By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com
The signs of inflammation in the colon (also called the large intestine) are the same regardless of cause: a gooey, mucous diarrhea, straining to pass stool, cramping, and sometimes a surprise urgency to "go." These symptoms can be acute, as is common with a short-term stress like boarding, returning from boarding, or diet change, or they can be chronic as with whipworm infection or inflammatory bowel disease.
Many people get confused between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD is a physical disease where the intestinal lining is infiltrated by inflammatory cells. The delicate intestinal lining becomes thickened and it alters the absorption of nutrients. The infiltration can be seen under the microscope, which is how the diagnosis is confirmed. This has nothing to do with IBS.
IBS is a psychosomatic disease. It is the activity of the mind that causes the symptoms. Most people have had some kind of experience where stress has produced intestinal distress, be it cramping, nausea, diarrhea or all of the above. Chronic anxiety can similarly result in chronic diarrhea, and this is basically what IBS is all about. Intestinal biopsy results are normal because there is nothing physically wrong with the large intestine.
Colon with Lymphocytic infiltration - "Inflammatory Bowel Disease" (This is not irritable bowel syndrome) Photo by Nephron via Wikimedia Commons
Large intestinal diarrhea can have many causes and IBS is afoot in about 10-15% of cases. It is important to rule out physical causes before blaming psychological reasons and it has been recommended not to use the term "IBS" until a thorough work up has ruled out physical diseases. After a thorough work up has turned up normal results and we are still left with an anxious patient with recurring diarrhea, then it is appropriate to diagnose IBS and proceed accordingly. It should be noted that fresh blood in diarrhea is common with large intestinal diarrheas, but not so much with the large intestinal diarrhea of IBS. Fresh blood in the diarrhea is a sign that there is a physical cause and not a psychosomatic cause. Knowing this can help direct the medical approach.
Treatment of IBS
The obvious approach is to address the anxiety. The source of emotional stress may not be obvious but general anti-anxiety medications such as amitriptyline, clomipramine, or fluoxetine may be of use, particularly if the anxiety source is not clear or cannot be removed. It is important to imagine the pet’s world from his perspective. The pet does not speak English and must infer what is going on from events he witnesses directly. Inconsistent scheduling, moving to a new home, noisy construction nearby, or even weather changes can be confusing for an animal.
More commonly, however, IBS is addressed through the GI tract rather than the psyche. Increasing dietary fiber is helpful to many IBS patients as fiber has been found to help normalize the spasms of the large intestinal muscles, and many therapeutic high-fiber diets are sold through veterinary hospitals. If your pet finds these unpalatable, ask your veterinarian about how to add wheat bran or a commercial fiber supplement to a diet your pet prefers. Several commercial dog foods contain calming supplements. Using one of these with a fiber supplement might cover both the fiber angle as well as the anxiety.
For many patients, cage rest or tranquilizers allow for enough rest to control symptoms. Antispasmodics or general anti-diarrhea medications such as loperamide, azulfidine, chlordiazepoxide, or metronidazole can be used on an as needed basis to control signs. Typically one to two weeks of treatment is needed.
As for anxiety, if the source is apparent and can be eliminated then this would be helpful. Often, it is not clear what the source is or it cannot be eliminated. In this situation, the following over-the-counter products may be helpful:
- Adaptil Defuser - The dog appeasement pheromone is naturally secreted by mother dogs to communicate safety and security to her litter of puppies. This pheromone has been synthesized and is available as a room spray, plug in wall defuser, and as an impregnated collar that the dog can wear. This gives the anxious dog a message in her own language that there is nothing to be anxious about.
- Alpha Casozepine - This is a milk protein with natural calming properties. It is available as an oral supplement (Zylkene®) for pets, or in therapeutic calming pet foods available at your veterinarian's.
Consult your veterinarian if you wish to pursue one of these therapies but keep in mind that IBS is not diagnosed until a medical work up for physical causes of large bowel diarrhea has come up empty.