This is a statement I hear from pet parents almost on a daily basis. When I ask them where they heard such a concept, the response is usually, “that’s what my vet said.” Furthermore their family veterinarians have usually simply treated the vast majority of these cats symptomatically with diets for “sensitive stomachs”, hypoallergenic diets, and/or medications for hairballs and nausea.
Yes it is true long- and medium-haired cats vomit the occasional hairball, but this frequency should be less than twice a month (if at all!). Vomiting a lot of hairballs, especially in shorthaired cats, isn’t normal. Commonly cited acceptable frequencies of vomiting hairballs are:
- Less than twice a month in long- and medium-haired cats
- Less than once every two months in shorthaired cats
A study of 100 cats with a history of chronic vomiting, weight loss and/or chronic diarrhea was recently published in the Journal of the American Veterinary Medical Association (http://www.ncbi.nlm.nih.gov/pubmed/?term=cats+vomiting+norsworthy). Although seventy three percent of the cats in the study chronically vomited, many pet parents and primary care doctors simply tried to explain the vomiting away. Commonly reported excuses were that an individual cat:
- Eats too fast
- Has a sensitive stomach
- Just has hairballs
- Just is a “puker”
This study also raised concern that formation and subsequent vomiting of hairballs may be secondary to reduced gastrointestinal motility that occurs because of a primary disease process in this location.
Indeed vomiting with or without hairballs is a common clinical sign of an underlying disease!
Wouldn’t you be worried about your own health if you vomited once a month? This isn’t normal for you, and it isn’t normal for your cat either!
Vomiting vs. Regurgitation
When I interview parents who bring their cats in for evaluation of chronic vomiting, one of my first priorities is to differentiate vomiting from regurgitation. Why? The difference matters – both in terms of diseases that cause each sign and the appropriate tests needed to determine a definitive diagnosis.
Vomiting is an active process and regurgitation is a passive one. Cats often show signs of nausea before vomiting, and common prodromal indicators include:
- Excess salivation
- Licking of the lips
- Vocalization / crying
During the act of vomiting, abdominal wall muscles contract to expel food and liquid from the stomach and the first part of the small intestine (duodenum). This material is called vomitus and commonly is yellow or green in color, indicating the presence of digested or fresh bile, respectively. Conversely regurgitation does not involve abdominal wall muscle contraction; rather it frequently occurs when a pet changes position (e.g., lowers his head). Often times parents say, “He just opened his mouth and food came out.” Regurgitus comes from the esophagus or the back of the throat (oropharynx) and often looks like a tube because of the time it spends in these locations.
My friends at the Veterinary Partner have developed a great animation to help show the difference between vomiting and regurgitation. Although the model uses a dog, the process is the same in cats. Check out http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2809 for more information.
If it isn’t hairballs…
There are many causes of chronic intermittent vomiting in cats, and it may be helpful to think of them in two main categories: diseases of the gastrointestinal tract (GIT) and diseases outside of the GIT. Common diseases of the GIT that can cause chronic intermittent vomiting in cats include:
- Inflammatory bowel disease (IBD)
- Cancer (i.e.: lymphoma, adenocarcinoma, mast cell disease)
- Food intolerance
- Motility disorders
- Partial obstructions
- Gastrointestinal ulceration
- Endoparasitism (aka: intestinal “worms”)
- Severe constipation / obstipation
Diseases outside the GIT that are frequently implicated in chronic intermittent vomiting in cats are:
- Hyperthyroidism (https://criticalcaredvm.com/understanding-feline-hyperthyroidism/)
- Chronic kidney disease
- Inflammatory liver disease (cholangiohepatitis)
- Hepatic lipidosis (aka: fatty liver syndrome)
- Diabetes mellitus
- Central nervous system disease
- Lung disease
- Diaphragmatic hernia
- Heartworm disease
In the study by Norsworthy et al referenced earlier in this post, only one cat was deemed normal. The other 99 had either small intestinal inflammation or cancer. Determining the cause of chronic vomiting can be challenging, and often the counsel of a board-certified veterinary internal medicine specialist is invaluable!
The take-away message about vomiting cats…
Chronic intermittent vomiting in cats is not normal and is frequently indicative of a serious underlying disease. Cats can vomit hairballs, but these hairballs may actually be the result of a chronic small intestinal disease that has caused the GIT to move more slowly than normal.
I encourage pet parents to have their cats evaluated by a board-certified veterinary internal medicine specialist to help determine the cause of their cats’ chronic vomiting.
Provision of only symptomatic care without determining the cause of chronic vomiting is not the best course of action for your cats, and a board-certified veterinary specialist can help make sure they receive the best possible healthcare.
To find a board-certified veterinary internal medicine specialist, please visit the American College of Veterinary Internal Medicine.
Wishing you wet-nosed kisses,