Chronic Diarrhea in Cats: A Personal (Poopy) Journey

Chronic diarrhea is fairly common and affects cats of all breeds and ages. It is one of the most frustrating illnesses for veterinarians to diagnose and treat, and for cat parents to manage. Sadly, Allegra has been dealing with on and off diarrhea for the past several months, and it’s been a challenging journey.

Causes of chronic diarrhea

Chronic diarrhea is either caused by a disease that affects the gastrointestinal system, or a disease that affects another part of the body, and diarrhea occurs as a result.

Common causes include:

• Inflammatory Bowel Disease
• Intestinal parasites
• Bacterial infections
• Viral infections
• food allergies
• Vitamin deficiencies
• Partial obstructions (foreign bodies, intussusceptions, or masses)
• Poor digestion of food
• Hyperthyroidism
• Kidney disease
• Liver disease
• Diabetes
• Cancer
• Pancreatitis

With such a wide array of possible causes, diarrhea can be extremely challenging to diagnose.

How is diarrhea diagnosed?

If your cat has chronic diarrhea, keeping a journal of your cat’s output can be an important diagnostic tool for your veterinarian. Note the size, consistency, color, and frequency of stools as well as anything that seems to improve or make things worse.

Depending on your cat’s symptoms and medical history, your vet may run the following tests:

• Complete blood count and blood chemistry
• Thyroid function test
• Fecal test
• Urinalysis
• Feline immunodeficiency virus and feline leukemia virus test
• Fecal PCR test
• Absorption test to determine how well the intestines absorb cobalamin (vitamin B12) and folate (vitamin B9)
• Feline trypsin-like immunoreactivity (fTLI), which ensures the pancreas is producing the digestive enzyme trypsinogen
• X-rays if an intestinal obstruction is suspected
• Abdominal ultrasound to evaluate the intestines, lymph nodes, liver, kidneys, and spleen
• Endoscopy/colonoscopy with biopsies

Treatment of chronic diarrhea

Treatment will depend on whether a cause can be determined, and may include a combination of medications, supplements and diet changes.

Depending on your cat’s condition, your vet may recommend a diet trial. Novel or hydrolyzed proteins are generally the best option for this type of diet. A novel protein diet is a diet containing only proteins that your pet has never eaten before. In a hydrolyzed protein diet, the protein has been broken down into smaller peptides and amino acids to reduce reactivity. Some cats may require a prescription diet. Diet trials typically last at least eight weeks, and the cat should only eat that the chose diet during that time.

Our experience with chronic diarrhea

Allegra has had low grade inflammatory bowel disease (IBD) for many years. Until recently, we’ve been able to keep it under control with low dose prednisolone and an L-Glutaimine supplement. She would have diarrhea once in a blue moon, but generally, she was doing well. Then, back in July, her diarrhea episodes started to occur more frequently.

All of the tests my wonderful vet Dr. Tasi ran at the time – CBC, blood chemistry, urinalysis, and a fecal PCR – came up negative. As a next step,  we had her microbiome tested. This is an easy to do at-home test. You put a small stool sample into the provided test tubes and send it in. The results take about two weeks. We were pleasantly surprised: her microbiome was in pretty good shape, especially considering the various medications she’s been on for the past few years. There was no evidence of bad bacteria, she was just a little low on the good bacteria.

Allegra had been on a high potency probiotic for several years, but given the more frequent diarrhea, it wasn’t the right one for her anymore. We started her on AnimalBiome’s S. boulardii and FOS powder. The results were almost miraculous: within a couple of days, she had normal stools again. Sadly, the improvement didn’t last, and we’re still struggling with on and off chronic diarrhea.

Diet changes

Through all of this, it became apparent early on that her digestive system could no longer handle raw food. She was not a happy camper, and it was a struggle to find a canned food she would eat. I was used to my girl practically inhaling her beloved Darwin’s, so this was frustrating time for both of us. I was getting desperate, trying to find something, anything, she would eat consistently, because she had been losing quite a bit of weight since all of this started in July.

After a month of trying what felt like a hundred different foods, she finally settled on eating Weruva Jeopurrdelicious and Carnivore Cravings.

I want to be clear that at no point in time did we think there was anything wrong with her food. Dr. Tasi fed the same food from the same batch to her own cat without any issues. There had been no reports of any issues with this particular raw food. Allegra is just not able to digest raw food anymore. Every time I tried to reintroduce it, her diarrhea got worse.

With a combination of the probiotics, prednisolone, omeprazole for her gastric reflux, methimazole for her hyperthyroidism, and various homeopathic remedies as prescribed by Dr. Tasi, we are doing our best to keep Allegra comfortable and hopefully also guide her toward lasting improvement.

Considering a fecal transplant

Our next step may be a fecal transplant. It means  introducing a filtered blend of stool from a healthy donor into the recipient’s GI tract. The donor’s stool contains beneficial bacteria and fungi that can help restore a healthy balance of gut microbiota. This can be done in a minimally invasive procedure under mild sedation via an enema, endoscopy or colonoscopy.

It can also be done via oral caspules, which is the option we’re considering. AnimalBiome’s KittyBiome Gut Restore Supplement one-of-a-kind fecal transplant in an oral capsule offers a convenient and safe approach to fecal transplants that can be done at home. The capsules contain species-specific bacterial cells in the form of carefully screened, cryoprotected, freeze-dried donor stool.The capsules cannot be opened and mixed with food or treats, they need to be given whole. Thankfully, Allegra is easy to pill.

A fecal transplant sounds much better to Dr. Tasi and to me than what we both consider the “nuclear option,” a metronidazole trial. We’re trying to avoid that if we can, because it’s usually just a band aid solution and improvements don’t last.

Additional diagnostics

Dr. Tasi and I discussed running additional diagnostics, but decided against it. With IBD symptoms, there’s always the possibility that it isn’t “just” IBD, but could be intestinal lymphoma. Or it could transition to intestinal lymphoma. Those of you who have followed me for a while know my position on diagnostic testing. The most important question to ask yourself before agreeing to any test is “what will you do with the information from the test?” In Allegra’s case, if it is lymphoma, it wouldn’t change how we treat her. I will not put her through chemotherapy.

I want to be clear that I don’t have an issue with chemotherapy. It can be a lifesaving treatment, and many cats tolerate it well. But for a cat with Allegra’s personality, the frequent vet visits required would add so much stress that it would most likely negate any benefits. Additionally, I swore after Feebee, my first cat, died after seven months of chemotherapy for intestinal lymphoma, that I would never put another cat through that. Dr. Tasi fully supports my choice.

The logistical and emotional challenges of chronic diarrhea

The emotional rollercoaster of treating chronic diarrhea has been challenging. From the sheer logistics of cleaning up after a cat with diarrhea to the uncertainty – will it ever stop? Will it keep getting worse? – dealing with this illness is not for the faint of heart.

I am blessed that my precious little girl never once misses the litter box, so clean up, while still not pleasant, is relatively simple, even in a home that is almost all off while carpet. I use Jackson Galaxy’s Pet Stain and Odor Remover to clean up the occasional vomit episode. I scoop as soon as she deposits anything stinky in the litter box. A good air purifier is a lifesaver when it’s too cold to have the windows open for any length of time. 

I have to confess that I have a certain amount of “litter box PTSD” at this point. Every time Allegra heads to one of her boxes, I hold my breath. Will it be formed stool? Will it be puddingy? Will it be liquid? Only a fellow cat parent dealing with chronic diarrhea will understand the elation of seeing formed stool in the litter box.

Allegra shakes off her episodes so much more quickly than I do. She does her business, cleans herself off, and gets on with her life. To me, every time she has diarrhea feels like a punch to the gut. Probably not the greatest analogy in this context, but it’s the truth.  I’m trying to not let my mind go to the worst case scenario. Of course any chronic condition in a 15-year-old cat that doesn’t resolve is cause for concern. The spectre of this being more than just IBD is ever present. I’ve had more than one emotional meltdown these past few months. When they do happen, I go to a different room, away from Allegra. I don’t want her to pick up on my fear and worry.

I’m blessed with a wonderful care team for Allegra. I’m fortunate that Dr. Tasi is not only the most brilliant feline vet I have ever met, she is also one of my closest friends. With her wealth of knowledge and decades of experience, and because she knows me and Allegra so well, she has talked me off the proverbial ledge more than once.

In addition to regular Reiki sessions from me, Allegra gets weekly sessions from our dear friend, healer and animal communicator Debra Denker.  I’m very intuitive, but when you’re worried about your own cat, it can be difficult to “see” past the fear. Allegra’s weekly sessions with Debra are invaluable to us, both in terms of the healing Allegra receives and the information Debra relays to me after each session.

I realize that the decisions I’m making about Allegra’s treatment may not be the decisions you might make for your cats in a similar situation. I ask that you respect my choices.  We are in the best possible hands with Dr. Tasi and “Team Allegra.” We have explored all treatment options, and we’ve chosen the ones that are best for us. To me, the most important thing is to not just take care of Allegra’s medical needs, but to honor her unique spirit and personality in every decision I make about her care.

I hope sharing this information was helpful, especially if you, too, are dealing with the challenges of caring for a cat with chronic diarrhea.

Affiliate link disclosure: Purrs of Wisdom is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. Purrs of Wisdom is an affiliate partner of Chewy.com. This means that if you decide to purchase through any of our links, we get a small commission. We only spread the word about products and services we’ve either used or would use ourselves.