Q: My cat vomits once every week or two. This has been happening for several months, maybe a year. He’s otherwise well and eating. Sometimes I see hair in his vomit. What should I do about it?
A: Cat lovers the world over are familiar with the disgusting experience of stepping on something slimy and gross while making their way, bleary-eyed, to the bathroom in the middle of the night. They don’t even need to turn on the lights to know that it’s cat vomit. While it is normal for cats to vomit once every month or two, if it is happening more often than that, is becoming more frequent over time, or is accompanied by other signs of illness, you might want to check in with your vet. Here’s what you need to know.
Could it be a hairball problem?
When there’s hair in the goopy mess, it’s tempting to blame hairballs (vets call them trichobezoars). When cats vomit up clumps of hair every few months — especially in the spring and fall when they shed more — it’s usually nothing to worry about.
Cats that vomit hairballs more often usually have something else going on. One oft-suggested possibility is “overgrooming,” or self-induced alopecia, which occurs when cats are bored, anxious or have skin problems (like flea allergies). Cats that overgroom often focus obsessively on their bellies, leaving their skin bald and inflamed. (Humans have a similar obsessive-compulsive condition called trichotillomania, or “hair-pulling disorder,” although they typically pluck hair on their scalp or eyebrows.)
To treat a hairball problem, you can find a variety of fiber-rich special diets online, all designed to help move hair into the intestinal tract and your cat’s stool (rather than in the reverse direction). Some of these diets contain vitamin E, omega-6-fatty acids or other supplements to improve haircoat quality. There’s also a mind-boggling array of products to prevent hairballs — including chews, treats and flavored laxative gels — and slicker brushes and “de-shedding tools” to help remove excess hair.
But Stanley Marks, a dog and cat internal medicine specialist at the University of California at Davis who focuses on gastroenterology, urges caution before dumping your precious savings on such products. “Even cats that overgroom should be able to pass excess hair if their GI tract is normal,” he says. For any cat with occasional vomiting — even if you suspect hairballs — he recommends keeping a diary of when it happens (including time of day relative to eating), because you otherwise might not notice an increase in frequency if it’s occurring slowly over months to years.
Vomiting vs. coughing vs. regurgitation
Sometimes what looks like vomiting actually is coughing or regurgitation. You want to be accurate here, because if you tell your vet that your cat is vomiting but really it’s coughing or regurgitating, you might end up squandering money on the wrong diagnostic tests. Collect as much information at home as possible. Start by taking out your phone and recording what’s going on. Reviewing an owner’s videos of events can help us figure out what tests to run. If you can’t catch it on video, it also helps if we see photos of any material that pets bring up (slime and all) as well as photos of their stool — whether you think it’s normal or not (trust me, we’ll be thrilled to see them, although your cat might be embarrassed). Bring your diary, too, if you have one.
Coughing is usually a sign of a respiratory problem rather than a gastrointestinal problem. Cats don’t cough as often as people and dogs do, but when they do, their intense body contractions can make them look like they’re retching to vomit, and they might bring up some saliva or foamy material. If that material contains hair or stomach contents (which might be yellow or green-tinged or contain food), your cat’s probably not coughing.
When cats regurgitate, they typically bring up mostly undigested food that hasn’t yet reached the stomach soon after eating. Sometimes the material has a tubular appearance. It might also contain hair. Cats that regurgitate usually don’t have the repeated abdominal contractions that occur with vomiting — they just bring up food passively. Regurgitation is typically a sign of a problem with the esophagus. That could be a blockage from a toy, bone, stricture, tumor or a birth defect; a hiatal hernia (where the stomach slides back and forth through the diaphragm into the chest); or a problem with the esophagus muscle that propels food into the stomach.
When should I be concerned?
Cats often hide illness until the underlying problem is advanced, so it’s important to pay attention to subtle signs. These signs may indicate something more concerning than a hairball issue:
- It happens more often than once a month or two, or it’s becoming more frequent over time.
- Your cat is losing weight or has less interest in food (weight loss is one of the most common signs of GI disease in cats).
- Your cat’s stool is softer or liquid.
- Your cat is grooming itself less frequently (leading to a dull, scruffy haircoat).
- Your cat is less active than normal.
Vomiting can occur because of a systemic illness (like a liver, kidney, pancreas or thyroid problem), or because of a problem in the GI tract itself. Although the list is long, some of the most common GI tract problems that cause cats to vomit include obstruction by toys, string or other swallowed foreign objects; inflammatory bowel disease (IBD); or cancer of the intestinal tract.
To figure out what’s going on, vets need to collect a detailed chronological history, do a physical exam, order blood tests, and possibly also do X-rays or an ultrasound. Endoscopy (which requires anesthesia) or surgery might be required for diagnosis. Sometimes, a vet can remove a foreign body or mass from your cat’s gastrointestinal tract during the endoscopy or surgery, solving the problem.
What if I can’t get in to see my vet or I’m short of money?
As long as your cat’s still active and eating well, there are some things you can try at home. Start by changing your cat’s food to one that contains a protein source your cat hasn’t eaten in the past, such as venison, rabbit or whitefish, Marks says. Sometimes cereal grains like wheat, corn or barley can be the culprit, so compare labels before buying a new food. Introduce the new food gradually by mixing it in with the previous diet over three days, so on the first day your cat’s getting one-quarter of its food as the new diet, the next day half, the third day three-quarters, then 100 percent on the fourth day. Stick with the new diet for at least three weeks, and don’t feed anything else (including treats). If food sensitivity is the problem, many cats will get better within a week or two.
If your cat continues to vomit, if the problem worsens (even during the trial diet period), or your cat’s lethargic and not eating, call your veterinarian or take your cat to an emergency clinic. Even for owners who can’t afford expensive diagnostic tests or surgery, vets can prescribe supportive therapies like appetite stimulants or anti-vomiting medications, special diets, or sequential treatment trials for IBD (which can often be managed successfully with diet and medications).
Hopefully, the result will be a happier cat — and no more ominous retching noises and slimy encounters in the middle of the night.
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