Constipation, Miralax & Pumpkin ... oh my! Need guidance.

Petie (still OTJ) recently had to visit the vet for an enema due to some bad constipation. His stool was very hard, but it only took one try to get it out (X-ray confirmed). My vet prescribed Miralax, and I've read about it on the boards so I was good with it. I haven't had good luck with Benefiber or pumpkin, seems to make him worse instead of better. I started with the vet's recommendation of 1/8 tsp. BID. I put it in his food (Wellness wet) over four meals a day. The first day he was back, a little BM ... next evening, poop fest. He was back and forth to both boxes, this time with the opposite problem. Made himself throw up once. (Can I pause to say that it totally freaked me out that neither the vet nor the tech seemed to know/understand that straining or constant pooping will cause many cats ... and some people!... to throw up?) I had to call an emergency vet and they said to stop the Miralax until the next day. I did, he kept pooping for a while, normal the next morning. That was yesterday ... called my regular vet today and got a big lecture about how ... "he will need that every day for the rest of his life! Why would you stop it? What are you doing? If it happens again, that's big trouble!" !!!!

Now, I'm totally freaked out. You guys have always worked out better for me than my vet, sadly, so I'm wondering what your thoughts on this. Too much is obviously not good, neither is not enough. How do I work out the dose? How long do I wait until I change the dose, and how do I change it? If I was already adding food to Petie's food prior to the Miralax, do I need to add even more? How much pooping is enough? Once a day, every other day, twice a day?

I think his blood sugar may be up a little, but I just ran out of strips. He's not drinking water (in fact, since he's been on Wellness and regulated, he doesn't even drink from the water dish ... neither does my littlest who is on the same diet), his coat is good, no excessive peeing. He just seems ... a little sluggish, not quite himself. I can't get strips for a while, but he has not had a diabetic number in a year & a half. He could just be not feeling good with all this pooping/not pooping/enema business, right? I know I wouldn't be myself.

Thank you!

 

I think you should go back on Miralax but drcrease the dose A LOT. Go to 0.2ml BID. Then, go up from there. Miralax takes titrating. You give "to effect".

Ideal poop-frequency is daily but (like people!), some cats don't go that much (or go more). He needs to poop enough so that he is comfortable but not straining.

Good luck!

 

The Miralax that we use is a powder and Skip gets 1/4 tsp BID. She gets 3 meals and I only dose 2 of them.
I would try reducing your boy's dose. It may take some trial and error to get the right dose; but he will be happier when you do.

 

Not very well organized, but ...

IIRC, it generally takes 48 hours for stuff to make it's way through the digestive tract in normal conditions, which is what I use in adjusting doses of stomach-affecting drugs.

I think it's Bed, Bath and Beyond or something similar, where you can find measuring spoons with 1/16 tsp and maybe also 1/32 tsp. Or just grab a pinch of Miralax between your thumbs and add it that way.

If you actually are using both pumpkin and Miralax, I'd try cutting back to just one or the other, not both, and see if that helps.

Did you remember to add water to the food when you added the Miralax? 'cause Miralax needs water to work properly. And it's possible that Petie just needs some extra water to get things going and don't actually need Miralax.

And speaking of water ... this seems to be a new problem, so -- how old is Petie? And have his kidney values been checked recently? Because a lot of older cats have reduced kidney function (half are diagnosed before 9 years old, half after). Kidney function can cause varying levels of dehydration, and any amount of dehydration can contribute to constipation. So, for any older cat who has new problems with constipation, I generally recommend that they get a kidney panel done. If Petie does have kidney problems, you can make sure you add extra water to his food for now and see how that helps both his kidney values and his constipation. If it doesn't help enough, you might talk with your vet about some supportive kidney treatment (potassium, whatever) that will help his kidneys operate better, or possibly talk about the risks/benefits of starting sub-Q fluids earlier than normal.

 

The Miralax won't work without water so you're going to have to make his meals into soup. Lucy gets 1/8 tsp once a day. Constipation is not a problem, although occasionally she will get some mild diarrhea.

 

If Petie is throwing up because he is straining to poop, he does not need a dose reduction. Is he having diarrhea? That would be the only reason to decrease the dose. Its possible that there was a lot of poo backed up and after the enema, now its working itself out.

The goal is to get the poo soft enough to make it easier to pass, so that he isnt straining so much. Merlyn vomited a lot after/during trying to poo.. and I would increase a bit. He was getting 1/8th teaspoon 2x a day.

Adding water is a must, and you do have to keep it up. I didnt keep up with my foster Monkeys Miralax when I brought her back to the shelter and she had some major constipation and discomfort because I didnt think to tell the vets she was getting it at my house.

 

Yes, he was having diarrhea, but I stopped the Miralax for a few meals and he stopped (he still got a good dose for the day, just a break from each meal). I think the enema continued to work after a while, even though the x-ray showed he was no longer really backed up. He hasn't thrown up at all today, and he's not constantly back and forth between cat boxes. I always added water, just wasn't sure if I needed a little more ... but I have added a little more anyway.

I am having a hard time monitoring how much he goes and how normal they are because I can't always catch him. My concern is that he still is not quite himself. He seems tired and sluggish, even a little lethargic, with a few play breaks. He doesn't seem to feel good.

No fever, no excessive thirst, eyes clear, coat shiny, appetite great - but not excessive. Vet said he could just feel a little icky right now because the constipation/enema process puts a lot of chemicals in the system. He even had a kitty acne outbreak that is now getting better (he never had it before). Thoughts?