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when management with diet and laxatives fails. Early use of cisapride is likely to prevent the progression of constipation to obstipation and dilated megacolon in these cats. However, some cases become refractory to conservative treatment and slowly progress to obstipation and dilated megacolon.
When treating a constipated cat, enemas should be injected slowly, as rapid administration may cause
reflex vomiting and rapid and excessive efflux of
the liquid, and may also increase the risk of colonic perforation. If several enemas fail to induce defecation, nasoesophageal administration of polyethylene glycol (PEG) 3350. PEG 3350 is an osmotic laxative that has been shown to be safe and palatable in cats. It can be administered to constipated or obstipated cats through a nasoesophageal tube as a CRI at a rate between 6 and 10 ml/kg/h. In a recent study, the mean total dose required was 80 ml/kg (range 40–156), and defecation occurred on average 8 hours after initiation of treatment (range 5–24). The technique has considerably decreased the need for enemas in feline practice, and the number of cases that need to undergo manual extraction of feces, a technique used when all other options have failed. Manual extraction is best performed on an anesthetized cat with careful transabdominal colonic massage and simultaneous rectal administration of a combination of warm water or physiologic saline with water-soluble lubricants to break down the impacted feces. Some authors recommend administering a low dose of metronidazole (7.5–15 mg/kg PO q12h) in order to limit the risk of bacterial translocation during or after the procedure.
A surgical approach is the last option for severe cases with obstipation or megacolon that does not respond to the conservative treatments options. Different techniques for colectomy have been successful.
PROGNOSIS
Many cats have one or two episodes of constipation without further recurrence, although others may progress to complete colonic failure. When conservative management has failed, colectomy is usually associated with a favorable prognosis, although mild to moderate diarrhea may persist for 4–6 weeks postoperatively in some cases.
FURTHER READING
1. Carr AP, Gaunt MC. Constipation resolution with administration of polyethylene-glycol solution in cats. J Vet Intern Med 2010; 24:723 [abstract] (Open access)
2. Gaschen F. Disorders of esophageal, gastric and intestinal motility in cats. In Little SE (Ed.): August’s Consultation in Feline Medicine, vol. 7. 2016. Elsevier, St. Louis, MO.
3. Washabau RJ. Colonic dysmotility. In Washabau RJ, Day MJ (Eds.): Canine and Feline Gastroenterology. 2013. Elsevier, St. Louis, MO
An Urban Experience
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