Gassy tummy makes it harder to express bladder

[amyestes]

I'm hoping someone else may have some experience with this one. It took me so long to learn to express Miss Kitty, and I still feel I am learning. But most of the time I am able to keep her clean and dry, and she is generally a happy baby. In the last few months, I have realized when I have trouble expressing her bladder, it's often because she has gas and it is very uncomfortable for her when I am squeezing her tummy! I have used infant liquid simethicone drops with some success, but I am worried because it seems I need to give them to her all the time. She has been almost impossible to express for the past few days and finally last night she leaked a lot. I have been trying all day today to get her back on track. She is still fighting me expressing her bladder. She takes Cisapride 2x/day but no other medicines. We have a prescription for Lactulose which I use as needed but I don't give it regularly because when I do her stool becomes too soft. She eats Weruva canned food and she loves it. I have tried dry foods as more recently freeze dried foods but both seem to make her bowel movements more difficult and increase this problem with stomach gas. I read that one common reason for gas is eating too fast, but I don't think that is the issue. I don't have any other cats and although she *loves* to eat, she does not gobble her food. If anyone has any experience with this or suggestions, I sure would be grateful! Thanks so much.

Amy & Miss Kitty

[critters]

You can use less lactulose; the fact that it's a liquid makes it so easy to change doses at will. You're right about runny poop being AWFUL with a handicapper!!

Hmm. I've never had a farty expressible, but Buddy would absolutely always poop right before the pee would start to flow.

[CarolC]

Amy are you feeding any of the flavors that have peas?

[amyestes]

Hi Buddy's mom! Hi Carol! Yea, I way turned the dose down on the Lactulose but still found a tiny dose once a day made her poo gooey after a few days. Most of the time it seems like we don't need it, thank goodness. Carol, I never would have thought of that, thank you! One of the flavors I feed has peas but I don't think she has ever eaten one. Skips right over them. Same for little chunks of pumpkin, or carrots, etc. But I am really open to food advice. I have used food to help make her feel like by enduring the bladder expression (I'm grateful I can do it now and we don't have to go to the vet everyday, but it is still not her favorite thing!), she will be rewarded. I am careful about her weight and I am fortunate to be home a lot, so usually that is a small amount of the Weruva, or in between Weruva feedings, those crunchy Greenies dental treats. I like the Weruva because I feel like it is a good quality food, and she likes it a lot, but I am definitely open to trying other things! Also wondering since you posed the question about the peas if maybe I need to stop giving the Greenies as treats? Thanks so much for your responses, I really appreciate it!

[norristhecat]

Not sure if my suggestions will be of any help, but I will offer them anyway. I use a welding jacket with a rawhide sleeve this protects me from his back legs scratching me. You can buy welding sleeves at any welding supply house, a Lowes or Home depot may also carry them. When I express my cat "a male" after he urinates squeezing the bladder again to restart the flow never worked, we had to stop, sit him up and just give him a minute or two just to relax and then repeat the process. Sort of like he needs to re-set himself. The welding jacket is almost unnecessary for me now since either I am better at this or Norris my cat understands what we are trying to do, or both.
I have a post going now with what I am going through and had a major breakthrough with my boy today he P`eed on his own in the box today, he was hit by a car just over a month ago, so having him hopefully re-gain his ability to pee on his own is awesome especially so soon. I was hoping something like this in 6 months if I was lucky, since it could never come back as I`m sure you are aware of!How long have you needed to express your cat? Good luck with her!

[amyestes]

Congratulations with Norris! I hope he regains all of his function - that would be wonderful! I have been expressing Miss Kitty's bladder for just over a year. Her tail is broken but she can walk, run, jump, and loves to play! Unfortunately she has not regained the ability to pee or poop on her own. Like your cat, she has to have a break between attempts at expressing. The day someone suggested that to me was a real breakthrough! Thank you so much for your post. Wishing you and Norris the best!

[CarolC]

Hi Amy,

I have tried to find some answers on this, but keep running into more questions. One thing that finally occurred to me is, I wonder if she's been a little bit gassy all along, which may have had something to do with your issues expressing. I never considered that, but it definitely is a lot harder to express when the abdomen is bloated and firm and uncomfortable. You can't feel the bladder and they don't want you squeezing them. What if you've been dealing with this all along, and it is simply more noticeable now. That's quite a thought.

I looked up cisapride in Plumb's Veterinary Drug Handbook, 7th ed. It does not mention gas per se but it says, "Occasionally vomiting, diarrhea, and abdominal discomfort may be noted." This link also mentions abdominal pain, but they may gave gotten their information from Plumb's as well. http://www.petmd.com/pet-medication/cisapride. Anyway, bloating does not appear to be commonly associated with cisapride as far as I can see, though any individual could always have an individual reaction to a medication.

Here is someone who had a megacolon cat who was giving pepcid a/c for gas (see first post by otto). You might ask the vet about that?
http://www.thecatsite.com/t/224286/cat- ... ues-advice

The petmd website is the one that mentions peas as one cause of gas in cats, and also mentions simethicone (which you are giving ) as a treatment.

Causes

•Diet change
•Serious gastrointestinal disease
•Foods that are difficult to digest:

◦Soybeans
◦Beans
◦Peas
◦Spoiled food

•High-fat diets
•Milk products
•Spices
High-fiber foods

Can you tell if she has much waste in her colon? Can you tell by feeling? I'm just wondering if an enema would do her some good?

Going back to the lactulose, as critters said the beauty of it is you can fine tune the dosage. You said she was having runny stools with it, well been there done that. I quickly learned that if I gave my dog the recommended dose, we paid the price! It is very much an individual thing. They can tell you what dose to start lactulose at, but you really have to see what will work with your pet. I think they recommended 1 ml for my 6-lb dog. I learned that the absolute max we were safe with was 0.6 ml, and the perfect dose was usually 0.4 ml. The way you can measure it so perfectly is with a TB syringe like this. Your vet may have given you one, but if not you definitely need one and they usually give it to you for free. It is the skinny little syringe about the size of a pencil. You can wash and reuse it for months. So for example if you were giving 1 ml, ask your vet if you could give 0.8 or 0.5 or whatever and give that a try. Lactulose is not too expensive and very safe. Later if she needs more you can raise the dose, you will know.

http://www.terumotmp.com/productdetails ... ductId=406

But anyway, none of this really solves the problem of the bloating, and it is really important because it definitely would complicate the expressing and make it less fun for both of you. I hope you can figure out what it is in her diet or medication that is causing it. They make formulations of food for digestive problems, I guess that would be an option if you can't find a Weruva that agrees with her, but I read about the Weruva and my cats want to eat at your house!

This flavor looks super plain, but I don't know. You're probably going to having to use a lot of experimentation and observation and instinct to figure this out, wish I knew how to help.

http://www.weruva.com/cat-cuisine-paw-l ... hicken.php

[critters]

You could even do the laculose every other day, or whatever.

[amyestes]

Dear Carol,

I realized I never replied and I wanted to say thank you. We are still limping along with this issue, but OMG, I think you are right, it has probably been part of the problem all along. What a revelation! We have been through a real rough patch in the past few months and I am struggling to pay off accumulated vet bills, so trying not to go back until I catch up if I don't absolutely have to. I have also started working a day job again after being able to set my own schedule the entire time Miss Kitty has been with me. So we are working on a lot of things all at once. I have been feeding her almost exclusively Paw Lickin Chicken since your message, and I do think it is helping. I also think one thing that is helping is me being gone during the day, because there are no little meals throughout the day for her. I think her digestion may be very slow (or I may not have been giving due consideration to a normal length of time for food to digest), but she is definitely easier to express the longer it has been since she ate. This is a little tricky because I have taught her to associate a spoonful of food as the treat for putting up with getting squeezed, and of course she likes that routine, but for me to get her fully expressed, we need to have maybe four sessions over the space of 40 minutes to an hour. I have read the saying over and over that a cat can't leak if the bladder is empty, and of course I know that is true, but I tried to express her about an hour ago and she practically climbed down me. She would not have it. And so I thought, OK, let's take a break, I will try again before bed. 30 minutes later I went in the bedroom to start getting ready for bed and she had leaked all over it. We've been experimenting with a treat that has a hairball laxative and also a little olive oil in her food since I don't have any Lactulose on hand and $ is so tight right now. That has definitely had an impact and I was careful to start small and lay off as soon as I started to fear things were getting too soft. I think maybe she needs more of the Cisapride to help keep everything moving though. It does seem like the gas is less but we still have a ways to go to figure this out. Anyway, I wanted to say thank you so much and we are still working on it. I know if I keep experimenting and loving her we will get there. I appreciate your taking time to look things up and ponder about this. You are amazing!

All our best,

Amy & Miss Kitty

[CarolC]

Hi Amy,

I've been thinking about you guys and it's been a couple of months. How are things going...?

[amyestes]

Carol, thank you so much for thinking of us! That means a lot to me. I am sorry I didn't respond right away. The day your message came, for some reason I could read it on email but couldn't access the board to reply. Since then whenever I have thought to respond, I haven't been at my computer. Things are still not as easy as I think they ultimately can be, but they are a lot better. Two things happened I think, that helped. One is that I was at my mom's for several days and Miss Kitty boarded at the vet. It has always been the case that she is backed up after a stay there. They are terrific, but they don't really experience the problems I do with bladder expression, I think mostly because they have a person who scruffs her while someone else expresses her. So, after a few days at home she had spectacular diarrhea. No fun for either of us, but it really cleaned her out. The other thing was that I did buy some Lactulose when I picked up her from the vet, anticipating some problems. I have been extremely careful about how much I give her, and even now, with about 2 drops in the morning and 2 at night, her poop is too soft. BUT the gas problems have mostly resolved and I think she is more comfortable in general. I am grateful for that. I am unemployed and in job search mode right now, which means we continue to have the good fortune of expressing her several times throughout the day instead of having to do two or three bouts over the course of a half an hour just three times a day, which is something I know I have to be ready for when I get a job. I know this is achievable, as after her bowels were all cleaned out, her belly was so relaxed, it didn't seem like me expressing her bladder bothered her in the least, and the amount I could get on each try was *much* more substantial than what has been usual for us, meaning she really was empty after a few tries in relatively quick succession. I have mostly kept her strictly on the Weruva Paw Lickin Chicken, and I think that, too, has made a big difference. My resolve today, after some too-soft poo and a hard time with the bladder, is to do exactly the same thing at the same time for the next week and see where we are. Same number of treats, exact same amount of the same kind of food, same number of drops of Lactulose, etc. One thing I wonder, and perhaps you know -- how quickly do the Lactulose and Cisapride act? For example, if her poo is too soft today, is that the result of a little extra Lactulose two days ago when she seemed to need it? And with the Cisapride, does a dose really get things moving within the hour? Or is the effect more cumulative? I guess I don't really know enough about how quickly the digestive process works in cats (is the little smidge of cheese I caved in and gave her yesterday the problem?) and if these two medicines work like aspirin, where you expect some relief within a half hour or hour of taking the meds, or more like taking an anti-depressant, where missing a single dose probably won't set you back a lot, and you probably can't expect to experience any change until a couple of weeks after you start it. Thanks a lot Carol; I continue to be very grateful for my ongoing education, and I appreciate so much you thinking of us. Not perfect yet, but definitely moving in the right direction, thanks to you!

[CarolC]

That's great! That does sound good. You deserve a break so I'm glad for the good news. Had to laugh at "spectacular", though I'm sure it wasn't funny at the time. I'll look up the medications. Let's see... It's not exactly answering the question, but here's what it says.

From Plumb's Veterinary Drug Handbook, 7th ed.

Cisapride
Pharmacokinetics
Human data: After oral administration, cisapride is rapidly absorbed with an absolute bioavailability of 35-40% The drug is highly bound to plasma proteins and apparently extensively distributed throughout the body. Cisapride is extensively metabolized and its elimination half-life is about 8-12 hours.

Doses
Cats:
As a promotility agent
a) for chronic constipation (eg. megacolon): In combination with a stool softener (author recommends lactulose at a starting dose of 2-3 mL PO three times a day; then adjust as needed) and a bulk agent (eg. psyllium or pumpkin pie filling) cisapride is given initially at 2.5 mg (for cats up to 10 pounds) or 5 mg (for cats 11 pounds or heavier) three times daily, 30 minutes before food. Cats weighing greater than 16 pounds may require 7.5 mg. (Tams 1994)
b) For chronic constipation (eg. megacolon): Used adjunctively with conventional dietary therapeutics: 1.25-2.5 mg per cat two to three times a day; cats with hepatic insufficiency should be treated with half the usual dose; probably most effective when given 15 minutes before a meal. (Nixon 1994)
c) For chronic constipation (eg. megacolon) 2.5-5 mg per cat PO q8-12h (Carr 2009)
d) For chronic constipation (eg. megacolon): 5 mg per cat (total dose) PO q8-12h. (Scherk 2003)

Lactulose
Pharmacokinetics
In humans, less than 3% of the oral dose of lactulose is absorbed (in the small intestine). The absorbed drug is not metabolized and excreted unchanged in the urine within 24 hours.

Doses
Cats:
For constipation:
a) As an enema: 5-10 mL per cat; administered slowly with a well-lubricated 10-12 (french) rubber catheter or feeding tube. Orally: 0.5 mL/kg PO two to three times a day. (Washabau 2007)
b) For maintaining soft stools in cats with chronic constipation: 0.5 mL/kg PO two to three times daily. Dosage is adjusted to obtain the stool quality desired. (Carr 2009)

Looks like they are having you give lactulose more than once a day, whether cats or dogs. I have always done once a day (or less) and it has worked. It would certainly keep you busy, giving medications so many times a day.

[amyestes]

I was online today and wanted to post this just in case it might help someone else who ran into any of the same troubles I have had. Miss Kitty continues to do well; the vet thinks she is great and she seems to feel good most of the time, and really terrific (like a young kitten, although she is 12 now!) quite often. That said, it has never gotten "easy" to express her bladder, and I still, after so much time, feel like I am constantly experimenting in search of ways to make it "easier" and better. Right now everything is certainly the best that it has been, and I continue to learn by paying attention to her and her body's signals.

Here are some things I believe to be true, although frankly, my wonderful vet thinks I make a mountain out of a mole hill. I remind myself that I am doing this all by myself, but when she is at his office there are two vet techs working together, AND no one knows how her body feels and how she responds to certain things better than I do at this point.

1) Miss Kitty has some sensation, more sensation about when she needs to poop than when she needs to pee. Depending on the size of her feces and where/how things are traveling through her colon, she can really feel it and will try (usually without success) to use the litter box.
2) Gas hurts her tummy and probably happens a lot more frequently because of her condition than it did before she was injured. It also makes it harder for me to really feel her bladder/express her, and it makes bladder expression A LOT more uncomfortable for her.
3) If she has been straining to poop, her muscles are incredibly tense and it can become very difficult to express her. I know she needs to pee, but it is very hard for me to get anything out.

After a ton of experimentation -- which yes, is definitely ongoing -- here is what is working best for us right now.

Food: she is eating Rad Cat Raw Food (chicken & turkey), which I buy frozen and defrost one container at a time as needed. After the first time I offered it to her she refused to eat anything else. In all this time, I had not seen her relax like she did after she ate in the first time. She conked out all stretched out on her side and slept through the night for the first time since I rescued her. It was obvious to me something about that food and the way her stomach felt was the right fit for her. She will not eat anything else now.

Laxative: when I first started feeding her this food, her abdomen was so soft that expressing her was like a dream come true. It was so easy. After several days, her poop got dry and hard. I think it would not be a problem for a cat with normal bowel function, but naturally, she became constipated. I experimented both with Lactulose and with powdered Miralax from the drugstore. Right now, about 1/8 tsp of Miralax with each meal seems to be right for her. The amount of poop she produces is *much* less on this diet.

Cisapride: I thought maybe she would be able to go off the Cisapride if I just had her on the right dose of laxative. Currently I am experimenting with one dose a day.

Gas: no longer a problem on this diet as long as I do not allow her to become constipated. That means expressing her is much easier and I am doing a lot less laundry.

I know that a raw food diet would not be for every pet or for every caretaker. For us, I really regret I did not try it sooner.

[CarolC]

Great news! Happy for both of you! I wanted to share what I did to relax my dog's abdomen, don't know if it would help you.

My chihuahua had a rigid abdomen for several days following a surgical procedure. I could not feel her bladder to express her. The answer was deep tissue massage, not lightly but really digging in, kneading the abdomen strongly by large handfuls. It relaxed the abdomen, then I could express.

[amyestes]

Carol, you are PAWSOME. Thank you!