Litter box habits are not the most pleasant discussion topic, but they are an important part of keeping your cat comfortable and happy. Many owners don’t know what is normal and what is not when it comes to kitty outputs. Problems with elimination are probably the second or third most common problems we treat in feline medicine. Most healthy adult cats urinate twice daily and defecate once daily, and deviations from this pattern should raise some concern.
Bugsie is a 12-year-old cat who was brought to my clinic for issues with defecating out of the litter box every few days. On his examination he was found to have a large amount of firm stool in his colon, and his back end seemed sensitive. In discussing Bugsie’s problem with his owner, it seemed like Bugsie was having some issues with arthritis and having a hard time posturing correctly in the litter box. He was only defecating once every couple of days. We took some x-rays and found that Bugsie had some arthritis in his back and hips. As part of his workup, we also performed some lab tests to see if there were any other internal problems that could lead to constipation. Fortunately, Bugsie’s lab work all looked good.
Overall, Bugsie was healthy so I felt confident that if we could control pain from arthritis, offer him a litter box that was easier to use, and treat him with some stool softener, we could solve his problem of defecating out of the box. Initially I started Bugsie with some pain reliever called buprenorphine. He was given an injection and sent home with a transdermal gel that his owner could apply inside his ears. He was also given some oral anti-inflammatory medication. I recommended that his owner get a larger litter box with shorter sides, so that it would be easier for him to get in and out. The ideal size of a cat litter box is 1.5 times the cat’s body length, and unfortunately most litter boxes are much smaller than this. His owner was able to find a plastic sweater box that worked. Finally I recommended that Bugsie start taking over-the-counter human Miralax daily.
Miralax has been studied in cats and found to be superior to just about any other stool softener available. We used to use a sticky syrup called lactulose with our patients but have converted almost all cats to Miralax. Miralax (or a generic polyethylene glycol equivalent) is easily mixed into canned food and very rarely refused by cats. It can be mixed with water and given orally as a suspension, but this is messier. Dosing Miralax is not an exact science – the goal is to increase or decrease the dose in order to achieve a soft but formed stool at least every other day. Most cats need about ¼ teaspoon daily, but some need ½ teaspoon or more twice daily.
The recommended treatments are working wonders for Bugsie. He returned to regular litter box use and is more comfortable. Once his stools were softer, he needed less pain medication. He will need treatment for the rest of his life. He is a happy boy because he really enjoys canned food and now he gets to eat a bit more in order to take his Miralax. Increasing canned food intake is another way to help constipation, since it also increases overall water intake (canned food is about 70 percent water). If you have a cat with defecation problems, be sure to consult with your veterinarian. Often owners think this is just bad behavior, but in many cases the cause is medical and can be easily treated.
Written by Dr. Wexler-Mitchell of The Cat Care Clinic in Orange, CA
Copyright © 2012 The Cat Care Clinic
