Hair Balls and Cats

By W. Jean Dodds, DVM Hemopet / NutriScan


Pet caregivers seem to have become accustomed to thinking that hairballs are the status quo for cats. It is true that many cats spend several hours per day grooming themselves and that can lead to a build-up of indigestible keratin (the insoluble protein in hair). Veterinarians may only become concerned when the situation is a clinically significant issue or emergency marked by lethargy, unproductive retching and inappetence, which can indicate a potential hair blockage in the small intestine. Other veterinarians are not only concerned about the acute emergency, but also are worried that frequent hairball vomiting is an indicator of chronic small bowel disease.

The frequency number is a matter of debate about when we, as veterinarians, should be more proactive in pursuing a more definitive diagnosis. Some experts say hairball vomiting every week or two is perfectly within normal range. However, Dr. Gary Norsworthy, a feline medicine expert, says that frequency of vomiting is way too often. In fact, he puts greater restrictions on it: not more often than every two months or more, in otherwise healthy shorthaired cats; or, cats that are not fastidious groomers. I agree.

Landmark Study

In 2014, Dr. Norsworthy released what I consider one of the landmark veterinary studies of current time. Landmark is an impressive word but he took cat vomiting – which is still widely accepted as a normal biological function – and proved that it is not.

His journey to discovery is one for the history books. Veterinarians were all convinced that cat vomiting was due to a stomach issue. So, Dr. Norsworthy was employing endoscopy – the technique of inserting a tube with a camera into the esophagus and stomach for observation – but the results were clinically insignificant. Then he would lump everything as inflammatory bowel disease (IBD) and prescribe corticosteroids, anti-vomiting medications, a special diet and hairball lubricants. But, none of these treatment options had much impact on fixing the issues.  Eventually, Dr. Norsworthy and his team opted for ultrasound to view the stomach and the small intestine. (Endoscopy cannot enter the small intestine.)

Time and again, the stomach looked fairly normal but the small intestine was always inflamed. Eureka! Biopsy then confirmed that the walls of the small intestine were indeed thickened and that it was the cause of chronic cat vomiting.

Study Results:

  • 100 cats – Sample size
  • 1 cat – normal biopsy findings
  • 49 cats – diagnosed with chronic enteritis (usually IBD)
  • 46 cats – diagnosed with small cell lymphoma (cancer); which can be caused by untreated or undiagnosed chronic enteritis
  • 3 cats – mast cell disease
  • 1 cat – adenocarcinoma

You are probably wondering how an inflamed small intestine causes vomiting, if vomitus originates in the stomach. The explanation is that the whole gastrointestinal system is “backed up” because of hypomotility, which means that hair and food move through the bowel at subnormal speed. When more hair or food is ingested, the full bowel results in reflux vomiting.

Preventative Tips

Our goal should be to prevent the onset of IBD, because otherwise there is no cure and the current non-specific treatment measures are less than effective or desirable.

I also emphatically stress that cat caregivers need to be even more prevention vigilant as compared to dog caregivers. Why? Because cats are more finicky and become set in their ways, so you need to acclimate them to these tips at the earliest age possible. If you adopt a senior cat, please keep trying.

Food Special prescription foods for hairballs, sensitivities and urinary tract infections exist. However, they are generally cereal-based kibble and possibly have ingredients that are not only questionable, but also can inflame the bowel. This is the opposite of what we want to achieve. But, workarounds are available.

Food rotation is a key component with cats. Many cats will lock onto one type of protein because of repeatedly being fed it. We should not permit this. So, rotation from the beginning helps cats get used to the taste and consistency of many proteins. In fact, I would rotate the diet every few days or at least weekly.

The bigger problem is that we should not assault the bowel with foods that cause inflammation. So, we need to figure out which foods are causing the sensitivity or intolerance in an individual cat. Veterinarians often suggest food elimination diets, but it is difficult to ascertain which foods are causing the inflammation with this method, it takes too long (weeks), and compliance by the client or cat is difficult to maintain.  I suggest instead performing the NutriScan Food Sensitivity & Intolerance Test that I and the team at Hemopet developed. It takes out the guesswork. Once we do this, we have identified specific proteins that a cat will want to and can safely eat.

Kibble is by nature contradictory to a cat’s needs since it only contains about 10% moisture. Cats never drink enough water because they are descended from the African Wildcat. Observations have demonstrated that the African Wildcat only derives 10% of his moisture needs from freshwater sources and 90% from prey. Even though cats started the domestication process over 10,000 years ago, their primary purpose was to curb rodent populations so they continued to receive moisture through prey. So, I clearly want all cats on a moisture-rich diet that could be canned, dehydrated and moistened, or raw. At Hemopet, we feed Saucy, the feral cat that stays around our clinic canned food.

Grooming I would not be surprised if ingested hair also contributes to IBD. However, we cannot stop the hair ingestion. The best solution is investing in several of the right brushes and combs for cats. Definitely do your research about the type of hair and talk to grooming experts. Then, set aside a few minutes a day to brush your cat thoroughly or as much as you can. Many cats need to become acclimated to it but be unwavering in your commitment. In fact, some cats begin to love it so much not only for the feeling but also for the devoted affection.

Omega-3 Supplements   Omega-3 fatty acids can help improve the condition of your cat’s skin and fur, as well as the ability of his digestive system to manage the hair and debris he swallows while grooming himself. The source of omega-3’s is generally from fish, so you need to make sure your cat does not have a sensitivity to the type of fish or its oils.

Hairball Remedy Granted, not all hairballs can be stopped but, again, we want to decrease their frequency. When they do occur, many veterinarians suggest a petroleum-based hairball remedy. If you think about it, petroleum beds come from fossil fuels (e.g. dead dinosaurs) and is a little counterintuitive. Petroleum-free and all-natural options are available. They are usually made with slippery elm, papaya or marshmallow. Dab it on the tip of your cat’s nose. Your kitty will lick the jelly and swallow it. This allows the hair to pass more easily through the GI tract.

Fiber Fiber helps keep things moving. With cats, you can try pumpkin, wheatgrass, coconut fiber or psyllium seed husk powder.


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