It's All About The Poop

For Episode 14, we dive right into poop. You read that right. Poop. As the famous book says: Everybody poops. And for everyone in the animal healthcare field, that’s a good thing! Your pet’s poop tells us a lot about what is going on with them. It can be a very easily seen (and smelled!) sign that can tip you off that something may be up with your furry family member. So, in this episode of Alicia Pet Care Center’s Pet Talk Podcast, the owner and chief of staff of the hospital, Dr. Matthew Wheaton, sits down to tell us why it really IS All About The Poop. So here is a transcript of the podcast episode (that you can listen to by clicking above, as well):

We believe this is a big topic for dogs and cats and an important one on the veterinary side and an important one for your pet’s health to know what's normal and what's not, as far as poop goes. Getting you up to speed on that is the goal of this podcast episode. We start off in kind of a weird place because there's a little bit of variance. Not to get too personal, but there's a bit of variance in every person on their poop consistency and their observance of it. Knowing when you are falling outside of the normal variance is one of the important points that I want to make. As I tell my clients a lot, when they ask about gastrointestinal health, choice of diet, how to assess whether their dog is healthy or not, or certain goals that they might want to do different with philosophies and feeding.

It's all about the poop. It really is all about the poop. So, if you have a pet that's not having the correct consistency of poop, you go to change the diet. It's kind of a no brainer there. But it sometimes takes a little while for owners to do that. Most importantly we'll start off with “normal”, as far as poop goes. Normal poop for a dog and cat should be a firm, well-formed stool. Color is not really all that important, though occasionally you have this strange color of poop for an extremely long period of time. When you have stool that is firm but not hard and has a segmented appearance and there's really no residue on the ground: that is a normal poop.

That's what we should see pretty much every single day. We should see it every day and we should certainly see it every poop. Sometimes there can be a daily variance in things. There are lots of ways to get out of the norm and there's not necessarily one particular diet that's going to get that accomplished. And every single pet is a little bit different. There are some universal things that we can point to that are more likely than not to make things go one direction or the other. But that's what you're looking for. I think if you get out of that zip code, let's say, on the consistency, then you have an abnormal poop. That means the intestines and/or stomach theoretically (but mostly it's the intestines) are maybe not right. And if you start to see some patterns, then maybe you have a pet who is “not right” more than just a tiny bit of the time.

Those are things that you don't want to overlook. Because what's going on to make the stool abnormal is not going to go away on its own, if it's taking longer than, say, a week. It would be one thing if you had soft stool maybe two or three times per week. But that should only go on for one or two weeks. I mean, why would that continue to keep going on? Every single soft stool is that particular pet, via their poop, telling you that something is not entirely right with their intestine. So, when we are told about things early on in the course of the disease, process, whatever that may be, we have a much better chance of getting early intervention, and an easier way out of things. When we wait too long to report illnesses to our veterinary team, that just sets the pet up for having a more difficult struggle.

Sometimes people really live in that place of hope. Again, it's fine to do that for a certain amount of time. But when we're working on multiple weeks going by or months with a visible issue -- or potentially even years, honestly, with some of the dogs that we see.  

Question from podcast host: “So, with regards to what you were describing as a good poop -- I know somebody who has two cats and they have one cat that sounds like a good pooper and their other cat, I guess, they kind of have that soft serve ice cream kind of poop intermittently. So, what's the story with that?”

Dr. Matthew Wheaton’s response: That “soft serve poop” is oftentimes not called ‘diarrhea’ by people. That's the first thing that I think we should make sure that we understand. Diarrhea is kind of a bad term. It's really a bummer because people think that unless it's liquid, like straight up liquid stool, it's not diarrhea. But diarrhea, I'm going to define it as a loose stool. And there are gradations of that, going from complete liquid to kind of a soft, unformed stool. You know, that soft serve ice cream kind of thing is definitely not normal. So, we shouldn't see that ever. Again, it's about trends, it's about time courses. Does your pet have soft stool for a day and then get better and everything is okay and normal for six months? And then there's another soft stool episode and that's fine. No big deal. We're not going to do anything for that. I don't think there's any consequence of that. And that doesn't speak to some underlying condition that we need to address or worry about. But a day-to-day kind of mildly, not-formed stool could potentially be a symptom of intestinal parasites or inflammatory bowel disease as our most common problem in dogs and cats. Maybe not as much for dogs, but on the inflammatory bowel disease side of things: definitely for cats.

Let’s talk more about that soft, not fully formed stool: that is not normal. It's kind of like a plop. That's kind of a moderate diarrhea and then a severe diarrhea liquid: it's not okay. All of those things are going to get you to the vet eventually. With the very liquid poop: I'll tell my clients that if nothing else is going on and the dog is wagging its tail and seemingly normal aside from the liquid stool: you're going to wait no more than 48 hours to bring your dog to the vet.

So, once you're working in that 72-hour window: a lot of people come in before that because, quite honestly, it's not fun. Potentially, the dog is defecating inside the house. If it's cats, they’re possibly defecating outside the box and it’s super stinky. The dog is uncomfortable, the kitty is not happy about things and you all might be waking up in the middle of the night to deal with this now more urgent feeling kind of situation. So sometimes you don't get the opportunity to sort of try to wait it out. You need to come into the vet for some help. And we generally don't get too crazy with a bunch of tests or whatever at the beginning of this. If it's a first episode or it's kind of a one-off episode, we generally will take it in stride and see it for what it is. It's an upset stomach that's causing diarrhea and we've got treatment for that that's very reliable. That oftentimes involves an injection typically of an antibiotic that's targeted towards the intestine and then a combination of antibiotics and probiotics going home.

I think we should talk about this briefly because it’s common for us to do this and it's occasional for people to have questions about it, but: why would we use antibiotics? Oftentimes, when you have diarrhea, you're dealing with multiple things going on at the same time. So, there's typically a flux in your gut bacteria and something sparks it, right? It's either a parasite or inflammation or it could potentially be a virus. It could be a diet change. Your gut has got a lot of stuff going on, so the bacteria is relatively sensitive to their environment that you're providing for them on a consistent basis. And when you alter that by changing the pH or changing the temperature or causing a bunch of inflammatory cells to rush in there: any of those things are going to potentially change the gut bacteria.

Additionally, you usually have a change in motility. Your gut motility is kind of like a wave pool in a way. It's got these very rhythmic contractions that are kind of going at a set pace. You've got kind of a rhythm that's going and that rhythm gets altered massively when you have a diarrhea situation. So that's going really fast usually. The rhythm could be kind of haphazard, weird and then oftentimes it has sped up. And if it's speeding up, the rhythm of the gut, things are going to get pushed a lot faster. You're going to have potentially a lot of intestinal discomfort too because there's a lot of nerves associated with the intestine and when it's moving around really fast or it's getting dilated by gas, that does not make the nerves happy. You're going to get some discomfort there, maybe that bloating feeling and that "you want to curl up into a ball kind of feel".

When you're moving really fast, you're not going to be able to have the body take up the water from the ingesta that is soon to be poop, and so if it can't get the water back up into the system, absorbing that water out, then you're going to have a much more watery stool. And then we're off to the races with diarrhea. Some other things that you might see with an altered stool consistency is all the other stuff that typically goes along with intestinal inflammation and an upset stomach, which could be blood. You might see fresh blood in the stool. That's pretty common because, a lot of times, our dogs are dealing with colitis, which is inflammation of the colon. Our cats will do this too. Dogs do it quite a bit with stress. Cats don't do it quite often with stress. Their stress organ is usually their urinary bladder. But occasionally, a cat will dump stress into their colon and this is not a long-term chronic stressor, by the way. We see this occasionally in boarders. We see it sometimes in a situation where a dog gets left behind in its own environment with a pet sitter. An environmental change like that's pretty stressful for a dog. So, they may put that stress into their colon and get a little bout of stress colitis.

Intestinal parasites and/or giardia are very common for this to cause gastrointestinal distress and mainly that plays out in the colon. The colon is inflamed, so you may see blood there because the inflammatory cells, when they are going in and attacking whatever, they oftentimes will kill off some of the normal intestinal cells and those are going to bleed when they're undergoing damage. So, you may see blood ending up in the stool. Which, when it's red blood, we know that it's coming from the colon because it doesn't have time to digest that blood. Whereas, if there was blood coming into the stomach or the upper small intestine, the intestine will be partially digesting that blood and it wouldn't pass through with a red coloration. It would be blacker in appearance or kind of a dark purple. We oftentimes will see mucus. That'll look kind of like KY jelly or snot. It's pretty gross. But, oftentimes, you'll see mucus with that kind of colitis episode and that can sometimes throw people off too. Occasionally we get mucus without a super abnormal poop. So sometimes we'll get a little mild colon inflammation.

There is a chance that those dogs will actually be fiber-responsive. That's where your usage of pumpkin comes out. A lot of people listening to this probably know that pumpkin is a great fiber source that you can easily obtain. You can use canned pumpkin from a grocery store and that's not a bad play to make on your first day of diarrhea if you really wanted to kind of do something at home. That's probably one of the things that I would universally give a thumbs up to because nobody's going to get harmed by that. But you certainly might see mucus...sometimes that'll look like a casing on a sausage. It's kind of weird. Sometimes it's super gross. It looks literally like somebody has pneumonia or something and they coughed up a bloody loogie and that's what's on the poop.

The pictures that people text me -- we actually do really like pictures of poop when the patient is being presented for diarrhea or if there's a chronic diarrhea issue or chronic soft stool issue. We can really benefit from that kind of documentation. That's actually a wonderful thing about technology and cell phones now; you can easily take a picture of that and then we don't have to guess at what you’re seeing or trying to describe to us. And we don't have to show you pictures that you have to select out of a police lineup or something like that to show us what your dog's poop looks like.

One of the other things that you would see potentially in a colitis episode besides blood and mucus and soft stool is straining to defecate. And this definitely throws people off quite a bit. We have people come in quite often that think that their pet is constipated. And they might've already given something to their pet, which we really do not recommend doing. But sometimes people think that the dog is constipated because it's sitting there straining to defecate and not much is coming out. Often, it’s just a small bit of liquid...very small amounts of liquid poop potentially or mucus. And if that happens, that frequently is coming because the rectum is irritated as well. And the rectum, when it's inflamed or undergoing some degree of damage, is going to be sending all these messages to the brain that it has to do its thing.

Many of us may have experiences we can reference that seem similar to this. Sometimes it can be helpful to look at your pet's experience through your own experience. Say, if you're eating wasabi today and the super-hot ghost peppers or anything like that, tomorrow you're probably not going to have normal poop. But your dog and cat are not doing that. So, don't get thrown off by your crazy diet and your potential gastrointestinal distress being the normal thing to expect for your dog or cat. Most of the time, they're eating similar diets daily, so they really shouldn't have a lot of variance. Why would they have variance in their poop if they're eating the same thing every day? So, it behooves us to be logical. Don't freak out and definitely be a good historian for us, as well. Minimizing the problem that the pet truly has doesn't really do the pet any good because it's not really telling the right story to the veterinarian. So, that is kind of a synopsis on the colitis side of things.

I want to talk about something that's kind of interesting. It's a study that was done in cats that, I think, people get their mind blown a little bit when I tell them. I'm going to take an opportunity to tell this story right now and I will also use it to plug our upcoming future podcast on cat food and feeding your cat; the basics of nutrition for a feline. It's a study that was done with cats and dry food versus canned food and they looked at stool consistency and the weight of the stool, which relates to how much water content is in the stool. And the heavier the stool is, the more water contents are going to be in there, which means the more loose it is, right? Which one is going to have more water in it? A cat that's eating canned food or a cat that's eating dry food. The obvious thought would be that it's canned (or wet) food, right? Well, that's wrong.

Cats are water eaters. They are not water drinkers. Since cats are water eaters this means that they have to eat their water. If they don't eat their water, they have to drink their water… and they suck at drinking water, so they don't do it well. Cats as house pets are borderline dehydrated all the time. If a cat is eating dry food, here's what happens. The dry food goes in, it sucks a bunch of water towards it like a sponge. Cats have an extremely fast transit time in their gut because they are strict carnivores. You don't need to ferment animal protein very long in the gut to digest it. Their gut has evolved with them to be strict carnivores, creating that really fast transit time. What happens with the dry food is that it makes it out of the stomach before it's actually sucked all the water towards it from the body. It's going to puff up to kind of like a maximum capacity just like a sponge would. And that's a factor of science; osmolality it's called. So, your water wants to always kind of be equal throughout. If you have something that's really dry next to something really wet, it's going to pull the water towards it and they're going to equal out. That's kind of osmolality in a nutshell. What happens is a cat will get it out of their stomach into their small intestine and it is still sucking up water from the body through the intestine. It makes it midway down the small intestine. It's still potentially sucking water towards it and then by the time the cat's trying to now get the water back – because, that's a thing. The cat and dog and person: we're all sucking water out of our gastrointestinal tract into our body to retain it so that we stay hydrated. But a cat is now having this very moist, water-laden sponge coming down its pipe too fast for the body to actually suck the water back up. Thusly, the poop comes out and is kind of watery. Even if it's formed, it's wetter than a canned food fed cat.

In the canned food cat story, the cat brings the water in with the food, it's in the stomach and it doesn't really draw a lot of water towards it. It's already potentially at equilibrium because a lot of the canned foods come in at about 70% water content. A body is about 80% water content, 77% something like that. So, there's not a lot of equilibrium that has to be attained there. And so, the cat, relatively quickly, at least by the time it's in the small intestine, is already able to start sucking that water out and making that poop into a firm poop.

Another thing that I want to talk about is kind of the opposite thing: when poop gets too hard. That's a thing that's going to cause constipation because the poop is too firm. And we deal with this in cats and dogs in sort of different stories. Let's start with dogs first, they're a little simpler. Pretty much we're not going to deal with constipation in dogs. It's extremely rare. So, unless you are feeding a particular type of diet, it's very unlikely that you will ever have your dog be constipated. It's even more rare that your dog would ever need treatment for constipation. In over 20 years of doing this, I really can't think of a dog without some kind of pathology in its colon or rectum that had to have an enema as a treatment for being constipated. So, if your dog is constipated, there's usually a really, really big problem going on back there. If you think your dog is constipated, you should definitely go to the vet.

Like I was saying earlier, people (unless they hear this podcast) are going to think that their dog is constipated when it's actually having diarrhea and frequently having colitis and it's straining to defecate. So, we're talking again about a very, very hard poop. In a dog, the reason why you would typically deal with that is a dog that's fed a raw diet that's almost all animal content. This possibility for constipation can increase if you're putting a bunch of bone in their diet. Bone is not entirely digestible. So, the dogs are going to do their best with it. They're built to digest bones, but if it’s an uncooked bone; it's just a lot. It's going to be a very small amount that they would actually normally eat; half of their diet wouldn't be bone.

I think most would agree that dogs now will eat what you feed them, right? So, if you feed them a big huge bone with a small amount of food, whatever that is, they could potentially get constipated with that. I've seen some bone-constipated dogs that have needed to be anesthetized to actually get that wad of bony stuff out of their colon safely. That is not nice and it’s seriously sad.

I would say for anybody that's feeding raw: be careful. I'm not going to go crazy on the raw people. I don't really have a problem with it as long as the poop is okay. And most of the time it is. But sometimes the poop from those raw fed dogs will be a little bit too dense. So, there's just no fiber in there and there's not a lot of partially digestible filler, if you want to call it that. But there's no fruit, vegetable, fiber, that kind of stuff that's going to add to the bulk of the poop. So, you have this really nicely digested food item that just has very little residue left. The poop is really compact and there's not a lot to it except for just the remnants of that broken-down protein. Consequently, you're going to have these really, really rock-hard poops. So be careful of that. Oftentimes, that needs a bit of a diet change to rectify that. And you can do that with various things by adding pumpkin or by just adding a little bit of some other diet to your raw.

If you're doing that in a cat, it's a totally different scenario. We don't really deal with raw fed cats having hard poops. That's not really a thing in kitties because, remember: they're strict carnivores. So, it's normal for them to eat that kind of diet. But we do see constipation in cats from a couple of different reasons. We get the old cat that has some kind of condition, usually chronic kidney failure, that makes them lose too much water from their system in their urine and keeps them clinically (maybe mildly) dehydrated a lot of the time. And if they have that, then they're just dry and their poop is going to just get the liquid. So, with chronic kidney failure, these cats will be clinically dehydrated a lot of the time and they're going to suck as much water from any place that they possibly can to stay as close to hydrated as possible.

Again, it's simple science. The water basically wants to go from the dry thing to the wet thing to maintain equilibrium. Consequently, they will suck this water out of the poop in their colon and then the poop will be very, very dry and small, oftentimes, in these cats and they're just not moving their bowels very well because they're just kind of dried up. It's just not so great. So, if you hydrate those cats, they actually get back to normal pretty quickly. So, you have to keep them hydrated. That, oftentimes for the chronic kidney failure cat, requires you to be doing fluids underneath the skin (subcutaneous fluids) at home; certainly, doing a canned food diet, again, because if they start with a watery food source, they're much more likely to be set up correctly. That's one version.

The second version is the cat that has something called megacolon. This does not happen in a dog, really. It's extremely rare for it to happen in a dog. But in a cat, it can happen. It's not so fun. They get this big, floppy, basically nonfunctional colon, and it's just a bag that just stores poop and it is inevitably going to lead to that cat developing not only constipation but also something called obstipation. The difference between those two things are a constipated individual, in theory, if they try hard enough, they're going to be able to get it out. They don't necessarily need significant intervention to resolve them. The obstipated cat: it's going to die if it doesn't get fixed. So, it's got a complete intestinal obstruction due to fecal matter sitting in its colon. And if it doesn't get resolved, it's going to just basically die of toxicity due to not being able to defecate.

Those cats are going to be uncomfortable. They're going to be straining to defecate. They're going to be acting the same as a constipated cat. But what's going to happen on physical exam is that they have this humongous tube full of poop. And I mean really humongous. These colons can get like three to four inches in diameter and the poop is oftentimes the consistency of clay… like hard clay. So those cats require an anesthesia to allow us to do multiple enemas and digitally (with a glove on), get the poop out of there. It's one of my favorite procedures to do on a cat. It is so rewarding; instant gratification that's like mowing your lawn. You know, you get this really weedy lawn and you go out there and you work for an hour and you're all sweaty and it looks amazing. Same kind of thing. 15 minutes, 20 minutes in: I have completely fixed that cat, it's empty as can be and squeaky clean. I feel like a hero in those moments dealing with a megacolon cat.

Here’s a brief addendum on the megacolon cat: sometimes they're difficult to manage with medicine. Diet plays a role and stool softeners and that kind of thing. But we frequently struggle with those kitties and they can receive a surgery to remove most of their colon: it's called a subtotal colectomy where the vast majority of their colon is surgically removed. That typically resolves the problem in the cat. Occasionally you'll get a cat that kind of pushes the issue beyond that, but it's pretty rare. Most of the time, it's one and done after the surgery is performed.

What else can we say about poop? Color doesn't matter all that much. Frequency: I guess we should talk about that. I don't think it's abnormal for a dog to poop four times a day. Here's a good point. If your dog goes out on a walk and it poops one time and you're continuing to walk -- let's say you walk for 2 miles. Certain dogs, they get stimulated on a walk. So that dog might poop 3 or 4 times and by the 4th time, that poop is probably going to be a little bit soft. I don't see that as an abnormal finding in that circumstance. Whereas, if your dog is going outside into your yard and it poops twice and the second poop is relatively soft, that's not normal. I mean, that dog should be able to poop twice and have still normal consistency to the poop. That's a frequent thing that confuses people a little bit. Not to worry if you're a long walker and the dog is a multiple pooper.

One thing that's not normal is a huge volume of poop being produced. And this we can see in a condition called exocrine pancreatic insufficiency: EPI. That's a condition where the pancreas loses its ability to produce digestive enzymes. That is the exocrine function of the pancreas. The endocrine function of the pancreas is to produce hormones. But the exocrine part produces digestive enzymes. If that part fails, and that happens with EPI, you then don't have an ability to digest your food. So, you have this situation where the poop is extremely voluminous and sometimes is pretty moist, but it's not usually straight up diarrhea. It's usually kind of a cow pie consistency poo. Most of the time this happens with dogs and most of the time, quite honestly, it's German shepherds. But these dogs are ravenous. These dogs are thin, underweight typically, producing loads of poop. And they are hungry like the wolf. They really are so hungry because they are not digesting their food. Otherwise the dog might still be looking okay and it oftentimes fools people for a while.

This is not unusual for us to see that dog coming in after two to three months of doing this at home. We don't want that dog to wait that long. But it's not unusual to hear the story playing out for weeks or months. Sometimes it's because we're seeing cases as a second opinion, which we frequently do. But it's not something that you want to overlook for a long period of time. Especially if you have a German shepherd. A special message to the German shepherd people out there: hear me now. Get pet insurance, first of all. Look for the exocrine pancreatic insufficiency symptoms that I just talked about and be aware that your German shepherd is also one of the highest risk breeds for inflammatory bowel disease, which in a dog is typically going to produce intermittent soft stool and potentially nausea. Oftentimes, that comes in the form of just not wanting to eat perfectly, being a little bit of a finicky eater, maybe the intermittent vomiting; most of the time it's a stool issue in a dog.

I think we've hit on a lot of poopy parts of poop. So, keep your eyes open for those other episodes that we talked about recording because we are on a roll now and we are definitely getting a good solid output of podcast episodes now. This episode also goes together as a phenomenal companion piece to our previous release: “Let’s Talk Liver Disease”. We know that a lot of people with pets with liver issues, we talk a lot about the poop in those scenarios. So, if you still need to hear that part, go check out Episode 13 about liver disease and elevated liver enzymes.

Make sure you listen to this actual episode to hear the part near the very end (appropriate, right?) where we read off some of the responses we got from people when we asked: “What do you call your pet’s poop?” There are some hilarious answers from all of you on there. Thanks to everyone who participated in that little bit of fun!

If you have more questions or if you have more topics that you want us to discuss, send us a line. You can drop us an email at: wecare@mypetsdr.com. You can also contact us through social media.

You can find Alicia Pet Care Center on Instagram, Twitter, Snapchat with our username @APCCvet. We are on Facebook as Alicia Pet Care Center. You can send any questions and topics you'd like us to discuss on a future episode to wecare@mypetsdr.com. Our hospital's website is www.mypetsdr.com and the podcast website is www.PetTalkPodcast.com.

The podcast is available on the Apple native app, and for you Android users, it’s available on Google Play and the Stitcher Radio app. You can share those with your neighbors, or friends, or family members that may be dealing with any of these issues as well.

Thanks for listening!