Feline Constipation: What to Do For Your Cat or Kitten

Cats can be pretty secretive about their bathroom habits. Cat urine and poop contain pheromones, which in the wild (or to other pets in the household) can signal that this area is theirs, among many other important messages.

Animal behaviorists theorize that cats bury their poop to signal that they are not the dominant creature.

In the wild, cats may catch and eat smaller prey, but there are bigger predators after them. So, it is no wonder that cats like privacy in the litter box.

Despite their need for privacy, it is best to scoop their box once daily. If you are using an automatic box, empty the drawer once daily. That way, you can tell if there are any major changes in your cat’s pee or poop habits.

Since cats are programmed by nature to hide signs of illness from predators, these changes are your first clue that there is a problem at hand.

How Often Should Cats Poop?

Every cat has their normal poop frequency, which depends on their diet (wet or dry, fiber content), their energy level (couch potatoes tend to have slower digestion than adventurous kitties who prowl all night long), and their health status.

Most cats poop once daily.

Normal poop is dark brown and firm but not hard, with separate pieces or segments. When you scoop the poop, there should be little or no poop left on the scoop or the litter. The poop should not smell very strong. If it does, have your vet check your kitty and a poop sample. If you are uncertain whether your cat’s poop is normal, you can check a poop chart here.

The Difference Between Constipation, Obstipation, and Megacolon

Constipation

Veterinarians are concerned that a cat is constipated when a cat strains to poop or passes poop less frequently than normal. The poop that is passed is hard and dry and may come out in hard balls rather than the usual linear or log shape.

This means that if your cat usually poops twice a day but hasn’t pooped in 24 hours, we are worried about constipation. Or if your cat normally poops once a day but during that usual once daily poop is straining in the box, we are worried about constipation.

Here's an illustration of the difference between straining to pee and pooping. Straining to pee is a dangerous condition, and your cat must see a veterinarian immediately. See below on when constipation is of concern and what you can do at home. It can be difficult to tell the difference, especially if nothing is coming out. Do not hesitate to reach out to your veterinarian for guidance.

Obstipation

Obstipation occurs when the poop is so hard or dry that the cat cannot pass the poop on their own without veterinary assistance.

Megacolon

Megacolon occurs when the colon (the large intestine) becomes extremely thin and dilated — the muscles no longer function effectively to send poop towards the anus. Despite being on multiple medications, the cat still requires help with enemas to poop.

Although there are X-ray measurement criteria for megacolon, veterinarians diagnose megacolon primarily on the cat’s signs, i.e., the cat needs frequent enemas in order to poop.

What Are the Symptoms of Constipation in Cats?

Cats may have one or more of these signs:

• Straining (this may also look like your cat is straining to pee)
• Hard, dry poop
• Poop comes out as balls instead of logs
• May have diarrhea behind hard poop
• Reduced or absent appetite
• Vomiting
• Weight loss
• Lethargy
• Blood when passing poop
• Crying out when pooping

When You Should Take Your Constipated Cat to the Vet

1. Have you seen your cat straining repeatedly in the litter box?

2. Has your cat passed any blood in their poop?

3. Has your cat had any vomiting, appetite loss, or lethargy?

4. Has it been 2 days or more since your cat pooped?

If the answer is YES to any of those questions, it is time for a vet visit today.

See below for what treatment and care your veterinarian will provide.

What You Can Do to Relieve Your Cat’s Constipation at Home

If your cat is still acting like their usual self but just hasn't pooped today, it is alright to observe them for another day.

One of the most common reasons for constipation is dehydration. If the dehydration is mild, you can help your cat drink more water.

Here are some things that may help your cat at home:

• Add warm water to wet (or dry) food. While some cats cannot be fooled by this trick, this does help many cats take in extra water.

• Hydra Care is a liver-flavored gravy hydration supplement that most cats love. A treat of two packets a day is a great way to help your cat rehydrate.

• Laxatone is a tasty lubricant gel that helps hard poops pass more easily. It is available online and at most pet stores.

If these do not help your cat poop within a day or you see any of the signs listed above, it is time for a vet visit.

What NOT to do to treat your cat’s constipation at home:

• Do not use an enema made for humans (adults or children) on a cat. Enemas containing phosphate can cause phosphate toxicity, leading to weakness, muscle spasms, brain swelling, seizures, and death.

• Do not use an enema designed for pets, either! A cat with constipation may be painful and/or have a medical condition that can lead to a possible injury to you or your cat if you try an enema. Your veterinarian may give your cat an enema at the clinic based on the results of the physical exam and/or X-ray. When given at a clinic, your cat may receive sedation, and the enema will be given by two or more trained people to prevent injury. 

• Never give your cat mineral oil as a laxative. It is not safe when given by syringe, dropper, or when put in food. If your cat inhales even a tiny bit, it can cause dangerous lipid pneumonia.

• Never use any over-the-counter human laxatives, like Miralax^®, Colace^®, Dulcolax^®, or Metameucil^® without a veterinarian’s permission and instructions on dosing. Make sure that your cat is eating and drinking before using a laxative at home. A laxative needs food and water to work!
  
  
• Other human laxatives like Ex-Lax^®, Senekot^®, and Milk of Magnesia are not safe for cats.
  
  

Why Do Cats Get Constipated?

Not Drinking Enough Water Leads to Dehydration

This is more commonly seen in:

• Chronic kidney disease
• Diabetes mellitus
• Kittens
  
  

You can check for dehydration at home, although a veterinarian will be best to determine if your cat is well-hydrated.

Stress and Behavioral Issues

For example:

• Dirty litter box
• Change in household location or routine (such as renovations or household guests)
• A cat who is hiding and inactive
• A cat who is ambushed by other cats in or near the litter box

Overweight Cats

The exact cause of constipation in overweight kitties is unknown. Some of the suspected causes include decreased overall activity levels and a higher incidence of arthritis (the more you move, the more your intestines move as well). Also, the increased abdominal fat may decrease intestinal movement.

Nerve and Muscle Disorders

• Idiopathic megacolon
• Lumbosacral disc or degenerative disease
• Manx cat sacral spinal deformity
• Dysautonomia

Blood Electrolyte Changes

• Low potassium
• High calcium

Low Thyroid Levels

• Most commonly seen in kittens as a congenital disorder.
• Occasionally, we see it in adult cats who develop low thyroid levels after treatment for hyperthyroidism with radioactive iodine (I131 therapy) or removal of both thyroid glands (bilateral thyroidectomy).

Blockage in the Pelvis, Colon, Rectum, or Anus

• Obstipation: The poop has become too large and hard to pass.
• Healed pelvic fracture that has narrowed the pelvic canal
• Cancer
• Rectal Stricture: Narrowing of the rectum due to injury, mass, or inflammation.
• Matting of hair over the anus

Eating Foreign Objects

• Hair, bones, cloth, cat litter, plastic, and all the things we ask our cats not to eat!

Pain When Pooping

• Arthritis
• Anal gland infection or abscess

Medications

• Sucralfate
• Opioid medications such as Buprenorphine, Butorphanol, Simbadol
• Aluminum hydroxide

Constipation Care at the Vet Clinic

Veterinarians and their staff know that your cat would much rather be at home than at a vet clinic being treated for constipation. Our goal is to treat your cat gently, kindly, and quickly so we can get your kitty back home where they belong. The first step is to diagnose why your cat is not feeling well.

Physical Examination

The physical exam may include a neurologic examination to look for one of the neurologic causes of the constipation listed above.

Radiographs

The X-rays will view the belly, looking at the colon, pelvic size (checking whether the pelvis is large enough for poop to pass), any masses or enlarged lymph nodes that could be blocking the colon, or any signs of any underlying disease that could cause constipation.

Lab Tests

These tests will check for dehydration and any underlying diseases that could cause constipation, such as kidney disease, diabetes, or abnormal electrolytes.

Goals of Constipation Treatment

1. Identify why the constipation occurred (see the list above)

2. Give your cat relief from this episode of constipation

3. Prevent future episodes of constipation

If this is your cat’s first episode of constipation, your vet may be able to address all of these goals in one visit. If your cat has repeated episodes of constipation, your cat may need a long-term plan that includes a diet change and medication.

Most cats who present to a veterinarian with constipation have not pooped in several days and are at the point of requiring an enema for relief. While no one likes an enema, it is over quickly, and trust me, you would prefer the clean-up to happen in a vet's office rather than your home!

If a cat is obstipated — the poop is so hard that there is no way that the cat can remove the poop on their own, even with an enema — these kitties typically need intravenous (IV) or subcutaneous (SQ) fluids for rehydration, and some need to stay in the hospital overnight. To remove the poop, there are two options: an enema and manual removal of the poop under anesthesia or placing a nasal tube with a slow drip of a laxative to help break up the feces so that the cat can go on their own after 6–12 hours.

Prevention and Treatment of Constipation in Cats

Now that the poop is out, we must ensure that the kitty does not have a relapse of the constipation. For cats who became constipated due to temporary household or diet change, the risk of relapse may be low. But other cats may need diet or medications to ensure that their poops stay normal.

Diet

Humans often turn to fiber to stay "regular" or poop regularly. Fiber has the advantage of adding bulk and moisture to the poop.

Certain fibers, called soluble fibers, such as psyllium, pectin, and guar gum, have additional benefits since they produce short-chain fatty acids that help stimulate the movement of the colon.

Fiber and Psyllium

Fiber works well for some cats, either incorporated into a prescription diet or as psyllium husk added to wet food plus water. Psyllium husk should never be given without water, as it could cause an intestinal blockage.

For some cats, especially cats with megacolon, fiber bulks up the poop too much, causing a relapse of the constipation. These cats do best with a prescription low-residue diet. Low-residue means that the diet is very easy to digest, leaving behind much less material to be pooped out.

Ask your veterinarian before starting your cat on a high-fiber diet or psyllium.

Psyllium fiber can be purchased over the counter as whole husks in products like unsweetened, unflavored Metamucil. Serving: 1 – 4 teaspoons once to twice daily mixed in wet cat food. The effects can take 12 to 72 hours. You can also grind the psyllium fiber finer if you want to. Start with the lower dose and work upwards to a higher dose of psyllium, if needed.

Warnings: While it is rare, some cats can have allergic reactions to psyllium. Signs of a reaction include itching or difficulty breathing. If you notice these symptoms, contact your veterinarian immediately. Use extreme caution using this with diabetic cats. Its use can result in hypoglycemia.

Water

Most cats with repeated episodes of constipation will benefit from a wet food diet, especially with a little water added if they tolerate that. However, some cats with constipation do fine on a dry diet. You can ensure that they get extra water with the Hydra Care supplement, a water fountain, and water bowls placed throughout your home. Read tips on helping your cat to drink more.

Supplements

There have not been many studies on supplements to help cats with constipation. The evidence so far suggests that prebiotics and probiotics may be helpful for cats with constipation.

Prebiotics

Prebiotics are plant sources such as inulin, beet pulp, chicory root, galactooligosaccharide, and fructooligosaccharide that promote the growth of good bacteria in the intestines. Psyllium fiber is also a prebiotic and is known to be helpful for some cats with constipation (see our tips about psyllium in the previous section on Diet). Prebiotics may be found in some over-the-counter and prescription diets, as well as mixed with probiotics such as Proviable-DC.

Probiotics

Probiotics are live bacteria that you give to your cat to benefit its health. Most probiotics are designed for intestinal health. A 90-day European study showed that a specific probiotic strain called SLAB51® was helpful in cats with constipation.

In this study, cats with idiopathic megacolon and healthy cats were fed the same probiotic for 90 days.

The megacolon cats showed improvement in both their clinical signs of constipation and in microscopic biopsies of their colon after taking the probiotic for 90 days. Other probiotics may be helpful for constipation but have not been studied. Ask your veterinarian if your cat may benefit from a probiotic to help with constipation.

Medications

There are several medications that veterinarians use for constipated cats, in addition to diet. Cats with mild, recurrent constipation may only need one daily medication. Those with moderate to severe constipation typically need two to three medications a day to help manage their condition.

Here are the most commonly used medications:

• Lubricant Laxatives (such as the Laxatone): These are available over the counter. They are tasty to most cats, which makes them easy to give.
  
  
• Osmotic Laxatives: These laxatives pull water from the body into the colon. Use with caution in dehydrated cats.
  • Polyethylene glycol 3360 (MiraLAX®): This tasteless powder is easy to give in wet food. Ask your veterinarian if it is appropriate for your cat and for the dose.
  • Lactulose: This is a very effective liquid prescription laxative.
    
    
• Prokinetics: These medications stimulate increased motility (movement) of the gastrointestinal tract.
  • Cisapride: This the most commonly used prokinetic medication. It is available by prescription from compounding pharmacies.
  • Mosapride and Prucalopride are additional prescription prokinetics that are occasionally used in cats.

Litter Boxes

Litter box placement, size, shape, and location is essential for cats with constipation. Some cats develop an avoidance of their litter box due to the pain they experience in the box. Or if the box isn’t to their liking (scented litter, noisy area, aggressive housemates attack when they use it), they will avoid using the box as long as they can.

Giving a cat with constipation multiple clean, large boxes on each level of the house can be very helpful to reduce pooping outside the box, but also to improve how often a cat will poop. Think about it, if your colon or bottom hurts, you would be much more likely to want to poop if there was a nice clean bathroom nearby where no one would disturb you. Your cat feels the same way!

Older cats will benefit from low-entry litter boxes. Studies have shown that 90% of cats over 12 years of age and 61% of cats over 6 years of age had signs of arthritis on X-rays. If a cat is overweight, they are also more likely to suffer from constipation, possibly from decreased intestinal motility. However, overweight cats also have more pain from arthritis and may have a harder time getting to the litterbox, as well as getting in and out of the box. We need to make going to the bathroom as easy as possible for these kitties. Here are some litter box articles with a lot more litter box tips.

Choosing the Best Litter Box for Your Cat

How to Setup Your Cat’s Litter Box

Megacolon Surgery

The most effective treatment for cats with megacolon is a surgery called a sub-total colectomy. A cat is considered to have megacolon when the colon reaches a certain size on X-rays and, more importantly, is still constipated or obstipated despite medical and dietary therapy./p>

In this surgery, 95–98% of the colon is removed, leaving the ileocolic junction, the part where the colon meets the small intestine. After surgery, cats tend to have diarrhea for 1–6 weeks before developing soft, formed stools. A few cats have long-term diarrhea, which is easier for most cats, pet parents, and veterinarians to manage than the previous severe, persistent constipation.

Occasionally, cats who have had a sub-total colectomy develop chronic constipation again. But this time, the constipation is manageable with diet and medications.

Helping Kittens With Constipation

When a kitten under the age of 16 weeks old becomes constipated, it is important not to reach right for a laxative or fiber. In fact, fiber can make constipation worse for many kittens!

Kittens may have different causes for constipation than adults, so what works for an adult cat may not work for a kitten. Also, kittens need to be treated more quickly because they are more likely to stop eating, develop low blood sugar, and become dehydrated. This can become fatal very quickly, especially for very young kittens.

There are certain periods when a kitten may become constipated.

• Newborn: 0–4 weeks
• Transitioning from mother’s milk or formula to solid food: 3 or 4 weeks to 6 weeks
• Transitioning to a new home and new diets: 8–16 weeks
  
  

See a veterinarian if the kitten:

• Is lethargic, difficult to rouse, or is too weak to move around
• Has not pooped in 2 days
• Has not urinated in 12–18 hours
• Is persistently crying
• Is straining to poop but nothing comes out, or only hard poops
• Has blood in their poop
• Is vomiting (or has diarrhea)
  
  

Stimulating a Kitten to Poop

Kittens 0–3 weeks of age will need to be stimulated to pee and poop after each feeding. Kittens this age should poop every day and urinate light yellow urine after most, if not every, meal. If their cat mom is providing their care, typically, she licks the kitten’s back end to make sure the kitten can take care of business after each meal.

If you are bottle-feeding the kitten, you will need to stimulate the kitten yourself. Occasionally, bottle-fed kittens develop constipation because they are not being stimulated correctly by their caregiver. If you are unsure whether you have been stimulating your kitten in the correct way, here is a video from Maddie’s Fund on how to do it.

Diet and Environmental Changes

Every time a kitten's diet changes, from milk to formula, to a new formula, to solid food, or to a new food in a new home, the kitten may develop diarrhea or constipation. For mild cases of diet-change constipation, introducing more water to the formula or diet for a day or two may help.

Many veterinarians recommend a gradual diet change for kittens older than 8 weeks and adding probiotics to their food to help their intestinal tract adjust to the diet change.

Medical Conditions That Can Cause Constipation in Kittens

We love kittens because they are precious micro-cats. However, kittens have certain conditions associated with constipation that are not typically seen in adults. When kittens are constipated, and it the constipation keeps coming back, a vet is going to look for these issues, depending on the kitten’s history and age:

Dehydration

Young kittens receive all their hydration through milk, either their mother’s milk or formula. If there is competition among the littermates to get to the nipples, a weaker kitten may not receive as much milk. This kitten will not only receive fewer calories and grow less over time, but it can very quickly become dehydrated.

Signs of Dehydration in Kittens:

• Weakness
• Not moving much or not playful
• Hiding or huddling away from the mom and other kittens
• Dry, sticky gums
• Reduced urination or dark yellow urine (newborn kittens)
• Sunken eyes (easiest to see in newborn kittens)
• Constipation

Mild dehydration in newborn kittens can be treated by ensuring that they receive alone time with their mothers to nurse. If you are bottle-feeding, double-check that the formula concentration is correct. If you are feeding the correct amount, try feeding more frequently (every 2–3 hours). If the kitten will not allow this, it is time for a vet visit to see whether there is an underlying issue causing dehydration and constipation.

In kittens who are eating solid food, mild dehydration can be treated by adding warm water to wet food and offering Hydra Care. If the kitten is reluctant to eat or drink, or remains less playful, the kitten needs a vet visit as soon as possible to treat the dehydration and constipation.

Eating Foreign Objects

Have you noticed that little kids like to put almost everything in their mouths? Well, kittens and puppies do the very same thing! Kittens are notorious for eating kitty litter, so we do not recommend introducing clumping or silica litter to kittens until they are at least 10 weeks old. In fact, my 5-month-old kitten still eats cat litter, so we use this Tidy Cats unscented clay litter.

Cat litter, pieces of toys or plastic bags, pen caps, cloth, hair ties, Lego® pieces, you name it, a kitten has tried to swallow it. Unfortunately, these objects do not all make it out to the other end easily. If they cause a full blockage, the kitten will start vomiting, become lethargic, or stop eating. But if it is a partial blockage, a kitten may poop less, may strain to poop, eat less, vomit occasionally, or become less active. If you do not know what is causing your kitten’s signs, your veterinarian can do X-rays, an ultrasound, or a contrast X-ray if they suspect a foreign object. This will help the vet determine whether your cat needs medical treatment or surgery to feel better.

Hypothyroidism

An overactive thyroid (hyperthyroidism) is the most common thyroid condition in senior cats. Kittens are rarely born with an underactive thyroid (hypothyroidism). But if they are, these kittens are persistently constipated. Their baby teeth and, more importantly, their bones develop late, so they are smaller than their littermates. The vet will diagnose hypothyroidism with a blood test, which will show low thyroid (T4) levels and high thyroid stimulating hormone (TSH) levels. Kittens are treated with prescription thyroid medication lifelong, although depending on when the diagnosis is made, kittens with hypothyroidism may always be small.

Rectal Prolapse

Infections causing diarrhea are very common in kittens. These kittens can have such severe diarrhea that they strain persistently to poop. Some cats strain so much that part of the rectum (the last part of the large intestine) will loosen and fall outside of the anus. This is called a rectal prolapse. When this happens, it is an emergency because the rectal tissue becomes very swollen and easily damaged outside the body. It also becomes very difficult, if not impossible, for the kitty to poop. If you have a cone collar, put one on your kitten before you head to the vet right away.

The veterinarian will anesthetize your kitty to replace the section of the prolapsed intestine. The vet will also treat the underlying cause of diarrhea, often parasitic, protozoal, or bacterial infection. Your kitty will need to wear that cone collar until their bottom heals, usually about 2 weeks.

Atresia Ani (also called Imperforate Anus)

Atresia ani is a rare congenital disorder in which the kitten has either an extremely narrow opening of the anus or the anus does not open at all. If the anus is very narrow, humans caring for the kitten may not notice that there is an issue until the kitten starts to eat solid food.

Signs may include not passing poop after starting solid food, belly swelling, crying, not eating, vomiting, and/or poop passing through the vagina in female kittens. The veterinarian may need to refer the kitten to a specialist to determine whether the opening can be repaired with surgery.

Constipation for most cats and kittens is only temporary. If it becomes frequent, fortunately, there are treatments, both medical and surgical, to help most cats live comfortably. Never hesitate to reach out to your veterinarian so that your cat can feel better as quickly as possible.

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