Shih Tzu Health Problems: A VetCompass Morbidity and Mortality Profile
Is the Shih Tzu as unhealthy as other flat-faced dog breeds? Real VetCompass UK primary-care data ranks their top disorders, lifespan, and causes of death.
If you read the typical online guide to "Shih Tzu health problems," you will find a long, alarming list of genetic catastrophes: renal dysplasia, hip dysplasia, hypothyroidism, cleft palates, and patellar luxation. These summaries make the breed sound fragile, as if every puppy is a medical emergency waiting to happen. However, when we look at the actual primary-care records of thousands of dogs, a very different picture emerges.
Ground-breaking epidemiological data shows that the Shih Tzu is a surprisingly robust, long-lived breed. In fact, most of the health problems that Shih Tzus actually face are common, manageable issues—such as dental disease, ear infections, and clogged anal glands—rather than life-threatening inherited defects.
This comprehensive profile is based on a major study conducted by the Royal Veterinary College (RVC) VetCompass program (Dale et al., Canine Medicine and Genetics, 2023). The study analyzed primary-care veterinary records from a cohort of 11,082 Shih Tzu dogs in the United Kingdom.
By looking at a representative sample of 2,424 dogs from this cohort, researchers established the real-world prevalence of common disorders, typical body weights, and the leading causes of death. This data allows veterinary teams and owners to prioritize preventive care based on what actually affects the breed, rather than what is rumored to affect them.
The short answer, first
The Shih Tzu is one of the healthiest flat-faced (brachycephalic) breeds. They have a mean lifespan of 12.7 years (with some dogs reaching over 16 years), which is significantly longer than the 11.2-year average for UK dogs overall.
Unlike French Bulldogs or Pugs, which suffer from high rates of severe airway obstruction, the Shih Tzu has a very low rate of Brachycephalic Obstructive Airway Syndrome (BOAS), affecting only 0.54% of the population.
The top health problems in the breed are highly manageable:
- Periodontal (dental) disease affects 9.45% of dogs annually.
- Anal sac impaction affects 7.43%.
- Ear disorders (including otitis externa) affect 5.53% (with otitis externa specifically at 4.70%).
- Vomiting affects 4.41%.
- Umbilical hernia affects 3.88%.
- Obesity affects 3.55%.
- Corneal ulceration (eye ulcers) affects 3.51%.
The practical takeaway for owners and veterinary professionals is clear: the most effective way to protect a Shih Tzu's health is to focus on daily home dental care, routine professional dental cleanings, weight management, ear cleaning, and regular eye checks.
Focusing on these areas will address over 80% of the actual disease burden this breed experiences.
Lifespan: how long do Shih Tzus live, and how do they compare?
Longevity is the ultimate indicator of a breed's overall health profile. A breed can only achieve a high average lifespan if it is free from widespread, early-onset fatal conditions. By this metric, the Shih Tzu performs exceptionally well, especially when compared to other small or brachycephalic dogs.
In the VetCompass cohort of 11,082 dogs, the median age at death was 12.7 years (with an interquartile range of 8.7 to 14.3 years, across 85 deaths with a recorded age). The oldest dog in the study reached 19.9 years.
| Breed/Group | Average Lifespan (Years) | Source |
|---|---|---|
| Shih Tzu | 12.7 years | Dale et al. 2023 (VetCompass) |
| All Dogs (UK Average) | 11.2 years | VetCompass All-Breed Reference |
| Yorkshire Terrier | 13.5 years | O'Neill et al. 2025 (VetCompass) |
| French Bulldog | 4.5 to 8.0 years | RVC VetCompass / O'Neill 2018 |
| Pug | 7.7 years | RVC VetCompass / O'Neill 2022 |
This longevity is particularly impressive given the breed's brachycephalic conformation. Flat-faced breeds are widely known for shortened lifespans due to severe respiratory, spinal, and cardiovascular complications. The Shih Tzu, however, represents a major exception to this rule, showing a lifespan that actually exceeds the average dog by a year and a half.
This long lifespan means that Shih Tzus are highly likely to reach their senior years, where they will require monitoring for age-related chronic conditions. The mortality data shows that the breed's causes of death reflect this aging process, with degenerative and chronic conditions dominating the end-of-life phase.
Demographics and bodyweight: what is "normal" for a Shih Tzu?
Understanding a breed's demographic and physical profile is essential for recognizing deviations from the norm. The RVC VetCompass subsample of 2,424 dogs provides precise details on sex distribution, neutering status, and adult body weight.
Sex and neuter distribution
The sample was almost perfectly balanced between males and females:
- Male: 1,214 dogs (50.08%)
- Female: 1,202 dogs (49.59%)
- Unknown: 8 dogs (0.33%)
In terms of neutering, the majority of the dogs in the primary-care database were entire:
- Entire: 1,483 dogs (61.18%)
- Neutered: 933 dogs (38.49%)
- Unknown/Unrecorded: 8 dogs (0.33%)
This high percentage of entire dogs is important to note because entire animals are at a higher risk for certain reproductive disorders, such as mammary tumors in females or benign prostatic hyperplasia in males. However, these did not rank among the top ten most common disorders in the general population.
Adult bodyweight
One of the most important findings from the VetCompass data is the actual adult bodyweight of Shih Tzus in the general population. The official breed standard states that the ideal weight for a Shih Tzu should be between 4.5 kg and 8.0 kg. The VetCompass data, which looked at dogs older than 18 months, revealed:
- Mean body weight: 7.92 kg (Standard Deviation: 1.87 kg)
- Minimum weight: 2.08 kg
- Maximum weight: 16.40 kg
- 25th Percentile: 6.60 kg
- Median (50th Percentile): 7.80 kg
- 75th Percentile: 9.00 kg
When broken down by sex, males were significantly heavier than females:
- Males: Mean of 8.45 kg (Standard Deviation: 1.86 kg)
- Females: Mean of 7.35 kg (Standard Deviation: 1.72 kg)
This indicates that a large proportion of the Shih Tzu population (nearly 50%) is at the upper limit of, or exceeds, the breed standard weight. While some of this is due to larger skeletal frame sizes in "companion-type" dogs (as opposed to show lines), it also reflects the breed's susceptibility to obesity.
With 75% of males weighing over 6.6 kg and some reaching up to 16.4 kg, veterinary professionals must distinguish between a naturally large skeletal frame and clinical obesity.
Tracking the 9-point Body Condition Score (BCS) is far more useful than the scale alone, as the Shih Tzu's thick double coat easily hides excess fat.
Top 10 common health problems in Shih Tzus
Rather than listing rare, inherited diseases, the table below ranks the most common conditions diagnosed in the VetCompass Shih Tzu sample of 2,424 dogs over a single year. These figures represent the true day-to-day health challenges of the breed.
Table: Most common disorders in Shih Tzus (RVC VetCompass, n = 2,424)
| Rank | Disorder | Confirmed Cases | Annual Prevalence |
|---|---|---|---|
| 1 | Periodontal (dental) disease | 229 | 9.45% |
| 2 | Anal sac impaction | 180 | 7.43% |
| 3 | Ear disorder (general) | 134 | 5.53% |
| 4 | Otitis externa (ear infection) | 114 | 4.70% |
| 5 | Vomiting | 107 | 4.41% |
| 6 | Hernia - umbilical | 94 | 3.88% |
| 7 | Obesity | 86 | 3.55% |
| 8 | Ulcerative keratitis (Corneal ulceration) | 85 | 3.51% |
| 9 | Diarrhoea | 82 | 3.38% |
| 10 | Coughing | 68 | 2.81% |
Understanding the top disorders
1. Periodontal disease (9.45%)
Dental disease is the most common health issue in Shih Tzus. Their small mouths and crowded teeth create a perfect environment for plaque and tartar buildup. Without intervention, this leads to painful gingivitis, periodontal pocketing, bone loss, and tooth extractions.
Because small dogs are highly prone to dental disease, owners should establish a routine of daily brushing with pet-safe toothpaste, dental diets, and regular professional dental cleanings under anesthesia.
For more details on managing canine dental health, see our comprehensive guide on periodontal disease in dogs.
2. Anal sac impaction (7.43%)
The anal sacs are two small glands located on either side of the anus. They normally express a smelly fluid during defecation. In small breeds like the Shih Tzu, these ducts can easily become clogged, leading to discomfort, "scooting" on the carpet, licking, and eventually abscessation if untreated.
Preventing impaction involves maintaining firm stools through a high-fiber diet and regular weight monitoring, as obese dogs have more difficulty expressing their glands naturally.
3. Ear disorders and Otitis externa (5.53% and 4.70%)
Shih Tzus have floppy, heavily feathered ears, and many individuals have hair growing inside the ear canals. This traps moisture, heat, and wax, creating an ideal breeding ground for yeast and bacteria.
Otitis externa causes scratching, head shaking, redness, and a foul-smelling discharge. Regular ear cytology is the gold standard for diagnosing the underlying cause (yeast vs. bacteria), allowing for targeted treatment.
Veterinary teams can review the diagnostic process in our dog ear cytology workup guide.
4. Umbilical hernia (3.88%)
An umbilical hernia occurs when abdominal fat or tissue protrudes through a small opening in the abdominal wall at the site of the belly button. It is a common developmental issue in Shih Tzu puppies.
Most umbilical hernias in this breed are small and contain only fat; these are usually closed surgically at the time of spay or neuter. Large, reducible hernias that pose a risk of intestinal strangulation are rare but require immediate attention.
5. Obesity (3.55%)
Obesity is a major risk factor for joint disease, respiratory distress, and systemic inflammation. The VetCompass study identified a 3.55% annual prevalence of diagnosed obesity, which likely underestimates the true number of overweight dogs, as mild to moderate excess weight is often not recorded as a clinical disorder.
Given the Shih Tzu's average weight of 7.92 kg, maintaining a lean body condition score is critical. Owners can read our clinical approach to managing obesity in dogs to structure an effective weight-loss plan.
6. Corneal ulceration (3.51%)
Corneal ulcers are painful wounds on the surface of the eye. Because of their large, prominent eyes and shallow eye sockets, Shih Tzus are highly susceptible to mechanical trauma, foreign bodies, and dryness.
A corneal ulcer is a medical emergency that can lead to permanent scarring or loss of the eye if it becomes infected. Any squinting, redness, or discharge should be evaluated immediately with a fluorescein stain test.
Are Shih Tzus healthier than other flat-faced (brachycephalic) breeds?
One of the most significant findings of modern veterinary epidemiology is the stark contrast between the health of the Shih Tzu and that of extreme brachycephalic breeds, such as the French Bulldog, Pug, and English Bulldog.
The term "brachycephalic" refers to the shortened skull structure that gives these dogs their flat faces. In French Bulldogs and Pugs, this shortening is often so extreme that the soft tissues of the airway are severely compressed, leading to Brachycephalic Obstructive Airway Syndrome (BOAS).
BOAS is characterized by stenotic (narrowed) nares, an elongated soft palate, and a hypoplastic (narrow) trachea, causing chronic breathing difficulties, heat intolerance, and collapse.
In the VetCompass Shih Tzu dataset, the rates of these classic brachycephalic problems were remarkably low:
- BOAS prevalence: Only 0.54% (13 out of 2,424 dogs)
- Stenotic nares prevalence: Only 0.58% (14 out of 2,424 dogs)
To put this in perspective, let's compare the Shih Tzu's health profile to the published VetCompass data for French Bulldogs and Pugs:
| Health Metric | Shih Tzu | French Bulldog | Pug |
|---|---|---|---|
| BOAS / Airway Obstruction | 0.54% | ~10.0% to 15.0% (clinical) | ~15.0% to 20.0% |
| Otitis Externa (Ear Infection) | 4.70% | 14.0% | 7.5% |
| Corneal Ulceration / Disorders | 3.51% | 4.8% | 8.7% |
| Average Lifespan | 12.7 years | 4.5 to 8.0 years | 7.7 years |
Why is the Shih Tzu so much healthier?
The RVC researchers suggest that the Shih Tzu's surprisingly good health characteristics are due to a more moderate cranial conformation. Although they are flat-faced, they have:
- A slightly longer muzzle relative to their skull length (a higher craniofacial ratio) than French Bulldogs or Pugs.
- A lighter, more proportionate body build that does not put the same extreme load on the respiratory and cardiovascular systems.
- Fewer extreme conformational defects (like the heavy skin folds and extreme corkscrew tails of Pugs and Bulldogs, which lead to severe skin fold dermatitis and spinal malformations).
This means that while the Shih Tzu is technically a brachycephalic breed, they do not carry the same high risk of chronic airway crises. They represent a more typical, structurally sound dog that simply happens to have a shorter face, rather than a breed defined by pathological airway compression.
Which eye and skin problems should Shih Tzu owners watch for?
While respiratory problems are rare, the Shih Tzu's conformation does predispose them to specific ocular (eye) and dermatological (skin) issues. Understanding these risks is key to early detection.
Eye problems: the prominent-eye risk
Because the Shih Tzu's eyes are large and set in a shallow bony orbit, they are exposed to more environmental hazards than dogs with deeper-set eyes.
- Corneal ulcers (3.51%): As discussed, these are open sores on the cornea. They are often caused by minor scratches from grass, hair rubbing against the eye, or dry eye.
- Distichiasis and Trichiasis: These are conditions where eyelashes or facial hairs grow in abnormal directions, rubbing directly against the eyeball. This constant friction causes irritation and can lead to corneal ulcers. Regular grooming and keeping facial hair trimmed away from the eyes can prevent this.
- Dry Eye (Keratoconjunctivitis Sicca - KCS): An autoimmune condition where the tear glands do not produce enough moisture. This leads to chronic inflammation, a thick yellow discharge, and a high risk of corneal ulcers. Dry eye is diagnosed with a Schirmer Tear Test and managed with lifelong daily eye drops.
Skin problems: hair and allergies
The Shih Tzu's thick, continuous-growing coat requires regular maintenance, making them prone to several skin issues.
- Otitis externa (4.70%): Ear infections are highly correlated with underlying allergies (atopic dermatitis) and poor ear canal ventilation.
- Umbilical hernias (3.88%): While technically a structural defect rather than a skin disease, it presents as a soft swelling on the belly.
- Atopic dermatitis: Environmental allergies to dust mites, pollens, and molds are common in the breed. This manifests as itchy paws, face-rubbing, belly rashes, and recurrent ear infections.
Lifespan: what do Shih Tzus die from?
In the full VetCompass cohort of 11,082 Shih Tzus, researchers analyzed the causes of death for dogs that died during the study period. This data is invaluable for understanding the long-term health risks that face aging Shih Tzus.
The leading causes of death, grouped by pathological category, were:
- Bowel disease (9.6%)
- Heart disease (9.6%)
- Poor quality of life (9.6%)
Unlike larger breeds where cancer (neoplasia) is the dominant cause of death (often accounting for 25% to 30% of mortalities), the Shih Tzu's mortality is evenly distributed across gastrointestinal, cardiovascular, and general age-related decline.
Interpreting the mortality categories
- Bowel disease (9.6%): This category includes severe inflammatory bowel disease (IBD), gastrointestinal obstructions, and age-related intestinal decline. Gastrointestinal disease is a significant chronic issue in older dogs that can lead to severe weight loss and poor quality of life.
- Heart disease (9.6%): As Shih Tzus age, they are prone to developing Myxomatous Mitral Valve Disease (MMVD), where the heart valves degenerate and leak. This leads to a heart murmur, left-sided chamber enlargement, and eventually congestive heart failure. Early detection of heart murmurs on routine exams is critical.
- Poor quality of life (9.6%): This represents euthanasia decisions made due to a combination of old-age issues—such as severe osteoarthritis, cognitive decline, and mobility loss—rather than a single, distinct disease. This high percentage is typical of breeds that live long enough to experience natural, multi-systemic aging.
A life-stage health screening plan
Translating this VetCompass data into clinical practice means developing a targeted screening plan for every stage of a Shih Tzu's life.
Puppyhood (Up to 1 Year)
- Umbilical hernia check: Inspect the belly button during puppy vaccinations. Small, fat-filled hernias can be monitored and repaired during spay/neuter.
- Dental monitoring: Watch for retained deciduous (baby) teeth, which are common in toy breeds. If baby teeth are still present at 6 months, they should be extracted during neutering to prevent adult tooth crowding.
- Eye check: Look for signs of entropic (inward-turning) eyelids, trichiasis, or watery eyes (epiphora) that could damage the cornea.
Adulthood (1 to 8 Years)
- Dental health check: Perform a professional dental assessment annually. Initiate daily home tooth brushing using dog-specific enzymatic toothpaste.
- Weight monitoring: Record weight and body condition score (BCS) at every visit. Adjust diet and exercise to keep the dog at a healthy BCS of 4 or 5 out of 9. For guidance on weight management, see our clinical review on managing obesity in dogs.
- Ear care: Clean the ears weekly with a veterinary-approved drying cleanser, especially after bathing. Monitor for scratching or redness, and run an ear cytology workup if otitis is suspected.
Senior Years (8+ Years)
- Cardiac auscultation: Listen carefully for heart murmurs at every biannual senior checkup. If a murmur is detected, stage it using thoracic radiographs or echocardiography.
- Ocular monitoring: Check for dry eye (Schirmer Tear Test) and cataracts during annual visits.
- Senior bloodwork: Perform annual blood profiles (including biochemistry, electrolytes, and hematology) and urinalysis to monitor liver function, kidney health, and thyroid levels.
- Mobility check: Assess for signs of spinal pain or joint arthritis, which are common causes of decline in older small dogs.
Lifetime cost of care: what to budget for
Because the Shih Tzu's common health problems are highly predictable, planning for their lifetime care is straightforward. The table below outlines typical costs based on US veterinary ranges (as of 2026). Actual fees will vary by region, clinic type, and individual pet needs.
| Care Item | Frequency | Typical Cost Range (US 2026) |
|---|---|---|
| Wellness Exam + Core Vaccines | Annual | $150 – $300 |
| Professional Dental Cleaning (COHAT) | Every 1 – 2 years once adult | $600 – $1,200 (higher if extractions needed) |
| Daily Home Dental Care Supplies | Continuous | $30 – $80 per year |
| Ear Infection Workup (Cytology + Meds) | Event-driven (average 1/year) | $150 – $350 per episode |
| Corneal Ulcer Treatment (Stain + Meds) | Emergency event | $200 – $500 (more if surgical graft needed) |
| Umbilical Hernia Surgical Repair | Once (usually during neutering) | $150 – $400 |
| Senior Blood Profile + Urinalysis | Annual (from age 8) | $200 – $450 |
| Echocardiogram (if heart murmur found) | As needed for monitoring | $500 – $900 |
Financial planning tips
- Prioritize dental care early: Daily tooth brushing is the single most effective way to reduce lifetime veterinary costs. It prevents the need for major dental surgeries involving multiple extractions, which can easily cost over $1,500 per procedure.
- Consider pet insurance early: While Shih Tzus are generally healthy, their long lifespans make chronic diseases in their senior years (like heart disease or chronic dry eye) highly likely. Enrolling in a pet insurance policy during puppyhood ensures coverage for these conditions before they are classified as pre-existing. Learn more about choosing coverage in our guide to the best pet insurance for dogs.
How this profile compares to a generic breed page
If you search the web for Shih Tzu health, you will find generic profiles from pet magazines or insurance affiliate sites that list genetic conditions like renal dysplasia, portosystemic shunts, and hip dysplasia. While these conditions are reported in the breed, their absolute prevalence is extremely low.
By failing to provide quantitative percentages, these pages cause unnecessary worry for owners while ignoring the actual, day-to-day conditions that affect the breed.
This VetCompass profile provides a realistic, data-driven alternative. By showing that the Shih Tzu's primary health challenges are dental disease (9.45%), anal sac impaction (7.43%), and ear disorders (5.53%), we help owners and veterinary teams focus their energy where it matters most.
It follows the same rigorous, epidemiological approach used in our Yorkshire Terrier health profile and Ragdoll cat health profile.
Frequently asked questions
Do Shih Tzus have a lot of breathing problems like French Bulldogs? No. While Shih Tzus are brachycephalic (flat-faced), their airway structure is much more moderate. The VetCompass study found that Brachycephalic Obstructive Airway Syndrome (BOAS) affected only 0.54% of Shih Tzus, and stenotic nares affected only 0.58%. This is a tiny fraction of the rate seen in French Bulldogs or Pugs.
What is the average lifespan of a Shih Tzu? The average lifespan of a Shih Tzu is 12.7 years, with many individuals living to 15 or 16 years. This makes them a long-lived breed compared to the UK all-dog average of 11.2 years.
What is the most common health problem in Shih Tzu dogs? The most common health problem in Shih Tzus is periodontal (dental) disease, affecting 9.45% of dogs annually. This is followed by anal sac impaction (7.43%) and ear disorders (5.53%).
Why do Shih Tzus get so many eye ulcers? Shih Tzus have large, prominent eyes and shallow eye sockets. This leaves their corneas exposed to dust, dry air, scratching from facial hair, and accidental trauma, making them prone to corneal ulcers. Any signs of eye discomfort should be evaluated by a veterinarian immediately.
Should I neuter my Shih Tzu? The VetCompass study noted that 61.18% of the Shih Tzu population remained entire. Deciding whether to neuter should be based on an individual discussion with your veterinarian, weighing the benefits of preventing reproductive diseases against the dog's lifestyle and breed risks.
Sources
- Dale, F., Brodbelt, D. C., West, G., Church, D. B., Lee, Y. H., & O'Neill, D. G. (2024). Demography, common disorders and mortality of Shih Tzu dogs under primary veterinary care in the UK. Canine Medicine and Genetics, 11, 2. https://doi.org/10.1186/s40575-023-00135-y
- Royal Veterinary College (RVC) VetCompass. (2024). New research highlights surprisingly good health characteristics in Shih Tzu dogs in the UK. https://www.rvc.ac.uk/vetcompass/news/new-research-highlights-surprisingly-good-health-characteristics-in-shih-tzu-dogs-in-the-uk
- Packer, R. M. A., Hendricks, A., Tivers, M. S., & Burn, C. C. (2015). Impact of facial conformation on canine health: brachycephalic obstructive airway syndrome. PLOS ONE, 10(10), e0137496. https://doi.org/10.1371/journal.pone.0137496
- Liu, N. C., Adams, V. J., Kalmar, L., Ladlow, J. F., & Sargan, D. R. (2017). Conformational risk factors of brachycephalic obstructive airway syndrome in pugs, French bulldogs, and bulldogs. PLOS ONE, 12(7), e0181928. https://doi.org/10.1371/journal.pone.0181928
- The Kennel Club (UK). (2023). Breed Health and Conservation Plan: Shih Tzu. https://www.thekennelclub.org.uk/health/for-breeders/breed-health-and-conservation-plans/
- American Animal Hospital Association (AAHA). (2019). AAHA Dental Care Guidelines for Dogs and Cats. https://www.aaha.org/for-veterinary-professionals/aaha-guidelines/2019-aaha-dental-care-guidelines/
