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Dr. Kara
Dr. Kara, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 15924
Experience:  Over 20 years of experience as a veterinarian.
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My 3 yr old male cat Alex came home last thursday with a

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My 3 yr old male cat Alex came home last thursday with a limp, flaccid hanging tail. He also had urinary retention. I took him to the vet who cathetarized him and started him on analgesics and antibiotics. He also had constipation. On reaching home (the same evening) he pulled out the cathetar. For the next 2 days the vet had to perform cystocenteses to draw out the urine. On 4th day he developed ascites. The vet performed performed an abdomenocyntesis and put in a cathter. For the next day and a half he was fine. Eating and drinking normally. Then on day 6 he pulled out the cathetar again. Again he developed urinary retention and stopped eating. The tail is still flaccid. His blood and urine tests were done twice. Liver and renal function tests were normal. Hemoblogin was fine but leukocytes were very high. Lease advise as to what should be the next course of action.
JA: I'm sorry to hear that. Did Alex have a fall?
Customer: I don't know he came home after 3 days
JA: Is there anything else the Veterinarian should be aware of about Alex?
Customer: Like what?
Customer: replied 6 months ago.
He still can't pass stool and urine

Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

This sounds like Alex has damage to his spinal cord, which is a soft tissue structure and so this won't show up on radiographs. He may need an MRI to fully diagnose his condition and give you an idea of whether he can be expected to improve.

Since he goes outdoors the most common cause of these symptoms is a tail pull injury or tailhead trauma.

This occurs when a cat falls and lands on his tailhead/back of the pelvis or the tail gets caught (by another animal or a car) and pulled hard enough that the caudal spinal cord is stretched. Sometimes the nerves are just stretched, but in some cases they break and when that happens the damage can be permanent. Cats may not show the full extent of their injury for several days as secondary inflammation and nerve death occur. Treatment is with steroids. My concern is that he is not responding and he is having trouble controlling his eliminations, that means prognosis for improvement is very guarded.

The other possible causes of his condition are an intervertebral disc protrusion putting pressure on his spinal cord, a blood clot, granuloma (can be inflammatory or from a parasite encysting there) or mass/tumor within the spinal cord canal which places pressure on his spinal cord.

If it hasn't been done I highly recommend that he be tested for feline leukemia and feline immunodeficiency virus which predispose to cancers, and the toxoplasmosis parasite.

I think that he likely needs to either be hospitalized and have his catheter replaced as chronic urinary retention can lead to back pressure on his kidneys and kidney failure. He may need warm water enemas to remove impacted stools too if he cannot pass them on his own. An elizabethan collar (lampshade collar) needs to be placed so he doesn't continue to remove his catheter.

If this is indeed a spinal cord injury it may take weeks to months to heal, and they can get worse before they get better as inflammation after the injury sets in. If you wish to continue treatment you need to be prepared for him needing long term nursing care and that he may never get better.

Given that you may want to discuss further testing with your veterinarian as well as referral to a veterinary neurologist for an MRI.

Best of luck with Alex, please let me know if you have any further questions.

Customer: replied 6 months ago.
Thank you Dr. Kara for your valuable advice. I took him to the vet again today. He did some x-rays which, as you very correctly pointed out, were not very helpful in indicating the spinal/nerve injury. However, there was no fractured or dislocated bones or joints. He has started him on corticosteroids and replaced his cathetar. As far as MRI and CT scans are concerned, unfortunately Alex and I reside in Pakistan where such facilities are not available for animals/pets. In case there is anything else you could tell us to improve his condition, I would be most grateful.

I understand that availability of advanced imaging is an issue in some places, my apologies for recommending something that isn't possible where you live.

The cornerstone of treatment of possible (very probable in his case) nerve damage then is anti-inflammatories (steroids) and probably antibiotics in his case to prevent a urinary tract infection since with a catheter bacteria have easier access.

A urinary catheter is essential for your fellow both because we do not want back pressure on his kidneys and because we want to keep the bladder small and not allow it to get overstretched. That could cause difficulty regaining function even should his nerves start to function again.

Then time to see what sort of progress he can make.

Ideally we would see some improvement in the next 4-6 weeks. Rarely we can see progress as far as 3-4 months out but most of the time if they are no better in 4-6 weeks odds are very against him ever regaining function. At that point you would need to consider what his quality of life is or will ever be.

Customer: replied 6 months ago.
Thanks again Dr. Kara for your valuable input. However, I think you might have misunderstood Alex's condition. He is not incontinent. On the contrary, his urinary and anal sphincters seem to be closed tight resulting in urine and fecal matter retention. He does have some bowel movement though probably due to the paristaltic wave. The urinary sphincter is the real problem area as he cannot pass urine. This is also evident from the fact that yesterday the vet passed the cathetar while he was awake and not sedated. He didn't protest at all! Could you please guide us in light of these facts?

No, I understand that he is retaining urine and unable to pass it normally. There is a whole complex of nerves and processes that go into allowing the bladder sphincter to open, the urethra to relax and the bladder musculature to contract to force urine out. Damage or loss of function, or a miscommunication between any of those nerves leads to an inability to urinate normally. That can lead to incontinence and dribbling urine or it can lead to a kitty that either cannot feel a full bladder or cannot relax his bladder sphincter or urethra and initiate a urine stream.

The same sort of thing applies to passing stools.

I think in your fellow's case he cannot feel his full bladder or stool building up in his colon, and I suspect the nerves that control the ability to relax and allow the initiation of urine release are affected. Stool is a bit easier and that can sometimes get pushed out if there is enough pressure building up from a large amount of stool and the stools are soft enough.

The loss of nerve function leads us to where he is now. We need to hope that the nerves can begin to function again, and in the meantime keep him catheterized and use enemas or suppositories as needed to keep the muscles in his bladder and colon from becoming stretched beyond recovery.

Time and steroids are his best hope, but like a paralyzed person those nerves may never regenerate in which case he would need to be catheterized forever.

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