Lessons Learned About Caring for Incontinent Cats
NOTE: These statements are based on our experience and research. What I have learned is that every incontinent cat we have is a built a bit differently, so caring for them is not one-size-fits-all. Feel free to comment with any experience you want to contribute and try not to be a jerk if you disagree;-)
Caring for an incontinent cat, whether from injury, illness or birth defect, is a lifetime commitment. For many, their life expectancy is the same as for any other cat. Others don't make it through kittenhood or die of complications, such as bladder rupture or bowel perforations. And while some cats with bowel and/or bladder problems are otherwise healthy, the care and feeding of these cats can be very time consuming and well...gross. Proactive bowel and bladder care is critical.
There are few people who are willing to open their homes and hearts to these kitties. Most are considered unadoptable and will either be euthanized, die an early death or spend their lives in a sanctuary. A sanctuary is not the worst thing that can happen, but there are few spaces available and a lot of cats - and it is expensive. Without the help of people like you, many will die unnecessarily.
Quality of life is the main consideration.
Let me define what incontinence means in these cats. Many incontinent cats are unable to pee or poop, but leak urine or feces when they are full or relaxed. This is often on your clothes when loving on you or your furniture. It can happen at any time, but especially when they are asleep. Our first Manx Syndrome cat was adopted and returned three times before we got her; she was lovingly accused of holding her urine until someone picked her up (smile).
It is counterintuitive that cats that can't pee or poop on their own leave trails of pee and poop in their wake. Many people tell us their cats with incontinence can pee and poop but won't use the litterbox. In reality, they cannot empty their bowel or bladder INTENTIONALLY because they lack the nerves and muscle control to recognize when they need to 'go' and push it out. For many, poor sphincter and muscle control in their rear ends leaves them unable to hold their pee or poop in when they are full. As they relax, or their bladder/bowel continues to fill without relief, they overflow and the leaking begins. This can be life-threatening!
Some may recognize a sense of discomfort when they are really full and try to use the litterbox with no success other than drips or dribbles at times. Many pet owners see the cat in the box, yet find a mess outside the box. They may assume the cat simply won't use the box when in many cases they cannot.
Two of our CCAS cats have missing feet; they are trained to use pee pads on the floor. They occasionally get their nubs or rear end in the pee or poop, so it is important to watch for that. A lot of CH cats are unable to use the box and so they use diapers. Paralyzed cats are usually expressed, and may use a diaper between times.
Urinary tract infections, cystitis, bowel impaction, constipation, urine scald and diarrhea are common problems with incontinent cats. Preventative care makes a huge difference, so being proactive is required. If they are full and cannot empty, a human will need to intervene. Some cats that don't leak are at risk of death without relief asap.
Options for Incontinent Cat Care
There are a few ways to care for cats that are unable to pee and poop on their own.
1. Manual expression means that a human uses their fingers to gently press on the bladder to expel the urine, and press along the colon to move the poop down and out the anus. You get used to it - it is not nearly as bad after the learning curve, but never pleasant
2. Diapers are another option. Baby diapers may not work for some cats, whether they have tails or not. Sometimes putting them on backwards helps. There are several small businesses that make specialized diapers specifically to fit cats. Some have suspenders to hold them up - see Little Charlie at 2 pounds wearing his snazzy diaper above;-)
3. A combination of manual expression and diapers is ideal if you choose to diaper, but there are problems with both. See FAQ for more details.
4, Expressing the cat before bed and when they get up can prevent lots of problems. They will still need to sleep on a pee pad (best not to diaper at night, if possible) and can wear a diaper during the day if you will be home in a reasonable amount of time to change them. Expressing them before leaving for long periods reduces the risk of urine scald and UTI. They will most likely leak at night when sleeping, so prepare for that.
5. If the cat knows when they need to potty and you recognize the signs, you can teach them to use pee pads. Once they are trained (just like training a puppy) they may simply go on the pad instead of in a box. This only works with cats that can feel when their bladder or bowel is full and have the muscle control to empty completely. They may miss the pad at times, so put something under the pads like a washable rug.
Cleaning and laundry are much more time consuming than caring for the cats. If they are not diapered or expressed, assume they are leaking on every surface they touch. Never buy anything that can't be cleaned easily (and probably nothing new or expensive).
We use washable pee pads and it saves a ton of money - but it means we do laundry every day. And, it may be gross laundry if they throw up or poop during the night.
Keeping the furniture, cat crates, counters and floors clean of urine and poop, etc. is a lot of work. Although we are not licensed as a shelter, we try to follow all the guidelines the state requires of shelters. It keeps us busy, so I finally hired someone to come once a week to deep clean.
The amount of work involved in caring for incontinent cats is about the equivalent of two or three regular cats. My best advice is limit the number of cats you have if you care for or plan to get an incontinent cat. Unless you confine them to a specific area, you will be cleaning all the time.
A few lessons learned:
1. Little or no carpet! If you must, as we do for our cats with no feet, get area rugs with rubber backing that can be washed - several of them so you can switch them out for laundry. Toss them and replace as needed.
2. No expensive furniture where the cats will be - an open kitchen is NOT a good idea. Cover furniture with pee pads - it is unattractive but functional.
3. Keep plenty of laundry detergent and bleach on hand - and wipes.
4. Buy a carpet/upholstery formula that works and purchase your own carpet cleaner with a handheld hose. We have found Furry Freshness most helpful.
5. Don't let them get fat! Getting your hand around the belly of a cat to express them gets harder with belly fat - and small hands.
6. Keep your nails trimmed so you don't hurt them when you express.
7. Keep their nails trimmed so they don't hurt you when you express.
8. New cats that have never been expressed will fight against it - go slow and be brief. Most likely it will be weeks or months before you can empty them completely, so use diapers or keep them isolated. Never keep pressing on them if they seem to be in pain - it is better to wait or let them leak, if necessary. But - keep checking the bladder and don't let it get too big. If you can't get the urine out and they are not leaking, it is an emergency - go to the vet ASAP.
9. Crate them at night when they sleep and are most likely to leak. Use pee pads over their pillows and make sure to change the pads daily if they are soiled in the least - same for the pillows.
10. Clean the crates or carriers daily unless you have a setup that prevents soiling the crate - then clean weekly.
11. Feed on a regular schedule as it helps regulate their pee and poop schedule. Free feeding is not a good idea. They will pee and poop less frequently and more predictably if on a feeding schedule.
12. Buy the best food you can afford (with your vet's input) to reduce the likelihood of crystals in the urine, diarrhea and other uncool things. Do anything you can to avoid parasites. We have used Royal Canin Urinary/Calm formula successfully for a few years. Those with megacolon or prone to constipation usually do well on Royal Canin Gastro Intestinal Fiber Response which also has the urinary support included.
13. Ask for help - people text and email us all the time - we are available. There are lots of Facebook groups and pages and Instagram folks who love to help. Get acquainted and ask questions.
Q: Should I use diapers for my incontinent cat or express manually?
A: This really depends on your skill and comfort level expressing your kitty, the kitty's tolerance for it, your schedule and your tolerance for bodily fluids. Talk to your vet about this. You will need to learn how to express the bladder and bowel. Some are easier than other - all fight it in the beginning.
When we got our first Manx Syndrome baby, we went to the shelter every other day for a month to practice with her before they would let her come home with us. It was a wise decision. We now know that every cat is different so there is no one way that works for all of them. Scar tissue, pain sensitivity, stress, and your ability to remain calm are only a few factors.
Q: Do Manx Syndrome and other incontinent cats get more UTIs than others?
A: Often, they do. There are many factors; food and hygiene are two.
All of these require veterinary care, sooner rather than later. Always apply only as much pressure as necessary when expressing a cat - it varies from one cat to the next and is more difficult when they are stressed and tense their muscles. Mitt pees in small spurts with tummy rubs in between. It took almost a year on anti-anxiety meds to help him relax enough to pee in less than 30-45 minutes! It is now about 1-3 minutes, which is more than most who take 5-10 seconds.
Q: Are there medications that can help with incontinence?
A: Yes, and some work well for some cats to relax the bladder. Mitt does not leak and used to tense all his muscles when it was time to go, so those meds didn't work for him. Ask your vet if that happens.
It is very dangerous for cats to go too long without peeing, especially if they do not leak. I hear about this with pelvic injuries more than Manx Syndrome or paralysis, but anything is possible! It is an emergency if the bladder is enlarged, they are not leaking and can't be expressed. Do not wait until morning or after work - go to the vet NOW!
There were times Mitt's bladder had to be aspirated to remove urine. If the kitty has crystals, it will only continue to worsen - and it is painful. Also, if you keep trying to express them when they cannot go, especially if it is painful, they will begin to resist expression all the time. You definitely don't want that.
Some cats that have a lot of pain, for whatever reason, may need meds before expressing them. CBD oil about an hour before expressing them can help them relax (to the point of more incontinence) and may help with inflammation and pain - ask your vet and use reputable CBD oil if you go that route. Dosing is not exact, so be sure you get clear instructions on how to dose.
Q: Do cats with Manx Syndrome have mobility problems?
A: Some do - little Charlie is unable to walk due to other deformities. All the cats at the sanctuary are mobile. One has stiffness in his back legs, but he walks okay after stretching. I know that many Manx Syndrome cats are lame in one or both back legs. X-rays may give the vet more insight into those kinds of problems.
Q: What are the problems associated with diapering?
A: Getting the diaper on is the first one! Our cats hate it, so we only use diapers when diarrhea lasts more than a day.
Q: My cat has diarrhea all the time - nothing seems to stop it, including medication. I am ready to give up!
A: I get it! Food makes a big difference, so talk to your vet. I have read and found that Royal Canin Fiber Response helps a lot; it also has urinary support. For some of our cats, it firms up the stool. But, it softens the feces for our cat with megacolon (constipation is a problem) and makes it possible for our cat with a spinal cord injury to poop in the litterbox on his own now. I have found it is pretty amazing! Again – ask your vet!
Q: My cat is prolapsing - is that normal for these cats? Constipation is a never-ending battle.
A: It can happen to any cat, especially if they are straining to poop. In addition to anal/rectal prolapse, the bladder and/or bowel and other organs prolapse. It is usually caused by an underlying condition such as parasites, megacolon or others that result in straining or diarrhea. The underlying condition must be treated successfully to prevent prolapse. In some cases, it may be due to lack of anal sphincter control due to injury or birth defect as with many Manx Syndrome cats that lack muscles in the colon to move the digested food through the system.
All of this is serious and needs immediate attention by a vet! Tissue can die if left exposed and it hurts! For minor prolapse, some people use Preparation H to decrease swelling and inflammation but ask your vet before trying any home remedies.
Some Manx cats have an anus that puckers outward, which can be an indicator that they are at risk for prolapse. Those that have megacolon as a symptom are especially at risk if they get constipated, which is usually followed by diarrhea. It is critical that you find food and/or medicine that will limit their risk of constipation. Talk to your vet!
We have found Optagest Digestive Enzymes with Pre/Probiotics helped one of our megacolon cats that was at risk of euthanasia.
There are surgical treatments that some cat and dog owners try that involves stitching around the anus and/or stitching the tissue to the lining of the stomach (as I understand it) and another surgery that resections the bowel. I have personally never heard/read good outcomes after bowel resection which often results in a lifetime of diarrhea. My vet said, "No way!" should we consider this for our 13-year-old Manx with megacolon that now prolapses every day - her bladder and/or colon comes out her anus when she is expressed. See the resource section for links to other information and stories about surgery results.
Our 13-year-old kitty now prolapses most days. It hurts at times and may bleed - sometimes more than others. It hurts me very much to know she experiences this - my husband takes care of her poop expressions. When she was younger, she only prolapsed if she got constipated, which we tried to prevent at all costs. The fiber response food has helped, thankfully. Since she has megacolon it is simply a result of the underlying condition that cannot be reversed.
Q: My vet recommends euthanasia for my kitten because she has Manx Syndrome (or paralysis from an injury). What should I do?
A: Ask around for recommendations for a vet that knows about special needs cats. Get a second opinion. See a neurologist.
Most doctors recommend euthanasia citing poor quality of life. Many Manx Syndrome cats live a very full life, some longer than others.
If the kitty is suffering, euthanasia may be the best option. But, ask experienced Manx Syndrome parents for guidance before deciding based on a vet recommendation. If the prognosis is poor and keeping the kitty alive is for your benefit, not his or hers, consider all options.
In many cases, waiting for swelling to decrease after an injury or doing some at-home exercises to build muscle strength can make a difference. Get a vet or veterinary physical therapist to prescribe exercises you can do at home.
If things don't improve, or you can't afford to care for the kitty, ask in the online groups if someone will help or adopt IF the quality of life is good otherwise. Consult with professionals always, and don't hesitate to get a second opinion. Getting recommendations for vets with experience is always best.
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Disclaimer: I am not a vet. This information is my personal, unprofessional, biased opinion based on experience, my own limited research and learning from others. Please seek information and advice from a vet that has firsthand knowledge of you specific pet. CCAS is not responsible for recommendations based on these experiences.