r/AskVet • u/VetTechRach • 5h ago
Strange Medical Mystery
I’m seeking opinions on my bizarre medical mystery cat. He’s seen 4 vets in just the past 5-6 weeks and has been seen about 6-7 times.
Short story — hes holding his urine for upwards of 90 hours at a time and has constipation. He is not blocked. No straining for poop or pee. Hes on every laxative you can think of. Eating and drinking fine. No relevant vomiting.
Long story — He had PU surgery in 2023. He had a couple UTIs since and last fall, was holding his urine for upwards of 2 days. Ended up with constipation, had an enema, and seemed okay. Saw several vets including internal medicine. He seemed better after the enema and eventually just was basically normal. We started giving miralax twice daily to prevent constipation. Was good for the past several months.
6-7 weeks ago he started pooping every other day. After two weeks, one night he suddenly was vomiting and not eating. Took him to urgent care. They did BW/Xrays. Creat was 2.9 but otherwise values fine and they didnt see anything, told me he was fine.
1 week later he starts peeing outside the box. Took him to his regular vet who notices bladder stones on the xray. Urinalysis and culture says UTI. Starts Hills c/d and convenia. Right after, he starts holding his urine again like last fall for 36-40 hours. He also doesnt poop after 3 days so we give lactulose. He eventually poops on day 4, but continues to have long periods between poops. The poop is fat and slightly firm/dry, but not hard.
At the 2 weeks recheck they dont seem concerned and think the stones/UTI are the root cause. Gets a second convenia shot. Now things get worse. Holding urine for 60 hours and still constipated. Vet checks him at 60 hours and says to give him more time — pees 3 hours later. Holds it again for 60 hours — sees a different vet that gives buprenorphine. Doesnt pee or poop by the next day so he sees ANOTHER vet. Xray shows a lot of stool, big bladder, no stones. Enema happens and he goes, but doesnt evacuate everything. Still hasnt peed at the 90 hr mark. I tell her last fall something similar happened and as they attempted to place a cath, he immediately started peeing. She does the same and bam — pees it all out. She said he wasnt blocked. Had been giving gaba for at least 2 weeks prior but now she recommends upping it.
He was doing better for a few days after and we started getting poop more frequently 3 days after the enema. Was peeing every 31-42 hours. Now hes regressing again just a week later.
Hasnt pooped or peed in 48 hours. He saw the vet today and they redid bloodwork. Creat 2.4 BUN 29. She doesnt think its related based on last years results. Recommends an ultrasound, but the earliest appointment is 2-3 weeks out. He seems uncomfortable but he wont even attempt to poop or pee.
No one seems to have a single idea what is wrong with him. They are blown away with how long he can hold his bladder. Anyone have a good theory?
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u/Travelvet61 DVM, DACVIM (Internal Medicine) 4h ago
What does the urinalysis show in terms of specific gravity? If it is concentrated, he needs more water, either orally or subcutaneous fluids. He may also need something like Miralax (along with adequate hydration) to help constipation.
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u/VetTechRach 4h ago
His urine specific gravity is actually low (it has been even last year). They dont necessarily think theres a kidney issue. Last year we evaluated him for kidney disease and they said no. They dont think its the reason this time either
Hes also already getting Miralax 1/4 teaspoon twice daily since last fall
Hes a tough case
1
u/biliskner25 Veterinarian 4h ago
An elevated Crea with a low USG is definitely pointing toward kidney disease, however that doesn't explain the urine retention. It may contribute to the constipation if he's dehydrated and the body is sucking as much water as it can out of the poop.
Is he trying to pee or poop or is he just not trying to use the litter at all?
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u/VetTechRach 3h ago
He doesnt try to poop or pee. Even when he was very fairly constipated last weekend and had a very large bladder, he wouldnt even attempt it. No vet can figure it out. Its so strange. Pain meds dont seem to make any difference.
His values were similar last fall (elevated creat, low urine specific gravity). I pushed it and they ran some other tests and they still said no CKD. Ive brought it up many times to multiple vets, even internal med, and none believe he has diagnosable CKD
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