IBS

[Liz]

My caveat of course is I’m no substitute for a professional. I had a mystery cat…never could get a good diagnosis and she was also a very picky eater (she would just lick the gravy off wet food). For the constipation PEG powder (miralax, restorlax) were miracles. We tried so hard to give her the foods the vets suggested – she was ok with the dry but never ate quite as much as she should & wasn’t into the wet, other than the gravy. She loved treats & I would boil chicken and give her the cooked chicken & broth sometimes but that didn’t have the proper nutrients so it was more of a treat. In hindsight I wonder if I should have just given her whatever cat food she would eat to get the nutrients, along with the laxative, as we never could keep her at a proper weight. The only other suggestion I have is try some of the creamy treats – some (like Catit) have taurine added so have some essentials and can be a good addition to their food or a few times a day treat.

[Chris]

Hi Shan, I’m going to be a little nit picky with the terminology, but I think it’s important. If your kitty is on prednisolone, then you likely mean IBD (which they now call a chronic inflammatory enteropathy, though I still prefer IBD because it’s an easier term) and not IBS. They are actually very separate disorders. IBD is related to protein allergy and possibly immune reaction to bacterial populations and environmental factors. IBS is more of a stress-related disorder which can be addressed with anxiety medication and other supportive care.

Cats can normally be picky but the other issue with IBD is that if their bowels are uncomfortable, trying a new diet is sometimes very hard because they may associate bowel discomfort with eating a certain food. While it is ideal to have an appropriate novel protein or hydrolyzed protein diet, I have recognzied that this is not possible for every cat because eating the diet is up to them, not to us. When I was trying to get my own cat with IBD on a special diet, I had to transition very slowly to a new one over weeks and it was a trial/error process over about three diets before we (she) settled on the Royal Canin HP dry with the rabbit and pea select protein wet. So a total of a couple months process. I have had other patients who wouldn’t eat the HP and others where the rabbit/pea actually gave them diarrhea. So it’s a very individualized response.

Although I understand your desire to get your cat off of a steroid, it may not be practical to have that expectation. Mild IBD can be controlled with diet alone, but if your cat had any weight loss associated with the condition, a steroid may always be necessary. It can be possible to taper the pred down to a lower dose or only being given two or three times a week (discuss with your vet first). I’ve had that success with some patients (but not all). That can at least mitigate potential long-term effects.

Budesonide is another option that can work as well as pred but it acts more locally on the digestive tract. It may not be a good option if IBD is accompanied also by cholangiohepatitis and/or pancreatitis, but if only intestinal disease is present, it’s not bad to consider and chat with your vet about if the potential systemic affects of pred are a concern (or if there is any underlying concern for kidney disease, diabetes risk, or heart disease risk).

I agree with the other reader that miralax can be a good option for constipation without messing other things up too badly. Most cats may only need 1/8th to 1/4 teaspoon once or twice a day mixed with food and it is flavorless.

Constipation can also be an issue with dietary fiber as well. There are special diets for that too, which are best, but you end up with problems trying to balance multiple conditions. A balance of both soluble and insoluble fiber is usually best. Nutramax makes a mixed fiber supplement under the Proviable label that is one option.

• This reply was modified 3 days, 18 hours ago by  Chris.

[Shan]

Thank you both for the input .. I truly appreciate it.

Chris have you ever tried Metronidazole on an IBD cat? I was reading this can help with changing up the microbiome and may be beneficial.

[Chris]

Hi Shan,

You do have to be careful with metronidazole in general as a long-term medication. It can target overgrowth of not so beneficial bacteria, but it will also affect good bacteria as well. There are protocols where it is used alongside a steroid but the immune-modulating properties it is purported to have that would support its longterm use have never been really proven. And so in the last few years, it is falling out of favor more and more as a long-term medication. There are more concerns about actually depleting the GI biome and cultivating antibiotic resistance. There is more emphasis placed on prebiotics (fiber) and probiotics to cultivate more the beneficial bacterial populations.

From a practical standpoint, it doesn’t taste great and for some cats, even 1/4 of a 250mg tablet may be too much, requiring compounding. The Araydia brand of liquid metro labeled for dogs can be used in cats but palatability is a huge issue and it’s expensive for what it is compared to the tablets.

If an IBD case is still not doing well with a primary steroid +/- diet, further testing with ultrasound may be needed at a minimum to see if there are concerns for potential small cell lymphoma, which can appear similarly. There are also just very severe IBD cases. Only tissue biopsies can tell for sure, which is not commonly pursued. But in those refractory cases, I would say that chlorambucil is more often added vs. metronidazole.