This clinical review examined chronic hairball production in cats as a possible sign of underlying disease and offers prevention and treatment options. Hairball formation is caused by excessive hair ingestion and/or improper upper GI mobility secondary to illnesses such as dietary intolerance or inflammatory bowel disease. Domestic cats normally spend ~25% of their waking hours grooming; this may be increased by the presence of fleas or other ectoparasites, pruritic skin diseases, and behavioral overgrooming. Controlling underlying skin and GI diseases is crucial to preventing hairball formation.

Hairballs not expelled by vomiting may cause significant illness, including partial or complete intestinal obstruction, esophageal obstruction, esophagitis, and upper respiratory inflammation (from vomition into the nasopharynx). As cats have fewer interdigestive GI contractions, it is best to feed smaller, more frequent meals to increase gastric emptying time. Canned food and round (not triangular) dry food clear quickly, helping hairballs exit the stomach. Commercial hairball control diets may help. Other preventive measures include shaving fur, gastric lubricants, and medical management using prokinetic agents (eg, metoclopramide, cisapride, ranitidine).

Commentary
Frequent hairball elimination indicates excessive fur ingestion or underlying GI disease. Once excessive fur ingestion from ectoparasite infestation, pruritic skin disease, or overgrooming from pain or anxiety is ruled out, treatment of underlying GI disease may be necessary. The paucity of well designed studies regarding hairball vomiting makes objective recommendations difficult. Dietary manipulation, gastric lubricants, and clipping long-haired cats are recommended before considering long-term medication. Of note, the included poll of cat owners suggested that long-haired cats vomit hairballs roughly twice as often as short-haired cats.—Glenn Allen Olah, DVM, PhD, DABVP (Feline)

Source
Hairballs in cats: A normal nuisance or a sign that something is wrong? Cannon M. J FELINE MED SURG 15:21-29, 2013.