Inflammatory Bowel Disease (IBD)
and
Chronic Diarrhea In Your Ferret

 

Why did my ferret develop this problem ?

Nothing seems to be helping ? Consider an all meat home-prepared diet similar to the ones prepared for cats

 

Ron Hines DVM PhD

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What Is Inflammatory Bowel Disease In Ferrets?

All living things have their weakest points. In ferrets, their digestive and endocrine systems are where problems usually occur. Inflammatory Bowel Disease (IBD) describes the most common illness of mid-life ferrets.

The less a problem is understood, the more names it is given - Inflammatory Bowel disease in your pet is also called Irritable Bowel Syndrome (IBD), Chronic Colitis, Wasting Disease, Proliferative colitis, and Proliferative Bowel Disease. Many cases that were once thought to be Epizootic Catarrhal Enteritis (ECE), Helicobacter infections and Aleutian Disease of Mink overlap with what we now think of as ferret IBD. So, as you can see, there is a lot of confusion when it comes to ferrets with loose poop.

Irritable Bowel Disease is not a specific problem with a single cause. It is a catch-all term that only describes the general symptoms that occur long-term or occasionally. Like a "headache" or a "stomach ache", there are many, many possible causes. Unfortunately, veterinarians have few ways to determine what the cause or causes may be in individual pets.

We do know that all causes have one thing in common, they make the lining of your pet’s intestines irritated. When your pet’s intestine is irritated, it becomes inflamed and slowly changes. It’s power to absorb nutrients decreases and the structure of the lining and intestinal wall changes. In many cases, this results in loose stools, intestinal ulceration, vomiting, weight loss and debility. The pet’s liver is closely associated with its digestive system – so inflammation there (hepatitis) sometimes results.

What Causes This Problem In Ferrets?

The short answer to that question is “a lot of things”.

I divided IBD into groups by their suspected causes. These groups are conjectured – that is, they are theories with little sold proof that any of them actually exist. Not much money is spent on ferret health research. Much of what veterinarians suspect is occurring in your ferret is taken from what they known occurs in other animals and people with chronic intestinal problems.

In the future, some theories will be proven to be true in ferrets, but others will be found not to exist at all.

Bacterial-Induced IBD

We know that a particular bacteria, Helicobacter mustelae, can be isolated from many ferrets that have inflammatory gastrointestinal problems. However, the bacteria are also present in many ferrets that appear perfectly healthy. Very few, if any, suppliers of pet ferrets keep their colonies free of this organism.

It appears that some other stress must be present to weaken the ferret before Helicobacter can cause gastrointestinal problems. When it does, the type of pathology seen is an invasion of the stomach lining with lymphocytes and plasmacytes, two defensive cells of the body. Ulceration of the stomach lining is also common.

The idea that Helicobacter is important in this condition is reinforced by the fact that many ferrets get better when they are given antibiotics. However, the known fact that the signs of IBD have natural peaks and valleys makes it hard to be sure if the pet actually improved because the antibiotic was give or would have improved anyway without it.

Tumors of the stomach have been found in ferrets that harbor Helicobacter. But a cause and effect relationship has not been established.

Some veterinarians de-emphasize the role of Helicobacter as a primary cause of chronic inflammatory bowel disease. The bacteria and the problem may be related – but the relationship is certainly not a simple one of cause and effect.

Another organism, Lawsonia intracellularis, was isolated in the mid 1980s from weanling ferrets with intestinal inflammation - and once from a pet ferret in 1989. Whether this organism is important in the clinical problems we see in our pet ferrets is unknown.

Viral-Associate IBD

Coronavirus have been associated with intestinal inflammation in ferrets. This form of the disease is called Epizootic Catarrhal Enteritis

When this virus is associated with intestinal disease, it has usually been in very young ferrets. We do not know if coronavirus plays any part in the chronic intestinal problems that are so common in mature animals. Some veterinarians and ferret fanciers see similarities between this condition and a coronavirus disease of cats called FIP. If this is true, a high blood globulin level in the ferret might be an indicator.

Rotavirus have also been implicated in similar disease in young ferret kits.

Immune-mediated IBD

Some forms of chronic diarrhea in humans are due to the immune system attacking the patient’s own body. Some veterinarians wonder if similar things might occur in ferrets. One fact that hints in this direction is that some ferrets improve when given prednisone, a drug that restricts parts of the body's immune process.

Food Sensitivity-induced IBD

Veterinarians know that chronic diarrheas occur in dogs and cats due to allergies and sensitivities to food ingredients. Just as some cases of IBD in ferrets improve with prednisone, others improve when the meat protein or starch sources in the pet’s diet are changed.

Idiopathic Chronic IBD

Idiopathic is a fancy way doctors say they do not know the cause. Chronic diarrhea can occur when the actual underlying problem is in some other organ or system of your pet’s body. It is not uncommon for pets with IBD to have other health problems such as lymphoma, pancreatic or adrenal gland disease. All these conditions can affect the intestinal tract in secondary ways.

Stress-induced IBD

Stress alone is capable of causing diarrhea in ferrets. Ferrets are less expressive than dogs, cats and people in showing overt signs when they are under stress. In that sense, they are more like wild animals - concealing stress and illness in an attempt not to get eaten. Stress has a direct influence on the intestinal motility and immune system of all animals. Things like excessive room temperature, overcrowding, excessive thirst or hunger and over-exertion all cause diarrhea in ferrets. If these stress occur chronically the problems will be chronic as well.

IBD Described By What Changes Pathologists See

Your ferret’s intestines have a limited number of ways they can respond to irritation and inflammation. But in some cases, pathologists notice an overabundance of one defensive cell more than another. The most common form of IBD, based on these cells, is lymphocytic/plasmacytic gastroenteritis. A second form, eosinophilic gastroenteritis is less common.

Coccidiosis

Ferret shelters have had outbreaks of diarrhea linked to an intestinal coccidian parasite, Eimeria furonis. Since these parasites are usually seen microscopically in stool specimens, your veterinarian will find them if they are present.
Coccidia tend to take advantage of young, stressed and crowded animals living in unsanitary conditions.

What Are The Signs Of IBD I Would See In My Ferret?

In many ferrets, softening of their stools occurs gradually – over months or years. When these changes first occur, they are easily overlooked by ferret owners. These pets gradually loose weigh and condition and some owners think they are just getting old.

Less frequently, the problem appears suddenly, with loose or bloody (tarry) stools, tender tummies, depressed mood, nausea and disinterest in their food.

When the problem has been present for a long time, the pets develop a washed out, debilitated look. Their hair coat lacks luster. They are bony. Lumps can be felt in their abdomen. These are their intestinal lymph nodes that have enlarged. Stools from these animals are poorly digested. They having a typical grainy, poppy seed-like appearance. The stools are often jelly-like in consistency. Stools usually increase in volume and frequency. The mucus content of these stools often increases as well. During an examination, I often notice that the pet’s rectum and anus are inflamed and protruding due to their frequent defecation.

The speed at which these changes occur and their severity varies greatly between pets. Some never develop the severest symptoms. In many pets, the symptoms come and go.

How Can My Veterinarian Be Sure This Is My Ferret’s Problem?
What Diagnostic Tests Will They Use?

The diagnosis of IBD is not difficult when the typical signs are present. But since IBD is a catch-all diagnosis, it does not tell your veterinarian how to proceed.

To tell the amount and type of disease that is occurring in your pet’s intestine requires a complicated intestinal biopsy.This is an intricate procedure that requires the use of an endoscope to retrieve tissue samples. Because of that, and its expense, it is not commonly done. When it is performed, it is because the diagnosis is unclear. The tissue samples that are collected can be studied through immunohistochemistry, traditional microscopic examination and tests that detect the presence of virus or bacteria. However, the precise diagnosis obtained this way does not often increase your pet's treatment options.

X-rays of your pet might should enlarged intestinal lymph nodes suggestive of IBD - but they are not diagnostic. Blood tests can hint at IBD but other health problems can give similar test results. Elevated serum lipase levels, serum globulin and serum ALT all sometimes occur in IBD, but they also occur in many other health conditions.

If your pet is young and your veterinarian suspects that coronavirus might be involved, the vet might collaborate with the Michigan State University group with that interest.

However, in the vast majority of cases, diagnosis of IBD is made because the ferret gets better when known IBD treatments work.

What Treatments Are Available For My Pet ?

Because there are so many poorly understood syndromes that could be responsible for your pet’s illness, most veterinarians proceed with treatments on many fronts. They will use lifestyle modifications and medications that have helped other of their patients in the past. Even when further tests are planned, most veterinarians begin treatment immediately.

Antibiotics

Many ferrets show marked improvement soon after being placed on oral ammoxicillin and metronidazole antibiotics.
Because neither of these medications are dangerous in correct dosage, they are included in almost all therapy plans. Even when the underlying problem is not bacterial, metronidazole seems able to lessen diarrhea. Perhaps this is through some unique property of the drug, perhaps it is by removing opportunistic bacteria and other pathogens that are secondary invaders taking advantage of your weakened pet.

Some veterinarians have had good success substituting Biaxin for ammoxicillin.

Protectants, Antacids And Antispasmodics

Medications that coat and soothe the lining of the stomach and intestine help in all forms of intestinal inflammation. The most common ones used are salicylate-free bismuth subsalicylate and sucralfate.

Medications that decrease stomach acidity can also be helpful. These are called H-2 antagonists (Tagamet, etc.) and Proton-pump inhibitors (Prilosec, etc.) Do not give these medications to your ferret other than as your veterinarian suggests them.

Antispasmodics are medications that decrease gastrointestinal motility. By relaxing these organs, they often lessen nausea, vomiting and diarrhea. They also have a number of side effects and should not be given other than on the advice of your veterinarian.

Prednisone

Prednisone is a corticosteroid hormone that decreases inflammation throughout the body. It can be helpful in decreasing the intestinal inflammation associated with IBD. It is not a cure and it has a number of unwanted side effects. Most can be controlled if the dose is tailored specifically to your pet and the drug is given only intermittently. In some animals, long term use of prednisone is the best option available.

There are many other similar compounds in the corticosteroid class that can also be used.

Bland Diet And Nutritional Support

Sick ferrets need to be tempted to eat and drink. Ferrets do not mobilize their body stores of energy well and must not fast for extended periods. Ferrets that vomit or have diarrhea become dehydrated rapidly and exhaust their body stores of fluid and electrolytes. So they need to be provide with electrolytes such as pedialyte when they are still drinking or with subcutaneous fluids when they are not.

If your ferret is tuning its nose up at its food or if it is simply loosing weight, Gerber’s chicken based baby foods often help. However, baby foods are not nutritionally adequate as a sole, long-term, diet for your ferret.

Some ferrets show marked improvement when they are put on a new diet. If the pet has been eating a beef-based food, it may do better on one that contains chicken or turkey. Specialty diets of this sort, produced for cats, work well in ferrets. Your veterinarian sells them. You can also make them. When you change your ferret's diet, do so gradually.

Added Vitamins

Because nutrients move through the intestine too fast in IBD, your pet may not get all the vitamins it needs from its diet. Complicating this issue are that changes in the lining of the pet's intestine may make it harder to absorb the vitamins that are there. Your pet may show added vitality, energy and coat luster if a pet or pediatric multivitamin supplement is added to its diet in proper amounts.

Anti-rejection Medications

These medications have the same inflammation-blocking abilities as prednisone. They are used when prednisone alone is not sufficient. However, the undesirable side effects of anti-rejection medications tend to be greater than those of prednisone. The most common drug in this group that is used to treat IBD in ferrets is Imuran (aziothioprine). Because it depresses the bone marrow’s ability to build blood, pets on this medication need to be closely monitored.

Rest And TLC

Ferrets, under the weather, need special care and pampering. Don’t play or exercise them more than they are willing. Protect them from your children, other pets and other ferrets. Give them their own special places and see to it that the temperature of their environment is neither too hot nor too cold. Monitor your pet’s rectal temperature. It should remain between 101.5 and 102.5F. Purchase a digital scale and keep a diary of it's weight.

Can IBD Be Permanently Cured?

Ferrets that develop IBD in maturity usually need special lifetime care.

With that special care and medications, flare-ups can usually be minimized - but never completely eliminated. Carefully monitor your pet’s food intake and weight and keep its life as stress-free as possible. With time, you will see flare-ups coming and know what will get your pet through them. Ferrets with this problem have lived a long time.

Can Recent Discoveries In Humans With Chronic Intestinal Inflammations Help My Ferret ?

Microbiota transplantation (FMT)

Perhaps.

Physicians are coming to realize that the vast number of micro organisms that naturally live in the large intestine have a tremendous influence on general health. Most ferrets with IBR or similar conditions have received antibiotics on various occasions. Those antibiotics invariably change the species of bacteria and other beneficial organisms (gut flora) that live in your pet's intestine. It is possible that those flora changes will not return to what they were prior to antibiotic therapy and that those changes might have a negative impact on your ferret's intestinal health. Your veterinarian may attempt to correct the problem with probiotic pastes. However, those pastes, at best, restore only a small fraction of the species that were lost. Their effect is minimal and short-lived. The best way to attempt to restore your pets bacterial flora is through a process called microbiota transplantation (FMT) , in which a complete, healthy bacterial population is transferred by high enema from a healthy ferret to your pet. This concept is a new one for most small animal veterinarians. These links will take you to two recent key articles on the subject ( link 1, link 2)

IBD is also the most common cause of persistent diarrhea in people. So considerable effort is being made to develop better medications to treat us. Some of those medications might be found to help our pets as well. Eluxadoline (VIBERZI™) is one of them. It was approved (in 2015) as an additional option in the treatment of human IBD. (ref) I do not know if it has been tried yet in ferrets. If you do, please let me know.