Managing incontinence in a paraparetic kitten (partial bladder control)

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sinkoman
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Managing incontinence in a paraparetic kitten (partial bladder control)

Post by sinkoman »

Hi Folks,

I really need your help trying to figure this out, because I love my little paraparetic kitten, yet this issue is driving me insane right now.

Bodie is a paraparetic kitten that came to us after a friend saw him fall out of a tree. At the time, he was somewhere around 4-6 weeks old, so I suppose he is now somewhere around 3-4 months. When we first found him, he had little to no movement in his lower limbs, and responded only to very deep pinching of his back legs (nothing from his tail though). Since then, he has made some good progress, with his back legs now responding to light brushing and scratching, and with some flickering of the tail when it is brushed as well (his tail also goes #### when I firmly brush above his hips). I fear however that we have hit a plateau in his recovery, and he is still not able to walk (well, I catch him standing and slowly crawling sometimes when heʻs sniffing around, but he generally drags/kicks around the house, and when he actually does walk itʻs incredibly gimpy and uncoordinated; he can only manage a handful of steps before he tangles his legs together and falls over. What little walking he does seems to be with all his weight shifted onto his front end).

Both of the vets he has seen so far seemed to think he still had good control of his bladder (they have both seen him urinate; the first one was able to fully express him at around 2 mo with a light pinch and release of his bladder, and then he fully emptied on his own. More recently, the second vet has given him a few enemas, and claimed that after the procedure he saw him fully empty on his own).

However, my experience at home has run contrary to this. He seems to have two different "modes" of peeing: ones where his back end drops down into something resembling the correct peeing position, and his back end "shivers" a little like heʻs trying to get it all out (usually he kicks his legs too, but sometimes he will lift them above his head and start sprinting around...), and another mode where pee just comes out with no sign that he is aware of whatʻs happening (sometimes just a few drops, sometimes a LOT though). The first mode usually occurs when something exciting happens (e.g. sometimes when I make his food, or when he finds his way to a part of the house heʻs not supposed to be in), the second generally seems to happen when thereʻs a lot of activity in his back end (e.g. I am making him practice running around in the yard, or when chasing his toys).

Unfortunately, he basically never pees in his litter box, other than the rare occasions when he decides to nap in there (he empties himself invariably while he is sleeping), which leads me to believe that he is either reluctant to go in the box, or isnʻt actually aware of when he is peeing. I feel confident saying that it is NOT an issue with the cleanliness of the box, because every morning one of the first things he does is crawl into his box, dig a little, and then roll around in the litter while making trilling noises.

I suppose I should also mention that he has been battling constipation since the day we got him, and that he became severely impacted with stool shortly after he came to us (vet actually had to put him under to get it all out and then kept him overnight; he is now on cisapride to combat this, but still has off days where things get stuck). He has also been on amoxicillin for the past 4 days as a precaution against a possible bladder infection (I thought I saw what looked like mucous in his urine, and doc decided weʻd just put him on the antibiotics w/o bothering to get a urine sample).

I have brought up the possibility of having to express Bodieʻs bladder with his current vet (who is an orthopedic specialist), but he has been reluctant to go that route, since he thinks he can control it. I HAVE however been giving his bladder a little squeeze when I catch him going, to try to help him empty completely (since this minimizes the chances of him having an accident later on). I believe the doctor when he says he thinks Bodie still has bladder control, but I am kind of stuck at this point with trying to figure out how to get him to go in his litter box (which is a low entry handicapped pet letterbox with rounded edges).
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critters
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Re: Managing incontinence in a paraparetic kitten (partial bladder control)

Post by critters »

sinkoman wrote: Wed Mar 20, 2019 9:39 pm Hi Folks,

I really need your help trying to figure this out, because I love my little paraparetic kitten, yet this issue is driving me insane right now.

Bodie is a paraparetic kitten that came to us after a friend saw him fall out of a tree. At the time, he was somewhere around 4-6 weeks old, so I suppose he is now somewhere around 3-4 months. When we first found him, he had little to no movement in his lower limbs, and responded only to very deep pinching of his back legs (nothing from his tail though). Since then, he has made some good progress, with his back legs now responding to light brushing and scratching, and with some flickering of the tail when it is brushed as well (his tail also goes #### when I firmly brush above his hips). I fear however that we have hit a plateau in his recovery, and he is still not able to walk (well, I catch him standing and slowly crawling sometimes when heʻs sniffing around, but he generally drags/kicks around the house, and when he actually does walk itʻs incredibly gimpy and uncoordinated; he can only manage a handful of steps before he tangles his legs together and falls over. What little walking he does seems to be with all his weight shifted onto his front end). This isn't unusual, but the fact that he can walk a bit sounds good to me. Did he take any prednisone or other steroids when you first got him?

Both of the vets he has seen so far seemed to think he still had good control of his bladder (they have both seen him urinate; the first one was able to fully express him at around 2 mo with a light pinch and release of his bladder, and then he fully emptied on his own. More recently, the second vet has given him a few enemas, and claimed that after the procedure he saw him fully empty on his own).

However, my experience at home has run contrary to this. He seems to have two different "modes" of peeing: ones where his back end drops down into something resembling the correct peeing position, and his back end "shivers" a little like heʻs trying to get it all out (usually he kicks his legs too, but sometimes he will lift them above his head and start sprinting around...), and another mode where pee just comes out with no sign that he is aware of whatʻs happening (sometimes just a few drops, sometimes a LOT though). The first mode usually occurs when something exciting happens (e.g. sometimes when I make his food, or when he finds his way to a part of the house heʻs not supposed to be in), the second generally seems to happen when thereʻs a lot of activity in his back end (e.g. I am making him practice running around in the yard, or when chasing his toys).

Unfortunately, he basically never pees in his litter box, other than the rare occasions when he decides to nap in there (he empties himself invariably while he is sleeping), which leads me to believe that he is either reluctant to go in the box, or isnʻt actually aware of when he is peeing. I feel confident saying that it is NOT an issue with the cleanliness of the box, because every morning one of the first things he does is crawl into his box, dig a little, and then roll around in the litter while making trilling noises.

I suppose I should also mention that he has been battling constipation since the day we got him, and that he became severely impacted with stool shortly after he came to us (vet actually had to put him under to get it all out and then kept him overnight; he is now on cisapride to combat this, but still has off days where things get stuck). How about a stool softener, like lactulose? That one always worked for us because it's sweet and yummy, but it's a mess if it spills. It's a liquid, so it's easy to give more or less as necessary. He has also been on amoxicillin for the past 4 days as a precaution against a possible bladder infection (I thought I saw what looked like mucous in his urine, and doc decided weʻd just put him on the antibiotics w/o bothering to get a urine sample).

I have brought up the possibility of having to express Bodieʻs bladder with his current vet (who is an orthopedic specialist), but he has been reluctant to go that route, since he thinks he can control it. I HAVE however been giving his bladder a little squeeze when I catch him going, to try to help him empty completely (since this minimizes the chances of him having an accident later on). I believe the doctor when he says he thinks Bodie still has bladder control, but I am kind of stuck at this point with trying to figure out how to get him to go in his litter box (which is a low entry handicapped pet letterbox with rounded edges).I'd express him, too. I had vets who firmly asserted that I couldn't learn to do it, but the fact is that vets weren't born doing it, either. If they can learn, so can we! I'd find another vet willing to teach me. It's not that hard, but your hands have to learn to play "tiptoe through the guts." The added advantage is that what ain't in can't leak out!
:welcome:
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critters
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Re: Managing incontinence in a paraparetic kitten (partial bladder control)

Post by critters »

PS--There are also meds that might help him pee alone. In my experience, phenoxybenzamine (PBZ) is good for a spastic (tight) bladder, and bethanechol is good for a hypotonic (floppy) one.
sinkoman
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Re: Managing incontinence in a paraparetic kitten (partial bladder control)

Post by sinkoman »

Thanks for your response! Sorry that these posts are coming out so wordy...
critters wrote: Fri Mar 22, 2019 6:42 am This isn't unusual, but the fact that he can walk a bit sounds good to me. Did he take any prednisone or other steroids when you first got him?
The first vet had him on an NSAID for a while starting from the day after we got him. Second one had him on prednisone for what I want to say was a couple of weeks, and has mentioned the possibility of putting him back on it. Itʻs hard to say how much good the prednisone actually did for him, but what little tail movement he has now came back while he was on the meds. His walking situation currently resembles spinal walking (and I think the vet might have used this term too, idk itʻs hard for me to remember since lately heʻs been seeing this vet at least once a week for laser therapy).
critters wrote: How about a stool softener, like lactulose? That one always worked for us because it's sweet and yummy, but it's a mess if it spills. It's a liquid, so it's easy to give more or less as necessary.
First vet actually put him on lactulose after cleaning him out, and brought up the possibility of him developing megacolon from that incident. It was really bad; all his feces had distended his colon and dried up into a solid mass. The hope was that the colon could regain its original shape and heʻd be able to regain paristalsis, but things have seemed been iffy ever since then. I still feel extremely guilty that I let it even get that bad in the first place. When we first found him, he didnʻt poop for a couple days, so we started giving him pumpkin to get him moving again. He then developed diarrhea, so we gradually stopped the pumpkin and he started passing hard stools again, so we thought all was fine until he started vomiting :(

Anyways, I just realized a day or two ago that I still have the lactulose from that whole experience, so that is something I could try. The way that I currently get him moving again if things get stuck is to give a bath, which usually gets something to come out. The other thing I try sometimes (but have been trying to avoid doing regularly) is a mixture of mineral oil, hairball gel, and metamucil, which lately has been incredibly effective.
critters wrote: I'd express him, too. I had vets who firmly asserted that I couldn't learn to do it, but the fact is that vets weren't born doing it, either. If they can learn, so can we! I'd find another vet willing to teach me. It's not that hard, but your hands have to learn to play "tiptoe through the guts." The added advantage is that what ain't in can't leak out!
Well, itʻs odd. I donʻt think it was a reluctance to teach us how to do it; doc said that itʻs an option for pets that have no control (that or catheterization), but that he didnʻt think we were there yet, and that the current issue could be behavioral (since heʻs still a little guy).

In general, his incontinence kind of perplexes me (although I admittedly have no previous experience with this sort of thing): I know that he has SOME kind of control of his pooping, because in the mornings (or after a long nap) he will consciously try to poop. He lifts his legs up and then drags his butt around on the ground, then flexes his backside like heʻs trying to poop (I can see his butthole wink and push out a little like heʻs trying to push out a turd, and his tail will also flex and wiggle a bit). He will also run into and out of the litter box (often repeatedly) while he is doing this. Usually heʻs successful and can get something out, but unfortunately seems to only try right after he wakes up. In the past couple of weeks he seems to be doing a much better job of getting it all out; His stools previously came either as small balls, or very stringy, but lately he has been making really nicely formed logs on his own, and with much larger volume (although I still have to help out here and there).

The urination is also perplexing, because he can definitely push out pee on his own. It seems like he has a preference for peeing on towels, mats, and grass, and the act generally appears very conscious (other than the bed wetting, and the occasional leaks during running, but even when he wets the bed, he is clearly "pushing it out" after having filled up and triggered his reflex, and is not simply leaking all over). The "over-excited" pees also seem to occur even when he is not full, which leads me to wonder if peeing in the litterbox is just uncomfortable for him due to his condition. I can understand that from his perspective. If I were him, peeing on a towel does seem way more effective than going in a litter box, since the towel is a comfortable and stable surface, will absorb the pee without it puddling onto my butt and feet, and whatever pee I do end up getting on my butt and tail, will not immediately pull clay litter into my fur.

Sometimes he does things that seem very conscious: last week he came up to the bathroom door while I was pooping, looked at me for a few seconds, went into one of his peeing stances (where he carefully balances on his front legs and elevates his entire back half, legs and all, off of the ground), and started unloading while running around the bathroom entrance (I think the running is to keep his front hands out of the pee puddle). Just last night, IMMEDIATELY after I changed the puppy-pad on his bed, he crawled into his bed, squatted into the position, and then peed.

But then I will catch him going seemingly randomly on a tile or stone surface, which makes it feel again like itʻs purely reflexive...
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critters
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Re: Managing incontinence in a paraparetic kitten (partial bladder control)

Post by critters »

It could be both reflexive AND intentional, depending on the circumstances. He's healing, and recovery tends to wax and wane--up and down. It's definitely not a straight line!

I'd also make sure the mineral oil is mixed into food or something; it can be nasty if it becomes inhaled.

What kind of litter is in his box?

Much of what you say is terrific--like his butt winking. If his spinal injury were total, I don't think much if any of that movement would happen.
Diana R.
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Re: Managing incontinence in a paraparetic kitten (partial bladder control)

Post by Diana R. »

I agree with everything Critters said in the red. It sounds like you are very dedicated to this little guy and thank you for taking him and giving him such good care. I get more concerned about bladder infections so I express even my diapered boy who leaks out 3 times a day. I would also express bowels which I also do for all my incontinent cats---my one cat will sometimes poop on her own after I express her and I just pick it up; expressing sometimes stimulates them to poop on their own. I would not worry about the fact that he does not use the litter box, just express him and you can diaper him as well. I have had a cat on cisapride in conjunction with lactulose but I would continue to try to help him by expressing.
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