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Cat Anal Sac Ruptures

Dupree the Cat
duPree has a good life, despite her digestive conditions

Did you ever awake to find your cat acting strangely and a crime scene on their backside?  If yes, then you've experienced an anal rupture.  My cat, duPree, suffers from both megacolon and anal ruptures and this is a guide to how I treat those conditions.  

Megacolon is a disease that develops in cats when the muscles within the wall of the colon (large intestine) no longer contract as they should.  Feces builds up and dries out within the colon, resulting in constipation and life-threatening impaction.  Extraction, IV fluids and huge vet bills follow.  Treatment for Megacolon is daily Miralax to loosen stool.  Unfortunately the looser stools interrupt the function of the anal sacs in some cats leading to periodic ruptures.  It is a delicate balancing act treating cats with both Megacolon and Anal Sac Rupture conditions.
Anal sacs are two small glands that are found just inside of your pets anus that contain a foul-smelling material. Prior to domestication, these glands served the purpose of marking an animals territory, and could be readily emptied voluntarily.  21st century pets have largely lost their ability to empty their sacs on demand, and the process occurs naturally during normal defecation when firm feces are passed, lubricating the anal opening in the process. Glands can also “spontaneously empty” during times of stress or excitement; you can recognize this has happened if your dog or cat suddenly develops a very unpleasant odor.
Anal Rupture Day 1
It looks like a crime scene, especially because duPree has long hair.  Blood and pus are matted all over back there.  Day 1 administer Onslor (robenacoxib) 6mg. for pain and inflammation and clean the area if possible.  In general the cat doesn't want any attention back there.  Let the pain/inflammation meds do their thing before/if trying to clean it up.

Domestic (especially indoor) cats don't need these sacs, but it's best to leave them alone as long as they're healthy because many of the nerves that control bowel movements are in this area.  If your pets anal sacs need to be emptied every month or more, you may opt to have the sacs surgically (and therefore permanently) removed. The procedure can be complicated as the sacs are located next to many important nerves- mainly those that control rectal sphincter function- and meaning, if improperly performed, you pet could be permanently incontinent of its feces.
Anal Rupture Day 3
During this event the site closed up nicely and scabbed over so this will be the last day of pain/inflammation treatement with Onsior (robenacoxib) 6 mg.  If it had remained an open wound I would have continued pain/inflammation treatment for 3 more days.

Sometimes problems develop and the cat's glands become clogged, infected or abscessed.

1.  Impaction.  The most common problem happens when the duct or tube used to empty out the anal sac gets clogged.  Pressure builds up and it becomes painful for your cat to poop.  They may also become constipated which can become life-threatening in cats.

2.  Infection.  When bacteria build up in the anal sacs, it can cause an infection.  It can become so painful and itchy that your cat may show signs of fear or anger.  The cat will become antisocial, hide, and substantially deviate from daily routines.

3.  Abscess.  An abscess is a swollen, tender mass of pus.  Its the most painful of the three and needs to be tended before it ruptures.

4.  Rupture.  Rupture is what I illustrate here.  duPree has mega-colon which causes her to become constipated and creates a life-threatening blockage.  For that we treat her daily with Miralax which in turn has caused her anal sacs to impact, infect, abscess, and then rupture on a regular basis.
Anal Rupture Day 4
The wound evolves as duPree cleans it herself.  Sometimes it looks worse, sometimes better, but overall it is shrinking in size and there is no obvious inflammation, so I do nothing.  No more pain pills, no special treatment. 

First Signs
The first sign I had that duPree had a ruptured anal sac was when she was acting lethargic and withdrawn.  When I finally got her out into the light and inspected it looked like a crime scene on her backside.  Blood everywhere.  

I took her to the vet and $500 later they had flushed the wound with saline fluid and given kitty a shot of antibiotic and some pain pills.  Two more visits to vet @$100 each followup and they said she was OK.  A week later a second rupture occurred, then a third, then a fourth. 

It became untenable financially to continue going to vet every three weeks with this condition and surgery was not recommended because of complications (incontinence) that can follow.  
Anal Rupture Day 5
little change, a new scab

I decided to treat duPree at home, as best I could.  Eventually, after 6 ruptures coming about 3 weeks apart she healed completely and did quite well for about 2 months before the 7th rupture occurred.  At that event I only treated with pain medication for 3 days and completely ignored the rupture otherwise.  By the 3rd day of pain pills the rupture site looks less like a crime scene and more like a big scab.   By 1 week it has significantly shrunk.  By week 2 the scab falls off and duPree looks normal again.    The irregular cycle of ruptures has continued.  This strategy works for me financially and for the cat it seems to be at least as effective as going to the vet every time a rupture occurs.  I love my vets but their options for treating this condition are limited, and it is unmanageably expensive.

For pain and inflammation I use Onsior (robenacoxib) 6mg. once a day for 3-6 days.  As soon as duPree is acting normally again (usually by day 3) I discontinue pain treatment.
Anal Rupture Day 11
little changed, scabs evolving, duPree acting normally

However, it should be stressed that impacted anal sacs can be very serious and lead to infections. The anal sacs will rupture because the impacted fluid becomes so hard that the sacs become infected, and it ruptures through the skin because the infection takes the path of least resistance, meaning that it must burst through the skin. During the period of time leading up to these anal sac ruptures your cat can be in pain and the impaction can lead to lethargy, a decreased appetite, and secondary infections. Preventing these ruptures is very important for your cat.
Anal Rupture Day 12
Area is cleaned (by duPree) . Scab still visible.  duPree's behavior is normal.

First and foremost, your cat likely needs to have his anal sacs expressed regularly. If you are willing to do so, you could be taught how to express your cat’s anal sacs at home, or bring your cat to the vet on a regular basis for expressions. Doing so will prevent the fluid from becoming so terribly impacted that the sacs rupture.

Additionally, adding bulk to your cat’s stool can be helpful in some cats with chronic anal sac impactions. Adding some canned pumpkin to your cat’s diet, Metamucil, or additional fiber can make the stool larger, harder, and bulkier, which can help put enough pressure on the anal sacs to secrete the fluid.
Anal Rupture Day 14
Scabs fall off, affected area is pink and appears healthy

Unfortunately in cats with megacolon one has to treat with Miralax which reduces the hardness of stool and likely contributes to to anal sac issues.  It is a trial and error process of improving the lives of cats who suffer from both megacolon and anal sac ruptures.
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