTIPATION, & MEGACOLON IN CATS
Glenn A. Olah, DVM, PhD, DABVP (Feline)
Winn Feline Foundation
Albuquerque Cat Clinic
Albuquerque, New Mexico
TENESMUS & DYSCHEZIA EVIDENT
INVESTIGATION
Obtain signalment and history and conduct physical examination, including:
h
U rination and defecation habits, including potential decrease in stool or urine output
h
H istory of dysuria, stranguria, hematuria, or periuria
h History of vomiting
h
A bdominal palpation (hard stool in colon, urinary bladder size and turgidity)
h Painful bladder
h Protrusion of tissue at the rectum
h Rectal or penile discharge
h
Penile tip discoloration (eg, dark red) and/or small crystalline grain present
Urogenital disease suspected First episode of constipation suspected Recurrent episode of constipation suspected
Diagnostics pursued to determine cause?
YES NO
INVESTIGATION Make diagnosis based on TREATMENT
Obtain minimum database, including: diagnostic test results h
R ehydration (SC or IV) to
h CBC correct deficit and provide
h Serum chemistry profile maintenance
h
Total thyroxine (in patients >7 years of h ± enema
age) •A void sodium phosphate
h FeLV/FIV status enemas due to potential
h Urinalysis ± urine culture
DIAGNOSIS DIAGNOSIS life-threatening electrolyte
h Abdominal ± pelvic diagnostic imaging imbalance
Urogenital disease Constipation, with
h ± rectal examination (under sedation) h •W arm water (5-10 mL/kg)
F eline idiopathic potential progression
h
± orthopedic examination with lubricant gel (5-10
cystitis to obstipation and
h ± neurologic examination h mL/cat), DSS (5-10 mL/cat),
U rogenital neoplasia megacolon
h
U rethral obstruction or lactulose (5-10 mL/cat)
h UTI is recommended
h Urolithiasis h
± polyethylene glycol 3350
h
P rostatic disease (rare) solution
•T rickle via NE tube (6-10
mL/kg/hr)
•D efecation usually occurs in
6-12 hours (median, ≈8 hr)
DSS = dioctyl sodium sulfosuccinate TREATMENT h ± removal of impaction
Treat appropriately for concurrent h
± treatment of any other
FeLV = feline leukemia virus diseases and/or urogenital disease concurrent diseases
FIV = feline immunodeficiency virus
NE = nasoesophageal
18 cliniciansbrief.com September 2018
, DIAGNOSTIC/MANAGEMENT TREE h FELINE MEDICINE h PEER REVIEWED
Bowel movement within 24 hours of treatment?
YES NO
TREATMENT
Repeat therapy
h
R ehydration
h
E nema (see previous page)
h
Manual deobstipation under
anesthesia
h
Treatment of any other concurrent
diseases
TREATMENT
L ong-term management
h Maintain hydration
h A djust diet to canned foods with water or low-residue or psyllium-enriched diets
h P reventive laxative (psyllium, wheat bran, pumpkin, polyethylene glycol 3350, lactulose)
h ± prokinetic agents (eg, cisapride, mosapride, tegaserod, prucalopride)
Patient refractory to medical or dietary management?
YES NO
INVESTIGATION TREATMENT
Repeat or conduct physical Continue medical
examination and minimum database management
as needed
DIAGNOSIS
Constipation, with potential progression
to obstipation and megacolon
TREATMENT
To determine cause and
treatment, proceed to next page
September 2018 cliniciansbrief.com 19
