Cat Constipation - Causes, Symptoms & Treatment of Constipation with Dr. Jean Hofve

Cat Constipation - Causes, Symptoms & Treatment of Constipation with Dr. Jean Hofve

Originally published on Jul 11, 2012

God love Dr. Jean for taking the time to talk to Floppycats about Cat Constipation.

Dr. Jean’s book, The Complete Guide to Holistic Cat Care: An Illustrated Handbook, will teach you more about the holistic approach to cat health and care.

Dr. Jean also covers Constipation in Cats on her site as well.

We've now done several interviews with Dr. Jean, feel free to check any of them out:

• Cat Allergies with Dr. Jean
• Food Allergies in Cats with Dr. Jean Hofve
• Litterbox Questions with Dr. Jean
• Obesity in Cats with Dr. Jean Hofve, DVM
• Kidney Disease in Cats with Dr. Jean Hofve, DVM
• Cat Conjunctivitis and Cat Herpes with Dr. Jean Hofve
• Cat Constipation – Causes, Symptoms & Treatment of Constipation with Dr. Jean Hofve
• Feline Hyperthyroidism Interview with Dr. Jean Hofve of Little Big Cat

Interview with Dr. Jean Hofve about Cat Constipation - Causes, Symptoms & Treatment of Constipation with Dr. Jean Hofve:

You can Listen to the Podcast of Cat Constipation - Causes, Symptoms & Treatment of Constipation with Dr. Jean Hofve or read the interview below.

Or listen to it on YouTube:

Jenny: Today is May 30th and we are talking with Dr. Jean Hofve today about cat constipation.  Dr. Jean thanks again for doing another podcast interview with us.

Dr. Jean: My pleasure. It's about my favorite subject cat poop.

Jenny: I know. Everybody loves cat poop.

Dr. Jean: Well, every cat's got some.

Jenny: Yes. Well I went ahead and read the article on Little Big Cat about constipated cats that you wrote to kind of get some ideas for the interview, and I loved the Bristol Stool Chart.

Dr. Jean: Yeah, I found that a number of years ago and I thought that was the greatest thing since sliced bread. You know have you ever watched Dr. Oz? Dr. Oz has said the exact same thing.

Jenny: That's what I was going to tell you. It reminded me of Dr. Oz.

Dr. Jean: I know. Me and Dr. Oz, we're on the same page!

Jenny: Yeah, because ever since Dr. Oz started talking about you want your stool to look like your intestines, you now you want the S-shape, I mean I first heard about it on Oprah when Dr. Oz was on Oprah, and then saw it on Dr. Oz.  That's my goal for my own stool now. More than anybody wanted to know but that Bristol Stool Chart is like that.

Dr. Jean: He talks about the S-shape but the S-shape only curves because the toilet bowl will put it in an S-shape.  So Type 4 on the Bristol Stool Chart is what… if your pet is piling that up it might not be an S-shape but you can see that it could be made into an S-shape if it had gone into a container that shape. So it's a pliable.  I have one cat… I had a friend over the other day we were working on the computer, and Puzzle, her box is in the office.  And she gets off her feet and the box.  So she has no expectation that her ass isn't in the box, but her ass is hanging over the edge of the box so she just poops out on the mat. And we both looked incredulously at this thing; it looked like it came out of a German Shepherd.  It was definitely a Type 3 but it was soft.  It was huge.  We laughed for half an hour about that.

Jenny: That's hilarious.

Dr. Jean: She avoids the box most times because if the boys hear her in the box they will come in and bug her.  So she kind of waits until the last possible second and she does a bang up job.

Jenny: Okay.  So what's one of the leading causes of constipation in cats?

Dr. Jean: I would say dry food, and closely related would be lack of exercise. Between a sedentary cat eating as much as it wants 24/7 of a dehydrating food, yeah, you're going to have a problem sooner or later.  Now I just talked to someone else about this the other day and he said well isn't this a problem with older cats? And yeah it is.  It is mostly older cats.  But I remember seeing a cat, cute little guy, little tabby and white. When we went to neuter him at six months his exam was normal except he had a lot of stool in his colon, which I didn't have a reason to suspect it.  We went ahead with the surgery. He did fine. But I mentioned to the mom you know he's got a ton of stool in there, and I want you to pay attention.  And sure enough, he turned out to be chronically constipated the rest of his life.  There was something wrong with his nerves or his muscles or something and it manifested itself when he was six months old.  So it's not only older cats and it's not always only dry food cats.  Since I published this article about 10 years ago, I've heard from exactly three people who say that their cats have always been on a wet diet and became constipated anyway.  But that's three out of thousands.  So I think we've got a pretty good idea that if we feed a cat correctly, we're going to be better off with that.

Jenny: Okay. So what does it mean when a cat is constipated?  In other words, like, what are the consequences or the dangers involved?

Dr. Jean: Well, it's uncomfortable for the cat. And if the cat gets constipated enough they will stop eating.  You know the old saying garbage in garbage out. Well if there's no garbage coming out, they start feeling full and they feel nauseous and they won't eat.  So now you have the ingredients to a real crisis because if they don't eat they can develop Hepatic Lipidosis and all kinds of other stuff.  And if the stool gets really compacted up in there, constipated or worse, obstipated, which is the next level of bad constipation, then you start damaging the colon.  You can actually start tearing the muscle fibers, and you can start damaging the nerve endings, and eventually you'll come up with a condition called megacolon, which is severe retractable constipation.  And these guys, they can have unbelievable amounts of poop backed up in there.  That is a surgical emergency.  With megacolon, you’re likely not to ever get that function back. The only solution for that is surgery. Fortunately surgery works very well, but it’s a… why let it get to that point.  I wouldn’t say it’s easy to manage constipation but it is manageable. And there’s no reason for it to ever get to the point where it’s going to cause physical damage to the inside of the colon.

Jenny: Okay.

Dr. Jean: Not to mention the pain.  My sister, now I hope she doesn’t ever listen to this, but she’s chronically constipated because she drinks milk like a big dog, which will guarantee… in my mind guarantees constipation. I have completely the opposite problem.  But it’s truly dietary related and she tells me how miserable she is and it is really awful.  She’s crampy.  She’s bloated.  She just feels terrible. And you know what; you wouldn’t want to wish that on a cat. And they can’t tell you.  They can’t email you and say hey I’m feeling kind of stopped up here. They don’t know what to do.  They only have the limited repertoire of behaviors which is you know they go in the box and they strain and nothing happens, and then they give up and then they go back in a little while. So if you’re paying any attention at all and if you’re scooping the box daily like you ought to be, it should not take you very long to figure out that there’s a problem. There’s not enough stool in the box or the stool that’s in the box is hard as a rock and teeny tiny and black and dried up. Those are not normal.  Think of Dr. Oz.  Go for the sausage. I’m really glad he’s on our side, don’t you think?

Jenny: Yes.

Dr. Jean: Some of these cats, sometimes the only symptom will be vomiting because they eat and there’s no place for the food to go so it comes right back.  But you know, a lot of people are getting into this automatic kitty boxes. You know the Genie that rinses it away and Littermaid that scoops it out and all that. You know part of your job as a pet parent is to keep track of that.  You should look at it every day and see what it’s like.  You should know what normal is and you should be able to tell what’s not normal. Any time things change, appetite changes, stool quality, consistency or amount changes, urine amount changes, drinking changes, eating changes, vomiting changes, anytime you’re seeing changes that are associated with the GI system, those can take you down a bad road real fast. So it’s definitely time to call your vet.

Jenny: Okay. And you had mentioned in your article on Little Big Cat and I’ll provide a link if somebody’s listening to this on the website that sometimes that’s one of the reasons why cats are defecating outside the litter box which seems to be a common problem I’ve found with people that they say that they’ll pee in the litter box but that they always go number 2 outside the litter box.

Dr. Jean: Yes, and so that’s why the behaviorist say 1 box per cat plus 1. So if you have 1 cat you should have 2 litter boxes, because there are a lot of cats who prefer to pee in one and poop in the other. They’re kind of different functions in the cat’s eyes and you can get territorial marking with either urine or feces. You can get all kinds of fussbudgety or you get somebody like Puzzle, my other older cats Spirit and Schnook used to do that also.  They would get in or near the box and say oh yeah, good enough, and let loose. So you want to try and accommodate those cats. Sometimes it's a condition of the box that they’re holding it for some reason, like I hold it if I go to Carter lake in the summer because like I’m not going in that out house.  So if the box isn't clean enough they will hold it.  If the box is not the right texture or consistency of placement or configuration they will hold it, and you know as well as I know, if you really have to holding you will.  And they will hold it until they get into real trouble.  You want them to be pooping daily and it should look similar and it should be fairly regular.  Sometimes you get a twice a day kitty or every other day like Puzzle because she does hold it.  But when she goes she really goes.  I don't have any doubt at all that she has emptied herself out completely when I see that.  So it's a matter of paying attention and taking action before things go on too long because these are very tender tissues.  The muscular power in the colon is phenomenal but it's still the same mucous membrane that lines your mouth and your eyes and everywhere else, and your GI tract.  You can hurt that stuff real easy.

Jenny: So do you think that... I guess this is going to be a hard question to answer because there are so many factors involved... but if a cat is fed the same diet basically its whole life, then you can pretty much guarantee that how many times it defecates as a kitten will be kind of consistent with... I mean in other words if it's once a day as a 1-year-old it should be once a day as a 5-year-old type of thing?

Dr. Jean: Well, I think kittens go more often because they're smaller and there's less room in there.  And to take the bull by the horns right off, don't ever feed the same diet to your cat its whole life because what if one day that diet becomes unsuitable, and you have a cat that's 100% addicted to it, does not recognize anything else on the planet as food, then you have a real problem.

Jenny: I poorly phrased that question for sure.

Dr. Jean: What I have found since I work from home and I'm home most of the time, I find that their appetite actually varies a lot.  One day they're hungrier than the next day.  I go through periods where they'll eat two humongous meals a day every day for a week or two. And then all of a sudden none of them are interested in breakfast, they're barely interested in lunch... you know it's like they catch up.  And cats are sensitive to their own needs and they know when they need to take a break.  So one day... unfortunately most of mine are on the same schedule, similar bio I guess I've got two pairs of siblings.... we don't eat the same thing every day.  We don't eat the same amount every day.  Some days we feel like Mexican, some days we feel like Italian, some days we feel like a bologna sandwich would just be the best thing in the world.  There's variety.  And I wish people could understand that whatever it says on the bag or box or can or whatever, that's an estimate.  It's a general rule of thumb, and not every cat, in fact very few cats will actually be zeroed in on with that amount.  Most animals will need a little more or a little less. Some need a little more if it's windy because they're burning more energy because they're nervoused up, or if there's an earthquake or the house next door is constructing, their appetite will vary with the weather and conditions.  So you're planning a party and they get all anxious and upset and they don't eat.  Well if you don't eat, then nothing's coming out the other end.  So you need to kind of, as the owner, as the guardian... it's your job to keep track of what's going in and make sure an appropriate amount is coming out in an appropriate time frame.  And the only way you'll know that is to pay attention.  If you... and I literally have had clients that kept a diary.  Mongo ate 2 kibbles at 11:45 and then he at 6 kibbles at 11:48.

Jenny: Wow.

Dr. Jean: You don't have to be like that, but you should have a general idea of what's going in, what's coming out, and you should have a general idea of what's normal so that if things change you can accommodate that.  Yes, some days your cat's going to be hungry, some days you're cat's not going to be as hungry.  That's perfectly normal.

Jenny: Yeah.  That makes sense... because Charlie and Trigg... I struggle like every other cat owner does with cat food brands and flavors and all that kind of stuff because like you said some days they feel like Mexican, some days they feel like Chinese.  And so I'm constantly trying new flavors to see if it's a hit or whatever.  So as a result, I'm also watching the litter box to make sure we're not making diarrhea because then that gets stuck on their fur and then it gets on my bed or wherever they're lying, and I don't want that kind of stuff.  So I definitely watch it like a hawk.

Dr. Jean: Yeah.  But it is a really good thing.  What you're doing is to try different things all the time and then pay attention to how it works.  If I had a nickel for every time someone you know thought.... hang on.... somebody wants to go for a walk.  Let's see, if you're feeding a variety, if you're constantly feeding a variety which is kind of an oxymoron but... like my cats don't ever get the same meal twice. They get raw food, they get canned food, they get this, they get that, they get the other thing.  I make homemade food for them.  Even if they're getting canned food they get their supplements with it.  I like to buy a large variety of flavors and brands.  I had a call from a friend who has a cat rescue and they had been getting a good deal on food from Wellness.  And so their entire flock of kitties, all of the rescue kitties, and there were a lot of them, 50 cats or something, they were eating only Wellness.  And then there was the Wellness recall for thiamine deficiency.  And they had a lot of cats get sick and they had a lot of cats die.  So if you're feeding one brand and one flavor only, you are walking on the sharp edge of a recall at any time.  Look at the foods that have been recalled in the last month.  There are dozens and dozens of foods.  So it's good to feed a variety because you protect your kitty from those kinds of excesses and deficiencies, you prevent finicky behavior, you prevent food addictions, you prevent inflammatory bowel disease.  It's so important to give them a variety, but you do have to watch how they respond.  It's not enough just to here, oh you like that? Here I'll give you 10 cans of it.  Just feed them on the pattern that they do well on and not what's convenient for you.  I know that's a really striking thought to a lot of people. Because people feed what's comfortable and easy and convenient and cheap for them.  But if you really want your cat to be healthy, it takes more work.  You need to pay attention to their cycles and their patterns.  And what they be happily one day they don't eat happily the next day.  Well, after a few days of the same leftovers I don't want any more either.  It's not that hard to have a cat if you're paying attention and relating to them.  If you're doing that to even the least extent, you're going to be fine.

Jenny: When my cat Rags was going through chronic renal failure, one of the consequences of that was constipation because obviously his kidneys weren't helping him.

Dr. Jean: Right. They're not retaining the water so they're getting dehydrated and the colon tries to rehydrate but if there just isn't enough fluid, that’s not going to happen.  They're losing so much fluid that everything is going to be dried out including the poop.

Jenny: Yeah. So one of the things that I wanted to ask you about in this interview was how do you treat cats with constipation and I guess we've covered that kind of with healthy cats, but can you talk about diseases like chronic renal failure that cause constipation and how to deal with that in that sense?

Dr. Jean: Well, yeah, the diseases that will hydrate you are chronic renal failure, diabetes, hyperthyroidism because they often cause vomiting and diarrhea.  And if they're not keeping up with their food intake then you're going to try things up.  So any kind of thing that causes dehydration and there are a big pile of things that do, because of course the first thing that happens when a cat feels sick is they stop eating.  And if they're not getting wet food, then they're also not getting that water.  So things can go downhill real fast.

Jenny: Okay.  So like my vet recommended Enulose and that was a disaster.  So we did probiotics and that worked.  What things have worked for patients of yours?

Dr. Jean: Well, here's what you'll get if you go to a normal vet... your average vet... and you say I think my cat is constipated. They palpate the cat. They say oh yeah there's a lot of stool in the colon.  They will put your cat on a high fiber diet because fiber modulates the passage of stool through the feces.  If it's too fast they'll slow it down, if it's too slow they'll speed it up in theory, and usually it does work for a little while.  And then they stop working and then you are worse off than you were before because now your cat is really dehydrated and he's got buckets of fiber now stuck in the colon.  And you're going to be way worse off than you would have been had you gone in another direction.  When the high fiber diet stops working, vets tend to put them on a low residue diet which means virtually no fiber.  Well, come on people.  This is a shades of gray kind of world. What I do for constipated cats is immediately... I give them fluids. And if it's been a chronic problem, I teach the parents how to give fluids at home because that's the easiest thing and they need the fluids at that point.  Now if they're very constipated, they're obstipated, they're going to need more than fluids.  One of my favorite tricks, believe it or not, is Vaseline.  Vaseline is just grand for this sort of thing and everybody is going to go oh my God, you're feeding petroleum to the cat, oh my God.  Well let me tell you the story of my cat Spirit who loved Vaseline, and she ate Vaseline 2, or 3, or 4 or more times a day every day for 20 and 1/2 years.  Apparently it did not cause her a problem. The thing about a petroleum product like petroleum jelly, it's a very, very big molecule and it's basically inert in the body. The body can't break it down.  You don't have any Vaseline enzymes sitting in your pancreas.  It's not possible to break it down.  Now people say well if all you want is to grease up the food, why can't we give vegetable oil or butter or something.  Because they'll get digested and they will not complete the job.  What you want is for whatever you're giving to grease up the food... the ball of food that's in there... and slide it all the way.  Well if the coating gets digested, now you're left with a big wad of food two-thirds of the way down the GI tract with nothing to escort it anymore.  So that's why I like Vaseline, it's because it escorts it all the way out. It's a grand thing.  And Petromalt, Cat Lax and Laxatol, those are all basically Vaseline or mineral oil with flavor. You know I don't like those flavors.  My cats have never liked those flavors. I give them plain Vaseline. Some of them like it. Some of them don't. But it works real good.

Jenny: In what amount?

Dr. Jean: If they have problems, then I just give them a big wad of Vaseline in the corner of their mouth, and that will usually take care of hairballs and most other things pretty quickly.

Jenny: Yeah, I've heard about Vaseline for hairballs but not for constipation, but it makes sense.

Dr. Jean: Well especially because it warms up inside the cat and it's nice and gooey and it flows and it'll just slide right on out to the colon and it'll coat what's in there and help to get it out. You know it doesn't work all the time if a cat is real obstipated; it's not going to be enough. But it’s a great thing to try and first and it’s not going to hurt your cat.

Jenny: Right.

Dr. Jean: The other things you want, you want more moisture in the cat because if the stool stays moist enough, you're never going to have this problem.  So canned food, raw food, homemade food, something high moisture.  I really like water fountains to get the cats to drink more.  My cats all abandoned the sink which you know when you go in the bathroom and you turn on the water, and you have 4 or 5 cats immediately trying to get to the faucet, it's really annoying. So I got them a fountain and it totally took care of the problem. They quit bugging me and I could control and see how much they were drinking and all that. So fountains are great.  You know then you get into the tougher stuff.  Now slippery elm is really nice.  A lot of cats do well with slippery elm because it also forms like a mucilaginous gel that will make this poop slipperier and it's also got a lot of fiber in it. So it's pretty good for not severe constipation.  It's a nice thing to try.  If you're going to put slippery elm bark in your cat’s food, you must add water and usually cold water, because slippery elm itself is like a sponge and it'll absorb the water out of the food, and then you have a food ball going through the GI tract that's actually drier than it would have been to begin with because it’s slippery elm. So you have to make up for the water that that's going to take.  It's water balance and what kind of food and fiber to some extent. The other couple of non-medical solutions are exercise and weight loss, because 90% of these cats are obese. Our guts don't work too good if we're not exercising. So it just stands to reason, cats normally in the real world would be very active. They would be getting a lot of exercise as they're trying to get to their food, and they're hunting, and they're doing all their cat things, and patrolling and climbing and checking things out. Cats are moving around all the time.  So if your cat is a couch potato, you want to exercise them.  For that I recommend play therapy.  You know we have an article about it on LittleBigCat.com, and play therapy is a very specific, ritualized, structured play session, and it's really, really good for your cat. Stress management in case you have a cat like Puzzle that avoids the box because of territorial issues, then stress management.  They get box flower remedies, they get homeopathic remedies, they get a product call acai, they get all kinds of things that I feel are relieving stress and creating better health for them.  The other thing we have to remember is sometimes constipation isn't due to a GI problem at all but it's due to pain.  So making sure that your cat is not in pain, doesn't have a disc out, or hasn't had some kind of injury or something.  A short course of some kind of pain killer, non-opioid pain killer, because of course opioids cause constipation. So there's Medacam or something low dose for a few days just to make sure that that isn't a factor.  Then we go... the rest of the treatments are more medical in nature... the Mirilax or Lactulose or stool softeners or Cisapride, which has been taken off of the human market because it has dangerous side effects, but cats aren't prone to those side effects; they do real well with it.  The drug name when it was available was Propulsid but now it's called Cisapride, it’s the generic, and you can get it from a compounding pharmacy that can call it in from anywhere.  Pediatric suppositories, those sometimes work.  If you can get your cat to tolerate it.  Enemas for when you're, when it's too late for all the minor interventions.  Some people give enemas at home.  I've given plenty of enemas to cats in the clinic.  If the enema doesn't work then you may have to have what we politely call a dig out which is under anesthesia. The tech, usually not the vet, this is usually going to be your favorite techs who'll bring them cookies, will go in there with their fingers and pull the poop out.  And they have to basically milk it down the colon, out into the pelvic area where they can hook it with the finger and pull it out. A very unpleasant procedure for everyone concerned.  Really try to get it solved before you have to go there.  And for the cats that are too far gone, there's surgery. They do what they call a subtotal colectomy.  Colectomy means removing the colon.  And they don't remove the whole thing, but they remove the damaged part which is often a great portion of it.  And then your problem will be diarrhea.  But the cat will be more comfortable, and eventually the small intestines will start to take on some of the functions of the colon, and it will make it.... the cat will regain control and it will be a much better situation all together.  But the recovery is not fun and it's dangerous. But people are very, very happy with the results overall, because the cats that need this, they really need it. They're in such terrible trouble and it's so hard to watch a cat go through that.  It's just not fair.  But there's a lot of things to do before it comes to that and prevention is way better than treatment of course.

Jenny: Yes.  I mean I assume if it goes untreated then the cat will die.

Dr. Jean: Yeah.  And it will be a really ugly, painful and unpleasant death.  It's kind of related to the urinary thing when a white cat gets blocked.  It turns out that most people... it you're not monitoring the box and you don't see that there's a problem and the cat goes far enough, then the chances of it dying on the operating table are very high.  And I think a fair amount of cats just disappear and never come home and you think oh, they got eaten by a coyote or got locked in a garage or something. They could have died from the toxins in the stool or the pee that get backed up into the blood and they die of sepsis, and that is a very ugly way to die also. You want your cat to be indoors with a box that you can see what's going on because they can't talk; they can't say I've got a tummy ache, dagnabbit.  They can't email you, they can't leave you a post it note... you have to be paying attention to their behavior because their behavior is the only thing that's going to tell you how they feel.

Jenny: I agree.  In preparation for this interview, I asked on Facebook again if anybody had any questions.  So one of the questions kind of correlates to what you just said, you have to be paying attention. The reader asked, "In a multi-cat household, how do you know if one of the cats is constipated?"

Dr. Jean: You'll know from the behavior of that cat because if it goes on for more than a couple of days, that cat will stop eating, or it will start behaving... it will be lethargic or act painful, or if you try to pet his tummy he'll bite you. I have 4 cats and I have 4 litter boxes, and I know who uses which ones.  I have a pretty general good idea about it, and if I see something unusual I start watching the cats really closely, I start paying more attention.  It's not that hard to learn how to palpate your cat unless it's tremendously obese.  I think vets and techs should be teaching people to palpate the belly because a full bladder... a normal full bladder... feels different from a blocked bladder and a stool full of crap feels different from one that’s normal.  Normal stool feels different than abnormal stool, and these are all things we can be teaching people how to feel themselves.  It would save so many trips to the vet, and it would save animals so much trouble and pain and distress if people were more aware of how to feel them up so you can catch those problems early.  You see something suspicious… I see something suspicious; I go straight to Sundance and palpate his bladder. He's the one that just has a history.  If I see horrible dry little stool, I go for Flynn because he's the one that'll do that.  Because I've had these cats 10, 15 years and I know what their patterns of behavior are.  I know that Puzzle never uses the box in the bathroom, so if it's the box in the bathroom then it must be one of the other three.  And if it's the box in the living room it could be any of them.  If it's the box in the office, it won't be Sundance because he doesn't use that box. So, it's like if you have kids. If you have 4 kids, you know the traits of those children. You know their habits. You know who's the one that’s more likely to be caught with their hand in the cookie jar. You know which one is the one that likes to climb things, is going to break his arm when he falls. You're going to know what their habits are and you're going to be able to... if you come home and you find broken glass all over the place, you're going to have a pretty good idea which kids out of all 4 is going to be more likely to be involved. So it's playing the odds, and it's knowing your animals. And the only way you get to know your animals is to pay attention and to really be involved in their lives. Unlike kids, you don't have to drive them to soccer practice.  But you should be playing with them every day. You should be petting them every day. You should be kind of feeling them every day.  Make the abdominal palpation a part of a massage. I get cats in the clinic and I need to palpate their tummy and I just tell them, I'm going to give you a massage honey, and dogs same thing. You can rub around in that abdomen and you find out right away if their sensitive. If they're painful they're going to pull away, they're going to react unpleasantly. They're going to look at you like you're out of your freakin mind.  It's just being involved in your cat's life in the same way that you're involved with your family or your friends.  You know what they're like normally and so if they don't look right you're going to know.  This is not a problem that develops overnight.  This is something that you are going to have plenty of warning about.  Because they don't go from normal stool on Tuesday to obstipated on Wednesday. That doesn't happen.  First you're going to see that the stools are going to progress on the Bristol Stool Chart to drier, lumpier, and when they get into sheep pellets or elk pellets, it depends on where you live.  In my yard it's more likely to be deer pellets than sheep. But you're going to have plenty of warning. This is not something that doesn't tell you it's coming.  So it's just paying attention. Do the things that you know will prevent this problem as well as a host of other problems.  Play therapy every day, that's going to eliminate almost every behavior problem you could imagine.  It's going to reduce inter-cat aggression. It's going to get them exercise which is going to reduce obesity, and make all their systems, their urinary system, their respiratory system, their cardiac system, and their GI system; those are all going to work better. Their immune system's going to work better. Everything's going to work better if they're getting exercise and if they're getting an appropriate diet. These problems, pardon me while I climb upon my high horse, are mostly veterinarian caused because veterinarians don't educate people correctly and they have not educated people that dry food is not appropriate for cats, and the longer you feed dry food the more problems you're going to have because then you're signing your cat up for obesity, arthritis, diabetes, constipation, kidney problems, urinary problems, bladder stones.  That's what you sign up for when you feed your cat dry food.  Those are just some of the things, of course arthritis, skin allergies, every kind of thing.  So we have created this problem by not educating people, by promoting crap foods, and in crap I include all these fancy veterinarian diets.  If they're dry, they're no good. Just ask your cat.  I recently put an article up on my website called 10 Reasons Why Dry Food is Bad for Your Cat or Dog. I didn't have any trouble at all coming up with 10 reasons and I could have gone on.  So we need to feed our animals a species specific, species appropriate diet, and with cats that means wet food.  Because you know, they don't eat mummified mice.  They eat fresh prey that are full of water, and they're full of blood too so all the nutrients that are in the blood that are absent in the meat that we buy because animals that get slaughtered are bled out immediately, because the blood they can sell it for a bigger price somewhere else.  So our animals are missing out on that. So what we need to do is try and build a better [INAUDIBLE-43:51], it's not easy to do that.   So wet food, raw food, homemade food, as long as you've got a good recipe and you've got a reputable manufacturer, a high moisture diet is what cats are supposed to eat and if they eat that they will be less prone to every heath problem. You're not going to 100% eliminate it.  I've had cats eat a 100% wet diet that have developed urinary problems and blocked.  It happens, but it doesn't happen nearly as often as cats eating dry food.  So, the dry food thing just makes me nuts, and it's saddens me to see dry food spreading around the world. Japan is starting to feed their pets dry food, and China and Argentina and Brazil and South Africa. We're just not doing good by our cats. But those are very lucrative markets for the pet food makers. And you know pet food makers always promote dry food over wet food because they make a boatload more money.  The ingredients are much cheaper, the processing is much cheaper, the storage is much cheaper, transportation is much cheaper, they would rather everybody feed dry food. Cans food is a pain in the butt for me. You have to pay for the metal can, you have to pay for the liners for the cans, it's heavier to ship and it's mostly water so you're paying to ship water.  You know and it's expensive for people to buy. But you know do you want to invest in your cat's health now by feeding what it should eat with the right kind of foods, or do you want pay for a dig out procedure or a subtotal colectomy or a bladder stone removal or insulin for the rest of the cat's life. Is that what you'd rather do? You want to pay for cheap food now but you're going to pay thousands in vet bills later? No. Please, please, please invest in your cat now with a good diet and head these problems off. That's my big thing I've got to say.

Jenny: I posted something on Facebook yesterday that Ingrid at the Conscious Cat had written about dry food or the importance of wet food, something like that. And one of the Floppy Cats readers said like this is such BS. I worked at a vet and all we saw with cats who were on wet food was rotten teeth, rotten teeth.

Dr. Jean: I've seen tens of thousands of cats with rotten teeth that never saw wet food. The rotten teeth thing, that is such BS, and it is genetic. It's all genetic.  It has very little to do with diet.

Jenny: That's good to know about genetic because yeah, my two cats are obviously on the same thing but Charlie has 10 times the amount of tartar than Trigg does, so I figured it was genetic, and I want Charlie to get Trigg's genes for that.

Dr. Jean: And it can be environmental, and then I had one family of cats, I don't know they were lovely people, I loved them to death.  But they had like 16 cats and I took all teeth out of most of their cats.  But I think they had an endemic calicivirus that the cats had just passed around and so it was an environmental trigger but, you know, I was amazed when I realized that red-headed cats had less tartar and more gingivitis.  Well, red-heads tend to have more inflammation and that includes your red tabbies, your Abyssinians, very few of whom have any teeth at all by the time they're 4 years old.  Your calicos, your torties, any cat with red is more likely to have a genetic propensity to create inflammation as opposed to other kinds of physical reactions.

Jenny: That's interesting.  Okay so another question was... and I don't know if you can answer this but... what does it mean when your cat's litter box smells like moth balls?

Dr. Jean: That would not be good.  First I would clean the litter box. And if you're using moth balls to fill the litter box, you might want to stop that. You know they're little pellets but they're not really suitable because they're incredibly toxic. That could be diabetes because the acetone in the urine could smell vaguely like moth balls.  I'd have that checked out.

Jenny: Okay. Somebody asked is it true that if you feed them grain-free food their poop doesn't smell as bad as it's supposed to?

Dr. Jean: No. Grain-free food if it's dry is worse on every count for your cat. It is more dehydrating because protein is a diuretic. So I think the grain-free foods are stupid. Grains are very rare allergens and the grain-free the foods typically simply substitute sugary starchy vegetables, green peas or white potatoes or sweet potatoes; it's not like there are less carbs and the point is we want less carbs. Some of the grain-free foods are higher protein; there's still some carbs in there but they just pull the water right out of your cat. I'm really not happy about that.  Grain free canned food, if you want to go there that's fine. But there's really not that much carb in any canned food.  The cat food with the lowest... the lowest amount of carbs is Fancy Feast. So there you go.  Fancy Feast, a good diet for diabetic cats because it's got about…most of their flavors are about 8% carbohydrates which is very low and that's what you want.

Jenny: What about getting rid of your cat's runs so like the opposite of constipation? What could that be?

Dr. Jean: Well there are about 4,000 different causes for diarrhea. One of them, interestingly enough, is constipation. And I proved this to myself once.  I got obstipated but I had diarrhea because the only thing that was getting past the blockage was the liquid stuff.  So you know I swear, I promise, I am working on a book. I have said for the last couple of years, the next book I write is going to be about cat poop. And I really have to do it because there's so much people don't understand about cat poop. And every time you get a group of cat people together, eventually your conversation is going to devolve to cat poop.  I've seen it a million times, so you know, and especially if you get a group of veterinarians, then the talk will always turn to cat poop and abscesses because those will clear a restaurant out faster than anything else. And we have it all to ourselves.

Jenny: Yes.  Okay, somebody asked this but we kind of already covered it with the Bristol Stool Chart, but what's a normal ideal one supposed to look like.  Can you describe it in case someone can't see it visually while listening to this please?

Dr. Jean: Yes. It should be about the consistency of like silly putty or play dough, soft, moist, moldable... like if the cat poops in the corner of the box, it's going to stack up and tip over. It's pliable, it's not rock hard.  It should look fairly moist all over and be a nice long string of it, and it should be round in diameter, but not too thin.  I'm thinking of... sometimes I've seen stool that are this shape... the correct shape, but they are a quarter of an inch wide and just be a long string of this really soft gooey stuff.  It should be able to hold its shape like if you're going to scoop it with the scooper. Just nudge the end of it and see how easily it moves.  Can you fold it in half with your scooper thing?  You should be able to.  It'll break if you fold it over completely but you should be able to manipulate it and it shouldn't fall apart right away or melt or anything like that.  The Bristol Stool Chart, I was so thrilled. I wish I had had this when I was in practice.

Jenny: Yeah. You could put it next to that chart how to tell if your cat is fat or skinny too.

Dr. Jean: Exactly. Exactly.  Because they are very closely related.

Jenny: Yes.  That's funny.

Dr. Jean: If you watch Dr. Oz, your cat's stool should look the same as what Dr. Oz discusses.  And it should... you know when your cat pushes it out... this is another really important point is the anal glands on either side of the anus... the correct consistency of stool that's good size around so the anus has to expand, it has to stretch out for the stool to pass through, that is supposed to naturally empty the anal glands on the surface of the poop. That is the marking behavior. Anal gland juice is what makes poop smell so good, and it tells the story for other animals who then come and sniff it.  It's a marking behavior.  So if the stool is too thin and soft or too big and hard or it's pellets or something, the anal glands are not going to empty correctly and then you can get an anal gland impaction, and get an anal gland abscess. And those are really disgusting and tough to deal with. So, there are so many reasons to make sure that your cat is having a pretty normal poop.  If he has diarrhea one day, as long they're not acting like they're at death's door I don't worry about that.  But abnormal stool plus another symptom like lethargy or vomiting or fever, that is a veterinary visit right there. If it's just the stools, you've been changing the food and the stool consistency has been kind of wandering around, well yeah.  If you change foods too abruptly you will get diarrhea, and definitely probiotics will take care of that.

Jenny: Okay

Dr. Jean: So now I have another article on Little Big Cat called Switching Foods. And for the people who have cats with this type of problem you don't want to switch to diet too fast.  If they're not used to eating a variety of things already then you want to introduce the new food very gradually.  And cats of course are notorious about not wanting to change foods. So the Switching Foods article tells all why you should switch and how you should switch, and it has in it every tip and trick that I've ever heard of for getting a cat to eat a new food.

Jenny: Okay. I just found it so I'll include a link to that as well.

Dr. Jean: Okay, that's good. Because I’ve known cats and cats are stubborn.  Oh Lord they are stubborn and if they've only ever eaten dry food, they won't understand that wet food is food.  They won't recognize it as food and they won't touch it. You know there are tricks that you have to go through, and the problem that most people run into is just like the same problem when you introduce new cats and stuff, you go too fast. It's up to the cat to determine how fast it goes, and I have literally seen it take two years to convert a cat to a wet diet.

Jenny: Oh, that's good to know.

Dr. Jean: If you've been working on it for two weeks, get a grip because it could be a lot longer.  It's the cat's choice how fast to change, not you. You're not going to tell the cat what to eat. Because cats will starve themselves to death. If you put food down that they don't want, they won't eat it, and they will not eat it until they're at death's door.  They really will. I have seen cats literally try to starve themselves to death. They are that stubborn.  And they are that set in their ways, and they are that into this is food and nothing else is food. Or this is the food that I like and I don't like anything else. I’ve known kids like that.  My niece once decreed that she wasn't going to eat any green food.  Well, there are a lot of foods that are green, she just didn't happen to like any of them.  Well you know I don't like vegetables either but I eat them.

Jenny: Now see the smart ass in me, if I were her mom, would get green food coloring and put it in everything.  That's good to know it could take up to two years because I just got had a reader in Australia tell me today on Facebook that she can't get her cat to switch and I’m like keep trying.  Don't keep her on that dry food. So I'll tell her that.

Dr. Jean: If you want your cat to be healthy, you have to be persistent.  If you don't care, then don't do it, and there are people that don't care that much. The cat is just sort of an accessory, it's no better than a lamp or a stool. And those are not the people that are listening to us and those are not the people that are going to have healthy cats, I'm sorry.  But the people that are paying attention, the people that want to do the best for their cat, those are the people that are listening to you and me, and we want to give them all the tools they can get to make sure that these things work out.

Jenny: I agree.  One of my consistent readers on Floppy Cats, when I asked does anyone have any questions about constipation she was like not any more, thanks to your wonderful advice and switching to all wet food. Her cat has no pooping issues any more. So that made me feel really good because sometimes it's hard to push something so hard.  Especially when it seems to be of an inconvenience. But I keep saying it's prevention.

Dr. Jean: Yeah, and you know what they say about prevention.  I would much rather start... all my cats I started as kittens... 2 of them were 8 weeks old and 2 of them were 2 weeks old. I really had a good shot with the very young kittens. They were orphans from a feral mother. I started them on raw food when they were 3 weeks old.  I did everything from the get go that I knew how to do.  And I expect them to live very long healthy lives, because I set them up from the time they were tiny to do as good as they could possibly do.  I still have vet bills.  I still have to get the long hair shaved.  I still have to clean their teeth every year.  I still have to do kind of preventive maintenance. Like today I need to take my car in for an oil change. If I don't, what kind of prevention is that?  If I don't change the oil in my car, my engine is going to cease and I won't have a car. That would be a bad lesson to learn. So don't learn the lesson and harm your cat with it.

Jenny: And most people can relate that somebody along the lines has had one of the issues that you've talked about here that is a warning sign that they are subject to constipation.  It makes sense to me.

Dr. Jean: Yeah. It's like anything.  Having a cat is a responsibility. If you choose to bring a cat into your life, you are assuming responsibility for it. So it's not okay to treat it like a lamp.  Oh, the light bulb is burned out, I'll put in a new light bulb.  That's not enough. This is a living, breathing animal that is 100% dependent.  It's your responsibility to do the best by that cat.

Jenny: I agree.  Well those are all the questions that I had.  Is there anything that I should have asked you that I didn't?

Dr. Jean: Let me look here to see if I see any other... In this article I really put in everything I could think of.

Jenny: Your constipated cats article?

Dr. Jean: Yeah.  You know it's the number one searched article on our... it's our number one search term on Little Big Cats.

Jenny: Is it really?

Dr. Jean: More people find Little Big Cat through this article than anything else, and you know we have 250 some articles on this website.  That is the number one searched term.  So that tells me that there are a lot of people that are having this problem with their cats. And the things that the veterinarians are doing are not working, because they're just putting them on a high fiber diet.  If they put them on a high fiber diet, and that stops working, then they're kind of out of ideas already. Then you start getting into some pretty heavy drugs and surgery. And it's not... you should never have to get to that point really.  If you're paying attention and you catch it early, this is a very solvable problem.  I'm not going to say it's easy to solve, because sometimes it isn't, but boy oh boy, this is really the place where you could make a huge difference in your cat's health and wellbeing and comfort, and your annoyance levels as well.

Jenny: Yeah, I mean as a human, if you've ever been constipated then you know how uncomfortable it is, and I agree.

Dr. Jean: Yeah, and you know the stress management, the flower emphasis, those can really help because if there are emotional issues around pooping for the cat that’s ever been ambushed by another cat... and then you have to think of the whole litter box thing because if the cat doesn't like the litter box they're going to hold their poop longer and will become more likely constipated.  So you want to look at your configuration and what type of litter and all those things around it. There are a lot of complicating factors that can play into this, but it's pretty straight forward to resolve it early.  There's just you do this, you do that, you do the other thing. You keep the box real clean, take the lid off if the cat doesn't like the lid, take the liner out if the cat doesn't like the liner, put multiple boxes if there's a conflict between cats, and don't line them all up in the basement.  There needs to be a box on every level of the house because the choice of box and location is up to the cat, and it's not going to work if you put it where you want it.  Some cats will go along with you and many more will not. It's a whole thing... this is part of a whole environmental management and health and wellness program.  Stop it before it goes too far. That's the best advice I could give you. Take care of it right away.

Jenny: Yes, I agree. Well thank you so much again for another great interview.  I love that we're helping the kitties by educating.