Is it Hairballs or a Sign of Something More Serious?

Most cat owners have awakened to it. It’s a sound more effective than any alarm clock: the sound of a cat throwing up a hairball. You wonder if your cat is OK, and you wonder if you’re going to step in the hairball the next morning. But this is just the way things are when you live with a cat, right? For many years, both veterinarians and cat owners have believed that the intermittent vomiting of hairballs by cats was a normal, and possibly expected, activity that cats would occasionally experience as a consequence of grooming and swallowing hair.  Cats are inherently fastidious animals and will frequently lick their fur to remove old hair, surface dirt, parasites such as fleas, and foreign bodies from themselves and other cats.  Cats can spend up to 50% of their waking hours grooming.  In fact, this grooming activity is often part of social interaction in multi-cat situations.  However, the presence of a barbed tongue, together with their grooming activity, often leads to the ingestion of large amounts of hair that is then swallowed.  It therefore seems sensible that even normal cats will occasionally swallow an amount of hair that may exceed the digestive abilities of their stomach and consequently need to rid their stomach of this excess hair by vomiting the hairball. Despite this logic, and the fact that many cats that frequently vomit hairballs often seem to be otherwise normal, current studies have now confirmed that many cats with routine vomiting of hairballs often have chronic forms of significant gastrointestinal disease when assessed for the chronic vomiting.

At this time, it is not clear what frequency of occasional vomiting of hairballs, if any, may be normal.  Since the formation of hairballs depends upon the rate of ingestion of hair and the ability of the normal feline gastrointestinal tract to digest the hair, it is obvious that some individual cats could “overload” their normal digestive process by excessive grooming. Cats who are grooming a normal amount but vomiting hairballs frequently usually have an underlying disease.  In these cases, the actual hairballs are not the cause of the frequent vomiting, but are just “innocent bystanders” that are just part of what the cat is bringing up.  

Many people describe to us that their cats are “trying to cough up a hairball” without anything being produced, when in fact the cat is actually coughing due to lung disease.  While cats can retch and dry heave at times, they are usually able to vomit hairballs, fluid, or food without making multiple attempts. For more information about coughing in cats, download the PDF at the end of this article.

Unfortunately, the potential causes of chronic vomiting and hairballs are vast, and may involve diseases of numerous organ systems within the body in addition to the stomach and small intestine.  The cause for chronic vomiting can range from something as simple as food intolerance to something as complex as an unusual presentation for a form of seizures.  Common causes include food intolerance, food allergy, stomach or intestinal parasites, metabolic disease such as liver or kidney dysfunction, electrolyte and mineral imbalance, endocrine diseases such as elevated thyroid function, inflammation of the pancreas, heartworm and other inflammatory lung disease, and inflammatory bowel disease.  Many other less common diseases are also possible causes. It is also important to consider that an increase in hairball vomiting can be due to skin diseases that cause increased grooming, such as fleas, allergies, mites, and behavioral/compulsive over grooming. This long list of possibilities, which range from very simple to very complex, can make it difficult for veterinarians to assess the cause for chronic vomiting and frequent hairball in cats.

Pursuing the possible causes for chronic vomiting in general can vary with the individual patient but usually follows a diagnostic approach that first includes eliminating parasites and metabolic causes as a first step.  If this does not answer the cause, eliminating food insensitivities or allergies is a logical next step.

Dietary sensitivity or allergies may be one of the more common causes for chronic vomiting.  In simple terms, dietary sensitivity indicates that a particular ingredient within the diet can cause an adverse effect within the stomach or intestine that then induces vomiting (a human equivalent would be dairy intolerance).  This differs from a true food allergy that induces chronic inflammation via an adverse immune response, which is usually induced by a protein constituent of the diet.  Often food sensitivities can be eliminated by changing diets to those with limited ingredients. Cats with food sensitivity can often respond to changing diets and avoiding certain diet ingredients, such as grains. Food allergies are not as simple to manage, and actually require the use of special prescription diets fed for a minimum of 2 months without allowing the patient to eat anything else during that time.  For these cats, a change to a different readily available non-prescription diet will rarely result in determining if a food allergy is the cause for the vomiting.  

Unfortunately, in some cases of hairballs and chronic vomiting, more advanced diagnostics are needed.  These can include radiographs of the abdomen and the chest, ultrasound of the abdomen, and occasionally endoscopy or exploratory surgery to biopsy the stomach, intestine or other abdominal organs.  All of these procedures can be performed at Animal Hospital of North Asheville. While such diagnostics can seem excessive in a patient with “just hairballs,” we now know that hairballs are often an indicator of more significant disease and that diagnosis and treatment of these diseases can be very beneficial to our feline friends and result in a longer, more comfortable life for them.

Another common issue about hairballs is the question about whether or not hairball treatments are helpful or effective.  Despite the multitude of these products on the market, there is very little evidence that they actually provide any real benefit.  Trying to reduce the amount of hair a cat ingests through regular brushing and flea treatment is more likely to help control hairballs than trying to treat with laxatives once a hairball may have formed.

Unfortunately, the common problem of what we thought was hairballs in cats now appears to be more important than we previously appreciated, so if your cat is vomiting hairballs with any frequency, further investigation may be warranted.  Certainly, when the underlying cause for frequent hairballs and vomiting is identified and effectively treated, it can lead to a better life for our cats.  Also, it sure is nice if we would not have to clean up or step on another hairball!

 

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