Faecal incontinemce, IBD.

I’m waiting on an appointment for a second opinion at the moment but I’m so so grateful for any advice or input you may have- My cat pablo, male castrated ,Siamese - 2 in may has been suffering from bouts of diarrhoea, gas and bloated stomach for a few months. He saw one vet who said it’s likely IBD and after some steroids he got better. He’s had a couple of these flares and the steroids have helped each time. However, since feb 10th he’s had faecal incontinence and ulceration around his bottom. He’s losing faecal balls( not diarrhoea). I have a photo of this which I’ll put in the comments as it doesn’t look nice. Vets 1 - on 14th feb gave him a steroid injection and prebiotic paste( at this point the ulceration hadn’t started and it was just the ?IBD flare up and incontinence( thought to be due to him having bad stomach) Vets 2- 11th March - gave him antibiotics and an anti inflammatory fusidic acid gel to apply direct to ulceration. Anal glands very full and expressed. At this appointment the vet told me this was very unusual for a cat to have and she wasn’t sure what could be causing it but it should go in a week and incontinence will stop once healed. Vets 2 again( same place different vet)- 25th March- diarrhoea has stopped, glands checked and empty. Most prominent issue is the faecal balls / incontinence. They recommend X-ray, ultrasound and blood work to be done but said we may not find an issue for the incontinence as may need mri or ct which they don’t have. So my main question is- what ideas can I research myself and ask the vets about? Any personal experiences with this type of thing? Also he has an appointment with a different vet this coming Saturday- should I keep that and get a 2nd opinion or go forward with the diagnostics without another appointment? Just really stuck on what is best for him and my human nurse heart is hurting being helpless. Thanks

Hello!  I imgine that this is akin to how I feel when family members are ill.  Im always encouraged when professionals are prepared to admit they dont know - your vets, I mean.  It sounds as though they know how they want to move forwards, but of course there's a cost attatched and there's a chance they still won't see the culprit with standard vet imaging equipment.  Sensibly, they have been honest about this also.  Sometimes, faecal incontinence is caused by a lump etc, which might be obvious with simple imaging, but it can actually be hard to see that sort of thing in a poohey area.  I wonder whether contrast radiography has been completey eclipsed by the MRI machine now. Of course, there may be muscle or nerve-related factors - which might not be so easily pictured.  They might even see a lump or wall thickening that they cannot identify (as you'll appreciate, its a risky area to biopsy and not something Id  attempt).  I'm not sure what level of vets are working on this case at the moment and whethr a neurological exam would be useful.  If resources were available, I might be wondering abut referral to a multidisciplinary centre, with surgeons, neurologists, medics and imging specialists all in one place.  However, your vets can see more than me so may have a clearer idea of their next steps.  It sounds as though there are still boods they'd like to check, for instance, and they may prefer to do this themselves before eg referral / further tests.  Asking a) what are the top five things it could be and b) what needs to be done to rule the out?  Might provde a good basis as to where to go - please will you keep us posted?