Expert: Jessica - 10/6/2009

Question
We have two sweet cats that we adopted from the same litter.  They eat and drink out of the same bowl and even share the same litter box.  Despite all of their similarities, only one of the cats suffers from severe and chronic diarrhea. Her sister is fine.  Our vets over the years (4) we have had her tested for everything: parasites, bacterial infections, etc.  The vets have never found anything, but have treated her empirically with pills.  We also put them on a special prescription diet and tried enzymes and probiotics.

NOTHING has worked!! The food helped with the horrible gas she had and the anti-biotics helped for a few weeks, but eventually she reverts back to water and nearly constant diarrhea.  She will visit the box 2-3 times and hour.  She has now begun to go just outside of the litter box.  My husband and I are at out wits end about this and no longer trust our vet.  What can we do?

Answer
Hi Tierney.  It sounds like your kitty has Inflammatory Bowel Disease (IBD).  This can be frustrating to deal with because it isn't caused by infection, and hence, there is no one treatment that fits all cases.

IBD is believed to be caused by an overreaction on the part of the cat's immune system, and the most recent evidence links it to the nervous system.  It is at least partly stress/anxiety related.  The immune system overreacts to stimuli which may include food ingredients, bacteria in the gastrointestinal tract, and the lining of the intestines themselves.  So the best ways we know to deal with the disease are to try to reduce stress, feed a diet with limited ingredients, and give a medication to suppress the exaggerated immune response that cats have to these stimuli.

I'm not sure which diets you've tried.  My cats tend to like Hill's prescription foods the best.  For stomach problems, there is Hill’s i/d, and for those who can't even tolerate i/d, there is z/d.  If you haven't tried both diets, you may want to consider this.

However, the medication your kitty is on is probably of paramount importance.  Most cats respond well to prednisone.  But there are some this does not work for.  I have a cat with IBD who responded better to an antibiotic/anti-inflammatory called sulfasalazine.  This needs to be carefully dosed in cats because they are sensitive to ingredients in it, so it's not a first choice.  However, the effects of uncontrolled diarrhea are a worse threat to their health, and I've had it work in a couple of very tough cases that did not respond to prednisone.  For those who don't respond to either of these, there is also chlorambucil and cyclosporine to consider.  Chlorambucil is actually used as a chemotherapeutic agent and cyclosporine is an anti-rejection drug for organ transplant recipients.  One of my cats even did best on a daily dose of a strong, broad-spectrum antibiotic called Orbax (orbifloxacin).  This is because he had an overgrowth of bacteria in the intestines, and the antibiotic helped keep this under control.  Most vets have never heard of this treatment for IBD, but my internal specialist put him on the treatment, and it saved his life.  He had to continue the treatment for the rest of his years.

You could always seek the opinion of an internal specialist.  I have to travel about an hour to see mine, but he is indispensable.  With some combination of any of the above treatments, it’s very likely your kitty should be able to be brought to health.  It’s just a matter of finding the right medication for her, which takes lots of patience, indeed.

Hope she’s much better soon!

Jessica