Senior Cat Vomiting: When It's More Than a Hairball

Cats have a reputation for throwing up. We joke about it, clean it off the rug, and file it under things cats simply do. For a young, healthy cat, the occasional hairball really is nothing to worry about. A senior cat vomiting is a different matter, because in an older cat it is more often a symptom of disease than a quirk of the species. The difficulty is telling the ordinary from the ominous, and what separates them is usually how often it happens and what comes with it.

This walks through how much vomiting is too much and what tends to cause it in an older cat. What is behind your own cat's vomiting is a question for your vet, since the list of possibilities is long and a cat cannot tell you which one it is.

How much vomiting is too much?

A little vomiting can be normal, and a lot is not. VCA starts gently: occasional vomiting in an otherwise healthy cat may not indicate anything abnormal, particularly if it is mainly hair. Above the occasional, though, the hairball excuse wears thin. VCA is specific about the most common version: if your cat is vomiting hairballs more than once a month, contact your veterinarian. Cornell draws that particular line more loosely, and the guide to hairballs in senior cats sets the two figures side by side. Cornell draws its line by overall frequency, advising that cats that vomit more frequently than once per week should be seen. In a senior cat especially, regular vomiting is a reason to call the vet rather than a mess to keep wiping up.

How urgent is it?

Most vomiting is not an emergency, though some of it is. Frequency and the company it keeps are what tell them apart.

• Worth noting. A single episode, or a hairball now and then, in a cat who is otherwise bright, eating, and herself. Keep a quiet count of how often it comes back.
• Book a visit. Vomiting that has become a pattern: more than a hairball a month, or more than once a week, or any vomiting that arrives with weight loss, more thirst, or a shift in appetite in an older cat.
• Same day, or an emergency clinic. Cornell lists the signs to act on quickly: lethargy, weakness, decreased appetite, blood in the vomitus, increased thirst, increased or decreased urination, or simultaneous diarrhea. Repeated unproductive retching, a tense or painful belly, or any suspicion she has swallowed string or thread also belong here, since VCA counts intestinal obstruction from foreign bodies among the serious causes, and linear objects like string can be a surgical emergency.

What is usually behind vomiting in a senior cat

The causes worth knowing cluster into a few groups. VCA runs from the trivial to the serious: vomiting can be minor intestinal upset, but it can also be a sign of more serious illness, listing Bacterial infection, Viral infection and Intestinal obstruction from foreign bodies (indigestible objects that get stuck in the stomach or intestines), or Urinary tract obstruction, Liver or kidney disease, Thyroid disease, Inflammatory bowel disease and Cancer. Cornell's list overlaps, naming a wide range of metabolic diseases including diabetes, kidney disease, and hyperthyroidism, along with gastrointestinal conditions such as constipation and inflammatory bowel disease. A few of these deserve an older cat owner's particular attention:

• An overactive thyroid. Hyperthyroidism commonly brings vomiting along with weight loss and a large appetite.
• Kidney disease. The nausea of chronic kidney disease often surfaces as vomiting and a fading appetite.
• Inflammatory bowel disease. IBD turns up most in middle-aged and older cats, and chronic vomiting is one of its main signs, usually with weight loss or diarrhea.
• Diabetes and GI cancer. Diabetes can cause it, and the gastrointestinal cancer that most often affects older cats can be difficult to tell from IBD without a biopsy.
• Pancreatitis. An inflamed pancreas is a common and easily missed cause in older cats, often with little more than vomiting, a poor appetite, and low energy to show for it.

How the vet finds the cause of vomiting

Because so many things cause it, pinning down the right one is a process of elimination. Cornell describes the ladder plainly: diagnosing the cause of frequent vomiting in cats begins with a thorough history from the owner, a physical examination of the cat, and then bloodwork and fecal examination to rule out possible toxicities, parasites, and metabolic diseases. If those come back clear, a biopsy of the intestinal tract to rule out cancer or inflammatory bowel disease may be pursued, usually after x-rays and ultrasound have looked for masses and foreign objects. The most useful thing you can bring to that first visit is a clear history: how often she vomits, what it looks like, and what else has changed.

What you can do

While you wait for the appointment, keep notes and keep her comfortable. Write down each episode, the time, what came up (food, hair, liquid, or yellow bile), and whether she is keeping water down, because severe or chronic vomiting can lead to dehydration and to disturbances in electrolytes such as sodium. Do not withhold water from a vomiting cat unless your vet tells you to, and do not give any human anti-nausea medicine, since several are toxic to cats. If she is bright and it was a one-off, a small bland meal is reasonable. If she has stopped eating as well, that combination raises the urgency rather than lowering it.

When to call the vet

Book a visit for any vomiting that has become a habit in an older cat, sooner if it comes with weight loss, more drinking, or a change in appetite. Make it a same-day call for blood in the vomit, repeated retching that brings nothing up, a painful belly, obvious lethargy, or a known or suspected swallowed string. And remember VCA's quieter threshold: if vomiting comes with other signs, your veterinarian will perform a series of tests to determine the exact cause of the illness once a cat has been vomiting on and off for more than two to three weeks, even if she otherwise seems well.

Biscuit brings up the occasional hairball, and I have learned to hear the difference between that familiar sound and the one that means something is wrong: the second kind comes too often, or arrives on a day she barely touches her dinner. The old joke that cats just vomit holds a grain of truth for a young cat. Senior cat vomiting is worth trading the shrug for a notebook, because in an old cat the vomiting that turns out to matter almost always announces itself first as a pattern.

Frequently asked questions

Why is my old cat throwing up? In an older cat, vomiting is more often a symptom of disease than a simple hairball. The common culprits in senior cats are an overactive thyroid, kidney disease, inflammatory bowel disease, pancreatitis, and, less often, GI cancer. Only your vet can tell which one it is, because the list is long and the signs overlap.

Do older cats vomit more? They do not vomit more because they are old; they vomit more because the diseases that cause it, from thyroid and kidney disease to inflammatory bowel disease, are more common with age. So while it is easy to write off an old cat being sick as part of getting old, the opposite is true: regular vomiting in a senior cat is more likely to mean something, not less, and is worth a vet visit rather than a shrug.

When should I worry about my senior cat being sick? Worry when it becomes a pattern or arrives with other signs. VCA advises that if your cat is vomiting hairballs more than once a month, contact your veterinarian, and Cornell that cats that vomit more frequently than once per week should be seen. Treat it as same-day if you see blood in the vomit, repeated retching that brings nothing up, a painful belly, obvious lethargy, or vomiting alongside a drop in appetite or more thirst.

Sources

• Cornell Feline Health Center, Vomiting
• VCA Animal Hospitals, Vomiting in Cats