Dr. Enema, Your Lube is Ready

Sometimes the poo just won't come

Published: January 13, 2020
Photo courtesy of Depositphotos

If you’re finding the litterbox suddenly devoid of the usual land mines and that special earthy aroma, it’s time to pay close attention to your kitty’s hind end.

Constipation is an affliction that affects many cats at least once in their lifetime. As with humans, constipation means a cat is unable to regularly and easily empty their bowels. Depending on the diet fed, cats should typically move their bowels one or twice daily. When that process hits a standstill, stool becomes impacted and unable to move from the colon. This obstruction can be of varying degrees of severity ranging from mild to fully obstructed, of which the latter requires extensive medical care.

Some of the signs of constipation include straining while using the litter box, vocalizing while trying to go, or bloody streaks in the expelled stool. Initially, cats may still act normally when they are out of the litterbox, but as the “back up” continues, cats will often be unwell altogether. In serious cases, the feces are stuck in the colon for so long that it starts to stretch the wall; that causes bacteria to spread past the epithelium lining and shower into the blood stream. If left untreated, the cat can become sick, possibly even fatally.

Repeated and serious bouts of constipation can cause the colon to irreversibly enlarge. This results in reduced function and is seen in megacolon. Thankfully, most cases of cat constipation are mild and with veterinary assistance are relatively short lived.

What causes this condition and what can be done to prevent it?

Constipation is caused by many different factors and is most commonly seen in middle aged to senior cats. This is not to say a spry young fella can’t get bunged up in the rear end, but it is less common. One factor that can increase the likelihood of constipation are hairballs, especially in long-haired cats. Those balls can get pretty big and it’s not a stretch of the imagination to picture them blocking feces over the long term.

Trauma to the pelvis can also cause constipation by resulting in a narrowed pelvic region. Pain while posturing to poop, possibly from arthritis or anal gland disease, can make it hard to go.

Dehydration is another sneaky cause of constipation, drying out the stool and making it hard to pass the log. Picture a moist nugget in the Sahara Desert drying up. This may be associated with other problems like chronic kidney disease, hyperthyroidism, or diabetes.

Other disorders that can also lead to constipation include intestinal tumors or neurological diseases. A poor diet without adequate fiber can result in trouble in the hind end too. Remember how you were told to eat your vegetables? A balanced cat diet is similarly important to keep things moving along.

Obesity is another factor that can increase the likelihood of constipation, so it is important to keep your pet in a healthy weight range. Lastly, the ingestion of a foreign body can cause obstruction and constipation to occur.

Despite the best efforts, sometimes the poo just won’t come. If your kitty is straining, crying and not passing stool, a trip to the vet is needed. At this point, it is not a DIY kind of project. A physical exam, lab tests, and x-rays may be done to investigate the cause and confirm the diagnosis of getting bunged up in the rear end. Mild cases may not require treatment beyond dietary change or medications. Treatment of moderate to severe constipation varies and requires further medical intervention.

In most cases, an enema and some private time with a litter box is the first line of hospital treatment: “Paging Dr. Choi, the liquid is warm, and the lube is ready.” I would swap my white lab coat for a grungy old brown one, and having learned from experience, keep my mouth firmly closed. After receiving an enema – always a joyful time for all parties - the kitty is given a private bathroom and plenty of time to relax and let it flow naturally. Every piece of poo that follows is celebrated quietly as to not stress out the kitty.

In more significantly constipated cats, fluids and manual disimpaction are the next steps. Manual disimpaction is a fancy term for removing poo directly from kitty’s butt while said butt is under general anesthesia. By sheer luck of the draw, I treated several constipated kitties and earned the name of Dr. Enema by my veterinary technicians. When there was a meow of poopy agony or a hiss of hind end frustration, I would jump into action.

Dr. Enema isn’t a title I asked for or glorified in, but fate brought me to this calling. I was born with long, slender fingers that defied baby mittens. As a preschooler, those fingers gained dexterity through vigorous piano practicing. In vet school, they further increased in skill with surgery training and experience. Now, my long and slender fingers enable me to effectively relieve fecal balls gently from the rectum. Over the years, my fingers have mastered the gentle niggling dexterity necessary to coax out fecal rocks. (We all are especially good at something!) Once the boulder is removed, the cat is awakened from the anesthesia while being closely monitored, and feels much better. Rarely, in cats with severe and recurrent constipation (often a diagnosis of megacolon) a last resort procedure called a subtotal colectomy can be done by a specialist surgeon. This requires removing most of the colon to help with the symptoms, but it is associated with post-op complications, so the decision to go forward is not to be taken lightly.

Without that boulder on board, kitty feels much, much better and will go home with a new feeling of wellness and happy felininity (it’s not spelled wrong if you make it up).

It’s likely best to never to speak of what happened in front of kitty.

When kitty feels well enough to go home, there are some things you can do to minimize the chance of a repeat bout. Prevention is the best defense. Increase water intake for your feline friend by switching to a recommended canned food or by adding water to dry kibble. Place extra water bowls and increase access to litter boxes for your cat. Laxatives and fiber products may be prescribed to help soften the stool. Medications to help things move through the intestines may also be given, as well as an appetite stimulant to get things back to normal.

Finally, it is vital to reduce stress and treat any underlying conditions that may have led to the initial constipation. Hopefully these steps ensure that your cat will be purring with rectal relief for the foreseeable future.


Christy Corp-Minamiji, DVM
December 29, 2021

Hi Bonnie,  I'm sorry for the delay in responding.  It's that busy time of year!  As Dr. Choi wrote in this article, sometimes an enema just won't do the trick with a severely constipated cat.  A little bleeding can be normal secondary to manual disimpaction, just like one might find after a particularly large or firm bowel movement.  The inside of the rectum is sort of like the inside of our mouths, it can bleed pretty easily with just a little irritation.  As far as prevention goes, it all depends on the cat.  You can and should try the tips in this article, but you should also talk to your veterinarian about the best choices for your kitty.

Bonnie Smith
December 17, 2021

Hello, My cat was sedated for tests and anal gland emptying.  My vet said she found constipation and manually disimpacted him , which she said caused bleeding.  Is bleeding common?  Would an enema have been safer.  Unless he is on lactulose, he hunches and constipates.  I rather use a natural approach like pumpkin or Metamucil - which I have tried but maybe the does was too low.  What natural options do you use?  Thank you.

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