1. Feline Defecation
Dr. Serena Mills

2. Terms Diarrhea Constipation Obstipation Megacolon
The passing of loose or liquid stool, more often than normal.
Constipation
The infrequent or difficult evacuation of feces, which are typically dry and hard. 
Obstipation
Inability to evacuate the mass of dry, hard feces
Impaction extending from the rectum to the ileocolic valve can result. 
Megacolon
A pathologic condition of hypomotility and dilation of the large intestine that results in constipation and obstipation
Generalized dysfunction of colonic smooth muscle

3. The four C’s of Poop COLOR CONSISTENCY COATING CONTENTS
Happy healthy color = chocolate brown
Comes from bilirubin, a pigment in bile, from the gallbladder that is used to help digest food
Red = bleeding large intestine or rectum
Tarry black/maroon = bleeding in stomach or small intestine
Clay/pale yellow = problem with liver, gallbladder, or pancreas
CONSISTENCY
Fecal scoring system (next page)
COATING
Happy healthy coating = none
Mucus coating = large intestine problem
CONTENTS
Worms
Excessive grass
Hair
Etc.

4. Note that everything else we monitor at OHS uses a 1-4 scale and this is a 1-7 scale

5. What’s in a fecal?
Normal to have some bacteria in poop! Clostridium is not normal. Neutrophils are not normal.

6. Causes for diarrhea… Diet Infections Other Parasites Allergy (S)
Viral (S)
IBD (S/L)
Rapid change (S)
Panleukopenia
SIBO (S)
Poor quality food (S)
Coronavirus
Lymphoma (S/L)
FeLV/FIV
Parasites
Liver disease
Bacterial (S)
Hyperthyroidism
Roundworms (S)
Salmonella
Renal disease
Hookworms (S)
Clostridium
Pancreatic disease
Tapeworms (S)
E-coli
Stress (L)
Whipworms (L)
Campylobactor
Coccidia/giardia (S)
S = small intestinal diarrhea
L = Large intestinal diarrhea
IBD = inflammatory bowel disease (allergic to component of food, bacteria, or parasite)
SIBO = small intestinal bacterial overgrowth (overgrowth of normal bacteria)

7. Small Intestinal diarrhea
Large intestinal diarrhea
-Large amount of stool
-Small amounts of stool
-Increased frequency (3-5 x per day)
-Increased frequency (>5 x per day)
-No straining/difficulty passing stool
-Yes straining/difficulty
-May vomit and lose weight
-Does not usually vomit or lose weight
-Excess gas production sometimes seen
-May be slimy w/mucus
-If blood in stool = digested and black in color
-If blood in stool = red in color

8. History and r/o other causes
Most at risk
Diagnosis
Treatment
Diet change
Any
History and r/o other causes
Bland diet and then slowly back to normal diet
Food allergy
Food trial/elimination diet
Feed appropriate diet
Worms
Kittens
Fecal flotation
Pyrantel or droncit
Coccidia
Kittens + immunosuppressed
Marquis paste
Giardia
Fecal float + microscopic exam of feces +/- ELISA
Metronidazole (25mg/kg)
Bacterial infection
Microscopic slide exam of feces
Antibiotics
Panleukopenia
CBC and parvo snap test
Supportive care and antibiotics
FeLV/FIV
Outdoor cats/kittens
Snap test and r/o other causes
Supportive care
(poor prognosis)
IBD
Middle-age cats
Can occur in kittens
Biopsy and r/o other causes
Modify diet, probiotics, canned pumpkin,
Metronidazole (15mg/kg), prednisolone
SIBO
Biopsy +/- GI panel (folate/cobalamin)
Antibiotics, modify diet, give vitamin B12 injection
Note the 2 different doses of metronidazole

9. A few notes on diet…
Beef, wheat, and corn are the top 3 allergens for cats
Cats with IBD
Highly digestible (Hill's i/d, Iams Low Residue, Royal Canin GAstrointestinal, Purina EN, canned and dry) 
Cats with food allergy or IBD
Highly digestible + novel ingredients (Hills d/d, Royal Canin select protein) 
Highly digestible + hydrolyzed protein sources (Hill's z/d, Royal Canin HP, Purina HA) 
Cats with large intestinal diarrhea
High fiber (Hills w/d, Royal Canin GI fiber response).
High fiber diets are usually low on energy density, so cat might lose weight because the effect on the diarrhea is only cosmetic or because it cannot eat enough
Why don’t we do more diet trials in the shelter?
Inconsistent supply of food
Treats
Rapid adoption rate

10. Causes for constipation…
Diet
Behavioral
Other
Excessive fiber
Change in routine
Hypercalcemia
Ingestion of hair
“Bad box”
Hypokalemia
Obstruction
Inactivity
Nerve damage
Pain
Obesity
Perineal hernia
Stress
Dehydration (renal dz)
Foreign body
Drugs
Megacolon
Tumor
Pelvic fracture
Abscess
Opiates (buprenorphine)
Stricture
Sucralfate
*Note: typical feline patient is middle-age and male

11. A note on radiographs…
Colon >1.5x length of L7 = megacolon

12. Why is constipation a problem?
Job of large intestine/colon and rectum = reabsorb excess water, collect and retain feces in preparation for defecation
If fecal material is not passed it becomes extremely desiccated (dried out) making it even more difficult to pass
Can lead to megacolon
Decrease in peristaltic contractions and smooth muscle degeneration from over distention
Often permanent
Can result in systemic toxicity
Over absorption of toxic intestinal products

13. Treatment options… Removal of impacted feces Laxitaves Prokinetics
Enema or rectal suppository
Laxitaves
Only in well hydrated cats
Lactulose, Miralax, DSS
Prokinetics
Usually only work if acute not chronic
Cisapride, ranitidine
High fiber diets (Royal Canin GI fiber response, canned pumpkin)
Canned diet (increased water intake)
Acupuncture
Megacolon – subtotal colectomy if refractory to medical or dietary therapy

14. Questions??