A normal nuisance, or is something wrong?

—Takashi Hososhima

My husband, a city boy from the Bronx, has a pair of soft canvas shoes he calls his “indoor” shoes. Having spent much of my life barefoot, both inside and out, I make fun of him for donning footwear the moment he gets out of bed. “Really?” I tease. “You need shoes just to run downstairs?” But he had the last laugh the night I forgot my bedtime medications in the kitchen. Trotting down the stairs, unshod in the dark, my bare foot landed squarely on a large, squishy, slimy mass deposited on the bottom step by one of our cats. Let’s talk hairballs.

As any cat fancier knows, felines spend a lot of time grooming. In fact, grooming accounts for as much as 25 percent of a cat’s awake time. Their raspy sandpaper tongues tend to pull out bits of fur during all this primping, which they end up swallowing. In a typical, healthy, shorthaired cat, ingested fur simply slides on down the gastrointestinal tract along with the Fancy Feast, eventually coming out the other end, more or less undigested, into the litter box. This does not seem to cause any discomfort, though occasionally hair passing through becomes irritating, resulting in “hair-related” colitis with diarrhea, and sometimes blood in the stool. But your average shorthaired tabby grooms and consumes fur regularly with no untoward results … and without barfing on your rug.

So why is one of my cats booby-trapping my staircase with hairballs? In a 2012 article in the Journal of Feline Medicine and Surgery titled “hairballs in Cats: A Normal Nuisance or a Sign that Something Is Wrong?” by Dr. Martha Cannon, the author points out that there isn’t much peer-reviewed published information about the incidence and causes of hairballs in cats, and equally little scientific information on the efficacy of commonly used treatments and preventives. She decided to gather data at her cat-only veterinary clinic by taking two polls. Clients participating reported a 10 percent overall incidence of hairball vomiting in otherwise apparently healthy shorthaired cats. Long-haired cats had double that rate. So our first predisposing cause is length of fur.

I can personally vouch for this finding. In my house, the one who leaves oozing globs on my carpet is Captain Jack Sparrow, a Maine coon cat with an impressively bushy brown coat. The evidence is clear — hanks of long, dark fibers in the mass squished between my toes. Our other cat, Tigerlily, has short orange fur. It makes sense that long-haired cats are more prone to hairballs than shorthaired cats. There’s just more coat to be groomed. Individual strands of hair are longer, and thus harder to pass out of the stomach. The end result is a clump of hair that can’t go down, so it comes up instead.

Another factor predisposing certain cats to hairballs is overgrooming. Allergies or fleas can make cats itchy, so they lick more than just for normal grooming, and may even pull out hunks of fur with their teeth. Pain will cause some cats to lick compulsively at the offending body part, the way a person might constantly rub a sore shoulder. In other cats, overgrooming may be a behavioral habit related to stress or anxiety, like people who bite their nails. It may even be a compulsive psychological problem. In humans, it’s called trichotillomania — an uncontrollable urge to pull out one’s hair, eyebrows, or eyelashes. No one knows precisely what causes this in people, but it is thought to be a combination of genetic and environmental factors. Regardless of initiating cause, overgrooming can leave cats with a bellyful of hair that simply is more than their gastrointestinal tract can handle.

If your kitty has frequent hairballs, it’s worth bringing to your veterinarian’s attention, as this can sometimes be a symptom of underlying disease, especially conditions that occlude the gut or alter normal motility such as inflammatory bowel disease, gastrointestinal cancer, megaesophagus, intestinal parasites, pancreatitis, and gallbladder disease, to name a few. Having lived for more than 50 years with dozens of healthy cats, many of whom regularly yakked up clumps, I believe “coughing up” hairballs is often a normal mechanism for clearing accumulated fur from the stomach. But a cat who does it excessively, or has other symptoms, deserves a thorough examination, as diagnosing (and, if possible, curing) the primary problem is undoubtedly the best strategy. Depending on what your veterinarian finds, additional diagnostics recommended may include bloodwork, radiographs, ultrasound, or even a behavior consultation.

What about treatment? In cats with no other signs of illness, I start with simple, old-time lubricant remedies like Laxatone or Petromalt. These petroleum-based flavored gels are given orally. The idea is that they will grease up the hair and help it pass down. Although many specialists pooh-pooh such products, I’m not sure those folks are seeing all the day-to-day kitties that we general practice veterinarians see. In my experience, lubricant hairball remedies often seem effective, if used properly. You have to give more than just a dab on the nose, and you have to give it consistently.

What about commercial “hairball diets”? These contain increased levels of insoluble fiber to improve gastric motility and emptying, which, in turn, may help move hair down and out. Feeding frequent small meals throughout the day may also improve motility. There’s little data proving the efficacy of these diets, but anecdotally I can attest they do seem to have helped many of my patients. Another consideration when it comes to what’s for dinner is the possibility of food sensitivities or food allergies, which can play havoc with gastrointestinal function, and exacerbate hairball issues. Talk to your veterinarian about trying a hypoallergenic diet, if indicated. Finally, simply brushing your cat frequently is good preventive care. You comb out loose hair. Your cat swallows less. Sadly, Captain Jack doesn’t tolerate brushing. (I have scars to prove it.) I may have to start wearing shoes in the house.