As any dog owner will tell you, upset stomachs are part and parcel of owning a canine. Whether they have picked up the latest tummy bug from the park or eaten something unspeakable, dogs are rather prone to having the odd digestive upset. On occasion, however, there is something more going on inside our pets than we can see, and symptoms that can at first seem to be typical of a stomach bug, may in fact be signs of something much more serious. Such is the case with intussusception. Early symptoms can mimic a simple tummy upset with vomiting and diarrhoea but, as the condition worsens, the dog becomes very ill and urgent veterinary care is required. Knowing the signs of an intussusception - a condition that is uncommon, but fatal if not treated - can be the key to saving a pet's life.
What is Intussusception?
An intussusception is created when one piece of the intestine telescopes, or slides, into itself creating a fold in the bowel. The initial occurrence may not cause any symptoms, the bowel may even slide in and out of itself, causing periods of pain without any long-term illness. However, as the condition progresses the affected portion of the bowel becomes increasingly inflamed and the fold prevents material moving through the bowel. Waste matter and fluid will collect behind the fold and cause the intestine to bulge. An affected dog will now become depressed, can show signs of pain, and will have vomiting and diarrhoea.
An intussusception can occur at any point in the intestine, but is most commonly seen in the middle of the small intestine or at the point where the large intestine (colon) joins with the small. Intussusceptions usually follow the direction of normal peristalsis (the direction waste flows through the bowel), but very occasionally it is found to have occurred in reverse, or against normal peristalsis. Whichever way it occurs, it is a life threatening condition requiring urgent treatment.
Dogs of any age can suffer an intussusception, but it is most often seen in puppies and is sometimes associated with a heavy worm infestation. Many animals can suffer from the condition, including cats, horses and even humans.
What causes Intussusception?
Despite a range of theories being postulated, veterinary medicine has yet to discover what causes intussusception in dogs, though it is believed that hypermotility of the bowel (when food and waste is being pushed through the bowel too fast) can be a significant factor. Some intussusceptions may be caused when a segment of bowel that is hypermotile is next to a segment that has a lack of motility, causing the hypermotile segment to telescope into the segment lacking motility. However, hypermotility is, in itself, often a symptom of another underlying problem.
Other conditions that are considered possible triggers for intussusception include heavy infestations of intestinal parasites, gastroenteritis or similar bacterial or viral infections (parvovirus, canine distemper, salmonella, etc), foreign objects in the bowel (swallowed toys, bits of bone, etc), abrupt diet changes, intestinal tumours, or recent surgery to the abdominal region.
An article published in the Canadian Veterinary Journal (Vol 33, October 1992) reported the findings of a small study that had attempted to identify the most common cause of intussusception in dogs. Twenty-seven dogs which had suffered from the condition between 1981 and 1987 had their cases examined. While the findings showed that most dogs suffering from the condition were under a year old, there was no consensus on the apparent causes of the condition. Seven dogs had intestinal parasites, while six dogs had recently had surgery which may have triggered the intussusception. A further three dogs had parvovirus, but it was not thought this had caused the intussusception. The study had to conclude that no common predisposing condition could be found to explain why some dogs developed intussusception, rather there were multiple triggers for the condition, and in many cases the cause of the problem was never identified.
Symptoms of Intussusception
Symptoms of an intussusception vary depending on where the problem has occurred in the bowel, but commonly a dog will develop diarrhoea, vomiting, anorexia (lack of appetite), unexplained weight loss (when not showing signs of anorexia) and may seem depressed or lethargic. The study of 27 dogs published in 1992 cited above (see here) found that only 3 dogs showed signs of abdominal pain when examined.
Symptoms initially mimic a stomach upset but can rapidly become severe. Bloody diarrhoea and frequent vomiting are often reported, and the dog can quickly become dehydrated. The vomiting can become so severe that even anti-nausea medications can prove ineffective.
A vet may be able to feel a cylindrical mass in the intestine when examining the dog, if not an ultrasound may be performed to identify where the problem lies. A vet may also give the dog a barium meal to create a contrast effect on an x-ray, highlighting where the obstruction is occurring. Normal x-rays do not always show up an intussusception, but can be used to rule out other possible causes, such as a foreign object in the bowel. Due to the rarity of the condition, it is often only identified after other more common gastric issues are first ruled out.
How is Intussusception treated?
Intussusception is not a condition that normally goes away without treatment, and it usually requires surgical intervention, though in some cases the intestine can be helped to release itself by manual manipulation of the bowel through the abdomen wall. More commonly the vet will have to open the abdomen and perform a surgical reduction of the intussusception.
When a dog is diagnosed with intussusception it is usually already dehydrated from vomiting and diarrhoea. A vet will usually attempt to re-hydrate the dog using an intravenous drip, before performing surgery. However, time is of the essence with an intussusception, and surgery will be performed as soon as possible.
In the best case scenario the intussusception will be fairly recent and the affected bowel will still be healthy. The vet will attempt to slip the telescoped segment of bowel out, and may place small holding stitches to prevent the intussusception from reoccurring. If the condition has been ongoing for some time without treatment, then the affected bowel may have died and become necrotic. The only option when this occurs is to remove the entire affected piece of bowel and stitch the remaining healthy segments together. This is a far more invasive option than the first, and carries a higher risk of post-surgical complications. The bowel contains a lot of bacteria which, when released by opening the bowel during surgery, can lead to infection. This makes it important that intussusceptions are caught early before the bowel begins to die.
As soon as the intussusception is corrected a dog will likely showed marked signs of feeling better. The vet will want to keep them in for another 24-48 hours (longer in severe cases) to assess how the dog is eating and to ensure the bowel is working again. They will be on small, regular meals to give the digestive system a chance to settle and this may continue when sent home. Antibiotics are usually given as a precaution against infection.Exercise will be heavily restricted until the stitches from the dog's surgery can be removed, then the pet should be able to return to a normal routine.
Recovery depends greatly on how long the intussusception was left untreated, whether there were underlying conditions that caused the problem (ie.cancer), and whether a portion of the bowel had to be removed. Post-surgical infections, the age and general health of the dog are also factors in recovery. A previously healthy dog that was diagnosed early has a good chance of making a full recovery, especially if it was not required to remove any portion of the bowel.
Intussusceptions can reoccur. The American College of Veterinary Surgeons states in its article on the subject that between 11% and 20% of dogs will suffer a recurrence, and this may increase to 25% if the dog had a manual reduction not involving surgery [source not stated by the ACVS]. However studies vary widely on the subject with some putting the rate of recurrence as low as 6% or as high as 27% [as stated in the 2003 version of the Textbook of Small Animal Surgery, see sources listed below]. The 1980s study of 27 dogs reported in the Canadian Veterinary Journal found that 22% of dogs which had a manual reduction suffered a recurrence, but only 14-16% of dogs that had surgery. Recurrence usually happens within the first 3 days after surgery, though it can occur as much as three weeks later.
Table of results from 1978 study identifying causes of bowel obstruction
|Cause of Obstruction||Number of cases||Percentage out of total cases|
Pieces of metal
Preventing Intussusception in Dogs
The first thought on a pet owner's mind once their dog has recovered from an intussusception is how to prevent it from occurring again. With only limited studies conducted on what causes intussusception, finding ways to prevent it is challenging, but there are certain precautions which are thought to reduce the risk.
- Treat dogs regularly for worms and other parasites. In young puppies especially, heavy infestations of worms are thought to be a trigger for intussusception.
- Prevent dogs that like to chew from destroying and swallowing items. Foreign objects in the digestive tract can cause an intussusception.
- Keep vaccinations up to date or titer test. Deadly canine diseases such as parvovirus can inflame the bowels and risk an intussusception. Regular vaccinating or ensuring via titer testing that a dog has immunity to the conditions can be a life-saver.
- Maintain digestive health. In humans intussusception has been linked to conditions such as inflammatory bowel disease, which can affect the motility of the intestine. Keeping a dog's digestive system healthy by feeding a good quality food reduces the risks.
- Feed two or three meals a day. Feeding a dog a large meal once a day can cause the digestive system to go into overdrive, potentially causing hypermotility of the bowel. In dogs that have suffered an intussusception, smaller, regular meals may help keep the digestion running smoothly.
- Do not exercise before or after a meal. If you run on a full stomach you are likely to get indigestion, the same applies to dogs. Equally a dog that is panting hard from exercise will be likely to swallow a lot of air when eating. It is best not to exercise any dog either an hour before or for an hour after they have eaten.
- Avoid carbohydrates. There is anecdotal evidence to suggest carbohydrates can cause gastric torsion, or bloat, and may also be linked to intussusception. Dogs digest carbs slowly, meaning high-carb food takes a long time to pass through the bowel, and slow digestion has been suggested as another factor for intussusception.
- Give supplements. Canine probiotics and natural products such as Manuka Honey are thought to have a beneficial impact on the bowel. They may help to improve digestion and keep the intestines healthy.
Case Study: Sparrow's Story
Within the span of a few hours Sparrow the working cocker spaniel went from a vibrant, happy pup, to a dog fighting for her life. It was a pleasant summer day in July 2015 when Sparrow began to show symptoms of a stomach upset. At first it seemed the 15-month-old was suffering from a bug picked up in the park, but when she began to vomit every 20 minutes and became increasingly depressed, it was clear something was seriously wrong. By the early afternoon she was at the vet's being given anti-nausea medications, but while she stopped being sick, she began to drool uncontrollably. At 5pm she was back at the vet's being admitted and placed on a drip overnight.
With no improvement overnight, thoughts began to turn to possible causes other than a bad stomach bug. X-rays showed no signs of an obstruction, but by now Sparrow was gravely ill. She was so depressed and lethargic she did not even need to be sedated for an x-ray, she merely laid on the table. Concerns were growing, but the cause of the problem remained a mystery.
Then the vet in charge of Sparrow's case decided to try an ultrasound scan. Around teatime on the second day of Sparrow being ill the ultrasound was performed and 'something' appeared on the image. The vet now thought Sparrow was struggling with the rare condition of intussusception and sought permission for emergency surgery. At 7pm Sparrow was in the operating theatre. An hour later she was coming round and wanting to eat. The change was almost instant once the intussusception was diagnosed and resolved.
Two days later Sparrow was home having a tablespoon of food every two hours and being carefully monitored. Just before and during her illness Sparrow had lost 1.5kg, now she rapidly began regaining lost condition. Over the next ten days she returned to being the mad, naughty and energetic spaniel she was meant to be. Several weeks on Sparrow is fully recovered, and while the shadow of intussusception will always be a fear in the back of her owner's mind, it looks likely she will live a long and healthy life.
A Note on Sources
Due to being a relatively rare condition, there is limited scientific material available in the public domain concerning intussusception. Much that is available focuses on specific case studies examining one dog, often with an unusual form of what is already an uncommon condition. Statistical studies into causes, frequency and recovery rates for intussusception are few and far between. When those studies are available, they often are based on a very small sample of dogs.
When composing this article I chose to cite work that was freely available in the public domain, so that readers could refer to it directly for their own reference, rather than use material from subscription based libraries which could not be easily accessed. The two main studies cited are old, but their findings have not been contradicted by more recent research. In fact, there is a surprising lack of modern research on the subject. If anyone knows of a modern general study on intussusception of dogs that is available in the public domain, I would be glad to include it in this article.
Intussusception in Dogs and Cats: A review of 36 cases (Lyndell Levitt & Michael S. Baur) The Canadian Veterinary Journal (Vol 33) October 1992
Clinical Cases of Intestinal Obstruction with Foreign Bodies and Intussusception in Dogs (Toshio Koike, Kanjuro Otomo, Tadaaki Kudo & Tamotsu Sakai) Japanese Journal of Veterinary Research 1981
Intussusception American College of Veterinary Surgeons
Textbook of Small Animal Surgery, Volume 1 (Edited by Douglas H. Slatter) Saunders 2003
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Sophie Jackson (author) from England on September 15, 2015:
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