Getting to the bottom of Blanche’s problems

When diarrhea is chronic or acute.

Courtesy of youtube.

A client called last week because her cat, Blanche, was having diarrhea. I will pause while you giggle. We are going to talk about … well, you know … feces. Cultural taboos around all things fecal are strong, making folks feel awkward with these conversations, but you’d be surprised how much of a veterinarian’s day is focused on bowel movements. Frequency, consistency, urgency, color, content. Just remember, as the children’s book says, everybody poops, and we’ll get back to our topic.

I don’t have statistics to prove this, but at least in my experience, the majority of Vineyard cats are allowed outside. There are plenty of arguments for not letting cats out, ranging from impact on local bird populations to health risks to the cats themselves such as trauma, parasitism, and infectious disease, but when it comes to bathroom habits, the reality is even when they have access to a litter box, many Island cats prefer the great outhouse in the woods. The result is, unless urgency makes her poop in the house, you may not even know your cat has diarrhea. In Blanche’s case, she had been kept inside recently due to visiting dogs, so the abnormal bowel movements were readily apparent to her mom. In fact, the client wondered if the diarrhea might be stress-induced.

Diarrhea is not a disease. It is a sign of disease. To help us determine the underlying problem, and to assess how serious it is, we first look at whether there are other symptoms. Is Blanche vomiting? How is her appetite? Is she feeling perky? Or is she lethargic, dehydrated, feverish? Our next question is whether the diarrhea is acute or chronic, as these often have different underlying causes and different treatments. Acute cases are most typically caused by dietary indiscretion or intolerance, intestinal parasites, and infectious diseases. Did you suddenly change your pet’s diet? Is Blanche a big hunter? Did you invite strange, scary dogs into the house? Even when we are unable to pin down the cause, acute diarrhea frequently resolves within a few days, spontaneously or with simple symptomatic treatment.

Diarrhea lasting two weeks or more is considered chronic and is most commonly the result of primary intestinal disease, or other systemic illnesses that may affect intestinal function. That’s a long list. It may include cancer; motility disorders; idiopathic inflammatory conditions; food allergy; pancreatic, liver, or kidney disease; metabolic issues like hyperthyroidism; and a host of infectious diseases like salmonella, campylobacter, giardia, and tritrichomonas. Making these diagnoses can be expensive, time-consuming, and invasive.

When deciding how to proceed, it helps if we have an idea whether the problem is primarily in the small intestines or the large intestines. This is part of the reason for your veterinarian’s fascination with the icky details. We want to know consistency. Soft, cow-flop, pudding, watery? We want to know color, and whether there is visible blood. Is it bright red blood? This means bleeding from the large bowel, rectum, or anus. Is the stool dark, tarry black? This is called melena, and indicates bleeding higher up in the intestinal tract. Is there mucus? How frequently is Blanche in the box? Is she straining? Animals with large-bowel disease typically go very frequently, strain, and pass watery stools. Animals with small-bowel disease may have soft or semiformed stools, but do not typically strain or have significant increase in frequency. But it’s not unusual to see mixed clinical signs.

Blanche was feeling fine, other than the loose stools. There was no blood, no vomiting, no loss of appetite. We opted to start with symptomatic home treatment. For vomiting, standard protocols include withholding food 12 hours or more. The idea is that letting the upset gut rest and clear itself of any problematic contents will allow it to heal and sort of reboot. Some veterinarians also recommend withholding food in cases of diarrhea. I don’t usually do this. At least not for cats. I find most felines are pretty good at listening to their bodies. A cat who doesn’t feel well will often restrict food intake on her own. Not true for all dogs: Blackie, the Labrador, may continue to binge no matter how upset his tummy, so parental intervention may be advised. But cats? Finicky. Discerning. Sensible. If Blanche is not vomiting and has an appetite, I see little benefit in making her miss dinner. I do, however, advise modifying the menu.

Many cases of diarrhea are what we call “fiber-responsive.” Dog owners are familiar with the old “meat and rice” bland diet … but you know cats. Finicky. Discerning. Try to serve up a bowl of hamburger and Uncle Ben’s, and it’s likely to be sent back to the kitchen with complaints to the chef. I have had good success by keeping it simple and using a commercial high-fiber, low-fat cat food made by Hills called W/D. This can be mixed into Blanche’s usual food to add fiber and lower the overall fat content. Or we may try other prescription diets such as I/D, which is specifically formulated for intestinal problems. Your veterinarian may have other favorite brands or foods. Occasionally an animal will actually require the opposite of the high-fiber approach, and respond to “low residue” diets, and chronic diarrhea cases may have completely different food recommendations, depending on the underlying cause.

What about over-the-counter remedies? Generally not advisable for cats. Kaopectate contains salicylates, which can be toxic to kitties. Medications such as Imodium and Lomotil are opiates, to which cats can sometimes react oddly. Call your veterinarian before giving any medication, or you may do more harm than good. If the runs don’t clear up quickly, it’s time to visit the vet. Your cat might need prescription antidiarrheal medication, probiotics, and/or deworming. She might have other symptoms you haven’t noticed, that warrant more aggressive diagnostics and interventions. Happily, all our Blanche needed was a little high-fiber food … and for those visiting dogs to go home.