Diarrhoea


What a disgusting title I can hear you saying! But the simple fact is that if you have cats, at some time or another you are going to have to deal with diarrhoea (and now I've learned to spell it, I may as well write it down, Oh, and thanks to the helpful person who told me I had spelled it wrong, but generally I find that the Oxford English Dictionary is correct, and that’s my source).

I have started a Yahoo group as a support for people dealing with bowel problems, because results can be very slow and the process can be demoralising if you’re having to deal with this on your own, particularly if your vet is unable to help. Please join by going to http://pets.groups.yahoo.com/group/feline_IBS/

Why do cats get tummy upsets?

There could be any number of reasons:

Change of environment - A new environment means a new set of bacteria to deal with, and that can sometimes take a little bit of adjustment to get used to. If you're changing your environment, one of the most obvious things to consider is to use bottled water, just in case there is something in the local water that your cat isn't used to. A new house means a new set of bacteria to get used to, and this can take adjustments that end up with a bit of a runny tummy, especially in kittens with an immature immune system.

Change of food - You can also get problems if you change food, particularly if you go from a relatively natural, low-chemical additive food, on to something with high additives and very rich artificial content such as Whiskas.

Stress - this is surprisingly common, and most often seen in kittens the first few days after arrival at their new home, or perhaps following the introduction of a new cat, other animal, or baby into an established household

Overeating - another very common cause of sudden and unexplained bouts of diarrhoea. Eating things that they are allergic to or intolerant of, e.g. milk is one of the commonest causes of diarrhoea in Oriental and Foreign cat breeds: these breeds lack the necessary enzyme in the gut to make milk clot so that it can be absorbed. It can cause quite a dramatic reaction with even a tiny intake of milk like licking the bottom of the morning cereal bowls.

Poison - garden and household chemicals, illegal pest poisons put down to kill rats etc.

Allergies - Some cats develop allergic reactions to certain chemical additives in cat foods. Unfortunately, once sensisitized a cat can continue to show reactive symptoms even when the original source of the problem has been removed, and other chemicals can become allergens as well. Once in a reactive cycle the only way to break it is to use a completely bland diet. A couple of food manufacturers make hypo-allergenic foods for dealing with these situations, but usually a white fish diet at first is a good way to calm the situation. After that you can gradually introduce other foods such as cooked white-meat chicken and chemical-free foods with single-protein ingredients (i.e. just one 'meat' source, not several as is the case with most foods)

Bacteria and viruses - The commonest virus that causes diarrhoea is Feline Coronavirus (FCoV). About 80% of cats have antibodies to the virus, but antibodies only mean that the cat has been in contact with the virus, not necessarily that it currently has it. In a very few cases, FCoV causes the body to undergo an auto-immune reaction (other auto-immune diseases include Arthritis); the body starts to destroy itself. This disease is called Feline Infectious Peritonitis, which is a misnomer as we now know it is neither Peritonitis nor Infectious! FCoV symptoms usually last about 24 hours, after which the cat is completely well. It can be reinfected, as FCoV is a virus that mutates very fast. In multi-cat households reinfection is quite common, and sometimes to clear an infection the household has to be split into groups of three or less. Why? I will try to explain:

Cat A infects Cat B, Cat B infects Cat C. Cat C then infects Cat D. However by the time Cat D has the virus, it has mutated enough that the antibodies Cat A produced against the original virus are no longer effective as they are faced with what is effectively a new virus, so Cat A gets the virus again, and the whole thing goes round once more. In groups of three or less, the degree of mutation in the virus is not sufficient to counter the original antibodies, so the virus dies out naturally, UNLESS one of the cats is a carrier. Very few cats become carriers, but some do. There is currently NO PUBLICLY AVAILABLE TEST for carrier status, though one is under development and is currently being tested with a number of test households.

FCoV is passed in body fluids, but mostly from faeces - poo left lying in a litter tray can harbour the virus for some time, and another cat entering the tray and sniffing at what is already there can get FCoV from it. Cats who go out are generally less likely to have FCoV because the outdoor environment is less friendly to the virus, and it dies quicker. Also faeces left out of doors tend to be more effectively covered, and other cats are far less likely to defecate in the same place. All this information is widely available if you are a user of the internet. If you're not it's a little hard to keep in touch with it. However, most people now have someone they know who can help out with a web search on any subject, so if you are worried, don't be shy to ask! Vets are busy people, and often can't keep up with research. FIP and FCoV are hot topics at the moment, and the research is constantly being updated.

There are many common-or-garden viruses and bacteria that cause tummy bugs. Some go away by themselves, many cause loss of appetite in addition to the smelly business, some cause vomiting as well. It's very like human tummy bugs - there are loads of different types, and the symptoms range from bug to bug and from cat to cat.

What do I do?

First of all, take your cat to the vet, don't mess around. This article isn't designed to give you all the answers, but I hope it will help you to evaluate how your vet is coping, and perhaps provide you with some alternatives and other ideas. Remember, vets are not God: they don't know everything, and they can make mistakes! If an illness is viral, an antibiotic won't kill it, the cat's immune system must do that. If you introduce an antibiotic, it effectively wipes out the resident immune system, plus all the correct gut bacteria. However, it is a good guard against secondary infections that creep in if the cat is weakened, and since many tummy bugs are bacterial, it can kill the cause of the illness very effectively. That's probably a first line of defence for most vets.
However, the bug is dead, but so is everything the cat needs to digest food, so the gut needs to be repopulated by using a probiotic once the antibiotic has finished. Also you may need to re-introduce normal gut flora with things like natural yogourt (I don't know how to spell that one!) or Acidophilous. Acidophilous can be obtained from any health food shop, and nowadays from quite a few supermarkets. If your vet does not suggest anything to help the cat get back to normal after an antibiotic this is not bad practice. Most cats will recover normally without aids, but I prefer, particularly in the case of tummy bugs, to support the cat into recovery as much as possible.

The Correct course of action for a cat presenting with diarrhoea is the following:
1. Starve overnight at least, with water only (putting rehydration salts down instead of water may help).
2. Feed only cooked white fish (boiled not fried) in its own juice.
3. Feed only very small quantities at first
MOST cats will recover at this stage.
4. Give the cat Kaolin - this is a clay that lines the gut, protecting it. It also hardens the faeces and slows down their movement through the intestines.
5. Give the cat rehydration salts in its water (Lectade, from the vet). Many cats will drink this directly, sometimes you have to syringe it down, which is wet for everyone concerned, but can solve your problem, so it's worth doing. I have had cats recover completely, seemingly from the rehydration salts alone.
About 75% of cats will recover with a combination of the above 5 actions, or even with only one or two. Threr are also various herbal solutions not discussed here.
6. If 1-5 don't work, then the vet usually prescribes an antibiotic such as Synulox. Synulox is palatable for nearly all cats (a bright pink pill) and is a drug of first choice because it contains a special agent that prevents the bacteria from mutating and therefore fighting against the action of the drug. However, you MUST finish the course!
7. Rehydration: continuing diarrhoea can have serious consequences for the cat's hydration. Something that makes any cat feel really ill is getting dehydrated, and that happens surprisingly easily, particularly with diarrhoea, where the fluid the cat would normally absorb is just rushing through and coming out the other end. Sometimes rehydration salts are enough, but if a cat is severely dehydrated it may need to be put on a drip. An interim type of solution is to give sub-cutaneous fluids: a large amount of fluid is injected under the skin, making a big blob of fluid. This is absorbed fairly rapidly into the body, and you can see an almost immediate improvement in the cat's condition and alertness.

Something like 90% of cats will have recovered by now, with the above 7 actions. There are some however who don't and this is where it becomes more complicated, and something you have to attack on many levels at once if you hope for success.

Prolonged diarrhoea can be self-perpetuating, and can continue long after a cat actually has no viral or bacterial infection present because the gut has become habituated to behaving the wrong way, and is probably also damaged. Blood tests may help in determining what is happening, but may as often not. The test for FCoV antibodies would tell you only that your cat has been in contact with Coronavirus. It cannot tell you if the cat still has it, and some cats have died of FIP with a zero titre count, so it doesn't tell you anything about FIP either! The only accurate test for FIP is, sadly, still post-mortem.

Peritonitis, where the gut becomes septic, responds very well to antibiotic treatment, but it has to be quite aggressive, and the cat can become quite ill. Siamese in particular will refuse to eat and insist they are going to die - the stories about people force-feeding their Siamese and bringing them back to life when they had given up are very common - don't let the little beasts win!

If your cat has persistent diarrhoea there are two lines of attack that you should follow to deal with it, Diet and ‘Drugs’ (though not necessarily the antibiotic sort). You cannot use only one or you are likely to fail.

Diet - the gut lining is covered in small hair-like processes called cilia. These increase the surface area of the stomach and intestines enormously, and it is this surface area that enables the cat to absorb the necessary nutrients. With prolonged diarrhoea, the cilia get worn off the inside of the gut, and even if there is no bacteria, there is nothing to stop the food from rushing past and shooting out the back end again! There is also a problem that sometimes the gut becomes used to behaving a certain way, and the minute it gets some food, it spasms. So you need to do two things: you need to feed a diet that does not irritate the gut, and you need to help the gut to slow down so that the cilia can grow back and it can start to behave normally.

There are various ways of slowing things down. Continuing with Kaolin is a good course of action - if you have trouble getting the liquid down there are very good tablets made by Denes, who make a range of herbal veterinary products. Another product that slows down the gut is Peridale. Peridale comes in capsules, powder (less commonly seen now) and loose granules. It looks like little bits of orange plastic, and that's actually not far from what it is. The little hard gritty lumps are completely indigestible, however they absorb about 10-times their weight in fluid (rather like dried pasta). They absorb the excess fluid in the gut so that the contents are more solid. Because it's not a 'drug' as such, and is not digestible, you can use large quantities without hurting your cat: if the cat doesn't respond at first, then use more, and don't give up, keep using it. You can wean off it gradually, and re-increase the dose if the runs come back. It can take months for a damaged gut to recover, so give it plenty of time. I had a cat come to me after 2 years of constant diarrhoea (which is why I've found out so much about this!). It took about 5 months to get her completely well, but only about 3 months to get her stabilised with Peridale after various treatments to make sure that there was no nasty bug lurking. I also had to limit her diet very fiercely - something that was very hard for me.

It is very difficult for most people to limit a cat's diet: they are hungry and they bug, but you MUST only feed tiny quantities at a time. The trouble is that by now you have a skinny and miserable-looking cat, and as soon as he feels better and asks for more food, the temptation is to give it to him, and then things can go wrong again. The gut is convalescing, so don't let it get too much to deal with too soon. The vet may prescribe a long course of Synulox to ensure the cat does not get any secondary infections, but it may be advisable in this case to include digestive enzymes and probiotics with the food, to help the cat to absorb what it is eating. The vet can provide these.

Apart from Kaolin, another very soothing product that I have frequently used with great success is Slippery Elm (from the health-food shop again) or Tree Barks Powder from Dorwest Herbs, which is mostly Slippery Elm, but also includes White Poplar Bark. This is not an old-wives remedy (well, it is, but it is one that works). Slippery Elm has very long chain molecules, and coats the gut lining, protecting and soothing it. I have a cat who has to have pain medication that irritates her gut, so she can't keep the pain medication down. She's also chronically constipated, so I can't use Kaolin. I give her Slippery Elm three times a day, and she can lead a normal, happy and pain-free life thanks to the product. My vet had never heard of it, and thinks I'm mad, but he couldn't help my poor girl when she was vomiting her guts up every day! Another soothing product that will help the gut to regenerate is Aloe Vera. It comes in liquid form, and most cats don't object to the taste. Mine get it sloshed over cooked white fish, and they tend to slurp up the liquid before showing any interest in the fish.
It is possible that a cat with persistent diarrhoea has enteritis. This is not incurable, but is difficult to manage, and must include careful dietary control in tandem with drug treatment.

A very worst-case scenario of persistent diarrhoea could be caused by FIP. Unfortunately if this is the case the cat will die very soon, or become so sick that it has to be put to sleep. About 3 weeks is a maximum and the cat is visibly absolutely miserable. Usually the diarrhoea is accompanied by a very high temperature that does not respond to antibiotics, sometimes vomiting of pinkish liquid, and sometimes a distended gut (which is filling with fluids). The cat is almost never happy and active as if normal.

Pinning down cause is often difficult because many viruses and bacteria die outside the body, so sending faeces for testing is often inconclusive. Titre testing for FCoV antibodies is largely pointless because of the amount of time the antibodies persist in the bloodstream once the infection has been fought off by the cat. It certainly does not give you any indication of whether or not a cat has FIP. A primary cause, such as bacterial infection, may end up causing sensitivity to certain foods, or giving a cat irritable bowel syndrome, so the longer the problem persists, the more the potential causes and thus the more complicated the picture becomes and the more complex and wide-reaching the treatment has to be.

Finally, remember: there are many illnesses that mimic FIP without being FIP, so don't panic and don't be bullied or frightened by a diagnosis. Remember, the only conclusive way of diagnosing FIP is by post-mortem: although it is often possible to make a very good guess at a diagnosis of FIP, vets can be wrong, and a good one will always be cautious!