Don't panic! Just as with people, healthy cats can suffer an “upset stomach” from time-to-time. We may not know the cause, and it doesn’t necessarily mean a trip to the vet is in order. After all, we don’t always run to the doctor immediately if we or one of our children has a bout of diarrhea. The key is to observe your cat’s behavior both in and out of the litter box. This is at the heart of the distinction between heading to the vet now and taking steps at home to help your kitty get over this quickly. Where do I start? When do I take care of this at home? How do I know if I need to take my cat to see the vet? Read on! For Starters.... Put the pumpkin away. Don’t reach for the rice. Head to a health food store, vitamin shop, Whole Foods, pharmacy or chemist and purchase a probiotic called Saccharomyces boulardii, “S boulardii.” It’s OK – even better – if it has L acidophilus, Bifidobacterium, or other bacterial strains of probiotic in it. It is usually sold without other probiotics as 5 billion CFU or 250mg capsules. This is perfect. We’ll tell you how to use it. Pick up some chicken breast (if kitty has a chicken sensitivity or allergy, buy turkey breast or pork loin instead). Check the sodium level to make sure the meat isn’t “enhanced” (soaked in a salt solution). If the meat has less than 100mg of sodium per 4oz serving, it is safe to feed your cat. (This is typically a problem only in the U.S.). We’ll explain how to use this after we discuss when it is safe to care for kitty at home and when you need to get your cat to the vet.
First, let’s talk about poop. Acute Diarrhea vs. Chronic Diarrhea vs. Soft Stools Acute diarrhea is the abrupt onset of frequent loose or watery stools, more often than normal. Think stomach cramps and lots of trips to the bathroom. It is the body’s method of removing something it wants to be rid of. The most common causes are medicines, a sudden food change, eating something they shouldn’t have, eating too much, a virus, parasites, vaccinations, and stress and/or anxiety. It comes on and lasts for one to three days on average. Acute diarrhea is usually a large bowel problem, and kitty goes to the litter box frequently but may not pass much stool at each visit. There may be fresh blood or mucous in the stool. Chronic diarrhea is usually either a symptom of a medical condition, or due to an irritant to which kitty is constantly or frequently exposed. Poor quality food, grains, poor quality fats, too much fat, food allergies/sensitivities, untreated parasites, gut dysbiosis, inflammatory bowel disease, small intestinal bacterial overgrowth, hyperthyroid, exocrine pancreatic insufficiency (EPI), liver or kidney disease, etc. are often at the root of chronic diarrhea. Chronic diarrhea does not come-and-go (though if your cat has frequent recurring bouts of soft stool or watery stool, that may be an indication of an underlying problem). Chronic diarrhea is usually associated with the small intestine, where poop volume is normal to more-than-usual, and frequency is normal to slightly increased. There is not usually mucous in the poop. Soft stool is not diarrhea. We may never know what caused it, but it is not at all unusual for a cat, on occasion, to have a bowel movement that isn’t normal. The primary difference is kitty is not in the box frequently. It’s just a “not normal” stool texture/consistency being passed when your cat goes to the bathroom. It often only lasts for one or two bowel movements, unless a food change has caused it. Extremely watery stool with straining can be an indication of impacted feces or some type of obstruction in the bowel that only liquid can get around. The straining may cause vomiting. If the problem is due to impacted feces, the issue is actually constipation and the condition is called obstipation. Whatever the cause of the obstruction, a vet visit is required. X-rays are needed to rule obstruction (whether an ingested foreign object, a stuck hairball, or a growth in the intestines) in-or-out, and if the problem is impacted feces, kitty most likely needs an enema. What about Mucus and Blood? Seeing blood in or on your cat’s stool is distressing for anyone. But fresh blood and/or mucous due to irritation is not unusual. Mucus has a jelly-like quality and its function is to coat and protect our gastrointestinal tract from mouth to … the other end. Mucus coats the lining, providing lubrication and protection to the underlying tissues. An immune response can cause inflammation, and the body produces excess mucus to help protect and heal. Lining disruption due to inflammation can also, at times, lead to little burst vessels that cause some fresh blood to be present in or on stool. Slippery elm bark powder should be used when there is blood/and or mucus in the stool. See below for instructions. 
Do I Need to Run to the Vet? That is based on the age, prior health status, and behavior of your pet. Diarrhea in the young, the old, and those whose health is already compromised are at high risk for experiencing complications from diarrhea. Diarrhea can quickly cause dehydration for these cats, putting them in serious danger. Do not attempt to care for them at home without vet guidance. If you have an adult cat otherwise in good health (or with known chronic illness under management), you may just need to take a few steps to help the diarrhea resolve in a few days or less. In ANY cat, head to the vet if:
Your kitty’s eating and behavior patterns are very important. If your cat has diarrhea or soft stool, even if there is a little blood or mucus present, but your cat is otherwise behaving basically normally (though maybe her appetite is a little off), this isn’t an emergency and you can take steps to manage the problem at home. Lethargy or weakness should be considered an emergency. The Importance of Proper Hydration Dehydration is the condition diarrhea can cause that makes it potentially life threatening. To check for dehydration, gently pull up on the skin at the back of the neck between the shoulder blades. When released after “tenting” that loose skin a bit, it should pop back into place quickly. If the skin droops back into place slowly, kitty is dehydrated and you should get to the vet quickly, as severe dehydration can be life-threatening. To prevent dehydration:
Managing the Diarrhea Food First, remove ALL regular food and feed a bland diet. Do NOT feed your kitty her normal food. With the diarrhea, the food is just rushing through her not providing much in the way of nutrition anyway. The bland diet removes any possible dietary sources of upset, and is very easy for your cat to digest. Use the (unenhanced) chicken or turkey breast or pork loin (trimmed of excess fat) to make a bland, simple, low-fat food. Poach the meat in enough water to cook the meat and make a bit of broth. When cooked, either shred the meat, cut or chop it finely, or put it in a food processor or blender with the water used to poach it. Do not include rice. Many vets recommend a “bland diet” of chicken and rice. Rice can ferment in the GI tract, create gas, and make the diarrhea worse. No Pumpkin? No. While fiber can slow down transit time which helps kitty obtain nutrition and hydration in the face of diarrhea, slippery elm bark powder is a better choice, discussed below. Feed this plain bland food to your pet in small amounts, 4 to 8 times a day, depending on how much they’ll eat at a time. You can feed this unbalanced, plain food for the few days it should take the diarrhea to subside/resolve. In addition to the bland diet of just poached meat and broth, the next, most important – in fact, critical – aspect of addressing your kitty’s diarrhea is giving your kitty one of the most studied probiotics in the world, Saccharomyces boulardii.
The Probiotic – S boulardii S boulardii, a yeast (in fact, a close cousin to brewer’s yeast with vastly different properties) is a time-tested and proven probiotic strain with many supporting studies including clinical trials indicating its efficacy in the treatment of intestinal infections, the maintenance of inflammatory bowel disease, and the resolution of diarrhea from just about any cause. It is indicated for use with “Travelers Diarrhea,” where e coli, shigella and salmonella account for about 80% of acute diarrhea. (Zanello 2009). It is safe for use in children – and pets. Research published in the past decade has explored and discovered its direct anti-inflammatory and immuno-modulatory activities as well. Please see Saccharomyces Boulardii: Scientific Studies in GI Disease. The many studies of S boulardii indicate it is a very effective anti-diarrheal, and its use “decreases significantly the duration and frequency of diarrhea.” (Zanello 2009). It has been used in the treatment of antibiotic-resistant clostridium difficile infections in cats at U.C. Davis. Clearly the benefits of S boulardii in humans applies equally to cats. This should come as no surprise, as one of the lead researchers in the cat microbiome, Dr. Jan Suchodolski of Texas A&M, indicates “pet specific” probiotics are unnecessary – in fact, the use of researched strains is important as probiotics confer benefit across mammalian species. How does it work? Very simply, S boulardii is not digested or metabolized: it is not absorbed in the gut. It does not act systemically. S boulardii acts locally in the lumen of the intestines. During its passage through the intestines, it mimics the physiological effects of the digestive flora, stimulating healthy immune response, reducing inflammation, and promoting restoration and growth of healthy normal gut flora. “During the intestinal transit, S boulardii interacts with resident microflora and intestinal mucosa. Moreover, experimental studies displayed that S boulardii induces a protection against enteric pathogens, modulates the host immune response, decreases inflammation and hydroelectrolytic secretions, inhibits bacterial toxins, and enhances trophic factors such as brush border membrane enzymes and nutrient transporters.” (Zanello 2009). Thus S boulardii, unlike bacterial probiotics, does not colonize the gut. With dosages discussed in published studies, S boulardii takes about three days to achieve “steady-state” concentrations. When administration is stopped, the yeast is cleared from the colon in about 36 hours. Thus the use discussed here for “emergency treatment” of diarrhea is designed to literally flush the system with S boulardii, enabling it to get to work faster than with twice-a-day dosing. “Emergency Stop Diarrhea” S boulardii Administration for Cats with Severe Diarrhea Probiotics are typically sold in measures of “CFU.” CFU = colony forming units. S boulardii is the exception, it is often sold in mg. Note that 250mg of S boulardii is the same dose as 5 billion CFU. Traditional dosing for therapeutic treatment of diarrhea in adult cats as provided by U.C. Davis is one-half of a 250mg capsule (5 billion CFU) given twice daily. Treatment for kittens is half of the adult dose. It can be given with food; it does not have to be. This is usually sufficient for loose stools of normal frequency. For the “emergency stop diarrhea” approach, we find more frequent dosing of smaller amounts of the probiotic, providing a higher total CFU the first day or two, resolves diarrhea much more quickly. For adult cats (defined here as 9 months of age and older): Give one-quarter of the 250mg / 5 billion CFU capsule every two hours or so. Many cats accept it when mixed into finely ground poached chicken breast / turkey breast / pork loin or meat-only baby food. (Beech Nut, Goya, and Gerber list “meat” and broth or gravy as ingredients. These are fine, they are referring to the water used to cook the meat, and they contain no spices). If your cat does not like the taste of the probiotic, you can syringe after mixing with water. If you are not experienced syringing liquids into your cat, you can use empty #3 gel capsules. Simply fill 10 to 20 of these by transferring the S boulardii from the larger capsules into the smaller ones. These are a size easy to pill your cat. Pill your cat with one #3 capsule filled with S boulardii every two hours or so. For pilling instructions, see How to Pill (Your Cat). This frequent dosing method usually stops diarrhea within 24 – 48 hours, other than when diarrhea is caused by another disease that requires treatment (low B12, exocrine pancreatic insufficiency, hyperthyroidism, as examples). This “loading dose” can be continued for longer if necessary, up to three to four days – but if you do not see substantial improvement in the diarrhea on day 3, it is best to follow-up with your veterinarian. It is NOT necessary to use this approach, it can be given at “therapeutic” doses as discussed above twice a day (and doubled if you see improvement in stool but diarrhea or soft cow patty stools have not resolved). When the diarrhea has substantially resolved with use of the emergency stop treatment protocol, begin use of S. boulardii at the therapeutic dose level (2.5 billion CFU twice daily) and continue for at least one week. If stools soften, resume use of S. boulardii at the therapeutic dose as needed. Given its role in improving performance of bacterial probiotics and its anti-inflammatory properties, the use of S boulardii at maintenance levels (anywhere from 500 million CFU to a total of 2.5 billion CFU daily) can be continued indefinitely along with a bacterial probiotic. It confers many health and GI protective benefits, and we use it along with bacterial strains in all of our cats, all the time. For kittens under nine months old, follow the same instructions as for adults, just use half the amount. Please Note: If diarrhea becomes worse with S boulardii administration, stop use immediately. There can be several reasons for this reaction, however. We have seen cats do poorly with a brand of S boulardii that contains lactose, and switching to a brand like Jarrow without it, the product works quite well. This is most common. We have also seen what is most likely bacterial die-off with the S boulardii. Again, stop administration for 24 hours, and reintroduce it (while continuing to feed the bland diet) slowly. Do not follow the "emergency stop diarrhea" instructions. Use it just twice a day, but at 1/4 of the recommended amount the first day, and 1/2 the recommended amount the second day if kitty did not react to the lower dose. If you do not begin to see improvement even with this slower method of introduction, stop the S boulardii, best to see the vet. 
Brands of S boulardii:
In the U.S. Jarrow is one of the most widely available. It is combined with MOS (mannanoligosaccharides) which improve its efficacy. Florastor is available in many large chain stores, but it contains lactose, which may exacerbate diarrhea in some cats due to the common lactose intolerance. 
Walmart has a store brand very similar to Florastor, called Equate but without the lactose. Renew Life, carried by most Whole Foods stores, has two S boulardii products, one with larch arabinogalactan. Buy the one WITHOUT this ingredient. There are many brands of S boulardii available online: anything with just plan S boulardii in capsules of 3 billion CFU to 5 billion CFU will do.
You can click on the pictures to purchase the probiotics from amazon U.S. In the U.K. and some other countries in Europe, Bioglan is widely available. This contains S boulardii and several bacterial probiotics. The capsules contain 2.5 billion CFU of S boulardii. If you are using Bioglan, be aware that you need to provide twice the dose if following instructions for giving 5 billion CFU capsules. In Australia, Candex is the name of the S boulardii product widely available. This contains lactose. Even if you need to see your vet, and your cat is put on antibiotics, S boulardii is a wonderful probiotic to administer to your cat as it also helps prevent antibiotic-associated diarrhea. As yeast, not a bacteria, antibiotics do not kill it, and it remains effective. 
Slippery Elm Bark Powder (“SEB”) While the S boulardii alone will likely resolve the diarrhea in your cat, if kitty is in discomfort, if there is some blood and/or mucus in the stool, or if kitty is nauseous, slippery elm should be given to your kitty along with the plain diet and S boulardii. The can be given concurrently. SEB both manages nausea and is very soothing and healing to the entire GI tract. This also details why we prefer using slippery elm bark powder over pumpkin when managing diarrhea in our cats. As discussed at Dr. Jean Hofve’s LittleBigCat and in a 2011 review piece, Appalachian Plant Monographs: Ulmus rubra, slippery elm bark powder contains many healing properties:
In fact, slippery elm doesn’t just help restore normal intestinal function, it reduces inflammation, controls nausea, heals ulcers and gastric lesions, acts as a prebiotic to help manage gut dysbiosis, and it triggers stimulation of nerve endings in the GI tract, which promotes increased mucus secretion to protect and heal the underlying tissues. It lubricates, soothes, and heals, making kitty feel better. 
Slippery elm bark powder directions: mix one-quarter teaspoon of loose powder with one-half teaspoon water. Stir until all the powder is mixed with the water. Let it sit for a minute or so. You will see it becomes thick and gelatinous. You can add this to kitty’s plain meat and broth if she’s eating when you are using it to treat diarrhea. If she’s a bit nauseous or inappetent, give it to her about half an hour before a meal, just swipe a little bit at a time into her mouth with your finger (allow her to swallow before swiping in a bit more to get it all (or most of it) into her). You can also add a bit more water as necessary in order to use a food syringe to gently assist-feed your kitty the slippery elm bark/water mixture. During a bout of diarrhea, you can use this mixture three times a day.
Please note, the gelatinous mixture can slow the absorption of any drugs your kitty may be taking. Please separate administration of slippery elm bark powder and any medications by two hours.
Summary
Most cats will experience the infrequent bout of diarrhea, often with no identified cause. This is not unusual, and can usually be treated at home. Because the antibiotic most often prescribed for general “diarrhea” in cats (Flagyl, generic metronidazole) is toxic to their systems, using the bland diet, Saccharomyces boulardii (and if you feel a fiber is needed, or if there is some blood and/or mucus present in the diarrhea or kitty is nauseous, then also including slippery elm bark powder) is a gentle, safe, non-toxic, yet generally very effective approach. Given its roles in managing GI inflammation and immune modulation, we encourage you to give S boulardii to your cat along with an L acidophilus- based bacterial probiotic to help maintain a healthy GI tract on a daily basis. At Food Fur Life, we consider daily probiotic administration an important aspect of cat health. And if you are not feeding your cat fresh, minimally processed food, please read up on the benefits, and consider transitioning your kitty to homemade food. Of course, making your own with EZcomplete fur Cats is … easy! 
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