Diarrhea. The Very Basics, Canine Version

Most of my clients make appointments in hopes of my curing some clinical sign. They aren't so concerned on the disease that caused the clinical sign they would just,
"Very much like it if I could stop the diarrhea NOW!"

Diarrhea is always a consequence of something else.

"The good news," I tell my clients, "is that in most cases it is an acute self-limiting sign that will resolve with time."

Here's why:
The majority of cases that I see are caused by one of two things;

1. Dietary Indescretion. Anther words, "I ate something that I shouldn't have." Poop, trash, the Thanksgiving turkey leg, a tainted piece of food that probably smelled irresistible to your dog.  Why the dog brain says, "Smells rotten, Yumm! Let's eat!" I don't know, but it does.
2. Stress. When your vet talks about stress we are talking about both the good and the bad kind of stress. Stress to your dog might include visitors to the house, like a construction crew, movers, holiday visitors, other pets in the house. It can also include recent change in activity level, like a long hike, or a long day of play at the dog park. Or, a long car ride to visit friends. For many of the pets I see it is also associated with recent boarding or change in the normal routine.

For the rest of the dogs I look at the following;

• Intestinal worms. If your dog is on a monthly heartworm preventative thiss is less likely. But, there are a few common intestinal worms that cause diarrhea that the monthly heartworm pillss do not protect against. Therefore, ALL DOGS WITH DIARRHEA PERSISTING MOE THAN A FEW DAYS SHOULD HAVE A FECAL EXAMINATION TO LOOK FOR INTESTINAL PARASITES. This examination of the feces in performed by looking for the parasites eggs under the microscope. Not seeing worms in the feces is not a diagnostic tool to rue out intestinal worms. At my clinic this test is about $30.
• Change in the Diet. This can occur from either changing your pets food too quickly. I usually say transition over a few weeks. Here's how. Buy the new bag of food when you still have half a bag of the old food left. Then feed 1/4 new with 3/4 old for a week, then 1/2 and 1/2 for a week, then 3/4 new with 1/4 old for a week. If you get soft stools along the way slow down the transition.Remember that even the best of diets can cause soft stools or diarrhea. Some dogs just don't tolerate new foods, or high protein, or grain free, or whatever fad du jour there is.

For the rest of those pups that don't meet the above criteria I look to see how sick they are. We look for other clinical signs, for instance;

• Systemic Diseases and Obstructions usually also have diarrhea with concurrent vomiting and lethargy. Look for; 
• Parvo. Young puppies (8 weeks to 4 months), often recently adopted from high stress, high volume shelters, not vaccinated within last two weeks. Fecal test confirms, hospitalize, i.v. fluids, i.v. antibiotics.
• HGE, PCV is high. Bloody profuse diarrhea. Hospitalize until PCV and patient is normal.
• Infections. High temp and white blood cell count. I.v. fluids, i.v. antibiotics.
• Obstruction. Radiograph or ultrasound and surgery immediately.

For all of the above I recommend full blood work, urinalysis, radiographs and hospitalization.

Puppies; Every single puppy (up to 6 months old) with diarrhea regardless of duration, frequency, or consistency needs to see the vet immediately. There are no exceptions. Minutes matter. They may be dead by tomorrow.

For a healthy active dog with acute mild diarrhea (1-3 episodes of loose normal colored stool) I will recommend an examination to check temperature, hydration status, and overall demeanor. If they appear healthy and bright I recommend withholding food and water for 12-24 hours. I do this to stop the gut. Most episodes of diarrhea incorporate some degree of hypermotility. If you stop feeding the front end the back end of the gut should slow down which allows it time to heal. I usually also give SQ fluids. This allows 12-24 hours of slowly absorbed hydration so that my clients don't have to feed their pet or worry about dehydration. This only holds if the diarrhea stops. Pets can loose fluids from diarrhea quickly and need i.v. fluids to protect against dehydration and the cascade of issues this can cause.

I will hospitalize any pet that seems sicker then I expect them to be. This is a judgement call based on knowing  my clients and their pet. OR, if my client is so exhausted from cleaning up diarrhea that we need to give them a break. Our stainless steel cages are easier to clean than white carpet. And we have big stainless steel doggie bath tubs. Let us do the dirty work. It also allows us to monitor for progression of clinical signs and disease.

There are other diseases that are associated with diarrhea. Your vet can guide you through them. These are associated with chronic diarrhea that persists for longer then 5 days. These patients should have examinations, full blood work, urinalysis, radiographs, 1-3 serial intestinal parasite examinations, scrutinized diet discussion, and a lengthy discussion about any access to supplements, treats, stress, and the list of diagnostics that chronic diarrhea patients may require. Start with the simple most likely culprits as listed in order above and rule these out.

The biggest mistake I see clients make is thinking that their pet is constipated when in fact they have diarrhea. Dogs will posture and strain with both problems (and if they have a urinary tract problem) but clients assume that because there isn't anything being produced the pet is constipated. To add insult to injury the client starts treating with pumpkin, or mineral oil, or laxatives. Guess what that does to an already uncomfortable diarrhea stressed gut? Dogs rarely get constipated. The huge majority (I would guess 95%) have diarrhea. So don't give your pet anything without the vets consnt. There is a very good chance you will make your pet worse off.

If you have a pet question please join us at Pawbly.com. You can find me at Jarrettsville Veterinary Center, or on Twitter @FreePetAdvice.

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