Rectal, Anal and Colon Problems

The following are real life cases of Rectal, Anal and Colon problems in Cats that have been treated by Dr. Mike Richards, DVM.

Scooting on Carpet After Anal Sacs Have Been Removed
Painful Defecation and Urine Marking Behavior
Scooting and Hairloss Around Anus
Rectal Bleeding
Perineal Hernia
Bowel Incontinence
Prolapsed Rectum
Inflammatory Bowel Disease
Anal, Rectal and Colon Prolapse
Anal Sac Secretion
Prolapsed Rectum
Fecal (Stool) Incontinence

Scooting on Carpet After Anal Sacs Have Been Removed

Question:

In early 1995, Grey started having "scooting" problems. He did this frequently, so I would have to take him in to the office to have his anal sacs expressed on a regular basis. Because this seemed to be very traumatic for him - my vet suggested that we remove his anal sacs. He said it was unusual for cats to have such a persistent problem, but that Grey seemed to be an unusual case. Since then, the behavior has changed a lot, but he still scoots on the carpet about once or twice a month. Is this normal? What can I do to prevent this?

Answer:

I couldn't tell from your note if Grey had anal sac surgery or if it was just a suggested option. If he didn't have surgery and the scooting continues then the anal sacs are the most likely cause. If he did have surgery and the scooting continues then I would worry about a small possibility of tapeworms and a bigger possibility that something like allergies (especially flea allergy) was causing the itching leading to the scooting behavior. In both cases I think that a careful examination of his anal area for signs of problems and checking for rectal polyps would be a good idea. Rectal polyps seem rare in cats but we have seen them once or twice. Since this behavior is intermittent it may be hard to tell if treatment for it works --- so this is another problem that might fit into the category of something just to live with, unless the anal sacs haven't been removed. Then you might consider going ahead with the surgery.

Get additional information on the possibility of Tapeworms in your Cat.

Painful Defecation and Urine Marking Behavior

Question:

Ok, where to begin. This is about my 8 year old bengal cat "Butch". There are a couple of conditions I want to speak about and I'm not sure if they're related or not, but maybe you can help me out.

First of all there are times when he seems to be very agitated immediately after coming out of the littler box. He will often run about wrecklessly upon his exit and it seems like he's running from something. It also seems that sometimes he does not successfully complete his elimination (defecating). I will find remains littered about my home. The remains sometimes seem to be somewhat dry and not all uniform in width. This doesn't happen all the time. Maybe once every 2 weeks. All of his symptoms seem to be quite random.

Secondly, he has been having some unusual spraying incidents. Often it is on my shoes. But more curious are the incidents when he will jump onto my bed and stand on my chest, looking into my eyes and urinate all over me. Just this evening he jumped into my arms (he's very affectionate) and as soon as I caught him, he began spraying a strong steady flow. It seems to me that he is trying to communicate with me. He is very vocal beforehand and then he does his thing and I have no control. I don't scold him as I think he is trying to tell me something but I am nearly at my wits end.

Following are some incidentals that might help:

1. He is obsessed with going outside. He demands that I take him out on a leash frequently. He loves to just sit outside and watch the world go by. He's also quite territorial of some of the neighboring cats.
2. I have recently allowed a friend to stay with us. I've heard that a disruption in a home can cause strange behavior in cats. This would be more about the spraying, not the litterbox problem.
3. I have another bengal that is a year older than Butch. They are complete opposites and have never had a problem with the other.
4. I have recently taken Butch to the vet and they ran all kinds of tests. They have had no success.
5. He looks perfectly healthy. Bright shiny eyes, beautiful coat, very playful and no problems with appetite.

Some people have suggested that the spraying is his way of bullying me into taking him outside. Like I said before, he is obsessed with the outside world. I don't know what else I can tell you. Please let me know what you think. I'm one of those people that feel my pets are my children.

Answer: 

It is likely that you are seeing two separate problems in Butch but not certain. The behavior in which he runs out of the litterpan is one of those for which it would be nice to be able to talk to our patients. It sounds as if he may be experiencing pain or discomfort when defecating. This can happen with impaction of the anal sacs, constipation and orthopedic problems. There may be other causes.

Anal sac inflammation and impaction is less common in cats than it is in dogs and it is easy to overlook as a source of discomfort for cats. Dogs often let their owners know that their anal sacs are bothering them by sitting and "scooting" along the floor on their bottoms. Cats rarely do this sort of thing.

Constipation occurs in cats and is associated with megacolon, a condition in which the motility of the digestive tract is not normal and stool size becomes large enough to be uncomfortable or difficult to pass. This responds well to the use of lactulose (Chronulac Rx) and sometimes motility enhancing medications such as cisapride (Propulsid Rx).

Orthopedic problems and spinal disc problems are less common in cats than in dogs but still are a source of pain when defecating for some cats. This is just something else to consider if the above problems don't turn out to be the source of the discomfort.

There is also some chance that a urinary tract disorder is present that is painful when straining to defecate or urinate, or that Butch is actually straining to urinate but the effort is producing stools, even though that is not his goal. In this case, you might also see unusual urinary behavior at other times because it seems to really interfere with normal urinary behaviors. This doesn't seem likely, given the type of urinating that you are seeing but it is another one of those things that has to be considered at times.

The urinary behavior seems to be urine marking. A number of cats urine mark on their owners. Presumably this is a good thing from the cat's perspective but not many cat owners see it that way. It is also not especially uncommon for cats to urinate on beds or on piles of clothes. This type of urine marking is extremely frustrating for pet owners for obvious reasons.

There are some things about Butch's behavior that are very typical for cats with urine marking problems. Cats who are territorial and who are anxious about seeing and defending their territories tend to urine mark more. Urine marking behavior is much more prevalent in cats who are inside/outside cats than in cats who live indoors only. It can even help to limit the ability of particularly territorial cats to block their view of the outdoors, to cut down on anxiety from seeing other cats through the windows. Cats who urine mark often increase this activity when new cats or even new humans are added to the household.

There are a number of things that sometimes help with urine marking. We usually start off using Feliway (tm) spray around the household. It is a synthetic pheromone product that helps to control urine marking in most cats and can eliminate the behavior in many cats. If this doesn't work, we usually add buspirone (Buspar Rx). This has been the most consistently successful medication for the control of urine marking that we have used, but we haven't tried some of the newer medications, such as clomipramine (Clomicalm Rx) and fluoxetine (Prozac Rx) that are sometimes recommended. In many cats, if we use buspirone for 60 to 90 days and then taper it off slowly, the problem will resolve for months. Usually it comes back eventually, but it isn't too often than clients feel compelled to use medications on a continuous basis.

It is controversial whether cats have the capability of developing spiteful behaviors, such as urinating because they aren't being allowed outside. Personally, I think that there are a few cats who seem to be capable of this sort of thought and behavior but that is just an opinion from observing cats, not something I have thought through scientifically or even logically. If this were the case, you might find that you could satisfy Butch's desire by building a cat playground (enclosed space) attached to the house with a pet door, so that he can let himself in and out. Of course, there is a risk of increased urine marking with this solution, because of the already noted increase in urine marking behavior problems in cats who lead indoor/outdoor lives.

If your vets didn't check Butch's anal sacs the last time, it might be worth doing this the next time he exhibits the behavior of darting out of the litter box. You may have to watch for signs that he has arthritis or other orthopedic problems, based on other things like how he jumps onto the furniture, etc. It is often necessary just to treat for constipation if the stools are hard, to see if that helps. We do have pretty good luck with Feliway and since it isn't given to the cat it shouldn't have side effects that might be harmful so it is worth trying. Medication for urine marking does have some potential problems, such as increased aggression between the cats as a side effect of buspirone, or a reaction to the medication, but it can be helpful in controlling urine marking and may be worth trying for a short course of time to judge the effect.

Follow up by learning more about Territorial and Spraying Behavior in Cats.

Scooting and Hairloss Around Anus

Question: 

I am a subscriber and would like to ask you a couple questions about my 11 month old burmese named Tweed. Three weeks ago I had taken Tweed to the doctor for a problem with his eye. It was swollen & inflamed & the doctor said it looked like a herpes virus. He gave him an antibiotic shot & sent me home with antibiotic liquid & eye drops. It has cleared up. Now he has been scooting. I took a sample of his feces to be tested for parasites. It was negative. I cleaned his bottom & he didn't scoot as much. I went out of town for a few days and on my return he is scooting & has hair loss around his anus. I cleaned him and it looks a little better today. He has dandruff at the base of his tail. What do you think is going on? Could this be a reaction to the antibiotic. He eats primarily dry food--mixture of science diet growth, iams kitten, proplan kitten. He will eat maybe a teaspoon of wet food. Also, when he was altered, the doctor found a flea on him so he has been treated with Advantage & I believe he had a worm shot. Several months ago you helped me so much with Gabberdean. Anything you can help me with for Tweed is appreciated. 

Answer: 

There are three pretty likely causes of the scooting and hair loss around the rectum and then a lot of other possible causes. The three likely ones are tapeworms, sensitivity to flea bites (itching can last two or three weeks after a flea bite in sensitive pets) and irritation from diarrhea and/or constipation, since antibiotics can cause either effect. Once in a while we see anal sac impaction or infection in cats, there may be mites (Demodex, Cheyletiella, Notoedric or Otodectes (there are ear mites, which can live around the base of the tail). It would be a good idea to try to determine if either constipation or diarrhea is present. If so, your vet may be able to prescribe something to help with the problem present and in the case of diarrhea, using something like A&D ointment (tm?) or Desitin (tm) around the rectum to provide some protection to the skin can be helpful. If there is no evidence of either of these problems, it may be necessary to have a recheck done at your vets to try to rule in or rule out the other possible problems.

Rectal Bleeding

Question:

I have a 2-y/o dilute tortoise-shell, Squeaky. She's indoor/outdoor, and quite the little huntress.

I noticed when she was a kitten that she seemed to have the occasional anal prolapse (little red butt donut). I asked the vet about it and they didn't think it was significant.

Sometimes I've noticed a foul smell to her when I pet her, like she'd been rolling in something rather, uh, dead. Anal sacs, right?

The past few months I've noticed a bit of rectal bleeding after she passes stool (and it's gotten rather odoriferous, even by cat standards). Just a drop or so, but quite red, no mucus, not in her stool, but *afterwards*.

It got so when I'd notice it I'd give her a quarter tablet of Pepto-Bismol and she was okay for a while.

Well, it's not going away, and seems to be getting worse. I noticed this evening that she was, er, dripping blood from her anus after she had a bowel movement.

She's happy, hungry, and seems to be healthy other than the above mentioned symptoms. I looked up bloody stools, but that doesn't seem to be it -- this is more rectal bleeding. She eats Iams Senior (in deference to the older cats) and Iams canned (twice a day). I have some idea what she's getting into outside -- birds, mice, even lizards -- but it's not acute enough to be warfarin poisoning.

Should I just keep giving her the Pepto? Or do you think I should noodge the vet to give her butt a closer look?

Answer: 

I find it hard to decide how hard to pursue instances of fresh blood (bright red) in the stool of cats. It isn't unusual for owners of cats that appear to be absolutely normal to tell me at the time of yearly examinations or other visits that their cat has blood in its stool occasionally. Sometimes, this is happening as often as two or three times a week but the cat still seems normal. On the other hand, some of these cats do have rectal polyps, other rectal tumors or other problems. Since the problem is escalating, I think it would be best to ask your vet to look into it. Checking the rectum digitally for polyps, thickness of the rectal wall, hernias and hard or unusual stools is a good first step. It is possible to see the rectal area pretty well with an otoscope and an endoscope is even better, obviously -- it's just that most general practitioners don't have this equipment. If your vet can't find a problem, it is probably safe to wait and see what happens for a while but it is reasonable to ask for referral to someone who has an endoscope and can make a thorough examination of the colon, if desired.

I think that there is a good chance that anal sacs are the cause of the occasional odor when petting Squeaky. Sometimes this is due to flatulence, though.

Increased odor to the stools can occur when digestive problems are occurring. This may be due to digestive disorders, especially poor digestion of fat. If diarrhea occurs along with an increase in odor it would be important to discuss this with your vet.

Pepto-Bismol (tm) contains bismuth and salicylate, a relative of aspirin. Due to the problems with liver toxicity associated with aspirin use in cats, it is best to use Pepto-Bismol sparingly, or perhaps not to use it at all. In our practice, we have not seen a problem we could identify from the use of Pepto-Bismol, when people have said they were using it, but caution is still advisable.

Find out some of the Causes of a Bloody Stool in Cats.

Perineal Hernia

Question:

When my kitty, Baby Boy, started having troubles, I began to search for information on the Internet and was so glad to find this site. It has been very helpful, so I decided to become a member, in hopes you may be able to help me with my problem. In June I brought him to the vet because he was swollen where his tail begins. I also felt like maybe he was a little swollen near his rear on both sides. I showed the vet this and he said, if it is the same on both sides, that is probably just the way he is. He thought that BBoy has been bitten by another cat, and put him on antibiotics. Well, after a while that went away, but came back again, about a month later. This time, he was leaking an awful smelling mucus, and again, a little swollen at his tail. He was also straining terribly to poop, with no results. Very constipated. I brought him in again, and he had an enema, full blood work up, and x-rays. The colon was not abnormally swollen. The vet suggested the possibility of taking out part of the colon, if it became necessary. He also suggested doing a Barium study first, then an endoscopy, if necessary, or possibly exploratory surgery. This scared me, so I took him to another vet. They did the Barium study there, which apparently was pretty normal. No polyps or tumors. The vet pulled out a hard fecal ball about 3 inches in diameter, which accounted for the swelling at his tail. He had one decent size poop after another enema. She said he had chronic constipation. She put him on Propulsid 10 mgs and Lactulose 1cc orally daily. We switched him to wet food only, and I was sneaking him Metamucil. Almost a week later, BBoy still was not pooping. I brought him back in, she said he is still swollen, she referred me to a surgeon. He did a third enema, and diagnosed the problem as bilateral perineal hernias. He said he could move his finger from side to side, which your not supposed to be able to do. He recommended surgery to build a wall to get the poop moving in the right direction again. He said it was getting stuck in the fallen walls. I talked with the first vet about this, and he disagreed strongly, never having seen such a thing in a cat, only dogs, whose anatomy is different. He didn't say that it was impossible, however. He was leaning toward the Mega Colon, which, were the symptoms that BBoy was having. The other vets disagreed strongly. The colon wasn't swollen. I put the vets on the phone with each other to let them duke it out, me being thoroughly confused and scared for my BBoy. Neither came to the conclusion that either surgery would completely solve the problem. They both agreed they were trying to do the best they could for my cat. I have decided to hold off for a while, just not knowing what to do. In the meantime, I have upped the Lactulose, but not the Propulsid, in case it is perineal hernias. Still no poop, but he has the appetite of a horse. The doctor says he is well hydrated, and in every other way seems normal. How long can he go without pooping? Where is it all going? How come his appetite is so strong? Both surgeries are very expensive, I can't afford really to do either anyhow. I was hoping that there was some sort of Fund to help, but after asking around, there is none. I love my kitty, and want what's best. Any suggestions?

Answer: 

Perineal hernias are not very common in cats but it definitely occurs in them. I think that the swelling you describe is more likely to be due to a perineal hernia than to megacolon, though, just based on what we see in our practice.

There was a report in the Journal of the American Animal Hospital Association (Oct 1992, Welches, et al) on 40 cases of perineal hernias in cats. The primary signs reported were straining and constipation. Surgical repair was recommended but the authors strongly advised being cautious to rule out megacolon prior to surgery. This should be possible based on the barium X-ray studies that have already been done, although you are reporting disagreement among the vets looking at these films.

The medical treatment for the conditions is the same, with lactulose sufficient to make the stools stay soft being the mainstay of treatment. Currently it seems better to use low residue foods rather than higher fiber foods. Eukanuba Low Residue (tm) food is commonly recommended at this time. Cisapride (Propulsid Rx) is commonly used, as well. We have good success at medically treating colon problems but perineal hernias will almost certainly recur even with careful medical management, so that may help in differentiating the conditions, as well.

In the long run, if there are perineal hernias it is likely that surgery would be less expensive than medical treatment but I know that the up front cost can be prohibitive.

Bowel Incontinence

Question:

I am 14 years old and very concerned about my cat. Her name is Cookie she is a 8 year old American Long hair. She is litterbox broken, and is to my knowledge very health. But for a few moths now she has been making feces and vomiting on the floor all over the house. She is not misreated or anything. We have given her all different kinds of foods. No more dry food, or wet food. We give her Baby food like our veterenarian, had asked. He said use the lamb baby food cause its the easiest to digest. She has recently had problems with itching her stomach and bleeding. But we have fixed that with a medicine he perscribed. And she is not so much vomiting anymore but she is making feces all over the house, and my mom and dad think something is wrong with her. We also have a 6 year old dog. I think she makes feces all over cause the dog sometimes scares her, but our dog (Blackie) is a moosh, shes very friendly. But i nor my parents can figure out whats wrong with my cat. She is also about 8 pounds. One other thing to tell is that we are in construction and addeing another level to our house and the wooden floor was found with some feces today. And i read on your page that they like to try new territories so maybe thats the case. Anyway if you can email me an answer to this problem I would be very happy. And if i have to on your request get her medical attension i will.

Answer: 

Your cat may have incontinence (the inability to control when she will have a bowel movement). When this occurs, the cat usually doesn't realize it is going to have a bowel movement. That means that most of the time she will have a bowel movement when you are around, at least at times.

The other possibility is that she is aware she is having bowel movements is unable or unwilling to use her litterbox. In that case it is important to figure out if she is simply avoiding the litterbox (a behavioral problem) or if she can't make it to the box when she needs to go (likely to be a medical problem).

If her stools are formed and the places she picks have roughly the same sort of "feel" to them -- a secluded spot with a smooth floor, for instance, then it is more likely that the problem is behavioral.

If her stools are sometimes soft in consistency or if she has occasional diarrhea, then it is more likely that she has a medical problem.

Your vet can help you sort out which problem is present. The change to a lamb based diet is one step in the diagnostic process. It can take a long time to really eliminate the possibility of a medical problem with the digestive tract, so you are going to have to be a little patient and work with your vet on this.

In the meantime, giving her a second or even a third litterbox, located in one of the spots she likes to have bowel movements, with a different litter than you usually use, is a good idea. Cats with behavioral problems leading to avoiding the litterbox often do better with a different type of cat litter (the clumping type is favored by a lot of cats) and if you can put the litterbox somewhere she wants it to be, that will help a lot, too. Having more than one litterbox often will help a great deal with problems like this.

Keep working with your vet to find a solution. It isn't always possible to find a problem but it is worth trying. Incontinence is very hard to treat but most of the other things, even behavioral problems, will eventually respond to treatment.

Understanding Fecal Incontinence in Cats.

Prolapsed Rectum

Question:

I wonder what one does with a prolapse rectum. Years ago I was able to push one back in successfully.

Answer:

It is OK to put a prolapsed rectum or colon back in, gently, and see if that works. When it doesn't stay in, which is more often than not, most vets try using a purse string suture to close the rectal opening for twenty-four hours to see if that will keep the prolapse in and allow it time to become less inflamed, making it more likely to stay in. It is obviously very important to remember to remove the suture after the first day.

There are really several things that get lumped under the heading rectal prolapse. If the above treatments don't work it is important to figure out which of the possible problems is present.

In some cases, only a small amount of rectal mucosal tissue protrudes from the rectum. Once in a while it is possible to use a corticosteroid or Preparation H (TM) to get this to shrink and return to a normal position. When that doesn't work it is usually OK just to trim the mucosa down some so that it isn't so irritated and returns to a normal position. That does have to be done carefully, obviously.

In other cases, only the rectum is prolapsed. When this is the case, it is difficult to get a thermometer to pass in the space between the prolapse and the ring of rectal tissue (perineum) that usually surrounds the rectum. It is possible to remove the portion of the rectum that is prolapsed in these cases and suture the cut ends back together and replace the now much smaller prolapse back into the rectum.

In most cases, there is actually an intussusception of the colon through the rectum and a colon prolapse. A thermometer will pass to its full length between this type of prolapse and the perineal opening. In these cases, the best success with treatment usually occurs when an incision is made into the abdomen (usually on the midline of the underside of the abdomen) and the colon is retracted from inside the abdomen and then sutured to the body wall to stabilize it. This procedure is called a coloplexy. It usually works well, if the underlying cause of the prolapse can be identified and corrected along with the surgical repair.

Prolapses of the rectum can occur due to internal parasites, bacterial or viral enteritis, severe coughing and probably other reasons. In addition, they sometimes occur for no discernible reason. Still, it is important to try to eliminate possible causes of diarrhea, constipation, coughing and straining to have a bowel movement. Fecal exams for parasites are a good first step in trying to determine what might be causing the prolapse. A good physical exam helps and then further testing based on the results of that exam is sometimes necessary.

Find out more about Prolapse in Cats.

Inflammatory Bowel Disease

Question:

I really enjoy your website. Thank you for bringing such a great resource to us pet owners who want to be better educated about the health of their faithful companions!

My 12 year old cat has been blessed with good health thus far. In the last year, she has developed one symptom which concerns me. She intermittently leaves a spot of blood and mucus on the floor. It originally occurred maybe once every week to two weeks. It was literally just one drop, and it was a varying mixture of blood (sort of clot-like, or varicose-vein looking), mucus, and occasionally some really smelly, runny stool. She left it in all sorts of places, and I think she didn't realize when it was happening to her, because she once did it on my arm as I was holding her and she was just purring away.

I first took her to my regular vet. He felt her abdomen and took X-rays, but didn't find anything. He examined her rectum with his finger and said there was nothing unusual there. He said her anal glands were normal and everything else as far up as he could feel. He listed my options as being

1) to do nothing and wait and see if it worsens or disappears, or 2) to get an endoscopic exam from an internal medicine vet. He gave me a couple of references in my area.

I decided to wait a little bit. Over the next few months, the condition persisted. It didn't get worse or better. I called my vet sometimes to update him and brought her there another time or two. Still there was nothing that he could find. The strange thing is that she is entirely normal - happy and apparently healthy - in every other way. Nothing unusual about her eating habits, exercise, or stool.

I took her to another vet who had the same results. He recommended one other option before going for the endoscopy. He gave me some antibiotics as a more conservative treatment first, in case it was some sort of bacterial thing. This was not easy to do with my cat (getting her to swallow pills). Actually, it was impossible. I would have tried harder, but the vet said that this was just something to try, that there was no hard evidence that this would help, and so not to traumatize her.

I finally decided to take her to the vet. of internal medicine. By this time, her stool seemed to be a little softer and smellier than normal, but not extremely so. This doctor was recommended by both vets. She listened to my story and discouraged me from getting an endoscopy. She thought it to be a rather extreme procedure given the symptom. Although she thought it might be inflammatory bowel syndrome, she indicated that it is a slow-developing disease, and that it would surely be in the early stages. She suggested trying to get more fiber in her diet.

So, since March or so, I have been giving her 1/4 to 1/3 a teaspoon of metamucil every day. I have had to start giving her wet food in order to get her to eat it. It seems to be less frequent, but I still see it perhaps once a month or so. Her stool is still pretty soft and smelly. I don't know if the wet food would counteract the extra fiber or not.

Do you have any other ideas of what these symptoms may be caused by or any better of an idea of where to look? Should I be taking more aggressive action in treatment options? Are there any other treatment options?

Please advise! I can't bear to think of her getting irreversably ill because I didn't follow up on the signs she was giving me.

Answer:

I do not have any better ideas as to what might be going on. Your vets all sound like they have done pretty well in ruling out possible problems and then giving reasonable advice.

Giving the Metamucil with wet food doesn't harm its effect and may enhance it since the fiber works best after absorbing water.

I have had patients with very similar symptoms and can not recall ever really knowing what the cause was except for one cat that had a lump or polyp that eventually protruded a little from her rectum. It was easy to identify and to remove after it made itself apparent. I can't remember the other cats really getting into trouble due to this problem, either.

It sounds like you are doing pretty well with the decrease in frequency. If the symptoms become more frequent again the best course of action would probably be to call the specialist and see if the changes make her more inclined to do the endoscopic exam.

See our overview of Inflammatory Bowel Disease in Cats.

Anal, Rectal and Colon Prolapse

Question:

I read your section about the anal prolapse, but my cat Pinky was born this way. She has already had two unsuccesful operations. Is there anything else that we can do for her? She is now a year old and the condition doesn't seem to bother her at all.An odor ( which almost smells like something is rotting) will sometimes eminate from her anal area. Is this a bad sign? I usually notice this when her anus/rectum is very swollen. Sometimes things are looking good for her ( the swelling is not so severe) and other times it just isn't pleasant to look at. Although I do plan to have her spayed very soon,I was also wondering if this is a genetic problem that she could have gotten from one of her parents and if it could be passed on to future kittens. I love her to death and would truly appreciate anything you can tell me on this subject.

Answer:

I think that the answer to what can be done for Pinky depends a lot on what has already been done. There are several steps to take in controlling the problem of rectal prolapse and if any step is missed or if an incorrect conclusion is drawn at any stage in the process it can encourage relapse.

The first step is to carefully consider the problem. Is it a rectal prolapse, an anal prolapse or a prolapse of the colon through the rectum (colonic intussusception)? These are very different situations and the treatment is different, as well. Anal prolapses are small protrusions of the red mucosal tissue lining the rectum that usually occur right after a bowel movement. Rectal prolapse looks like a tube of tissue protruding from the anus. Colonic intussusception looks identical to rectal prolapse but the tube of tissue is actually the colon passing through the rectum in a "telescoped" manner. I am not sure of the overall incidence of these problems but anal prolapse is probably the most common and in our practice rectal prolapse and colonic intussusception appear to occur about equally.

Anal prolapse is more of an irritating problem for the cat and the owner than it is a life threatening condition. We look for problems that cause irritation in the anal area and try to resolve any that we can find. Tapeworm infestation,other intestinal parasites, anal sac irritation, allergies, fleas, an inability to groom in obese cats, hair entrapment in long haired cats and persistent diarrhea or straining for any reason can lead to anal prolapse. Sometimes local treatment with topical cortisone ointments or even Preparation H (tm) can be helpful. Elimination of any and all causes of irritation in the anal area usually will resolve the problem if it can be accomplished.

Rectal prolapse is more life threatening. In this case, the inner rectal tissue is protruding from the anus, sometimes for several inches. If the rectal tissue is not returned to its proper place in the body it will die, which usually results in the death of the pet. Recal prolapse can be differentiated from colonic intussusception by your vet using a well lubricated probe. If a probe can pass between the edge of the rectum and the tissue, the problem is usually an intussusception. If not, a rectal prolapse is more likely. Rectal prolapses occur because of chronic irritation in the rectal tissues. It is important to look for and find the cause of the irritation to have long term success in treatment of this condition. Possible problems that contribute to rectal prolapse include intestinal parasites, enteritis from bacterial or viral causes, cancer, foreign body ingestion (burrs and bones cause the most problems in our practice), straining associated with delivering kittens, straining associated with bladder infections or feline lower urinary tract disease, congenital rectal problems, and inflammatory bowel disease. It is usually necessary to reduce the prolapse (return the tissue to its normal position inside the body) and then to place sutures around the rectum to hold it in place while treating whatever underlying problem can be identified at the same time. The sutures are usually left in place 24 hours but can be left in place 48 hours when necessary. Lots of times this is sufficient to control the problem. Other times, it keeps coming back.

When rectal prolapse recurs there are two options. The first is a surgery known as colopexy. In this case, an incision is made into the abdomen similar to the incision made for spay surgery. The colon is identified and then retracted along one side of the muscular body wall. Sutures are placed through the colon wall and into the muscle layer to secure the colon to the body wall. Doing this prevents the rectum from prolapsing because it is attached to the colon and kept inside the body by the fixation of the colon. This works pretty well. It is sometimes necessary to repeat this surgery because of insufficient fixation to the body wall or because the rectum persists in stretching and attempting to prolapse again because the underlying cause of the problem has not been identified or can not be controlled. If the rectal tissue is damaged too severely to do a colopexy it is sometimes necessary to amputate the diseased portion of the rectum. This works better than it sounds like it would work but it does sometimes lead to blockages of the rectum by scarring or incontinence due to insufficient function of the remaining rectal tissue. If the cat's life is threatened by the prolapse it may be the best choice, though.

Colonic or ileocolic (colon and ileum - the last part of the small intestine) intussesception looks almost exactly like a rectal prolapse and the underlying causes are much the same. Intussusception will sometimes occur for no apparent reason, though. The tissue must be retracted by making an abdominal incision and pulling it back into place. This allows the surgeon to examine the tissue and make sure it is all still viable, too. We always do a colopexy when we repair an intussusception and have only had this problem recur once that I can remember. It is still very necessary to look for underyling causes and to treat any that are found.

Since your cat is continuing to have these problems it is important to do review the steps. Is this an anal prolapse? If so, look for the underlying cause and treat the inflammation. You may have to live with some degree of anal prolapse longterm, though. If this is a rectal prolapse and colopexy has not been attempted, that may help. Another careful review of possible underlying causes is always a good idea. If the problem is an intussusception and there is no cause of continuing straining or diarrhea it may just be bad luck - once in a while a patient is just prone to intussusception. I can't recall this happening more than two times in a cat patient but have fixed three intussusceptions in one dog patient.

I have not seen any information to suggest that this is or is not an inherited trait. I think that most of the time there is an underlying cause other than genetics - but some of those causes are genetic problems!

Anal Sac Secretion

Question:

I have a one year old tabby and her name is Mimi. In the past few months, she's had a hair ball problem with vomiting. so, I've been giving her petromalt every 4 days, which seems to be working. Just recently, I've noticed a foul, urea-smelling odor near her rectal/anal region. I'm a first-time pet owner, so I don't know if this is normal or abnormal. Are these anal secretions or is she dribbling urine? The first time I noticed this problem was about one week ago. I went to pick her up from the couch (where she was sleeping), and when I went to put her down, I noticed the pungent smell all over my hands. I checked to see if she had urinated on the couch, but she hadn't. then, I gave her a bath, hoping that would solve the problem. I thought everything was fine until tonite, when the odor came back, however, it wasn't as strong as the first time. I washed her behind again, but the smell still exists as I sit here typing this query. The smell has seemed to come about 6 hours after I give her the petromalt, and I see her licking her behind more often than usual. thank you ,sincerely, Amy

A: Amy- I can not tell you for sure what is wrong since it is not possible to examine Mimi. However, it seems likely that you may be seeing an anal sac secretion with the description you give or that the Petromalt itself may be leaking from her rectum (perhaps she has a little incontinence or other problem making this possible). It is a little unusual for anal sac secretions to build up as quickly as you seem to be seeing the problem recur with Mimi, which is why I am wondering about this. I think it might be best to look for a cause for the hairball problems, such as allergies or inflammatory bowel disease and see if a more definitive treatment can be used. I really think that might be worth the vet visit!

Prolapsed Rectum

Question:

A couple of months ago we found my missing cat dead under our house, he looked as if half of his intestines had come out of his rectum. This afternoon we noticed a raccoon stumbling around our backyard, he was twitching as he made it towards our creek. When animal control finally arrived {hours later!) the coon was dead. The officer said he had "drowned himself". As the officer was carrying it away, we noticed that it too seemed to have distended intestines. Short of being hit by a car (neither one showed any other signs of trauma) what could have caused such damage? My cat had been sneezing and having loose bowel movements before he died.

Answer:

At least once or twice a year we see a cat with intestines prolapsing out of its rectum. This appears to happen in cats with chronic diarrhea most commonly and in cats that are straining for other reasons, like bladder infections, occasionally. For some reason, it just seems like some cats are prone to this problem. We often have to suture the intestines to the inner wall of the abdomen to prevent them from prolapsing again after putting them back where they belong. Unfortunately, this condition can prove to be fatal rapidly, as you experienced. It is also possible that there was some sort of traumatic problem that wasn't obvious. It is surprising how much internal damage can occur with very little external sign at times. Especially in the case of being hit by a car or bitten by a large dog where the skin wound may be minor but the internal wounds severe. I can't think of a problem shared by cats and raccoons that would lead to this condition.

Fecal (Stool) Incontinence

Question:

I've looked through your website to try and find an answer to my problem, but haven't seen it addressed. Here goes: I have a 5 year old Manx (true Manx with no tail, just fuzz) who has developed a pooping problem over the past several months. He poops around the house, mostly solid, not in any particular place, just random. He does this for a few days and then won't for a few months. During this time, he also uses his litterbox. He never urinates in the house, though, always in the box. I have two other cats, and they all have their current shots, FIP, etc. They are all indoor cats, never go outside, and eat Science Diet Light Maintenance. I have taken Simon to the vet many times about this and she does a fecal float test and never finds any parasites or anything. I would appreciate any advice you could give me, because he's my "first born" kid :) Thank you very much, T.

Answer:

Manx cats are prone to fecal (stool) incontinence because they are often missing part of the nerve plexus that controls the rectal area as well as missing a tail. I do not know of a treatment for this. Many people use metamucil or Vetasyl type products to keep the stools firm and make them easier to manage but that is about all I know that can be done.