Approach to Constipation in Companion Animals

Approach to Constipation in Companion Animals

• Constipation is infrequent or difficult defecation with faecal retention in the colon and rectum.
• Obstipation is chronic constipation with impacted, dry faeces.
• Megacolon is chronic, recurrent constipation and obstipation which leads to an increased bowel diameter.
• Tenesmus is straining to defecate (or urinate).
• Dyschezia is painful expulsion of faeces.

Learning Objectives

• Construct a differential diagnosis list for constipation, including appropriate diagnostics.
• Determine appropriate medical and surgical interventions for constipation-related diseases, considering welfare implications.
• Assess prognosis and determine appropriate welfare implications for different treatment options.
• Establish control measures for preventing constipation.

Clinical Signs of Constipation

• Tenesmus
• Behavioural changes (reluctance to be touched, hiding)
• Intermittent diarrhoea
• Vomiting (consider cause)
• Not using litter tray
• Licking behind
• Vocalization
• Anorexia

Causes of Constipation

• Associated with difficulty defecating (pain, squatting inability).
• Faecal factors (dehydration, faecal bulk, poor peristalsis).
• Physical obstruction (mass, trauma).
• Localisation (luminal, mural, extra-mural, extra-intestinal).
• Dietary factors (foreign material ingestion, inadequate water intake, dirty litter tray, inactivity)
• Psychological/environmental factors (change in habitat/routine, competing with others)
• Painful conditions such as arthritis
• Colonic/anorectal obstruction (anal sac disorders, perianal disorders, pelvic fractures, tumours, rectal prolapse).
• Neuromuscular dysfunction (lumbosacral spinal cord disease, nerve injuries, hypothyroidism)
• Fluid and electrolyte abnormalities (dehydration, hypokalemia, hypercalcemia).

Investigation for Constipation

• History taking (onset, duration, persistent, feeding, water intake, toileting behaviour, accidents, environmental changes).
• Physical examination (abdominal palpation, neurological examination, musculoskeletal assessment).
• Rectal examination (consider sedation if needed).
• Haematology and biochemistry (electrolyte profile, assessing extraintestinal conditions - eg CKD).
• Radiography (abdominal).
• Musculoskeletal assessment.
• Ultrasound (assessing intramural lesions).
• Biopsy (investigating intramural/extramural causes).

Constipation Types

• Primary or Secondary
• Dysautonomia (Feline = Key-Gaskell).
• Megacolon (feline)

Principles of Management for Constipation

• Removal of obstructing faeces (manual removal, sedation if required).
• Ensure colonic motility and smooth passage for faeces.
• Reduce faecal bulk.
• Ensure adequate hydration.
• Manage underlying problems.

Treatment for Constipation (well-hydrated, otherwise healthy animals)

• Laxatives (lubricant - mineral oil; hyperosmotic - lactulose, Micralax; emollient - dioctyl sodium sulfosuccinate; stimulant - bisacodyl; bulk - high fibre diet or supplements such as psyllium).
• Prokinetics (No Obstruction!) - Cisapride.
• Manage underlying problems.
• Pain Management (if relevant).

Treatment for Constipation (other scenarios)

• Manual removal of impacted faeces (sedation, if needed).
• Surgical correction (sub-total colectomy - megacolon).
• Fracture repair.
• Treatment for extraintestinal conditions – dehydration, electrolytes, pain, wound management (abscesses).
• Long-term dietary management (water intake).
• Pain management.

Prognosis and Welfare

• Prognosis in uncomplicated cases is good.
• Prognosis depends on the underlying condition (good to poor).
• Consider welfare for cases with poor prognosis.
• Consider long-term management for episodic cases and prevention.
• Prognosis following subtotal colectomy is good if managed well.
• Client education is crucial for animal welfare.
• Pain management for long-term conditions.

Preventive and Long-Term Management

• Implementing strategies for long term management (e.g., ensuring adequate water and diet).

This quiz focuses on the identification and management of constipation in companion animals. It covers differential diagnosis, appropriate medical and surgical interventions, and welfare implications associated with treatment. Assess your knowledge on clinical signs and prevention strategies.