Early Signs
An observant person can often detect bladder disease in their rabbit before he becomes lethargic, anorectic, or is in a life-threatening situation. Signs of early trouble will vary with each rabbit, but you should seek veterinary help when any of the following occur: Loss of litterbox habits, straining to urinate, hopping in and out of the litter pan, wetness around the genital area or chronic skin irritation in that area from urine scalding, semi-solid (like toothpaste) urine, or blood in the urine. Blood in the urine must be confirmed with a veterinary urinalysis or microscopic exam, or by a urine “dipstick” which can be purchased over-the counter from a pharmacy. Many people mistake porphyrinuria (the presence of orange-to-red colored by-products in rabbit urine that result from chlorophyll and other vegetable component break-down) for blood in the urine.
Diagnosis
Any animal with clinical signs such as those mentioned should have a veterinary visit. An experienced rabbit veterinarian uses a urinalysis and radiographs (x-rays) as the initial steps in diagnosing a bladder problem. Because rabbits’ bladder stones and bladder “sludge” are primarily composed of calcium, they are able to be detected on plain radiographs (x-rays). Your veterinarian should be familiar with normal rabbit urinalysis values and the radiographic appearance of a rabbit bladder. Many normal rabbits may have some radio-opaque material present in their bladders but will not have the abnormal urinalysis or clinical signs to support a diagnosis of bladder disease. Once bladder disease is confirmed, a urine culture, serum (blood) chemistries, and a complete blood count will help the veterinarian determine the extent of the disease and how to treat the problem in that individual rabbit.
When Stones Are Detected
Treatment in a patient with actual bladder stones will necessitate having the stones removed, as they frequently do not pass on their own and there is no known way to dissolve them. If these calculi are left unattended, they will continue to enlarge and will irritate and damage the bladder wall, allowing chronic infection and inflammation of the bladder (cystitis) to make the rabbit seriously ill. Depending on the rabbit’s condition at the time of diagnosis, the veterinarian may first need to stabilize the patient with fluid therapy, nasogastric feeding, or antibiotic administration prior to surgery. Post-operatively, most rabbits require at least one to two days of hospitalization for continued fluid therapy and pain management before they are discharged.
“Sand” in the Bladder
If a rabbit does not have bladder stones, but has an accumulation of thick “sludge” or “sand” in the bladder causing disease and discomfort, treatment can usually be medical rather than surgical. It is again recommended that the rabbit’s overall health be looked into, not only with the urinalysis and radiographs mentioned earlier, but also with a urine culture, serum chemistries, and a complete blood count. This will allow the veterinarian to determine the degree of infection and disease, and whether other organs, such as the kidneys are affected. Rabbits with “sludgy bladder” disease may require several days of hospitalization for fluid and antibiotic therapy before being discharged. They may need manual help from the veterinarian in expressing the thick “sludge” from their bladders, and sometimes will require pain medication for bladder and urethral pain control and spasms.
At-home care for rabbits (after hospital treatment is complete) will involve a minimum of ten days of continued antibiotic therapy. Sometimes several weeks of antibiotics may be indicated if the urine culture indicates a severe infection. Dietary changes are also critical if the rabbit is not to have a recurrence of bladder disease.
Rabbits (over six months of age) with a history of bladder problems should have pellets removed or severely restricted. They should receive a variety of fresh vegetables (at least a cup or more daily), excluding those high in calcium such as kale. No alfalfa hay should be fed, but timothy or grass hay should be available at all times. Animals that are overweight should be encouraged to exercise a minimum of one hour at least twice daily. This can be accomplished by letting them chase you and then you chasing them, up and down stairs and around the house. Some rabbits will spend a considerable time tossing a wire ball back to you. There are numerous ways to both enjoy and exercise your rabbit at the same time.
All rabbits that initially presented with bacterial growth on a urine culture should have a urinalysis and urine culture repeated after the completion of antibiotic therapy to be sure all infection is resolved. Also, even with all the treatments described and diet changes, the bladder stones may still reoccur in some rabbits and frequent (at least every six months) visits to the veterinarian for regular radiographs to check for recurrence is important. If caught early by an observant person bladder disease should be controllable and should not cause any permanent damage to the rabbit’s health or life-span.
Sue A. Kestenman, DVM
House Rabbit Journal Volume III, Number 5, Summer 1995
References
1. Veterinary Clinics of North America, Small Animal Practice, Jan 94
2. Robert Clipsham, DVM, Veterinary Post Graduate Institute Conference, Seattle 1993 “Clinical Considerations for Pet Rabbits” conference notes P265