# Concern for cat - Lactulose reaction (constipation problems)



## Paisley77 (Jul 27, 2012)

HI. My kitty has had constipation problems for a while now. I've been trying different things to see if it will help, with no luck so far. He had to go in again two days ago to be cleaned out because he was backed up. The vet tech did the manual clean out of his poop, no enema (which all of it was hard with hair in it). He had liquid poop going on along with the hard stool at the time.

They started him on 2.5cc (ml?) of Lactulose twice a day and said that if it helped him that he'd be on that for the rest of his life. Since he's been home he's had diarrhea (he's never had diarrhea...only hard stool). He's also thrown up (once yesterday and once today). He's peeing fine. But today, he once again acts like he's in a trance. He was like that two days ago after we brought him home, but he had been given a pain shot (started with a B), which vet said can cause kitties to act like that for 24 hours. 

He was more himself yesterday - talking, wanting to be loved on & purring, but today he's not himself again and I'm concerned. I just read up on lactulose side effects and it makes me wonder if he's having an allergic reaction? Should I stop giving it to him? He's had 4 doses so far.


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## maggie23 (Mar 10, 2012)

we had problems with one of our "kids" being constipated all the time. she had had this problem before we adopted her as well and had enemas for it. when we adopted her, they were giving her 1 whole teaspoon of miralax and 1 whole ml of lactulose every other day with her breakfast. i thought that was a little weird (i mean, 1st of all, why not half that everyday instead to smooth things out?). so we started 'experimenting" and after a couple months of constant worry and a few trips to the vet to be have poop manually extracted and even one enema, we have her (knock on wood!) completely regular with 1/2 - 3/4 teaspoon of miralax every day. that is split up into equal doses 3X/day with her meals.

no more hard bulges in her rectum where the poop would collect and no more trips to the vet for this.

we also read bad things about lactulose due to high sugar content (?), so we really wanted to get her off of that. i haven't heard any long term bad effects with miralax, tho. good luck with yours!


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## razzle (May 20, 2010)

Geets has kidney disease which causes constipation because of the lack of enough fluids in the body even though he only eats wet food because cats with kidney disease pee a lot. I didn't do it with Razzle, I wish I had, but Geets gets 1 ml of lactulose 2 times a day. It has worked great. I take it myself because my meds cause constipation. 

Maybe you should reduce the doses and see what happens since he has diarrhea. I don't know how 2.5 cc equates to ml's but you can look up the conversion for this online. Just type in how to convert cc to ml.

It also depends on what you are feeding your cat. If it's dry food then dry food is dry and will cause constipation. Adding wet food should help but if your cat is used to dry food then add wet food gradually so he can get used to it.

If hair balls is causing constipation then giving petroleum jelly, Vaseline, will help with that problem. Not sure of how much but I would start with a dollop every other day on his paw.

Kathy


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## lovetimesfour (Dec 1, 2010)

First thing needs to be done is to find out WHY your precious boy is constipated.

What diagnostics have been done for your kitty? Has he had blood work to check his organs and thyroid and blood sugar? Urinalysis? X-ray to check for megacolon? 

What kind of diet is he on?

How old is he?

There are many alternatives to lactulose, these days. I have used it, many years ago, and won't, ever again.


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## Stryker (Apr 2, 2007)

Hi, *Paisley77*!

First, let's forget about "side effects" for now.

The amount of lactulose that's given will determine how soft the stool will be.

So, if you don't give enough....the stool will remain hard (constipation can result).

If you give "too much"....you'll get anything from very soft stool to diarrhea.

Now, wait, don't jump to any conclusion yet. MAYBE there's diarrhea because the dose is too high........but, it's also possible that he still has some stool obstruction inside - and, that could also be causing what you're seeing. Often, in obstructed cats, while the hard stool is "stuck" and blocking the road, liquid stool can find its way around the blockade and come out as diarrhea. That could be the reason you said *this*:


> *He had liquid poop going on along with the hard stool at the time*.


So: I need more info from you. (and, for now, stop the lactulose)

First, what are you feeding him?
Second, which wet foods will he eat?

I'll wait to hear back from you.


BTW - most cats who are treated for constipation will NOT need lactulose (nor any other laxative) for the rest of their lives! Was it the Vet or a Tech who told you that?


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## cat owner again (Dec 14, 2012)

How can you tell if your cat is constipated?


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## Stryker (Apr 2, 2007)

cat owner again said:


> How can you tell if your cat is constipated?


Hi there! (I've been following your saga...are you sure your door's shut?:lol

Simple answer: Know *WHAT* is in the litterbox, *WHO* dunnit and it's *CONDITION*. Second to that, know who's eating normally and who's not. Thirdly, vomiting with no sign of hair in it should, at least, suggest that there might be a blockade in there. 

There's a superb website devoted to nothing else but constipation - it's an easy read and will give you all you need to know. Here's how it starts:


> First, to ensure we are on the same page, here are several definitions and/or possible symptoms of constipation:
> 
> 
> 
> ...


If you want the free Feline Constipation 101, it's here Introduction

Hope that helps!


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## lovetimesfour (Dec 1, 2010)

I second that website. Pat is wonderful and she will gladly answer any questions you have, via e mail, besides. I bought her book in paper form too, it makes good reading.


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## Paisley77 (Jul 27, 2012)

thank you all for the responses, unfortunately I'm going to have to answer your questions later. i'm real sick at the moment and will get back to you later. thanks again.


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## Paisley77 (Jul 27, 2012)

Okay, I'm back. I was sick, but have also been working on my cat's health histories so that I can make better sense of what all has been/is going on.

First, I'll give a current update and then answer everyone's questions.

After having diarrhea for 2.5 days after he was manually cleaned out & then given lactulose, we stopped giving it to him. Unfortunately he hasn't pooped since then (it's been 3.5 days now of no poop at all - for the past month I've videotaped 24/7 my kitties litterbox activities to try to figure out how to help Munchie, so I know for sure when he's peeing & pooping, as well as the other kitties).

We had to fight to get the lactulose into him (he ended up having four 2.5ml doses total). He is very face shy when it comes to medicine. We'd get it more on his face & neck than down his mouth it seemed (very sticky stuff! even with him wrapped in a towel & two of us doing it). The morning we decided not to give him anymore, we went into the bathroom where he was being kept at the time (ie: diarrhea) and he started foaming at the mouth because he anticipated what he thought we were going to do. It was so sad! 



Answers to questions:

Munchie is 12.5 yrs old, male. He's part manx with stub tail, short-hair domestic.
He was prescribed 2.5ml of lactulose twice day by vet. It was the vet tech who told me that he'd be on it rest of his life if it worked (this was after telling me of another cat patient who was helped by it).
I'm currently feeding them Purina N/F canned food with 1/4 cup of water mixed in. No dry and haven't fed them dry since last September (before that, they were on dry for all their lives along with canned every now & then). The reason they're on this food is a long story, but to give some info about it is that I have a CRF/kidney cat (Bitsy). I'd been trying out different canned foods that they could all be on. Wellborne Core (tried 3 different flavors, which all 3 cats loved!!) made my two non-CRF cats have allergies and it caused my CRF cat to have pancreatitis and got very very sick. I was desperate to get Bitsy better. I can't even remember now what all I tried there for a while, but then finally settled on Purina N/F. Once again, the vet said it was fine for all cats to be on and since they all liked it, I've kept them on it. However, since Munchie's problems I've re-read some things (and after going thru their medical histories and tying more things together) I'm realizing that Munchie & Oliver (non-CRF) should not be on a kidney restricted diet alone. My third cat, Oliver, only has the health issue of weight loss and looks too thin (which I'm sure is due to the less protein/calories from this diet) & eye conjunctivitis that I've given steroid drops to him for yrs because of it.
As far as tests that have been done for Munchie. He got bloodwork done this past October. There were some things very slightly high (a/g ratio, hgb & eosinophil) & slightly low (lymphocytes), but vet said everything was fine.
Last week was the 3rd time he's had to be cleaned out because of constipation. The first time was Feb 2012 (enema - no megacolon from xray). Then 3 weeks ago (enema - no megacolon from xray) and then last week (manually, no xray done). Each of these times he was in very vocal pain.
Hopefully I answered your questions. I can give more info if needed. A few things that I've wondered if Munchie has working against him are:
He's part manx, and I've read that they can have some problems with pooping because of it the spine formation (his tail is stubbed, 3 inches long). Although, he went 11 yrs before having pooping/constipation issues. The first time he had to be cleaned out because of constipation was after he had been on Hill's K/D food for four months.
He has hair in his poop. He's had allergy problems for many years (although I've noticed since on this N/F diet, he hasn't had it as bad, although if it's seasonal problems then I can't base it on that). So, he grooms & licks alot. There will be times that I believe he's trying to throw up a hairball and it'll get up to his mouth but then he just swallows it again, so he rarely ever vomits them up. He won't eat hairball treats (i've tried 3 different brands so far) - he's always been very finicky on eating treats.
When he was about 2 yrs old, he broke his hip/femur after falling behind a bed and had to have FHO surgery. I don't know if that's caused problems for him in pooping as he's aged or not. But when he's straining I can tell that the hip that had surgery is positioned very awkwardly looking.
Here's some food history for my cats:

I can't remember prior to 2007, nor can I find notes or history.
From at least 2007 til Nov 2011 - Hill's M/D (weight control) DRY (along with some Science Diet chicken or turkey canned)
Nov 2011 til Sept 2012 - Hill's K/D (kidney) dry (along with some Science Diet turkey or chicken canned)
Sept-Oct 2012 - Wellborne Core canned (with 1/4 cup water mixed in - tried various others as well, but mainly fed Wellborne)
Nov 2012-present - Purina N/F canned (with 1/4 cup water mixed in)
Here's Munchie's health history (just the major issues listed - he's 12.5 yrs old):

At age 2, had to have FHO hip/femur surgery after falling behind bed. Healed perfectly, no issue.
Allergy issues for at least 6 years. Haven't been able to figure out the cause on whether it's seasonal or food related. Gets depo shots periodically to help him because he develops sores and licks away so much of his hair.
Feb 2012 - constipated (in vocal pain, straining) and got enema to be cleaned out. Xray showed no megacolon.
Mar 2012 - got anal glands expressed because straining again. bloodwork great.
May 2012 - diagnosed with bladder infection (urinating outside litterbox and urine was red). Antibiotic
June 2012 - no more infection, but had some crystals in urine. Had several urine tests.
July 2012 - more bladder issues. Blood showed he had elevated calcium & liver. Crystals in urine
Aug 2012 - acting like bladder inf again. Gave antibiotic. Did xray and has stone. <<started Hill's S/D diet for 38 days>>
Sept 2012 - another xray - stones were bigger, so I stopped feeding him S/D diet & started Wellborne Core diet <this was when I came out here for advice. >
Oct 2012 - the day he was to have stone removal surgery, they were miraculously gone (2 weeks from feeding him wellborne diet). Later that month had to stop Wellborne diet because his allergies were the worst they've been, plus Oliver developed allergies.
3/2/13 - Constipated - emerg vet clinic to clean him out (enema, xray showed no megacolon). stool full of hair. Gave him metamucil (as prescribed) for 3 days, twice a day.
3/20/13 - Constipated - manually cleaned out his stool, Buprenex inj for pain, no xray. Started 2.5 ml lactulose twice a day (only gave to him for 2.5 days). Had diarrhea & vomiting for 2 days after.
Currently - seems fine & normal, however hasn't pooped in 3.5 days.  I just found a Merrick Before-grains chicken canned food that I had left over from trying out foods last yr. Going to see if feeding him some high-protein food will help him to poop.
I don't know if I want to even think about giving him lactulose again because it just stresses him out so badly. I'm in the process of reading (the very wonderful, but very long/detailed info) from that one constipation cat website and still have about 1/4 of it to finish reading. More & more research to do. Praying for long-term solutions for my little guy, without causing other problems for the other kitties too. 

thanks again!


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## cat owner again (Dec 14, 2012)

Maybe some of this article can give you ideas to discuss with your vet.

Constipated Cats | Little Big Cat


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## lovetimesfour (Dec 1, 2010)

October is a long time ago. Things can change very quickly with a cat's health. 

I recommend you start with blood-work. 

Something is going on to cause the constipation and until you know the health status of him, there is no point in trying a million things. 

I hate lactulose for cats. Make sure, if you continue to use it, to wipe it completely off his fur, or his tongue could actually get stuck on his fur. I know this because it happened to my cat.

There are SO MANY other palliatives for constipation, but you really really need to know what's going on inside first, and that means new blood-work, and specify that the thyroid be checked, not all vets include that.


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## Stryker (Apr 2, 2007)

First off.........when I suggested stopping the lactulose, it was in the context of him having diarrhea, then being been manually cleared (although perhaps not fully), being given lactulose and, after all that... still having diarrhea.

At least, that's what I read......

I suggested two possibilities:


the dose was too high, causing the diarrhea
he might still be obstructed
Now we're 3 days later - all apparently without lactulose and it appears he may be constipated again - OR - at least, there has been no stool in those 3 days. In those 3 days, he's been eating


> Purina Veterinary Diets® NF Kidney Function® Feline Formula
> Water sufficient for processing, beef, poultry by-products, rice, meat by-products, chicken, calcium gluconate, powdered cellulose, artificial and natural flavors, guar gum, potassium citrate, potassium chloride, magnesium sulfate, Vitamin E supplement, choline chloride, taurine, carrageenan, zinc sulfate, thiamine mononitrate, calcium phosphate, ferrous sulfate, niacin, calcium pantothenate, Vitamin A supplement, copper sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), manganese sulfate, pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, potassium iodide, Vitamin D-3 supplement, sodium selenite. I-4569
> NF Kidney Function® Feline Formula | Purina Veterinary Diets


There are a few possibilities: if there is no current obstruction and, the diarrhea he had 3 days ago *was* caused by the lactulose, it might not be unusual to see no stool yet (I've witnessed this - it can take a few days to stabilize the system); it may be that the rice in that food isn't providing enough fibre; he may not have consumed enough food over the 3 days to have produced enough stool to trigger a bowel movement....or, some combination of the above.

Two questions for you:


Is he eating? (constipated cats will not eat***)
How often are you feeding and how much food does he eat?
 ***on the very first page of the Constipation website that you're going through, there is a list of symptoms - including not eating - is he displaying any of the others?

The struggle to administer the lactulose is a new factor (I presumed you mixed it into food)......this must stop, because there's a huge danger that he will aspirate it - breathe it in. That can cause disastrous lung issues.

MiraLAX is the safest alternative. It's undetectable and easily mixed in with wet foods. Read about it here: Prevention

If you want MiraLAX info from a " kidney" perspective, it's here Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Constipation

It would be comforting to know conclusively whether/not he is constipated now....but, if he is eating, I would presume him not to be, and I would probably start using the MiraLAX right away.

That said, you might want to have the Vet do a simple palpitation of his colon - then you could talk about the MiraLAX too.


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## Paisley77 (Jul 27, 2012)

Thanks Cat Owner Again for that link - hadn't seen that article for constipation yet.


Stryker - yes, he's been eating. He's never been one to eat a whole lot, he's more petite & small, but he's been eating normally since the diarrhea. I know for sure that he's eaten today because I giving him a different type of canned food to eat. 


I wonder if he didn't get completely cleaned out last Wed, especially if he had more poop sitting in the transverse colon that they couldn't feel. I've spent so much $$ over the past 2 yrs with the cats that I was trying to save some money and not have them do an xray if possible. I would have been fine with an enema & fluids, etc - but since the poop was visible they decided to manually try for it (especially since he is so well behaved as well - which I couldn't believe! that was awful to watch/hear/smell ).


As far as how often do I feed. I leave their wet food out all day long. I replenish it once to twice a day, depending on how much they've all eaten. That's 2 to 3 5.5 oz cans of food each day for 3 cats.


Not only because of him being so stressed because of administering the lactulose, I had read before about aspiration as well and was fearful of that, so that was another reason for stopping it. I had not tried mixing it with food, but I can almost guarantee that he'd smell it in it and not eat it - he's the pickiest of all my kitties on eating.


I honestly do not fear that he has an obstruction other than poop based on his history. I've been home mostly lately and would know if he had gotten into anything (which I'm careful about not leaving certain things out). 


Of the list of symptoms of constipation, I've only seen the lack of him pooping. He hasn't been walking around crying or with his tail sticking horizontal like he's done in times past. Since I'm recording their litterbox activities, I've been looking out for him to be seen straining, but he's only going to the litterbox to pee and I try to watch him when he's not sleeping to see if he's straining in other places in the house like when he's pooped outside the litterbox and haven't seen anything so far. I'm praying that it's just his body recooping from the manual extraction/pain injection/lactulose episode. But of course, there's no reason for him not to be constipated since nothing major has changed diet-wise so far, other than him getting some lactulose for a couple of days. I've still got alot to learn about this constipation issue.

I'm willing to look into Miralax - especially if I don't have to shoot it into his mouth and he can eat with food.


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