Diarrhea Management in the Boarding Environment
By Kate Boatright, VMD
Diarrhea is a frustrating but common condition. When it develops in a pet at a boarding facility, it can raise concerns for infectious causes, such as gastrointestinal parasites.
In other cases, it occurs because of changes in the environment of the gastrointestinal tract in response to stress or dietary changes, and will often resolve with appropriate symptomatic management. It can also be a sign of a more insidious disease process, such as cancer or inflammatory bowel disease.
Recent research has changed recommendations for symptomatic treatment of diarrhea for veterinary patients. The following covers a systematic approach to diarrhea management in the boarding environment.
Step 1: Patient History at Check-In
The first step to managing diarrhea in boarding animals is to get a thorough history at check-in before the owners leave. The answers to these questions will help you to anticipate patients who will not only be more likely to develop diarrhea while boarding, but also to be aware of patients coming to the facility with diarrhea and to fully evaluate patients that develop diarrhea during their boarding stay. Consider questions such as:
• What is the pet’s normal diet?Did the owner bring their normal food with them? An acute dietary change can induce diarrhea in many pets. If you know a pet is receiving a different diet than their usual, you can anticipate the potential for diarrhea.
• Does the pet have a known food allergy, if so, to what? Exposure to a food allergen can cause inflammation that leads to diarrhea and/or itchy skin.
• Has a recent fecal sample been tested for the presence of gastrointestinal parasites? If positive, has the pet been fully treated? Knowing dogs and cats in your facility have a recent negative fecal test can decrease the suspicion of an infectious cause of diarrhea. Pets with known parasites should be managed differently as their stool can contain infectious organisms that can sometimes be difficult to kill in the environment.
• Is the pet’s stool normal as of the morning of drop-off? If not, have they been examined by a veterinarian for the problem? Some patients will have chronic diarrhea, so knowing this is important for managing them in boarding.
• Does the pet have a history of diarrhea or other gastrointestinal issues (e.g., changes in appetite, vomiting) during boarding or changes in environment? Some pets are very sensitive to stress and will develop what is known as stress colitis, which is a common cause of diarrhea. Knowing a pet is prone to this will help to ease the mind of staff should this pet develop diarrhea.
Additionally, don’t forget to collect the information for the primary veterinarian of the pet and how the owners would like you to proceed in the event of illness during the boarding stay.
Step 2: Individual Pet Evaluation
Definitively diagnosing the cause of diarrhea is difficult and requires a full physical examination by a veterinarian and some combination of fecal testing, blood testing and imaging (x-rays and ultrasound). Sometimes, despite a thorough work-up, a definitive cause is not identified. In most cases of acute diarrhea, the condition is self-limiting and resolves within a week.1
It is not uncommon for pet owners to try symptomatic treatment for diarrhea prior to seeking veterinary attention if their pet is otherwise acting normal and the diarrhea is mild. When pets are having accidents in the house, blood in the stool or waking the owner through the night to go outside, they are more likely to come to the vet earlier in the course of the disease process.
If diarrhea occurs in the boarding environment, it may be reasonable to try symptomatic treatment for some patients—especially those with a known diet change or history of stress colitis. The pet’s appetite, water intake, energy level and stools should be closely monitored if symptomatic treatment is instituted.
Seek veterinary attention if the diarrhea is profuse or bloody, as these pets can become dehydrated quickly. Additional indications for veterinary evaluation include pets that are not eating and drinking, also vomiting, lethargic, have ingested something abnormal (e.g., bedding in their enclosure), displaying abnormal behavior, worsening in the face of symptomatic treatment or showing no improvement after several days of symptomatic management.
It is better to be overly cautious and have a veterinarian perform a full physical examination to ensure a more serious cause of diarrhea is not overlooked. Also consider fecal testing to check for gastrointestinal parasites. Even pets with a recent negative fecal sample should be retested, as some parasites shed in cycles, meaning false negative results are possible.
Step 3: Symptomatic Treatment (New Protocols)
Symptomatic management should include a bland, highly-digestible diet and a probiotic as the first-line treatment choice. Ideally, a prescription-grade, bland diet is recommended as this food is fully nutritionally-balanced. Although, feeding boiled chicken/ground beef and rice for a few days is unlikely to have a long-term detriment to the pet. Reach out to your facility’s preferred veterinarian to determine their recommendation for a probiotic that you can keep on hand for these affected pets. Any pet that is not improving with symptomatic treatment alone, or worsening in the face of treatment, should be evaluated by a veterinarian.
A Note on Metronidazole
Historically, metronidazole (Flagyl®) has been used in cases of acute diarrhea. Metronidazole is an antibiotic with efficacy against many common fecal pathogens and some protozoal parasites (e.g., Giardia). It additionally has anti-inflammatory effects on the gastrointestinal tract. However, concerns about the over-usage of metronidazole for non-specific diarrhea have been raised in recent years.
First, antimicrobial resistance is a growing concern and is considered one of the top ten public health threats by the World Health Organization (WHO).2 This concern calls for medical professionals to carefully select which patients receive antibiotics as well as critically assessing the duration and dosages prescribed. Since metronidazole is an antibiotic, its use should be carefully evaluated.
Second, new research has shown that while metronidazole can have beneficial effects in the gastrointestinal tract, it is not benign to the normal bacteria that help to maintain a healthy gut environment. In fact, it can have detrimental effects on these normal bacteria that can last for several weeks after its use ends.3 Additionally, its use only shortened the length of diarrhea by one and a half days in one study,1 suggesting its use makes minimal difference in the course of disease for many patients.
Step 4: Hygiene and Sanitation
Finally, because the potential for an infectious cause of diarrhea is always a possibility, appropriate hygiene and sanitation practices should be followed to minimize the chances of spreading parasites to other boarders. Make sure all of your staff are up to date on protocols for cleaning and disinfecting. Pets with diarrhea should also be leash-walked and kept out of play groups until the diarrhea resolves. In addition, all stool should be removed promptly to prevent contamination of the environment by infectious parasite eggs or larvae.
The development of diarrhea in boarding pets can be concerning due to the potential for underlying infectious causes and serious health concerns. The good news is that many cases will be self-limiting and respond to symptomatic management.
Having a thorough check-in protocol can help to anticipate the potential for diarrhea to develop and alert staff to at-risk pets. All staff should be trained on what to do if a pet develops diarrhea during their stay, including appropriate monitoring and hygiene practices. Make sure that you discuss with your facility’s preferred veterinarian any cases that are concerning and what their recommendations are for diarrhea management, but consider limiting metronidazole use as a first-line treatment for the pets in your care.
1. Langlois DK, Koenigshof AM, and Mani R. Metronidazole treatment of acute diarrhea in dogs: A randomized double blinded placebo-controlled clinical trial. JVIM 2020;34(1):98-104. https://onlinelibrary.wiley.com/doi/10.1111/jvim.15664
2. Antimicrobial resistance. (2021, Nov, 17). WHO. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
3. Pilla R, Gaschen FP, Barr JW, et al. Effects of metronidazole on the fecal microbiome and metabiome in healthy dogs. JVIM 2020;34(5):1853-1866. https://onlinelibrary.wiley.com/doi/10.1111/jvim.15871