Sick Shih Tzu: 30+ Signs of Pain or Illness

A sick Shih Tzu may not show one dramatic symptom. Often the useful clue is a change from that dog’s normal pattern: slower movement, interrupted sleep, less interest in food, a different breathing sound, hiding, repeated position changes, or resistance to handling that was previously comfortable.

These observations cannot identify the cause. The same sign can occur with pain, fear, respiratory disease, nausea, eye injury, medication effects, or many other problems. Use this guide to recognize urgency and prepare a clearer history for a veterinarian—not to diagnose or treat a dog at home.

Start with your dog’s baseline

“Normal” varies with age, health, routine, medication, weather, and the individual dog. A senior Shih Tzu who normally sleeps for much of the afternoon should not be compared with a puppy. Compare today with the dog’s own recent pattern.

Useful baseline questions include:

• Does the dog greet, eat, drink, rest, walk, toilet, and interact in the usual way?
• Is breathing as quiet and effortless as usual during sleep and rest?
• Can the dog settle into a comfortable position?
• Are the eyes open, clear, and used normally?
• Is movement symmetrical and confident on familiar surfaces?
• Is the change limited to one situation, or does it occur across the day?

A single mild variation may not identify a problem. A cluster of changes, worsening severity, or failure to return to baseline is more concerning.

Emergency signs: contact a veterinary service now

Do not use a blog post to monitor a dog with any of the following:

• labored breathing, open-mouth breathing at rest, choking, or obvious inability to draw air;
• blue, gray, or unusually pale gums with weakness or respiratory distress;
• collapse, unresponsiveness, or a prolonged or repeated seizure;
• major trauma, uncontrolled bleeding, or a rapidly enlarging painful abdomen;
• repeated unproductive retching with marked distress;
• suspected poisoning or ingestion of a dangerous object;
• heat-related collapse, confusion, or severe breathing distress;
• inability to urinate or repeated painful attempts with little or no urine;
• sudden inability to stand, dragging limbs, or rapid loss of coordination; or
• a suddenly closed, injured, bulging, cloudy, or severely painful eye.

Call the clinic while arranging transport so staff can advise on immediate safety and preparation. Do not give food, induce vomiting, manipulate an injured area, or administer human medication unless a veterinarian specifically directs it for this dog and situation.

More than 30 signs of pain or illness to notice

The following groups are observation prompts, not diagnoses. Several may occur together.

Energy, sleep, and social behavior

1. Markedly reduced interest in normal activities. The dog no longer engages with familiar people, food puzzles, walks, or play.
2. Weakness or unusual fatigue. Ordinary movement appears difficult or the dog stops much sooner than usual.
3. Hiding or withdrawal. The dog chooses isolated areas or avoids normal contact.
4. Restlessness. Pacing or repeated movement suggests the dog cannot settle comfortably.
5. Interrupted or altered sleep. The dog wakes repeatedly, changes position often, or cannot lie down comfortably.
6. Sudden clinginess or reassurance seeking. A new need to remain very close can accompany distress, though it is not specific to illness.
7. New irritability, growling, or avoidance of touch. Pain can reduce tolerance for handling.
8. Confusion or disorientation. Staring, getting stuck, seeming lost in familiar places, or an abrupt change in responsiveness needs veterinary context.

Breathing and circulation

9. Breathing that is louder than the dog’s usual baseline. New snorting, wheezing, harsh noise, or increased effort matters more than whether the breed is known to snore.
10. Panting at rest when the dog is not hot. Pain, stress, respiratory problems, and other medical causes can overlap.
11. Open-mouth breathing at rest. In a distressed dog, this can be urgent.
12. Pronounced abdominal effort or flared nostrils. Visible work to breathe warrants prompt assessment.
13. New or worsening cough, gagging, or repeated throat clearing. Record the sound and context without trying to diagnose its source.
14. Fainting, collapse, or near-collapse. Treat this as urgent even if recovery appears quick.
15. A change in gum color. Blue, gray, or very pale gums with other symptoms can indicate an emergency.

Shih Tzus are brachycephalic, so “normal for the breed” should not be used to dismiss respiratory effort. Cornell’s BOAS overview describes how shortened facial anatomy can obstruct airflow. Read our Shih Tzu breathing guide for a focused list of respiratory warning signs.

Appetite, digestion, and body weight

16. Reduced appetite or refusal of food. Dental pain, nausea, systemic illness, stress, and many other causes are possible.
17. Difficulty chewing or dropping food. Oral pain or swallowing problems need assessment.
18. Repeated lip licking, drooling, or hard swallowing. These can occur with nausea, oral pain, irritation, or anxiety.
19. Vomiting or repeated retching. Frequency, contents, access to toxins or objects, and the dog’s overall condition affect urgency.
20. Diarrhea or a major stool change. Blood, black stool, pain, weakness, dehydration, or repeated episodes raise concern.
21. A tense, enlarged, or painful abdomen. Rapid enlargement or distress can be an emergency.
22. Unexpected weight loss or gain. A trend is more reliable than one measurement; use the same scale and conditions when possible.
23. A new increase or decrease in water intake. Record the pattern and discuss a sustained change with a veterinarian.

Avoid waiting for a universal number of hours if the dog seems weak, painful, dehydrated, very young or old, has another condition, or symptoms are severe. Call a veterinary clinic for triage based on the whole picture.

Movement, posture, and neurologic changes

24. Limping or uneven weight bearing. Even intermittent lameness can indicate discomfort.
25. Reluctance to rise, walk, climb, or jump when that is new. Pain, weakness, respiratory limitation, and fear of a slippery surface are among possible contributors.
26. A hunched or guarded posture. The dog may protect the abdomen, back, neck, or another painful area.
27. Flinching, tensing, or turning toward a touched area. Stop testing the response; repeated palpation can hurt or provoke a bite.
28. Repeatedly changing position. Difficulty finding a comfortable way to sit or lie down can be a pain sign.
29. Stiffness or a shortened stride. Note whether it is worse after rest, activity, or on a particular surface.
30. Trembling or shaking. Temperature, fear, pain, metabolic disease, and neurologic causes can look similar.
31. Weakness, knuckling, dragging a limb, or inability to stand. Sudden onset is urgent.
32. Loss of balance, circling, head tilt, or abnormal eye movement. Contact a veterinarian promptly.
33. A seizure or unexplained episode of altered awareness. Protect the dog from nearby hazards, time the event, and seek veterinary direction.

Do not stretch, massage, manipulate the spine, or “test” how far a painful dog can move. Sudden weakness or severe spinal pain needs immediate professional assessment.

Eyes, ears, mouth, skin, and coat

34. Squinting or keeping an eye closed. Eye pain can worsen quickly.
35. New redness, cloudiness, swelling, trauma, or vision difficulty. Contact a veterinarian promptly rather than treating it as tear staining.
36. A new type or amount of eye, nose, or ear discharge. Color alone does not identify the cause; note associated pain, odor, swelling, and behavior.
37. Head shaking, ear scratching, odor, or touch sensitivity. These signs can indicate ear discomfort and need examination.
38. Bad breath with difficulty eating, bleeding, swelling, or pawing at the mouth. Dental and oral disease can be painful even when a dog still eats.
39. Repeated scratching, chewing, or licking of the skin. Parasites, allergy, infection, pain, and other causes require different care.
40. Redness, sores, swelling, odor, hair loss, or a new lump. A coat can conceal skin changes, so describe size, location, and change over time.
41. Tight or painful mats. Severe matting can pull on skin and hide wounds; do not cut blindly near skin.

Tear pigment without discomfort is different from an eye problem. The guide to Shih Tzu tear stains and warning signs explains why pain, squinting, cloudiness, and abnormal discharge need veterinary attention.

Urination and defecation

42. Repeated attempts to urinate, straining, or producing little or no urine. Inability to urinate can be an emergency.
43. Blood in urine or stool. Contact a veterinarian for triage, especially with pain, weakness, vomiting, or repeated episodes.
44. A major change in frequency or location. Medical, mobility, cognitive, environmental, and training factors can overlap.
45. Pain or vocalizing during elimination. Do not assume this is behavioral.
46. New incontinence. Leakage during rest or loss of a previously reliable pattern warrants medical context.
47. Constipation, repeated straining, or inability to pass stool. Urgency depends on pain, vomiting, abdominal change, duration, and overall condition.

How pain changes behavior

The Cornell guide to recognizing pain in dogs groups pain-related changes across mobility, activity, social interaction, touch response, appetite, sleep, elimination, and breathing. This is why a “behavior problem” can be the first visible sign of a medical issue.

A dog in pain may move away, freeze, guard a body part, growl, snap, or bite when approached. Growling is information, not proof of a bad temperament. Do not punish the warning or repeatedly touch the area to confirm it. Create space, keep children and other animals away, and contact a veterinarian.

Pain can also reduce play, alter house training, interrupt sleep, or make a previously easy grooming task difficult. Sudden territorial-looking behavior or handling sensitivity should be considered alongside health. Our guides to Shih Tzu anxiety signs and territorial behavior explain that overlap.

What to record for the veterinarian

Clear observations are more useful than a guessed diagnosis. Note:

• when the change began and whether onset was sudden or gradual;
• the dog’s activity, location, food, medication, and possible exposures beforehand;
• frequency, duration, severity, and whether episodes are becoming more common;
• appetite, water intake, urine, stool, sleep, movement, breathing, and interaction changes;
• photos of vomit, stool, urine, discharge, swelling, or product packaging when relevant;
• a short video of breathing, coughing, walking, or an episode when recording is safe; and
• current medicines, supplements, known conditions, recent procedures, travel, and possible toxins.

Do not delay urgent care to finish a log or capture a better video. Bring labels or packaging for a suspected exposure when it is safe to do so.

What not to do

• Do not give human painkillers, cold medicine, anti-diarrheal medicine, sedatives, or another animal’s prescription.
• Do not induce vomiting unless a veterinarian or animal poison professional gives specific instructions.
• Do not force food or water into a weak, vomiting, choking, or poorly responsive dog.
• Do not manipulate a painful limb, neck, back, or abdomen to identify the source.
• Do not punish hiding, growling, house soiling, or reduced cooperation when illness or pain may be involved.
• Do not assume noisy breathing, tear discharge, or low activity is harmless because the dog is a Shih Tzu.

Choosing the level of care

Emergency care now: breathing distress, abnormal gum color with weakness, collapse, unresponsiveness, major trauma or bleeding, suspected poisoning, severe heat illness, inability to urinate, sudden inability to stand, a prolonged or repeated seizure, or a severely painful eye problem.

Prompt veterinary contact: a sudden significant change, persistent pain signs, repeated vomiting or diarrhea, appetite or water changes, coughing, eye or ear symptoms, lameness, new neurologic signs, blood in urine or stool, or worsening symptoms.

Routine appointment or monitoring only after veterinary guidance: mild, stable changes in an otherwise comfortable dog may sometimes be observed, but the appropriate interval depends on age, history, severity, and associated signs. When uncertain, call the clinic and describe the full pattern.

Key takeaway

The most useful sign is often a change from your Shih Tzu’s normal behavior combined with another change in breathing, movement, appetite, sleep, toileting, or comfort. Notice patterns, avoid home diagnosis and medication, and let a veterinary professional determine the cause and urgency.

Sources and further reading

• Cornell University College of Veterinary Medicine: Recognizing pain in dogs
• Cornell University College of Veterinary Medicine: Brachycephalic obstructive airway syndrome
• VCA Animal Hospitals: Eye discharge or epiphora in dogs
• Merck Veterinary Manual: Behavior problems in dogs

This guide provides general education. It cannot determine whether a dog is sick, diagnose pain, or replace veterinary triage, examination, testing, or treatment.