Case study: Cat eating less, confused and incontinent — what's going on?
photo by owner
Flossie's owners were concerned about their beloved 17 year old cat. She'd been diagnosed with early kidney disease last year, and they'd watched her slowly decline since then. She was eating less, losing weight, and vomiting occasionally. She also appeared confused and incontinent, dropping small bits of stool around the house, something she'd never done before. It was reasonable to assume that Flossie's condition might be terminal, and they opted for a house call consultation, hoping to spare her any more distress.
On exam, Flossie was thin and mildly dehydrated, but, most significantly, had what appeared to be a large mass in her abdomen. I knew from experience that this wasn't a mass at all, but a dramatically distended colon, filled with fecal matter. Way beyond constipation, this condition is called obstipation, and results when the colon mysteriously stops contracting. In what amounts to a downward spiral, when the colon doesn't contract and expel fecal waste, it gets distended, further damaging mucosal contractility. Eventually, we get a condition called megacolon, where the distended colon is simply a tube where fecal material accumulates, and has to be manually evacuated, or worse, surgically removed. Fecal material is dropped out without control when the colon is just too full to hold any more.
You can imagine the kind of discomfort megacolon produces. Many of these cats are vocalizing with distress, straining, eating poorly, depressed, vomiting, and generally miserable. It is not really clear what causes this condition, and it can be frustrating, time consuming, and expensive to treat. Early intervention is crucial to success.
In Flossie's case, her alert owners caught the condition early on. When a geriatric blood panel showed her kidneys were working well, we instituted a treatment of subcutaneous fluids, a low residue (less waste) diet, and some medications that help the colon to contract, as well as medications that soften the stool and make it easier to pass. Because Flossie is not a cooperative pill taker, we ordered the medications in a transdermal gel, which delivers the medication through the skin, much less stressful for the cat and her owners.
Today, Flossie is passing stool on her own, in the litterbox, and loving her new all meat diet. Her owners report that she is back to her old self,gaining weight, and returning to a vibrant presence in their household.
Even cats of an advanced age can have treatable medical conditions, and Flossie reminds us that our assumptions aren't always correct. Geriatric medicine is centered around comfort care, and Flossie was a particularly satisfying case. If you have an older cat whose behaviour is worrying you, don't hesitate to contact your veterinarian. Based on a physical exam and laboratory work, your veterinarian can help advise you on how to maintain quality of life for your elderly friend.
Dr. Cathy Theisen is a house call veterinarian in Ann Arbor, with 24 years experience in small animal medicine and surgery. Visit her Web site at www.cathythevet.net, or e-mail questions/comments to firstname.lastname@example.org.