Chronic Vomiting in Dogs

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What Is Chronic Vomiting in Dogs?

Vomiting is one of the most common medical issues that affects dogs. It is technically defined as the forceful expulsion of stomach contents through the mouth.

Vomiting is composed of three stages: nausea, retching, and vomiting. While vomiting can serve a protective function to eliminate potential toxins in dogs, it is usually a sign that something is wrong with your pet.

Chronic vomiting refers to either continuous or intermittent vomiting for a period of at least 7 days. This is different from acute vomiting, or “regular” vomiting, which is a short-term problem. Sometimes a pet may vomit once, then return to normal and have no change in their energy or appetite. Chronic vomiting is a longer-term problem that may have different underlying causes. This can be a very frustrating condition to pet parents who are tired of cleaning up messes and are worried about their pet.

A single bout of vomiting that is not accompanied by any lethargy or decreased appetite in a dog who is having normal bowel movements may resolve after a short fast and with a bland diet.

If your dog is experiencing protracted vomiting (multiple bouts of vomiting) with lethargy and/or lack of appetite, it is considered a medical emergency.

Symptoms of Chronic Vomiting in Dogs

Vomiting is a clinical sign of an underlying problem or disease rather than a disease itself. Your dog may be experiencing chronic vomiting if they have vomiting episodes that occur for 7 or more days and/or repeated bouts of intermittent vomiting.

One of the first steps in determining whether your dog is experiencing chronic vomiting is to rule out regurgitating. Vomiting and regurgitating can look alike but are very different conditions.  In both cases, processed food, stomach acid, and water can come up from the stomach and out of the mouth. Vomiting is associated with signs of nausea including:

• Drooling, increased salivating

• Decreased appetite

• Lethargy

• Frequent swallowing

Vomiting is an active process and requires some contraction of the abdominal muscles to expel the stomach contents. You will often see your dogs' sides heave as they work to vomit. Retching is a part of the vomiting process. Your dog will make noise as they open the throat to allow the vomit to come up.

This is different from regurgitation, which is a passive process. When dogs regurgitate, they simply open their mouth and food and other stomach contents fall out. Regurgitation occurs right after a meal, whereas vomiting may be immediately after a meal or several hours later.

Causes of Chronic Vomiting in Dogs

There are many different possible causes of chronic vomiting in dogs. It is important to work with your veterinarian to determine which of the causes is more likely triggering chronic vomiting in your dog. The following is a list of some of the more frequent causes of chronic vomiting in dogs:

• Gastrointestinal sensitivity or intolerance, or “sensitive stomach”

• Food allergy 

• Frequent diet changes

• Stress

• Bilious Vomiting Syndrome

• Dietary indiscretions (i.e., repeatedly getting into the garbage)

• Gastric foreign bodies

• Parasites

• Toxins

• Infectious disease or underlying infection i.e.. an infection of the uterus (Pyometra)

• Underlying systemic diseases i.e. kidney, pancreatic, liver disease, or cancer

• Medication side effect

• Addison’s (a disease of the adrenal gland) or other endocrine disease like diabetic ketosis

• Stenotic pylorus

• Inflammatory Bowel Disease (IBD)

• Gastric ulcers

Younger dogs are more likely to experience gastrointestinal foreign bodies, parasites, and to have dietary indiscretions. Certain underlying genetic conditions like a stenotic pylorus or food allergy may be diagnosed in a dog’s early years. It is not uncommon however, for food allergies or intolerance to develop with time rather than be present at birth. Senior dogs are more commonly affected by systemic diseases like kidney disease and cancer.

How Veterinarians Diagnose Chronic Vomiting in Dogs

When a dog experiences chronic vomiting, a veterinarian will start with getting a thorough history. It is important to note any patterns seen at home (i.e.: Is vomiting more frequently observed at a certain time of day or after a meal?) Try to be as complete as possible and share any observations you’ve made regarding when the episodes occur and any other behaviors. Other helpful insights include type and brand of food, dog’s energy level and appetite, frequency of bowel movement, and what stool looks like. Stool samples are recommended.

During the physical exam, your veterinarian will likely palpate your dog’s abdomen for any abnormalities and check over their entire body for possibly correlated issues. The next step is to pursue diagnostics. A fecal exam, x-rays, or blood work will likely be recommended. If these first-line tests do not provide any answers, your veterinarian may recommend advanced diagnostics like abdominal ultrasonography, endoscopy, CT, or an exploratory surgery and biopsies.

Treatment of Chronic Vomiting in Dogs

Treatment varies dramatically, depending on the underlying problem. Sometimes diet therapy alone can manage chronic vomiting conditions. There are several prescription diets that are formulated specifically to manage dogs with sensitive GI tracts that benefit from prebiotics and highly digestible fiber-rich diets, like Hill’s Gastrointestinal Biome or Royal Canin Gastrointestinal High Fiber diet.

Other diets are made to address food allergies, either with alternate protein sources, like egg or kangaroo, or by using hydrolyzed protein that has been broken down into small pieces to avoid triggering an allergic response. If your veterinarian prescribes a prescription diet for your dog, be sure to feed that food exclusively for 8-12 weeks. Do not give unapproved treats that may affect results of the diet trial. You won’t be able to tell if a diet trial is working if your dog is receiving additional food.

Oral medications may be necessary to manage chronic vomiting. Parasites and other infectious diseases are usually managed with oral meds like dewormers or antibiotics. Ulcers may also be treated with medicines given by mouth that protect the lining of the GI tract. Bilious vomiting syndrome, where dogs vomit first thing in the morning, may be managed with over-the-counter antacids, or with lifestyle changes. Sometimes management may be as simple as feeding a late-night snack so that your dog’s stomach is not empty for a long period of time.

Chronic kidney disease is a common cause of chronic vomiting in senior small breed dogs. It is often accompanied by increased drinking, peeing, and weight loss. Prescription diet food can dramatically increase a dog’s quality of life by reducing the workload of the kidneys, hence slowing the progression of the disease process. Other systemic underlying diseases like pancreatitis, liver disease, and diabetes may also benefit from nutritional prescription diets that are specially formulated to spare that organ system and avoid flare-ups of clinical disease.

Certain diagnoses require surgical intervention, like gastric foreign bodies. Gastric foreign bodies are non-food items eaten by a dog. This may be a ball, sock, or pieces of a toy or bedding. Surgery may be considered to explore the gastrointestinal tract to look for any problems that may be causing the chronic vomiting.

There are many things that a dog can eat that do not show up on x-rays. Sometimes these items may be stuck in the stomach and occasionally obstruct the outflow tract to the intestines, leading to bouts of vomiting. These items can be found on exploratory surgery. Even if an exploratory surgery does not yield any foreign body, biopsies can be taken to look for signs of underlying gastric or intestinal disease.

Recovery and Management of Chronic Vomiting in Dogs

Recovery from chronic vomiting varies, depending on the diagnosis. If the problem is managed with nutrition alone, then management requires due diligence to make sure your dog follows a strict prescribed diet. Talk to your veterinarian about which treats are acceptable, if any.

If your dog’s vomiting was related to parasites, treatment may be curative. It’s important to keep your dog on a quality preventative product monthly to avoid reinfection. Many of the heartworm prevention products on the market today also prevent the most popular gastrointestinal parasites as well. Talk to your veterinarian about which product is recommended for your dog.

Underlying systemic diseases may be managed with chronic oral medications or lifestyle changes. Follow the instructions set by your veterinarian and be sure to check in regularly with recheck visits to monitor your dog’s response to treatment and make any necessary adjustments.

If surgery was required to treat your dog’s chronic vomiting due to an underlying foreign body or stenotic pylorus that was treated surgically, be sure to keep your pet calm and quiet in the postoperative two-week period while they are healing from surgery. Prevent any running, jumping, stairs, or other activities that put undue stress and tension on their healing incision. Your veterinarian may send your dog home with a prescription bland diet and oral medications after surgery. Give all prescribed medicines until they are gone and closely monitor all intake and output during the recovery period. Leash walking is often recommended so that all bowel movements can be observed after surgery. If at any time after surgery your dog becomes lethargic, won’t eat, or has continued vomiting, contact your veterinarian immediately.

Prevention of Chronic Vomiting in Dogs

While some causes of chronic vomiting can be prevented — such as parasites, toxins, and dietary indiscretions — others are more likely due to genetics and cannot be avoided, only managed. Be sure your dog is being given all recommended regular parasite prevention products and minimize exposure to toxins and other temptations.

If your dog likes to get in the trash, try getting a trash can with a lid and keeping it in a room behind closed doors. Avoid letting your dog mouth non-food items or chew on bones or toys without direct supervision. Feed a quality balanced diet and avoid frequent diet changes that can upset your dog's stomach. Your veterinarian is the best person to discuss your dog’s optimal nutrition with. They may refer you to a board-certified veterinary nutritionist if a homemade diet is recommended for a diet trial.

While a single intermittent episode of vomiting may be something that can wait, it is important to get your dog in to see an emergency veterinarian if they are not able to keep any food or water down. With gastrointestinal foreign bodies, especially if they have moved into the intestines, time is critical.

If your dog occasionally vomits but otherwise is bright, energetic and keeps most meals down, this may be a situation where you can wait and schedule an appointment with your veterinarian.  Remember, vomiting is a sign that something is wrong and should be investigated. However, if your dog is only having intermittent bouts of vomiting, it may be addressed during office hours for a full work-up with your veterinarian.