Diarrhea in Ferrets

Diarrhea may be defined as an increase in frequency, liquid content and volume of the feces. When feces are normally formed, the amount of fluid in the feces is controlled by intestinal absorption or secretion. Diarrhea occurs when the intestinal tract fails to absorb sufficient liquid or increases the amount of liquid secreted into the feces, or both. Diarrhea is one of the most common manifestations of intestinal tract disease in ferrets.

Causes

• Bacterial infections
• Viral infections
• Dietary changes
• Foreign bodies (objects lodged in the intestinal tract)
• Toxins
• Parasites

If your ferret occasionally has a few stools with a liquid or loosely formed consistency and has no other symptoms, it may be normal. If, however, the diarrhea is persistent, lasting more than a day, recurrent (returns frequently) or other symptoms occur, medical attention is needed. Continued diarrhea can cause a loss of fluid and electrolytes, leading to dehydration.

What to Watch For

• Lethargy
• Loss of appetite
• Straining to defecate
• Fresh blood or mucus in the feces
• Vomiting or regurgitation
• Dark, brown-black tarry stool
• Lack of feces

Diagnosis

The veterinarian will recommend specific diagnostic tests depending on the severity or duration of the diarrhea. Chronic diarrhea (diarrhea lasting for several days to weeks) or diarrhea along with other symptoms usually requires extensive diagnostic testing. A complete history is extremely helpful in reaching a diagnosis. Be prepared to tell your veterinarian when the diarrhea began, if the feces have changed or varied in consistency or color, the type of diet your ferret is on, and of any potential exposure to other ferrets.

Recommended tests may include:

• A thorough physical examination
• Sampling the feces to look for parasites
• Sampling the feces for bacterial culture and cytology
• A complete blood count (CBC) and serum biochemistry panel
• Endoscopy
• Radiography (X-Rays) to look for evidence of intestinal disease, and size and density of the liver, kidneys or other organs

Treatment

Treatment for diarrhea may include any combination of:

• Hospitalization
• Intravenous fluids
• Injectable medications
• Dietary change or forced-feeding
• Antibiotics or antiparasitic medications
• Medications to protect the intestinal tract or alter the motility of the intestinal tract

Home Care and Prevention

If only one or two of the stools appear diarrheic and the ferret is young (under two years of age) and has no other symptoms, withhold food for 12 hours. Offer a bland diet consisting of chicken baby food. Be sure plenty of fresh water is available, and that the ferret is drinking. Alternatively, offer Pedialyte or Gatorade to replace electrolytes lost in the diarrhea.

If stools do not return to normal within 24 hours, if diarrhea worsens or any other symptoms develop, contact your veterinarian.

Give all medication as directed, for as long as directed, even after the symptoms appear to be gone. Watch for a change in the stools, and report any changes to your veterinarian. If improvement is not seen, report this to your veterinarian.

If the diarrhea is worsening, or the ferret develops other symptoms, alert your veterinarian immediately.

Diarrhea occurs when the intestinal tract is unable to absorb fluid or when cells lining the intestines secrete excessive amounts of fluid. Many factors can alter the intestinal tract's ability to absorb or secrete fluids properly. For example, if food is not properly digested, it tends to pull fluid into the intestinal lumen. Or if the lining of the intestinal tract is irritated by a toxin, infection or irritation, cellular changes cause an increase in secretion of fluid into the intestinal lumen.

Peristaltic waves, which are rhythmic contractions of the intestinal tract that serve to push digested food forward, occur at regular controlled intervals in normal ferrets. In some ferrets with diarrhea, these waves lack coordination, so that food moves through the intestinal tract too quickly. This results in an increase in frequency of defecation, and an increase in the liquid content since fluid does not have a chance to be absorbed.

Ferrets may normally have an occasional stool that is not well formed. This can occur due to excitement, stress or sudden changes in the diet. For example, diarrhea may occur if the ferret is fed excessive numbers of treats or table foods, or if he eats spoiled food from the garbage. If due to a diet change, the diarrhea should resolve after all new food is digested, and should not last more than 12 hours after new food has been removed from the diet. If the diarrhea persists, or if the ferret develops any other symptoms such as vomiting, lethargy, excess drooling, pawing at the mouth or decrease in appetite, you should seek veterinary attention immediately.

The appearance of the stool often varies depending on the area of the intestinal tract that is damaged. For example, ferrets with a disorder of the large bowel (colon) will usually have diarrhea that is characterized by frequent, painful defecations in which only a small amount of stool is produced. Stool is liquid or has a formed but soft consistency, and may contain fresh blood or mucus. Rectal prolapse may be a sequela to chronic large bowel diarrhea.

Ferrets with diarrhea due to small intestinal disorders often produce a large volume of feces with each defecation. Stools often have a liquid consistency. If the small intestine is damaged and can no longer absorb nutrients properly, stools often have a grainy, or "bird seed" appearance. Ferrets with small intestinal diarrhea often lose weight despite having a good appetite.

Causes

There are many causes of diarrhea in ferrets. The cause may be very simple, such as a dietary change, or may be due to a number of complex disease processes. There are many contagious diseases that cause diarrhea, so it is important to inform your veterinarian of any potential contact – direct or indirect – with other ferrets.

• Bacterial infection. Bacterial infections are among the most common causes of diarrhea in ferrets. Bacteria may infect the stomach, small intestine or large intestine. Helicobacter mustelae is an extremely common cause of stomach ulcers, causing melena (digested blood in the feces) and sometimes diarrhea. Campylobacter spp., Salmonella sp., Clostridium spp., and Desulfovibiro are common bacteria that cause disease in the intestines.
• Viral infection. Epizootic catarrhal enteritis (ECE) is commonly known as "green slime disease" because of the characteristic green, mucous covered diarrhea produced by affected ferrets. The specific virus causing this disease has not yet been isolated. The disease appears to be highly contagious, and is usually spread by young asymptomatic carriers, which means they shed the virus without showing any symptoms. Other, less common causes of diarrhea include rotavirus and parvovirus (Aleutian disease virus, not canine parvovirus).
• Parasitic causes. Intestinal worms are rare. However, microscopic parasites, such as Giardia, Coccidia and Cryptosporidium are common causes of diarrhea in ferrets. These parasites are more likely to contribute to diarrhea when a bacterial or viral infection is also present.
• Neoplasia. Cancer, especially lymphoma, is extremely common in ferrets of all ages. Lymphoma may cause diarrhea by invading the intestinal tract or liver. Primary cancers of the gastrointestinal tract, such as adenocarcinoma, are less common neoplastic causes of diarrhea.
• Obstruction. Tumors or foreign objects may block the intestinal tract. Ferrets are extremely fond of chewing and often swallow toys. Most ferrets with intestinal obstruction have vague symptoms such as weight loss, lack of appetite and diarrhea. Occasionally, an intestinal intussusception, which is telescoping of one part of the intestinal tract into another, may cause diarrhea initially, then a lack of feces later in the course of disease.
• Infiltrative Disease. Eosinophilic gastroenteritis is a condition in which eosinophils (a type of white blood cell whose normal function is to fight infection) invades the intestinal tract. The cause of this disorder is unknown. Proliferative bowel disease is a condition in which lymphocytes and plasmacytes invade the large intestine. This disease is caused by a bacteria (Desulfovibiro).
• Drugs and toxins. These include plant toxins, heavy metal toxicity, and bacterial toxins from spoiled food.
• Metabolic disorders. These conditions include liver disease, kidney disease and pancreatic disease.
• Dietary. These include diet changes, eating spoiled food and dietary intolerance.
• Stress induced. This might be caused by a sudden change in environment.

Diagnosis In-depth

A thorough history is extremely important in the diagnosis of diarrhea. Be prepared to answer the following questions:

• When did the problem began?
• Is the diarrhea intermittent?
• Are all of the stools abnormal?
• Is there an increase or decrease in the amount and frequency of stools?
• Does he strain to defecate?
• Has the character of the diarrhea changed? For example, did it begin as a semi-formed stool, and now is completely liquid?
• Is there fresh blood or mucous in the feces?
• Has the diet changed?
• Does he tend to eat table foods or get into the garbage?
• Is he still eating a normal amount of food?
• What are his chewing habits?
• Does he have access to metal objects or plants?
• Does he chew apart toys?
• Are any other symptoms present, such as lethargy or vomiting?
• Has he been exposed to other ferrets?

Your veterinarian will recommend specific diagnostic tests depending on the severity and duration of the diarrhea and if other symptoms are present. Ferrets that have other symptoms or have had chronic diarrhea (diarrhea lasting for days to weeks) or recurrent diarrhea may require extensive diagnostic testing. Any combination of the following may be recommended:

• A thorough physical examination
• Sampling the feces for bacterial culture and cytology to look at cell types for evidence of infection or inflammation
• Sampling of the feces to look for intestinal parasites
• A complete blood count (CBC). The number of circulating white blood cells may be helpful in distinguishing between infectious and non-infectious causes of diarrhea. The number of red blood cells may be diminished if bleeding in the intestinal tract is present or other concurrent problems exist.
• Serum biochemistry panel to look for evidence of metabolic problems, such as diseases of the liver, kidney or pancreas
• Radiography (X-Rays) to look for evidence of intestinal disease, tumors, size and density of the liver, kidneys or other organs
• Contrast radiographs (such as barium studies), to look for tumors or foreign bodies, ulcerations or thickening of the lining of the intestinal tract. This test will also determine how quickly ingested material is moved through the intestinal tract.
• Abdominal ultrasound to visualize the intestinal tract for evidence of intestinal wall thickening, gastrointestinal masses and foreign bodies. This is also useful in identifying tumors. A small sample may be obtained by using the ultrasound to guide a needle into any mass found in the abdomen. A specialist usually performs this test.
• Endoscopy for viewing the intestinal tract directly with a flexible endoscope to collect samples for biopsy or culture. A specialist usually performs this test.
• Exploratory laparotomy. Often, surgery must be performed to obtain segments of the intestinal tract for biopsy in order to determine the cause of diarrhea.

Therapy In-depth

Your veterinarian may recommend one or more of the diagnostic tests described above. In the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following treatments may be applicable to some, but not all, ferrets with diarrhea. These treatments may reduce the severity of symptoms, or provide relief for your ferret. However, nonspecific therapy is not a substitute for definite treatment of the underlying disease responsible for your ferret's condition.

Ferrets with moderate-to-severe diarrhea and other symptoms such as lethargy and anorexia usually require hospitalization and 24-hour care.

• Fluid therapy. Many ferrets with diarrhea become dehydrated and require fluids. Fluids may be given by an intravenous catheter or subcutaneously (under the skin). The route of administration will depend on how severe the level of dehydration is.
• Dietary change. Ferrets that are still willing to eat will often benefit from a diet that is easy to digest.
• Forced-feeding. Ferrets that refuse food may require forced-feeding of an easily digestible, high-protein food. Your veterinarian may pass a tube into the ferret's stomach to deliver food.
• Antibiotics or antiparasitic medications may be needed to treat or prevent an overgrowth of bacteria or parasites.
• Intestinal protectants such as sucralfate (Carafate®), cimetidine (Tagamet®) or pepto bismol.