My dog has bowel/intestinal problems. What can we do to make her better?

Question: 

My dog has bowel/intestinal problems (IBD?) and has for about a year. She has been to a number of veterinarians and the problem continues. She eats goat meat but needs vitamins, nutrients and fiber. She has times when she has normal bowel movements then she picks up sticks, rocks, rabbit poop etc. and eats them – and the next day she is sick again! She also seems to be constipated sometimes. I am worried about her – what can we do to make her better?

Answer: 

Thank you for your email.  I’m uncertain of your dog’s symptoms (diarrhea, vomiting, inappetance, etc.) or the results of any tests that have been performed already, but will offer what advice I can with the information provided.

There are many causes for intestinal disease, inflammatory bowel disease (IBD) being but one of them.  IBD is a disease where the immune system attacks the intestines, causing inflammation.  However, it also is one of the most over-diagnosed diseases in veterinary medicine.  (In addition, people use the term IBD to incorrectly refer to irritable bowel syndrome, which is the most common cause of diarrhea in humans, and stress colitis). Confirmation of true IBD requires intestinal biopsies (either via surgery or endoscopy), but also necessitates elimination of all other causes of intestinal inflammation like infectious diseases, parasites, and food allergies.  In other words, the presence of inflammation in an intestinal biopsy does not necessarily mean your dog has IBD.  When IBD is correctly diagnosed, treatment involves suppression of the immune system - usually using high dosages of prednisone.

IBD usually causes constant diarrhea and/or vomiting.  If she only develops symptoms after eating things she shouldn’t, she might actually just have intolerance of the things she is eating, or bacterial overgrowth resulting from her dietary indiscretions. In addition, you indicated she has “constipation.”  Actual constipation refers to the inability to pass normal stool, resulting in a “backup” of feces in the intestines. I suspect, however, you are really referring to straining to defecate after she has diarrhea. This is called “tenesmus” and actually is sign of colitis (as is diarrhea with mucus or fresh blood in it), which also suggests that her dietary indiscretion may be the cause.  When colitis does occur after eating inappropriate items, a prescription for a common antibiotic (metronidazole) often can help if your veterinarian thinks it is appropriate for the situation.  In any case, avoiding these items is the best solution (including use of a cage muzzle when on walks, if necessary).

Lastly, she should be put on a balanced diet. Dogs are omnivores, not carnivores, so they need plant material in their diet. And, as you noted, dietary fiber often can help prevent many causes of diarrhea.

Ultimately, the most important thing is to determine the CAUSE of the diarrhea.  Just guessing (as I am, here) and trying different medications without first obtaining a diagnosis is a recipe for failure. If you don’t feel your local veterinarians have an understanding of the problem and its treatment, I would highly suggest referral to an internal medicine specialist.  They can evaluate your pet and, if indicated, can test for infectious causes, treat for parasites, recommend a hypoallergenic diet, perform imaging such as an abdominal ultrasound, and even obtain intestinal biopsies.  The tests may cost a little more, but they often save a lot of money and time (and sometimes even the patient) when compared to guessing and trying various treatments with no success.