Health & Medical

A cat crouches in the tray, strains, produces a small puddle of liquid, and gets out. The owner sees wet mess in the box and concludes diarrhoea. They switch to a bland diet, maybe pick up something from the pet shop, and wait for it to settle. Meanwhile the actual problem is the exact opposite: the cat is badly constipated, and what came out was liquid squeezing past a hard blockage further up. This mix-up happens constantly, and it costs cats days of unnecessary discomfort.

Constipation in cats is not just an inconvenient week. Left alone long enough it turns into obstipation, where the cat physically cannot pass what's in there, and eventually into megacolon, where the colon stretches so far and so often that the muscle in its wall gives up and stops squeezing altogether. That last stage is permanent. Catching things before you get there is the whole game.

Here is the ordinary version of what happens. Faeces sits in the colon, which is where water gets reabsorbed from it. The longer it sits, the drier and harder it gets. The harder it gets, the more difficult it is to move, so it sits longer still. It's a loop that feeds itself, and a cat can be several days into it before the owner notices anything, because most people genuinely do not know how often their cat poos. Once a day is typical. Once every two days can be fine for some cats. Nothing for three days is a problem worth a phone call.

The signs owners do pick up are mostly indirect. Repeated trips to the tray with nothing to show for it. Straining and posturing for long stretches, sometimes with a small cry. Hard, dry little pellets found outside the box, because cats often start associating the tray itself with pain and go elsewhere. Vomiting is common and surprises people. So is a drop in appetite, hiding, and a hunched posture with a tender belly. Owners of long-haired cats sometimes notice a scruffy, unkempt coat, because a cat who feels rotten stops grooming.

One warning that cannot be repeated often enough: a male cat straining in the litter box may be blocked at the bladder rather than the bowel, and a urinary obstruction kills within a day or two. If you cannot be completely certain that urine is coming out, treat it as an emergency and go now. Vets would far rather see a constipated cat at midnight than a blocked one at nine the next morning.

As for causes, dehydration heads the list, which is why it shows up so often in cats on dry food alone and in cats with early kidney disease. Chronic kidney disease and hyperthyroidism both dry a cat out from the inside. Pain elsewhere matters enormously and gets overlooked: an arthritic cat who has to climb into a high-sided box, or an overweight cat who cannot comfortably adopt the position, will hold on rather than go. So will a cat whose tray is dirty, or in a busy corridor, or being guarded by another cat in the house. A pelvic fracture from an old road accident can narrow the canal for life. Hairballs contribute. So do foreign material, bone fragments from raw feeding, and certain medications. And in a good number of cases, particularly middle-aged males, no cause is ever found at all, which is called idiopathic megacolon.

Diagnosis usually begins with hands. A vet can often feel a firm, sausage-like colon through the abdominal wall in seconds. From there an X-ray is the standard next step, because it shows how much is impacted, how far the colon has stretched, whether there is an obstruction, and whether the pelvis is narrowed. Bloodwork checks kidney function, calcium, potassium and thyroid levels, since those either cause or complicate the problem. Some cats need an ultrasound or, less commonly, a look inside with a scope if a mass is suspected.

Treatment splits into getting them empty and keeping them empty. For the acute blockage, that usually means fluids under the skin or in a vein to rehydrate, pain relief, and one or more enemas. Never, ever give a cat an over-the-counter human enema; the phosphate kind is lethal to cats. Severe cases need sedation or a full anaesthetic so the vet can manually break down and remove the mass, occasionally over more than one session. Expect that visit to run from a couple of hundred for a straightforward case to well over a thousand if hospitalisation and repeat procedures are needed.

The long-term half is where owners do most of the work, and it works better than people expect. Water goes in first: wet food as the base of the diet, extra water stirred into it, a fountain if the cat likes moving water, several bowls around the house. Lactulose is the workhorse medication, a syrup given once or twice daily and adjusted at home until the stool is soft, and most cats tolerate it reasonably well. Some cats do better with added fibre such as psyllium, others do worse on it, and finding out which is trial and error. Cisapride, a drug that makes the colon contract properly, is prescribed for cats who need more than lubrication and can be genuinely transformative. Then the practical things: a bigger, lower-sided tray, more trays than cats, quiet locations, and proper treatment of arthritis pain, because an achy old cat who can defecate comfortably often stops being constipated entirely.

For the small group whose colon has permanently failed despite all of that, there is a surgical option called subtotal colectomy, which removes most of the colon. It sounds drastic and it is major surgery, but the results are good. Most cats end up with soft, frequent stools for a few weeks and then settle into a workable normal, and their owners generally describe it as the right decision made later than it should have been.

Prognosis for ordinary feline constipation caught early is very good. Cats managed well with diet, water and lactulose often go years without another episode. Megacolon is a lifelong management job rather than a cure, but it is a manageable one.

Go straight to an emergency vet if your cat has produced nothing for more than two days and is vomiting, if there is blood, if she is lethargic, hiding or refusing food, or if you are not certain she is passing urine. And do get a vet to actually examine a straining cat rather than treating from a description, because the difference between a constipated cat and a blocked one is not something anyone should be guessing at from the other side of the room.