Warm water enema

Warning: Attempting this on a neonate kitten (birth through 6 weeks of age), unless you have been trained, should only be done by a veterinarian as it can be stressful for the kitten and requires expertise to identify the specific organs accurately.

How to know if a kitten is constipated
If you have the mama, you may not know unless the kitten's belly begins to appear distended (more prominent than normal, but not from food), if the kitten's belly starts turning color (that's more emergent), or if the kitten acts like they're hungry but refuses food (tummy hurts).

Until a kitten can walk, the most important thing, besides properly feeding them, is to ensure they are appropriately stimulated to defecate after feeding by gently rubbing their anal area with a warm, damp cloth to mimic a mother cat's grooming behavior. 

If the mama is not with them, then it's up to you to ensure they defecate before or after they eat. If it's been at least 2 days since the kitten has pooped, they may be constipated.

Examining the kitten:
Using your index and thumb of your dominant hand, GENTLY squeeze the kitten just above their hips, below the stomach, and with light pressure feel for the colon (if there are other kittens available, you can compare it to until you learn what to feel for, do that, but make sure you're washing your hands before touching those not of the same litter)

By touch, you should be able to feel a soft, tubular structure. That is the intestinal tract. The colon will be the larger, more distal part of that tract, closer to the kitten's rear end. It should be very small in girth. If the fourth is close to or equals the size of your pinky finger, and they are showing any signs listed under "How to know if a kitten is constipated,"

You should take them to a vet immediately, or if you have the following items available AND are skilled in tube-feeding, you can perform a warm water enema.

IMPORTANT: Do NOT ever substitute a feeding tube with anything you think might be the equivalent. Feeding tubes are required for both tube-feeding AND warm-water enemas. Otherwise, you are placing the kitten’s life in danger. 

Supplies needed:
• 5f (5 French) feeding tube for each kitten (or puppy)
• 3ml luer slip syringe
• Plain lubricant (unscented, nonflavored, no tingling, heating, or anything sensational)
• Lots of toilet tissue, folded and ready
 
Note: Cross-contamination should always be avoided. Never share feeding tubes or syringes between kittens. Anything that has touched their mouth or anus should NEVER be shared. The cost of supplies should never come before the cost of lives. 

Directions:
• Mark a little more than an inch on the tube above the second hole of the side that will be inserted.
• Using a 3ml lure slip syringe, load 1ml of warm (not hot) WARM water.
• Connect the syringe to the open end of the feeding tube.
• Role the end of the feeding tube in the lubricant and coat well.
• Insert into the anus VERY gently until you reach the mark. If there's resistance, try bringing it out a little, make TINY adjustments to the position, and then try inserting again. (Note: if you force it in or adjust too quickly, you could potentially tear the anus, which would be VERY painful for the kitten).
• Once the black mark is reached, VERY slowly, start to press the water in. 
• Again, you must be extremely gentle and careful not to puncture the kitten internally.
• Once the water is gone from the syringe, SLOWLY pull the tube out of the Kitten, much like with tube-feeding, but in this situation, you don't need to crimp the feeding tube.
• Using the toilet tissue, stimulate the kitten as usual, as their mama would.

Once the kitten starts pooping, DON'T STOP STIMULATING until they are done. An enema is a great skill to have in your tool kit. "A tool for the stool"
 
IMPORTANT NOTE: Some kittens get constipated before being diagnosed with Panleukopenia (panleuk). If you receive kittens without their mama and one requires a warm water enema, beginning them on a panleuk protocol would be wise. 

If diarrhea begins within two days of a warm water enema, refer immediately to our guide, Facing Panleukopenia. Ensure the kitten is quarantined and hydrated, and you are prepared for the longest few days of your life.