Fecal Impaction Treatment in Pets

Treatment Procedures Introduction

• This section covers treatment procedures for specific, diagnosed conditions, differentiating them from broader diagnostic or health-contributing procedures.

Fecal Impaction, Laxatives, and Enemas

• Fecal impaction (constipation) in dogs and cats usually involves feces mixed with indigestible materials such as hair or bone.
• Common treatments include laxatives and enemas.
• Veterinary assistants maintain enema equipment and supplies, including:
  • Sterile red rubber, polyvinyl chloride, or silicone tubes
  • Enema solutions or medications
  • Lubricating substances
• Enemas address constipation caused by foreign objects, narrowed pelvic canals (due to trauma or fractures), collapsed pelvic canals (due to nutritional imbalances or congenital defects), and inflammatory anal diseases.
• Signs of fecal impaction include days without defecation, frequent unsuccessful attempts, straining, liquid feces (possibly with blood or mucus), depression, listlessness, inappetence, and intermittent vomiting.
• Animals with fecal impaction are usually dehydrated.
• Cats may exhibit abdominal pain through a crouching or hunched posture, and abdominal distension might be noticeable.
• Abdominal palpation may reveal hard fecal masses in the large intestine.
• Rectal exams and abdominal palpation help determine retained feces amount and compressibility, and impaction's cause, like foreign objects or pelvic canal narrowing.
• Survey radiographs confirm fecal impaction and identify opaque foreign objects.

Treating Fecal Impaction

• Gentle fecal removal is optimal for impaction treatment.
• Mild to moderate impactions are treated with oral laxatives and frequent, small-volume enemas.
• Severe impactions require fluid administration to correct dehydration and electrolyte imbalances before impaction treatment begins.
• Gradual softening and removal of the impacted mass over two to three days is preferable to a single, aggressive attempt.
• Colon electrolyte lavage can be used to remove residual feces after fluid administration.
• Laxatives have mild effects, generally resulting in formed feces elimination.
• Dioctyl sodium sulfosuccinate and dioctyl calcium sulfosuccinate laxatives act as detergents to alter liquid surface tension, aiding water and fat mixing for stool softening, and should be avoided with mineral oil.
• They also decrease the small intestine's absorption while promoting colonic secretion, the animal should be well-hydrated.
• Mineral oil and white petrolatum soften feces by coating them, which prevents the colon's fecal water absorption.
• A small amount of oil absorption does occur, but the primary danger of giving mineral oil is laryngotracheal aspiration.
• Bulk-forming laxatives (psyllium, bran) stimulate the upper large intestine with bulk, which increases evacuation frequency and softens feces by retaining water.
• Metamucil (psyllium) is best with moistened food to ensure water intake.
• Bisacodyl stimulates the colon's mucosa and nerve networks, and should be used only in hydrated animals older than four months with no obstruction.
• Intestinal bacteria metabolize lactulose (galactose and fructose disaccharide) into organic acids which promote an osmotic fecal diarrhea.
• Lactulose dosage is based on stool consistency until a semi-formed stool is produced two to three times daily, and cats typically dislike the taste.
• Overdoses of lactulose can result in intestinal cramping, diarrhea, dehydration, flatulence, and acidosis.

Administering Enemas

• Enemas soften distal large intestine feces, which stimulates colonic motility and defecation.
• Enema fluids (room temperature or tepid) each have different functions:
  • Tap water, normal saline solution, and sodium biphosphate add bulk
  • Petrolatum oils soften, lubricate, and promote the evacuation of hardened fecal material.
  • Soapsuds solutions promote defecation by their irritant action.
• Veterinarians normally prefer normal saline or tap water at 5 ml/kg body weight.
• Soapy water solutions are an alternative if saline and tap water enemas fail and the animal is well hydrated.
• Slowly instill 5 ml/kg body weight of mild soap through a lubricated enema tube; normal saline, tap water, or soapy water enemas produce best results if repeated several times using small volumes.
• Mineral oil (5 to 20 ml) can be instilled directly into the rectum for extremely hard feces.
• Hexachlorophene causes central nervous system damage and should be avoided.
• Sodium phosphate retention enemas are convenient for impaction relief, but they should never be used on small animals due to risks of hyperphosphatemia, hypernatremia, and hypocalcemia.
• Place the animal in a bathtub or discharge-safe surface.
• Insert a lubricated rubber or plastic flexible tube into the rectum.
• Pass the enema tube as far into the colon as possible.
• Instill the enema solution, such as warm normal saline or tap water, at approximately 5 ml/kg body weight.
• Hold the anal opening closed for a minimum of three minutes.
• Place the animal in a run or cage for evacuation, if possible.
• Repeat the enema several times over 24 to 72 hours using small volumes.

Preventing Fecal Impaction

• Post-impaction relief includes avoiding indigestible materials, regular grooming, and aiming for soft, formed feces.
• Commercial veterinary laxatives containing petrolatum are effective for cats.

Blood Collection and Transfusion

• Animals sometimes serve as blood donors or require transfusions.
• Veterinary practices stock equipment and supplies for blood collection and transfusion:
  • Blood collection sets and CPD-A1 blood collecting bags
  • Blood administration sets
  • Triple-beam balance scale or digital electronic scale
  • Syringes and needles (assorted sizes)
  • Hair clippers, surgical scrub disinfectants, centrifuge, and glass microscope slides
• Veterinary assistants set up and help with blood collection and transfusion.

Collecting Blood

• The external jugular vein is the most accessible and safe for blood draws in dogs and cats.
• Up to 22 ml/kg (10 ml/lb) of body weight can be safely withdrawn from the external jugular vein of a donor dog or cat every two weeks.
• Blood donors may be minimally restrained or sedated as the venipuncture site is surgically prepared.
• Place a hemostat over the tubing and remove it only after the external jugular vein is entered.
• Donor venipuncture must be clean with rapid blood flow to minimize platelet activation, clotting factors, and tissue thromboplastin contamination.
• Re-clamp the collecting tube before needle removal from the external jugular vein after collecting the full blood volume.
• Apply direct pressure to the venipuncture site for 5 to 10 minutes post-collection to ensure hemostasis (bleeding control).
• Pale cats post-collection may be due to a combination of sedation, decreased circulating plasma volume, or hypovolemia.
• A 100 ml IV infusion of lactated Ringer's solution immediately after blood draw counteracts donor cat problems and is usually unnecessary for donor dogs.
• Blood should be collected in citrate-phosphate-adenine anticoagulant (CPD-A1) solution at a 1:7 ratio for storage purposes.
• Dog blood in CPD-A1 has a storage life of 35 days at 1° to 6° C.
• If blood is used immediately post-collection, the anticoagulant-to-blood ratio may be 1:10.
• If heparin is used, 625 units are needed per 50 ml of blood collected.
• Heparin isn't typically recommended as an anticoagulant because red blood cells can't be stored and platelet function becomes abnormal.
• Standard procedure is to collect whole blood in 450 ml CPD-A1 plastic blood-collecting bags to the appropriate volume, swirling during collection to mix with anticoagulant.
• A scale, either digital electronic or triple-beam balance, can monitor the volume of blood being withdrawn
• One milliliter of blood weighs approximately 1 gram, so a 450 ml unit of blood should weigh 450 grams plus the container's weight.
• Tie off the collecting tube at needle end post-collection.
• Strip the blood left in tube using a tube stripper twice, mixing with anticoagulant in collection bag.
• Use collected blood unit immediately, or store it at the appropriate temperature for later.
• Draw 7 ml of CPD-A1 anticoagulant into a 50 ml plastic syringe if a small volume of whole blood is needed for immediate use.
• Use any open system (needle-entered plastic syringe or bag) within 24 hours.

Transfusing Blood

• Blood transfusion is effective fluid replacement, but also potentially hazardous.
• Blood transfusion requires clear indications, such as severe blood loss due to trauma, surgery, or immunity-related disease.
• Professionals should rely on clinical parameters (total protein, pulse pressure, respiration rate/depth, mucous membrane color, capillary refill time, urine production, central venous pressure, and arterial blood gases).
• Blood transfusions are indicated to stop or prevent bleeding due to decreased platelet number or function.
• Platelet-rich plasma is preferred to replace platelets because platelets survive <12 hours in stored blood, large blood quantities are needed to significantly raise platelet count.
• Blood transfusions help manage hereditary or acquired bleeding disorders.
• Transfused blood should be <12 hours old, as some blood coagulation factors are unstable.
• The basis for blood transfusion is to provide adequate amounts of the deficient blood coagulation factor at the bleeding site.
• Blood donor dogs should have at least 40% PCV, not be on medication (excluding heartworm/flea preventatives), and not be sensitized by prior transfusions.
• Donor dogs should be blood-typed and negative for dog erythrocyte antigens 1.1, 1.2, and 7 (DEA-1.1, DEA-1.2, and DEA-7).
• Blood donor cats have similar requirements as donor dogs except that they should have at least 35% PCV.
• Blood donor cats should be routinely blood-typed and only blood typed for Type A but not for blood types B or AB.
• *All blood group antigens can stimulate formation of specific antibodies, however, DEA 1.1, DEA 1.2 and DEA 7 have the greatest potential of antigenic stimulation.

Blood Donor Animal Care

• Veterinary assistants can actively care for blood donor animals through periodic exams (complete blood counts, chemistry profiles, urinalyses, and fecal exams).
• Blood donor dogs should be negative for:
  • Dirofilaria immitis
  • Ehrlichia spp.
  • Babesia canis
  • Haemobartonella canis
  • Brucella canis
• Blood donor cats should:
  • weigh at least 4 kg
  • be negative for Toxoplasma gondii, Haemobartonella felis, feline coronavirus (FIP), feline leukemia virus, and feline immunodeficiency virus
  • be well-vaccinated
  • be maintained on a good nutritional feeding program
  • be free of fleas, ticks, and intestinal parasites.

Cross-Matching Blood

• The best alternative to blood group typing in house donors for receiving animals (recipients) is cross-matching blood with the potential recipient.
• Cross-matching reveals incompatibilities and potential reactions.
• Animals needing repeat transfusions should receive compatible blood from a cross-matched and blood-typed donor.
• Cross-matching is performed for major (donor cells versus recipient serum) and minor (recipient cells versus donor serum) incompatibilities.
• Both tests are performed on fresh blood to find any existing antibodies to canine erythrocyte antigens.
• Collecting donor and recipient blood samples into a centrifuge (uses centrifugal force to separate substances by spinning rapidly) is part of the procedure.
• Serum is withdrawn and placed into separate tubes after centrifugation. The clots are broken down gently and 0.3ml cell samples are put into tubes with 9.7ml saline solution.
• The separated cells are washed to remove plasma and avoid fibrin clots, then the liquid supernatant is discarded to be resuspended to the previous proportions.
• One-tenth mL of the receiver serum is added to one-tenth mL of the donor red cell suspension for the MAJOR crossmatch
• For the minor crossmatch one-tenth mL of donor serum is added to one-tenth mL of the candidate's red cell suspension
• Recipient serum and rinsed cells are used in the third test, the control response
• One set is incubated at 4 degrees C (39.2 degrees F), room temp (72 degrees F), set one at body termperature - 37 C (98.6F)
• Each tube is centrifuged at 280 G for one minute, and the supernatant is checked for hemolysis and agglutination
• Incompatible cross-matches show agglutination or hemolysis.

Administering Blood

• Warmed blood helps to prevent hypothermia.
• Blood can be warmed by running through transfusion tubing immersed in a 37° to 38° C water bath, or by keeping blood in a container bathed with water or using a dry heater.
• Blood bags shouldn't be heated faster by applying more than the prescribed setting as fibrinogen precipitates at 50° C (122° F) and excessive heat can cause the antibody reaction to occur at temperatures greater than 45° C (113° F).
• An open blood bag has to be used within the following 4 hours at the temperature of about 10 degrees C.
• Blood transfusions can cause hyperthermia and extremely high fever.
• Appropriate filters and administration sets are used when blood is transfused, designed to retain blood clots and leukocyte and platelet aggregates.
• Large dogs are given blood intravenously via a 20-gauge indwelling catheter by the cephalic or external jugular veins.
• Smaller dogs/ large cats infused with cephalic veins/ external jugular veins with 22 gauge catheter, small or very dehydrated puppies/ kittens cephalic vein/ external jugular vein by using 23 gauge infusion sets.
• It's not recommended to use fluid alternatives other than ordinary saline to address thickness.
• Hypothermic, dehydrated newborns can be given medication by the intraosseous or intraperitoneal route with the intraosseus route absorbing 95% infusion in 5 minutes
• Interperitoneal Route blood absorbs 50% in 24 hours and 70% within 48 to 72 hours.
• Baseline measurements (body weight and temperature, pulse and respiratory rate, mucous membrane color, PCV, total plasma protein concentration) should be taken before obtaining an infusion
• Professionals give 0.25 ml/kg initially in 30 minutes, and increase following this with slow infusion. Common complications are fever, difficulty breathing, diarrhea, vomiting.

Complications of Blood Transfusions

• If recipient has a haemolytic reaction the individual will display these complications and it involves antibodies when previously sensitised/transfused
• First transfusion for a Type B feline involves powerful anti-A antibodies and haemolysis.
• Most haemolytic reactions in canines are generally shortened red cell life.
• Haemolysis occurs when freezing or overheating, hypotonic fluids administered in conjunction and faulty equipment is in operation.
• Leukocyte-related platelet and plasma protein reactions incorporate the conditions fever/ neurologic indications or vomiting with oral antihistamines being administered.

Physical Therapy

• Treats conditions or injuries through massage, physical or mechanical agents e.g heat or cold sources.
• Decreases recovery length prevents any further disability as it can re-establish proper function.
• Physical rehab enables treatment for diseases involving joints/bones nerves ,skin and muscles, paralysis/paralysis,fractures abrasions and decubial sores
• Increase strength, minimise downtime, positive behaviour is gained with many forms of physio
• To relax the patient maintain suitable levels of cushioning/support/comfort levels.
• If there is any restlessness or overheating the session needs to conclude.
• Check for erythema (reddening) oedema(fluid retention) alongside any general pain. Note advancement of patient for additional sessions which is recorded.
• Massage does not involve any apparatus and involves the use of fingertips mainly

Basic Massage Techniques

• Effleurage, petrissage, and friction are massage techniques where effleurage includes skin-stroking and promotes settling prior to much deeper massage styles. The flow travels through the patient from the outside to the middle.
• Heavy handed massages are performed around 5 motions , light handed massages are carried out at approximately 15 motions,
• Around 10 minutes is designated for any massage routine, petrissage,or referred to compression involves working on adhesions with reduced muscle mobility.
• Friction massage can help with removing injuries involving rubbing motions.

Exercise Therapy

• Includes helping strength, improve balance/stability for those struggling due to cardiovascular conditions
• Incorporate passive/active movements where passive includes zero patient motion from the patient and involves range of movement of roughly 5-10 mins.

Hydrotherapy

• Includes water exercises where buoyancy can offer extra comfort; guidelines are - water must range from approximately 102/105 degrees. Animals may struggle and can potentially drown. Can prove incredibly hard and cause restricted animals with cardiac function should be monitored.
• Use a nonskid pad during the session and avoid using the turbine unless ready. The turbine ought to remain unpowered when installing to evade infecting wounds and tissue whilst ensuring that the turbine is aimed to face outwards from the affected body parts and keeping 20mins at minimum for these routines
• Contraindicated in cardiovascular animals as they may lack ability to decrease high temperatures. It is suited in advanced fractures/joint issues and wounds.

Cold Therapy

• Within 72 hours, the optimum result is met, ice and water are utilised and the procedure ensures any reduction in swelling/aches. Vasoconstriction involves a significant amount which means that applying cold is better within 60mins. Place towels on either animal with applications that stretch at a rough measurement from roughly 5 to 20 minutes at one time

Heat Therapy

• Radiation can often deliver much needed benefits regarding the animals well being and assists sprains in around 72 hours. In the cases with improper condition it is not for animals. Infrared sources should remain conservative as they inflict many burns.

Prophylaxis

• Often with dogs and cats older/middle aged should receive prophylaxis approximately every year which removes gingivitis
• The primary reason is eliminating oral pains by restoring the animal with good dental health by removing equipment.
• Ultrasonic waves are used to carry-out the procedures, although air should be removed pockets (where the device emits high-frequency signals).
• Before the anaesthetic is used the animal must avoid all eating for at least some time, blood records ought to remain in order for evaluation of disease progression which has high-degrees of success if both owner's commitment and maintenance are kept.
• The animal has to keep its head as far as can be to prevent the animal having to breathe in airbourne disease after cotton is installed as well to remove bacteria.
• The last step needs to take place and that is rinsing the sulcus to flush out pollution.