Diarrhea in cats

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Diarrhea in Cats and Kittens
Persistent diarrhea in adult cat
Chronic diarrhea
Diarrhea in Kittens
Diarrhea
Coronavirus infection and other possibilities for diarrhea
Coccidia
Persistent diarrhea in kitten
Diarrhea in kittens
Diarrhea in older kitten
Chronic diarrhea with Gas
Diarrhea
Diarrhea in young cat

also see Giardia
also see Vomit
also see Digestive System

Persistent Diarrhea in adult cat
Question: Dear Dr. Richards--
This is a question you probably get fairly often. I have an otherwise perfectly healthy fixed male cat who for the last six months or so has had persistent diarrhea. He's been examined for parasites, has had cortisone shots and has been put on an anti-allergen diet. So far, nothing has made any difference. I've been giving him Metamucil--jellified and mixed with his food--which has helped a little, but only to the extent that what comes out of him has some consistency, rather than being just liquid.He still has no control and leaves little puddings wherever he goes. Kaopectate hasn't helped, either. Any suggestions???I REALLY want to help him, so he can come inside when the weather gets cold
again.
Thanks--
E.C.
Answer: E.C.-
Whenever it is possible, it is best to get a specific diagnosis for the cause of the persistent diarrhea and then to treat that cause. This isn't always possible, though. These are the things that we do in these cases to try to figure out what the cause of the problem is, so that you can see what has and hasn't been done yet.
We check fecal examinations for parasites, just as your vets have done. It is helpful when a parasite is identified and can be specifically treated for. When we don't find anything on a fecal examination and diarrhea persists we usually go ahead and treat for several of the possible parasite infections, just to be sure they aren't present. We like to use fenbendazole (Panacur Rx) dewormer, because it kills hookworms, roundworms and giardia, which are three of the common parasites. Giardia can be really hard to find on fecal exams, which is why we think it is reasonable just to treat for it to rule it
out.
Early in the diagnostic process it is a good idea to check a complete blood count (CBC) and chemistry panel to try to be sure that some problem like kidney disease or liver disease is not contributing to the diarrhea. For cats over nine or ten years of age it is a good idea to check a total thyroxine (T4) value, as well. Hyperthyroidism can cause persistent diarrhea in some instances.
After treating for parasites we usually try two different dietary manipulations to see if they will help. If the cat will eat Hill's w/d (tm) diet, we usually try it. This is a low fat, moderate fiber diet and it will sometimes work to resolve chronic diarrhea. When this works it usually works quickly, so we try it first. If this does not work, then we try a diet that helps eliminate the possibility of food allergies. The best diet for doing this is probably Hill's z/d (tm) diet since it is thought to be truly "hypoallergenic" due to the hydrolyzed protein in it. However, there are alternatives to this diet that use proteins from unusual sources, such as duck, rabbit or deer which are not common in cat foods. It is usually necessary to feed these diets for six to eight weeks to be sure that food allergies are not the cause of the diarrhea. Adding fiber, as you are doing, does work for some cats. Our experience is that it works better when the diet is also low fat, though.
Once we get past the above steps, there is a decision to make. At this point, it is necessary to go to a "trial and error" approach or to consider obtaining biopsy samples of the intestines and possibly the pancreas and liver. Biopsy of the intestinal tract can be done in conjunction with endoscopic examination, which is less invasive than surgery. To obtain pancreas and liver samples surgery is usually necessary, though. I think that endoscopic examination and biopsy is the ideal next step but the cost and/or availability can limit access to this diagnostic test.
If we are going to use a trial and error approach I usually try metronidazole first but other vets like a different order. If it is successful I usually want to try sulfasalazine (Azulfidine Rx) when owners can readily give pills. If not, I might consider using injectable corticosteroids, usually methylprednisolone acetate (DepoMedrol Rx). In some cases, but not too often, we try to control the diarrhea using medications such as loperamide ( Immodium AD tm) or diphenoxylate (Lomotil Rx) for a few days.
For some reason, just stopping the diarrhea seems to help some patients recover. Either that, or some patients coincidentally get better after we use these medications for a few days. Since chronic diarrhea does sometimes stop on its own, especially in young and young adult cats, this is a possibility.
We are not adverse to going back to the beginning and starting this whole process over again when we are not having much success with treatment. For some reason, repeating the lab work sometimes shows a problem that wasn't there the first time or a cat will respond to a treatment we have already tried once, when it didn't the first time. While I can't always explain why these things occur, it is worth repeating some of the steps when therapy isn't working.
If you get really frustrated consider asking your vet to refer your cat to an internal medicine specialist or to a veterinary college. These folks tend to see the really difficult cases of things like diarrhea more frequently than general practitioners and sometimes there is something in that experience that makes it easier to recognize a particular problem.
Good luck with this.
Mike Richards, DVM
5/15/2001
Chronic diarrhea
Question: Dear Dr. Mike:
I have two cats, Olive (female, age 5) and Ferdinand
(male, age approx. 7 months). We live in New York City
and the cats do not go outside. Ferdinand came to live
with us in November when he was approximately 5 months
old. He was a former stray who had been rescued by an
agency, tested negative for FIV and leukemia,
dewormed, altered, and vaccinated.
He has always been a very healthy seeming, playful
cat, has a very nice glossy coat, eats and drinks
eagerly. He has gained weight consistently since I got
him. There has been no vomiting. The problem is, he
has always had loose stools. When I first got him the
stools were big, soft, and foul smelling. On 11/28 I
brought him in to my vet who did not see anything
wrong in the stool (or any other health problems) but
prescribed flagyl for one week. Meanwhile, Olive
seemed to have contracted FCV from him, as her
vaccinations were not up to date. Her nose was red and
painful and she seemed grouchy and depressed. No other
symptoms. The vet prescribed Clavamox and her symptoms
were gone within 2 weeks.
The flagyl did not lead to marked improvement. On
12/08 the vet looked at Ferdinand's stool again and
did not see anything but prescribed a course of Albon
and Droncit in case there were parasites that did not
show up in the lab tests. These medications seemed to
make his diarrhea much worse, to the point where it
was liquid, messy, his rectum looked very sore, and he
left spots accidentally around the house. On 12/12 the
vet instructed me to give him Kaopectate and also gave
him a cortisone shot which seemed to help.
I had been giving both cats Iams dry food, which Olive
has been eating most of her life with no ill effects.
After the cortisone shot I thought perhaps trying a
different food would be helpful as there didn't seem
to be anything actually wrong with Ferdinand. I
switched to Nutramax on 12/17 but the situation
declined as Ferdinand's cortisone shot wore off. His
diarrhea returned with even more flatulence. On 12/22,
the vet put Ferdinand on another course of Flagyl and
started us on an 8-week trial of Prescription Diet
formula z/d (dry food). I also gave him Kaopectate for
2 days. Both cats are now eating the z/d food, as it
would be too difficult to feed them separately. Two
weeks have passed and I have not noticed any change
except perhaps that Ferdinand's stool does not smell
foul. It is still extremely loose (has no form) and he
goes with some urgency at least 3 times a day. In
addition, the older cat, Olive, has begun to vomit
with regularity, just about every day for the past
week. She did not vomit very often previously. Usually
it is just undigested kibble or a yellowish clear
substance, sometimes containing a small amount of
hair. She continues to eat, drink, and use the
litterbox, and does not seem sick. I am wondering
about the z/d food. I've learned that most vets in my
area don't use it yet because it is so new. What do
you think of z/d? Could it be the food that is making
Olive throw up? Might the throwing up stop when she
gets more used to the food? Or could the vomiting be
related to the respiratory infection she had in
November? As for Ferdinand, is there a chance that his
diarrhea will improve within 8 weeks if there has been
no improvement after 2 weeks? The vet says that if
there is no improvement after 8 weeks, the next step
might be to do a scope of his insides. Do you agree?
What could I learn from this test, and is it worth it?
Thank you so much for any insights you can provide. I
really appreciate your site!
Katherine
Answer: Katherine-
We have not used z/d (tm) diet in our clinic, yet. However, we have used
Purina's HA and LA (tm) diets which are similar, but not identical. We
have only used these diets in dogs but of the dogs we have tried to use the
diets for, two have had vomiting that occurred when they were on the diet
and then stopped when it was withdrawn. I am not sure why this happens but
the diets are different in composition from anything that a pet may have
eaten before, so perhaps it is just the dietary change itself that leads to
these problems. I do think it is a good idea to try a hypoallergic food
trial in this type of case and z/d is a good choice as it is clearly
hypoallergenic, which is not always the case with the novel protein diets,
such as d/d (tm). It takes a minimum of 3 to 4 weeks to determine if
hypoallergenic diets will help and your vet's suggestion of 8 weeks is a
common recommendation since some cats do respond much later than others to
these diets.
I think that I would probably try a few other things prior to considering
endoscopic examination, but if they did not work, it is a good choice for
obtaining a diagnosis.
The things that I would try are a low fat diet (we use Hill's w/d (tm)
diet, but there may be others) and the Iams Low Residue (tm) diet. These
diets should be OK for Olive, too. It is important to change from one food
to another slowly, so the process of trying these diets may take several
weeks. Our experience has been that the low fat diet helps pretty quickly,
usually within a few days, when it works. We have not used the low residue
diet for diarrhea but I have seen anecdotal reports of success doing this.
We have had a couple of cats who got better when dewormed with fenbendazole
(Panacur Rx), so we usually try it, too. Sometimes we use loperamide
(Immodium AD tm) for a few days to see if it will control diarrhea. Once in
a while, if the diarrhea can be stopped it will continue to stay away.
There is a small chance of causing excitable behavior in cats when using
loperamide. Lastly, we have some patients that seem to respond to either
famotidine (Pepcid AC tm) or ranitidine ( Xantac Rx) administration.
As long as Ferdinand feels OK and continues to maintain his weight, it is
reasonable to pursue treatment options. If he starts to show signs of being
ill, exhibits weight loss or anything else that worries you, then it would
be better to pursue a diagnosis. The best way to get a diagnosis is to
obtain biopsy samples of the intestines and most vets and cat owners feel
that endoscopic examination is a better way to obtain these specimens than
exploratory surgery.
Good luck with this.
Mike Richards, DVM
1/15/2001
Diarrhea in Kittens
Question: Dear Dr. Richards,
Please can you give me some advice. My cat had 4 fours kittens. The whole
litter had to be treated with grisofulvin because they contracted
ringworm. Since then I have one male kitten who will not use the litter
tray. I have tried everything even locking him in a cage with only a
litter tray so he is forced to use it. I did this for a week and as soon
as he had an hour of freedom he did it in front of us. Any suggestions on
what I should do.
I also have a female in this litter who from time to time does the same
thing but not every day. She has very loose bowel movements and has
diarrhea often. I give her carbolevure to try to bind her but it doesn't
really work. I have tried various different cat foods, dry and wet
and have tried her on diced chicken and rice for days but it doesn't seem
to work. I think she must have a problem in digesting the food as you can
see the rice in diarrhea. This kitten seems to be always hungry and at the
food bowl. The kittens are now 4 months old. Is there something I can give
her before she eats.
Looking forward to hearing from you.
Regards
Jane
Answer: Jane-
The most common recommendation for dietary control of diarrhea in kittens
is to use a low fat, moderate fiber diet. In the United States, there are
commercial diets such as Hill's w/d available for this purpose, so I
haven't had to figure out a home-made equivalent diet but it seems to me
that chicken and rice would be low fat, so the missing ingredient would be
the moderate fiber, which you might be able to get just by adding a small
amount of psyllium (such as Metamucil tm) to the diet you are making.
Hill's w/d may be available to you or something similar, too. Some
veterinarians use unflavored yogurt to try to control diarrhea in kittens.
It is safe and it seems to work sometimes. There is no specific dose but
about 5ml or so before each meal is probably OK. Since this is an attempt
to add beneficial bacteria to the digestive tract it may take a while to
work, though.
I also like loperamide (Immodium AD tm) for diarrhea. The usual dosage for
cats is 0.1 to 0.2mg/kg every 8 to 12 hours. It is OK to try this for a few
days but if there is no response, it would be a good idea to have the
kittens rechecked by your veterinarian.
I can't really explain why the male kitten has given up on the litter pan.
However, it can help to change the type of litter, to change the type of
pan (covered vs. uncovered, high sides vs. low sides -- stuff like that)
just in case the aversion is specifically to the litter pan itself. Moving
the litter pan to a new location or providing extra litter pans can
sometimes help, too. If he has any problem with soft stools, diarrhea or
constipation, it would be best to try to address these problems, too.
I wish I could help more.
Mike Richards, DVM
11/30/2000

Diarrhea
Question: Dear Dr. Richards:
As usual, one of the feral cats I have been taking care of has become my
own a month ago. It is a female kitten and now is about 2.5 months old.
Since I got her, she has been having liquidy stool. I am not sure whether
or not she is having diarrhea. I may sound crazy, but the smell of her
stool is pretty bad too. I have never that young kittens before, so I do
not know it is usual for a kitten. I mainly feed her "Wisker" and "Fancy
Feast" can foods, but no milk at all. Except for that stool problem, she is
healthy and very active.
Is her stool normal for her age? Or is she having diarrhea?
Should I take her to the clinic?
What should I feed her?
How old should she be to get spayed?
Thank you very much.
Sincerely, Thandar
Answer: Thandar-
From your description, I think that this is probably an abnormal stool for
a kitten and that it probably does qualify as diarrhea. Cats do not have a
very efficient digestive system and when it isn't working right, the stools
tend to increase in odor, probably because fat and other nutrients are not
well digested. The most common causes of diarrhea in kittens are probably
parasites and viruses. When kittens get reovirus infections they often have
diarrhea for several weeks, which is not highly responsive to any
treatment. A restricted fat diet, such as Hill's w/d, sometimes seems to
help control the diarrhea, though. Parasites that can cause diarrhea
include roundworms, hookworms, coccidia, giardia and other protozoans. Most
of these can be found on microscopic examination of the stool, but it can
be hard to find giardia at times. It is a good idea to at least rule out
the parasites. If they are not the problem, then it may be necessary to
treat the diarrhea symptomatically. We use loperamide (Immodium AD tm) when
dietary changes alone won't help with diarrhea. If the stools are just
soft, it is probably OK just to do nothing. Even if you do nothing for
diarrhea, most kittens will eventually get over the problem without
residual problems.
Mike Richards, DVM
10/2/2000

Feline coronavirus infection
Q: Hi Dr. Richards,
Thank you for your response last week.
I have a follow up question:
Alex, a 3-yr old Ragdoll, had bad diarrhea, no temperature, wouldn't eat and
lost 2 lbs (from 9 lbs to 7 lbs).
Alex had blood work done with results:
Kidney norm, elevated white cell, elevated globulin, low albumin, titer
1:400
Using a scope down his throat, he was biopsied and all results, sent to U of
Pa for analysis, were negative.
He was put on prednisone, euroflaxin,and tylan for a week. He is now eating
and acting normal and has gained back some of his weight but still has the
diarrhea (formed like a pancake).
My vet thinks it may be the corona virus which would be chronic. Do you have
any advice?
Thanks,
Valerie
A: Valerie-
Pretty much all of the information that I can find on feline coronavirus
infection indicates that enteric coronavirus in cats causes a short term
illness, usually with diarrhea as the major clinical symptom, lasting about
three to five days. Feline enteric coronavirus is common and appears to be
able to mutate in some cats to become feline infectious peritonitis virus.
This is a much more serious illness that is usually fatal. It would be a
good idea to ask your vet if he is talking about FIP or enteric
coronavirus, just to be sure you are fully aware of the prognosis.
Rotavirus infection in cats has been reported to cause chronic diarrhea
that is unresponsive to therapy. This is usually a problem in kittens but I
don't know that it couldn't occur in an older cat. Definitive diagnosis of
rotavirus infection requires examination of fecal samples by electron
microscopsy and is therefore pretty difficult to prove or disprove. In
studies in which electron microscopy has been used to identify viral agents
causing diarrhea in cats, rotavirus accounted for about 1% of the viruses
identified (Krauss, 1988). This may not be an accurate indicator of the
percentage of time it is still causing disease, though -- as it has been
noted to cause symptoms even after the virus can no longer be found by
electron microscopy.
Other infectious agents that cause chronic diarrhea in cats and can be hard
to find include clostridium, campylobacter and cryptosporodiosis. Fecal
cytology can be helpful in identifying clostridium and cryptosporidium and
special fecal cultures help with identification of campylobacter. These
disorders are treatable, if identified. Sometimes it is just easier to give
antibiotics that will control these problems and hope they work. Tylosin
(Tylan Rx) is helpful in campylobacter and cryptosporidium infections.
Hypersensitivity to a food ingredient is also possible. Sometimes feeding a
single antigen diet (one meat source, preferably one that the cat has not
eaten before) can be helpful in chronic diarrheas. This diet helps to
eliminate the possibility of a food hypersensitivity reaction.
Intestinal lymphoma is another possible problem. Usually this is
identifiable by endoscopic biopsy but sometimes it is hard to find.
The workup so far has been good and it is frustrating to do the proper
tests and still have no diagnosis.
There are times when surgical exploration of the abdomen and full thickness
biopsy of the intestinal tract, pancreas and liver will produce a diagnosis
when endoscopic biopsy of the intestinal lining has failed to produce a
diagnosis. I am not sure I'd go this far prior to trying some other things,
though.
Since you are seeing progress, the best thing is probably to go ahead with
what your vet has advised and wait to see if it works. If it does, then
there isn't as much concern for knowing what really happened. If it stops
working well or the problem recurs after a remission period then it might
be better to try some other diagnostic testing.
Good luck with this.
Mike Richards, DVM
8/13/99
Coccidia
Q: It seems we have encountered a new or at least a VERY resistant strain of coccidia in the area where I live (Albany, NY). I rescued some kittens that tested positive for it and treated them with albon for the usual 10 days. I thought it was all cleared up as they returned to normal (no loose bowels). I was left with the last two kittens who suddenly started to have diarrhea again and I had them tested again. They have been treated and retreated with albon to no avail. The diarrhea just doesn't clear up. One of the vets we work with has told us he has seen this resistant strain popping up lately and is in the process of contacting Cornell Univ. for help because current treatments aren't working. These 2 kittens are older and more resilient so far and we are watching to be sure they are getting enough water. Most of the younger kittens the vet has tried to treat have passed on from this "new" strain. Have you any information about this? We really need to find an effective cure as soon as possible.
Thank you, bj
A: bj-
I am not aware of new strains of coccidia or of coccidia which is highly resistant to treatment but that doesn't mean that there isn't a problem with them.
We have used amprolium (CoRid Rx) when Albon didn't seem to be effective in dogs but have not used this in cats. In Dr.Morgan's text "Handbook of Small Animal Practice" 2nd ed., there is a dosage of amprolium listed for cats. We have used trimethoprim/sulfa combinations with good success except that some cats salivate excessively if they bite through the sugar coating on the tablets or if a pediatric suspension is used.
Mike Richards, DVM
Persistent diarrhea in Kitten
Q: Thank you so much for your site. Although I found it extremely
informative, I was hoping I might get a more specific answer to my
problem. I have a kitten not in good health, that I hope to save
because my three year old granddaughter has become quite attached to it,
and it's sister died and Gabby was okay with being told that cat went to
heaven, but I am afraid if this one dies it will be too upsetting for
her. Anyhow...and outside cat of mine (no shots or anything - I live in
the country and have several outside cats) had two kittens. I brought
the mother and kittens in when I discovered this. Everything seemed
fine for about the first 6-6 weeks when one kitty appeared to be losing
weight. By this time they were still nursing but also eating cat food
(either moistened dry or canned). The little cat seemed to have a
ravenous yet picky appetite = She wanted scraps of anything people
were eating, but turned her nose up at dry cat food, moist and even some
canned food. About the only way she would eat was if I moistened the
food with milk. I also noticed she began to have diarrhea. Well, she
continued to loose weight and I thought I'd better get an appointment at
the vets, but she died over the weekend. Oh yes, and her tummy was very
bloated so I thought of worms. Well, during all this (about a week) the
sister cat seemed fine and used the litter box (most times) and when she
went it was in little stools. By the way these are manx cats. Well,
about a week to two weeks after the first kitten died. the second one
started with the loose bowel movements and her stomach seems more
bloated than when she was younger. I called the vet and rather than see
her, they suggested we give her "Strongid". We bought that fro the vet
and gave it to her. The loose bowel movements got worse. The vets
office said this was to be expected. It has been two weeks. She is no
better. Actually, she is worse. I have to keep her in a cage or out on
the porch because this putty colored diarrhea just seems to "dribble"
out of her back side all the time. I set her outside and then bring her
in and wash her butt and put her in her cage until I can't stand the
meowing anymore. Yesterday, I thought I saw something hanging from her
butt - about 3/4 inch long, flat, but the width of thin spaghetti, with
legs; a cream color - sort of like a small centipede. It grossed me
out. I washed her butt and it must have just gone down the drain. An I
seeing things? Could this have gotten on her outside, or do you think
it could have come out if her. She is no better. HELP please. I had
called a different vet a day or two ago and they made an appointment for
her to be seen 2 days from now. I do not have a lot of money to run a
zillion tests and my preference would be to put the poor little thing to
sleep, but because my granddaughter is so sad that she is sick and loves
the kitten, I am hoping we can save her. Any ideas or suggestions.
Thank you so VERy VERy much.
Dee
A: Dee-
I can't think of any "normal" parasite that would live in the kitten's
intestinal tract and have legs. But everything except the legs part sounds
like you might have seen a tapeworm segment. These are muscular egg sacs
that move for several minutes after being expelled from an infested pet's
rectum. The segments of a tapeworm are developing egg sacs.
It is somewhat unlikely that tapeworms would cause the sort of persistent
diarrhea that you are seeing but it is possible so it may be worth using a
deworming medication for this parasite, too.
Drinking milk will cause diarrhea in many kittens and it will persist as
long as the milk is given and sometimes for a while after milk drinking is
discontinued.
A fecal examination is a relatively inexpensive test that would rule out
other possible parasites, such as coccidia or giardia. It takes about a
teaspoonful of stool (feces) to do a fecal exam. The fresher the sample is
the better when looking for parasites other than worms.
It is not unusual for kittens to develop persistent diarrhea. This can be a
very frustrating situation. It often takes several trips to the vet to be
able to work out a treatment plan that controls the diarrhea. Most of the
kittens with persistent diarrhea eventually get over the condition with or
without treatment but they are a lot easier to care for if the diarrhea can
be controlled. Sometimes we just resort to controlling the diarrhea with
medications such as diphenoxylate (Lomotil Rx) or loperamide (Immodium AD
TM). It is best to discuss this with your vet since the dosages are weight
dependent and there are times when anti-diarrheal medications are not a
good idea.
I know this isn't much help. It seems reasonable to me to go for at least
one exam and to do fecal testing before giving up on this little one, though.
Mike Richards, DVM
Diarrhea in kittens
Q: My kitten is not doing well :(
Please take the time to answer this - we don't want to put her to sleep
unless there is no other option.
We have a 11 week old kitten who has had awful diarrhea for the past 4
or 5 days now, and has a jondas look to her ears and gums. The vet
seems like he just doesn't know what to do. She is getting really
skinny, although she eats quite a bit. Just every 3 to 6 hours she'll
have awful diarrhea. She isn't happy, and doesn't do anything but lie
down and sleep. What can be done? Is there anything we should test her
for? Thank you for your time.
A: Jason-
Diarrhea in kittens is a major diagnostic challenge in some instances. It
is a good idea to test several fecal samples to rule out internal parasites
such as worms, coccidia and Giardia. Feline leukemia can cause many
symptoms of illness, including diarrhea. It would be a good idea to test
for this as well. A general blood chemistry panel and complete blood count
(CBC) is a good idea when kittens do not respond well to therapy. When
jaundice (icteris) is present it is important to determine if it is
happening due to internal bleeding or due to liver disease. These tests
will help in determining that. If liver disease seems to be the cause then
more specific liver function testing, such as bile acid response testing,
should be considered.
All of this testing is expensive but it is hard to treat chronic diarrhea
effectively without knowing why it is occurring. Even with a lot of testing
we are sometimes unable to provide a specific diagnosis, though. That is
very frustrating but it still helps us determine what we don't need to
treat for.
Keep working with your vet to find a solution to your kitten's problems. If
your vet has already done a lot of this testing and is still stumped, ask
about referral to an internal medicine specialist, if that is possible in
your area.
Good luck with this.
Mike Richards, DVM

Diarrhea in older kitten
Q: Lucy is our almost 6 month old kitten, and she has diarrhea. It seems like it goes away for awhile then comes back. But i was looking over some articles about this and they say if there is blood in the loose stools then that may be deadly. im not sure but i think i saw blood on my kittens bottom. Please tell me what this might mean as soon as possible. she is due to get fixed soon and i dont want any problems. i already lost one cat due to kidney failure and i dont want to loose this one. thanks Jackie
A: Jackie - Diarrhea can be caused by many things. Parasites such as hookworms and roundworms will cause diarrhea, sometimes bloody diarrhea (hookworms). Coccidia and giardia are protozoa that live in the intestinal tract and will also cause chronic bloody stools if they proliferate or if there are times of stress. Most of the time, medications will clear both conditions. Irritation to the bowel can cause bloody stools and again, medications will clear this up. If your veterinarian has not performed a fecal exam, that's the first thing that should be done. This will rule out intestinal parasites such as hookworms and roundworms. Giardia can be difficult to find on a fecal so if the fecal is negative and your cat has not been treated for giardia, I would advise treating anyway. The medication won't hurt your cat if she doesn't have giardia but it will certainly make her feel better if she does. Kidney disease is one cause of diarrhea in cats but 6mos. is young for kidney failure. Blood tests should be able to rule in or out this problem. I would have your vet perform a complete physical, fecal exam included, treat for intestinal parasites if any found, and treat for giardia if this has not been done. If the diarrhea persists, further diagnostics should be done to determine the underlying cause (bloodwork, intestinal biopsies, etc.) I would start with the simple things first and go from there. Good luck.
Mike Richards, DVM

Chronic diarrhea with GAS!
Q: Dear Dr. Mike I have a six month old male neutered kitten. He has chronic diarrhea with GAS! It is like an explosion when he goes and it gets all over the place. I had him into the vet and he ruled out feline leukemia and worms. He has a constant fever. The kitten has all his shots. He drinks a lot of water and has a supply of dry food. He has no weight problem and is very active. Do you have any idea what might be wrong, I never see any mention of gas in cats. Sincerely k.
A: I am pretty sure that your vet has probably thought of most of these things, but here is a review of the possible causes for flatulence and/or persistent diarrhea that I can think of. Some suggested diagnostic tests or treatments, too.
First it is very important to be sure that parasites are not present. It can be hard to find coccidia and giardia in sometimes, even when they are present. It may be necessary to treat for these conditions even if they are not identified in labwork.
Food sensitivities or allergies are sometimes present. Feeding a special diet that does not contain any ingredients found in foods your kitten has eaten before can help to eliminate these problems from the list of possible causes of diarrhea in kittens.
It may help to use a higher fiber diet. That works better for diarrhea in kittens than for gas, since high fiber diets can encourage flatulence. On the other hand, if it works to cut out the irritation to the intestinal tract the effect may at least be a even or possibly will be beneficial. In some cats, very low residue diets helps (low fiber). You just have to pick one and try it.
Stool culturing can identify bacterial problems such as Salmonella and campylobacter infection that occasionally (maybe rarely) cause persistent diarrhea.
It is also useful to do a general blood chemistry panel and complete blood cell count to rule out disorders of the kidneys or liver that are contributing to the problem. Tests for feline leukemia virus and feline immunodeficiency virus (FIV) are a good idea.
Medications to control increased intestinal mobility like loperamide (ImmodiumAD Rx) or diphenoxylate (Lomotil Rx) can be helpful in at least controlling the diarrhea.
Adding yogurt to the diet seems to help some kittens, at least based on anecdotal reports.
Some kittens seem to have persistent viral infections. Most of the time they get over these if you are patient long enough. Doing all this other stuff gives you something to do while you wait because actual diagnosis of a viral intestinal disease is pretty difficult unless you are near a veterinary hospital with an electron microscope.
The good news is that lots of times you find out you have a pretty healthy kitten who just has persistent diarrhea. In this case there is a very good chance that in 6 to 8 weeks or so, the diarrhea will stop.
Hope this helps some.
Mike Richards, DVM

Cat with diarrhea
Q: My wife and I just came back from a week's vacation, and discovered that one of our two cats (approximately six months old) has diarrhea. The other cat seems fine. Both are indoor cats, and one possibility we thought of is that the people who fed our cats while we were gone might have given them too many treats.
We are trying to find out (a) how he got it in the first place, and (b) what to do about it now that he has it.
Can you help?
A: Cats are prone to getting diarrhea when they are stressed. Obviously, I can't say for sure that is the cause, but it isn't really unusual in our practice for cats that are boarded, or even cared for by someone else in their own home, to get diarrhea. This is especially true with boarding, since many cats also have diet changes due to their owners not bringing along their own food. There are a number of possible causes of diarrhea and the only way to sort them out is diagnostic testing. Your vet can help you with this if it becomes necessary.
A general approach to the treatment of diarrhea is to withhold food for 24 to 36 hours and then give a partial meal. If the diarrhea has resolved, it is likely to be due to stress, bacterial overgrowth (occurs with sudden diet changes) or dietary indiscretions, such as too many treats. If not, it may be more serious and it is a good idea to have your vet examine your cat and begin testing to rule out other causes.
Also, look around the house and make sure that there wasn't something the cats got into when your were gone. Boredom can lead to some strange behaviors. We treated a cat that ate a bar of soap when its owner was away and that caused diarrhea.
Good luck with this.
Mike Richards, DVM

Chronic diarrhea in young Cat
Q: Our 10mo cat has diarrhea which we think has been chronic. Her temp was high normal, third eyelid often exposed, not really lethargic though. The vet who saw her gave us a differential of Feline leukemia, FIV, infectiuos peritonitis, and ulcerative colitis. Isn't there a more benign possibility? He sent us home with Flagyl, and a patatoe-venison diet. Would love to hear your thoughts ?Thanks!
A: There are a lot of causes of chronic diarrhea in cats. It is a very good idea to test for feline leukemia virus and FIV since they are a complicating factor in a number of other diseases. If they are present, it doesn't end the quest for what is wrong but it does sometimes change the approach to the problem.
Chronic diarrhea occurs with food allergies, parasitism (this can be hard to find -- we sometimes just treat for the possible parasites when frustrated), inflammatory bowel disease, malabsorption problems, maldigestion problems, bacterial infections or just changes in the normal bacterial flora. It can occur as a secondary problem with kidney liver or heart failure. It is sometimes seen with hyperthyroidism but that isn't too likely in a 10 month of cat.
If dehydration is occurring with the diarrhea that may explain the third eyelids being up.
Sorting through the possible causes of diarrhea is very challenging in chronic diarrhea cases. Sometimes I think the owners of cats with this problem must think I'm an idiot as I test for one thing after another and their cat doesn't get better. I just have to hope they have the patience to bear with me.
Treatment with metronidazole (Flagyl Rx) is a good start. It is helpful with some of the parasite problems and with bacterial flora changes. It is anti-inflammatory as well. Sometimes it will resolve the problem and no further testing or treatment is necessary. We usually deworm these cats even if we find no evidence of worms on a fecal exam. Sometimes that seems to work, too. When that doesn't work we usually try limited antigen diets to rule out food allergies. Your vet is doing this with the venison/potato diet. A general blood panel to rule out problems like kidney failure is a good idea. After that, we usually want to refer the cat to an internal medicine specialist for intestinal biopsies but often that is not possible for the client. This leaves us guessing what is wrong, still -- but we will continue to try to rule out problems such as inflammatory bowel disease through trial and error treatment. Sometimes it takes several tries to hit on the right treatment. I suspect that sometimes it isn't our treatment but the cat finally getting over the problem itself that works -- especially when the problem is one of the difficult bacterial or parasitic infections like Campylobacter or Toxoplasmosis.
As you can see, I do think there are a number of possible problems but I don't disagree with your vet's approach to diagnosis at all. I suspect that your vet is considering all of these but mentioned just a few. People tend to get the idea that you have absolutely no clue when you mention too many of the possible differentials in an illness, so vets often learn to give enough of them to justify testing but not so many that they overwhelm the client. My workdays would be easier if I could learn to do that!
Mike Richards, DVM

Last edited 05/11/04

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