Caring for an Incontinent Cat

Wed, 11/28/2018 - 01:00
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Dilly, a brown tabby incontinent cat

What is cat incontinence?

Urinary incontinence in a cat is defined as involuntary leakage of urine. Fecal incontinence is defined as involuntary defecation or lack of bowel control. These conditions are different from behaviorally inappropriate urination at sites other than the litter box or outdoors, urination at the wrong time (at night) or medically inappropriate urination because of a medical condition (UTI). Chronic diarrhea occurring as a result of irritable bowel syndrome or gastrointestinal cancer (such as lymphoma) is not considered fecal incontinence.

Causes of feline incontinence

There are a number of causes of feline incontinence:

  • Age-related conditions, such as senility, or chronic pain affecting mobility (These conditions are not due to physiological incontinence, but rather to cognitive or other factors, such as pain, that cause cats to eliminate on themselves or in their immediate surroundings.)
  • Renal disease or other deterioration of the urinary tract
  • Injury to the spinal column due to trauma
  • Manx syndrome, a deformation of the spinal column resulting in missing or damaged nerves and hind-end deformities that may or may not affect the cat’s ability to walk or jump
  • Other birth defects such as malformation in utero or injury at birth

Caring for an incontinent cat

It is important to note that incontinent cats are individuals: Some may not leak at all and require minimal care, while others may leak frequently and require more care. Before adopting an incontinent cat, make sure to consider your comfort level and the amount of time you can commit to care. This will ensure the right fit for your home and lifestyle.

Black cat with gold eyes with some orange shelves behind her

Creating a support system for you and your cat

Here are some tips for creating a support system:

  • Not all veterinarians have experience treating and maintaining incontinent cats, although most are willing to learn. Make sure that your veterinarian is able and willing to treat your incontinent cat because he or she will be an indispensable partner in maintaining the health and happiness of your cat.
  • Talk to your pet sitter and boarding facility to make sure they can handle the needs of your incontinent cat.
  • Friends and family can be wonderful supporters who can be there when needed to lend an extra hand.
  • Networking with other incontinent cat caregivers can be very helpful. There are several Facebook groups dedicated to cats with incontinence and mobility issues.

Assisting the cat with defecating or urinating

Nerve damage or malformation in the spine can prevent cats from urinating or defecating on their own. It then becomes necessary for you to assist two or three times a day by palpating and expressing the bladder or palpating and evacuating the colon. (See “How to Express a Cat’s Bladder” for more detailed information.)

Signs that medical intervention is needed

Contact your vet in these situations:

  • A pink tinge, bits of blood or a foul, sometimes fishy smell to the urine can indicate a urinary tract infection (UTI). Leakage of urine from a cat who doesn’t usually leak might also indicate a UTI. Promptly call your vet.
  • A blockage may be present in the urinary tract if a cat who usually leaks urine has not been urinating, or if the bladder is full or tense and you’re not able to express it. Since this could be a medical emergency, immediately call your vet. 
  • Very watery or mucous-laden stools or very large, hard stools may indicate the need for a supplement or medicine to help add form to and soften the stool and help prevent further complications. You’ll need to determine what is normal stool consistency for your particular cat. Consult your vet if you have any concerns about stool consistency or the evacuation process.
  • Cats with chronic diarrhea leakage frequently develop irritation around their anal area that may require an exam and a topical medicine (to heal, prevent infection and prevent further tissue deterioration). Your vet can advise you on proper treatment.
  • An impacted colon can be a medical emergency. Cats prone to constipation, especially those requiring daily evacuation because they cannot physiologically defecate, are particularly at risk. If you find that you cannot express the stool and the colon is large and full, contact your vet.

Recommendations for hygiene and health

Incontinent cats require help keeping themselves clean, especially around the hind end, because sometimes feces and urine can dry in the fur on the legs and other places. Daily or twice-daily butt baths may be necessary, either long-term or during a temporary period of illness.

First, determine the method of handling that works best for you and your cat. We recommend that you always wear gloves while bathing an incontinent cat. Don’t be afraid to ask a friend to restrain the cat while you bathe him, especially if you (or the cat) are new to the process. Eventually, the process will become more predictable and more comfortable for both you and the cat. Be prepared for some vocalization. Many cats do not like getting wet, especially on their feet, so have towels nearby to absorb splashing water.

Always make sure the water temperature is comfortably warm. Water that is too hot can burn, and if it’s too cold, it could startle or annoy the cat and cause you to lose your hold. Check the temperature against your own ungloved skin. If you are not sure, keep it slightly cooler.

You’ll want to use a mild cleaning agent, such as diluted Ivory soap, Castile soap or unmedicated pet shampoo. Paul Mitchell makes a waterless foaming pet shampoo that we sometimes use at Best Friends. Always rinse with water.

For a gentle rinse (when the fur is not sticky with feces), you can use two separate containers side by side — one with soapy water for the wash and one with fresh water for the rinse. Small or medium litter boxes placed on the floor work well. (Designate these boxes for butt baths only and don’t use as litter boxes.) This method is great for cats who become frightened or agitated when they are lifted off the floor. For cats requiring more cleaning (and cats who are comfortable being up high), working at the sink can give you better access and visibility.

Before you thoroughly wet down the dirty area, remove as much of the feces as you can. Dampen (but do not soak) the area. Then, using a comb, gloved fingers, a washcloth or some combination of these, gently pick out the solid bits, working away from the anus and genital area. Use a sprayer or cups of running water from the tap to rinse the excess before applying the soap. If the cat is agreeable, you can even shift or lift his hind end directly under the running water. Feces or urine left on the fur and skin (especially near the vulva or scrotum) can cause sores and infection. Keeping the cat clean and the skin healthy is very important.

It is ideal for female cats and male cats who have had perineal urethrostomy (PU) surgery to be bathed on their sides to prevent feces from being introduced into the vulva or PU site. That being said, sometimes the cat will not comply and a bath in any position is better than no bath at all. Sometimes a water rinse or wipe with a wet washcloth or baby wipe is sufficient.

When you’re done rinsing, dry off the cat well. Cat hair is multilayered and can retain moisture. When drying, work the towel against the hair to fluff it, and change towels to keep absorbing as much excess water as possible. Cats with mobility issues are particularly prone to skin deterioration, where moisture gets trapped between fused or dragging legs.

Incontinence is often related to mobility issues. There may be leg deformities that cause the cat’s weight to press on areas not natural to a normal gait, leaving him prone to developing sores. These areas require daily checking and may need cleaning with a special antiseptic, such as diluted chlorhexidine solution, application of ointments or creams and bandaging.

We recommend that the hind ends of incontinent cats be shaved so that it is easier to keep them clean and there is less hair to retain urine and feces. It is best to plan butt shaves every three weeks. Avoid shaving cats who drag, because it’s important for them to have hair on the parts of their bodies that touch the floor to prevent sores from forming. To learn how to safely shave your cat, speak with a vet or a professional groomer.

Here are the necessary butt bath supplies:

  • Clean water
  • Sink or two bins, one each for washing and rinsing (applicable to your method)
  • Mild shampoo
  • Various combs (plastic or metal with firm teeth), including a flea comb
  • Cups or sprayer for rinsing
  • Large supply of washcloths and towels
  • Baby wipes
  • Disposable gloves
  • Topical medications, creams, ointments or bandaging materials as determined by your vet
  • As needed, an assistant for restraining the cat and providing moral support

Gray tabby kitten lying on a white bed

Diet, supplements and medications

Each case of incontinence is individual. Some cats don’t require any medication or supplements and (in a calm environment) can live happily on a good commercial diet. Others benefit from medicines, supplements and special diets that can firm up or soften stools or assist the body in eliminating the stool or urine. Your vet can determine the correct diet and prescribe medications.

Sometimes cats who are incontinent due to injury regain some control of their bladders or bowels. In these cases, daily palpation and monitoring would be required, with expressing or evacuating done only as needed. Sometimes other related medical situations develop, such as sores, arthritis or spinal discomfort. As incontinent cats age, they become more prone to urinary tract infections, due to long-term wear on the bladder from expressing or due to recurrent diarrhea. Aging also can cause stool consistency to change over time. An adjustment in diet or a course of subcutaneous fluids (to ensure hydration) may be required. If at any point clinical signs worsen or change, call your vet.

Setting up your home for easy cleanup and enrichment

Depending upon the nature of a cat’s incontinence, your living area may require extra cleaning and your laundry load will be larger. The key is to set up your home for easy cleanup. Here are some tips for incorporating the extra work into your daily routine:

  • Keep a supply of easily laundered cat beds and blankets that can be changed when soiled.
  • Place easily removable small blankets or washable pee pads on surfaces such as windowsills, couches, chairs and beds. Add extra cloths or leak-proof cloths for extra protection. Be aware of the potential for permanent soiling of furniture and other upholstered items.
  • For quick cleanups, keep a mop and bucket containing a cat-safe cleaner in a chosen area of the house. Change out the mop water daily.
  • Prepare two or more spray bottles with cat-safe cleaners for small cleanups. Have handy a supply of rags and paper towels.
  • Use unscented baby wipes to clean up small messes (and to clean up the cat).
  • Use an enzymatic cleaner to clean up urine or feces leaked on carpets.

Regarding recommended cleaners, vinegar and water (1:1) is great for everyday quick cleanups. But the best formula for removing cat urine from hard and soft surfaces is a mixture of hydrogen peroxide, baking soda and dish soap. Gently mix two cups of 3 percent hydrogen peroxide with two teaspoons of baking soda and two drops of dish soap. Spray the mixture directly on urine spots; for larger areas, work out of a small bucket. You’ll want to wear gloves for this task. Let the area air-dry and keep in mind that stubborn or deeply penetrated areas may require several treatments. When using the mixture on fabric or carpet, test it on a small area first because it may remove color. This formula works best when applied within an hour of mixing.

Next, let’s talk about litter boxes. Cats who require manual bladder expressing and colon evacuation may not feel the need to use a litter box. However, you may want to set one up as a place for expressing and evacuating. Try different setups and gauge the comfort of the cat (and you) to decide what works best. A washable or disposable pee pad on the floor, counter or other surface may work better than a litter box. Evacuating or expressing into the sink or toilet is another option, but be sure to sanitize the sink and the drainpipe after each use.

Some incontinent cats do use the litter box, but sometimes because of mobility issues, they relieve themselves just outside of the box. When this happens, it’s helpful to provide the cat with a designated area, a towel and an easily washable rug beneath the litter box. If your cat is interested in using a litter box but has mobility issues, litter boxes with low sides are available, or you can use a potting tray as a less expensive option.

What about diapers? Best Friends does not use diapers because they trap urine and feces, prevent air flow, and encourage painful sores and infection. We recommend not using diapers all the time for cats, but diapering your cat is OK for limited periods of times during the day (e.g., for an hour or two so the cat can sit on the couch with you or spend some time snuggling in bed). Just make sure to bathe the cat after removing the diaper and make sure she doesn’t develop sores or become ill.

Incontinence will not slow down or inhibit a cat from jumping, playing, running and enjoying other feline pleasures. Sometimes, however, incontinence is accompanied by mobility issues such as missing or deformed limbs and paralysis. Make sure to safely set up rooms in your home to accommodate the need for activity and fun. Assess the cat’s abilities and interests, and then create spaces for him to climb, rest and explore. Here are some tips:

  • Pet stairs and ramps provide needed lifts for cats to get up on surfaces, as well as providing good exercise.
  • Cat trees and Kuranda beds of appropriate heights can enrich a cat’s life and provide interesting, fun and comfortable lookouts and hideouts. Though Kuranda beds do not allow for scratching or grabbing with claws, they are much easier to keep clean than other beds.
  • Simple cardboard boxes make great impromptu hideouts and beds, plus they can be disposed of when soiled.
  • Even with mobility limitations, a cat can play, scamper about and find stimulation in traditional cat toys. Make sure to provide both self-play toys (mice and balls) and interactive toys like feather teaser wands.
  • Depending upon their temperament and level of mobility, cats prone to constipation can benefit greatly from exercise, such as indoor play sessions or outdoor walks.
  • Make sure your cat does not have access to areas that she can’t navigate, or where she could become injured or stuck.

Black and white cat in a polka dot bed

To sum up: By providing the right support and know-how, you can help your incontinent cat have a good quality of life. And remember, a sense of humor helps maintain sanity when poop (literally) happens!