Stasis / Ileus / GI Hypomotility / Bloat

Image Source - Melbourne Rabbit Clinic

IF YOU HAVE TAKEN OR ARE TAKING YOUR RABBIT TO A NON RABBIT SAVVY  VET FOR STASIS TREATMENT PLEASE PRINT THIS ARTICLE AND TAKE IT WITH YOU OR SUPPLY THE LINK AND ASK YOUR VET TO READ IT -

Managing GI stasis in rabbits - Authors Michelle Clark, Richard Saunders. Published: Vet Times, November 26, 2012. Last reviewed: November 18 2020
Quick access to the full article can be found by clicking this text

...in addition, the following article discusses the difference between GI stasis and Bloat
Differentiating Gastrointestinal Stasis from Gastrointestinal Obstruction in Domestic Rabbits (Oryctolagus cuniculus) - by Brendan Noonan, DVM, DABVP 

***PLEASE NOTE - Enzymatic digestive aids such as Pineapple juice or Papaya are an outdated approach***
The following are often recommended but the latest studies prove that they are of no benefit and can actually make things worse.

Papain (found in papaya) and bromelain (found in pineapple) may help to break down mucus binding an obstruction, thus allowing it to slowly break up and pass. However, there is no evidence to suggest that these enzymes break down keratin, which is the main protein component of hair and studies have shown that rehydration is more beneficial and effective. Papaya tablets are little more than a sugary treat: they contain very little active enzyme. Canned pineapple juice is useless, as it has been cooked, and its enzymes denatured and inactivated. Even fresh pineapple juice is not as desirable as powdered. To have any beneficial effect the core of the Pineapple fed fresh would have to be used but since it is high in sugar it is not advisable. The last thing you want to add to a compromised rabbit's intestine is big doses of sugar!

Gillett et al. (1983) conducted an experiment which concluded that Pineapple juice/enzyme treatments do not dissolve hair/Keratin. Francis Harcourt-Brown in the Textbook of Rabbit Medicine suggests that "the success of pineapple juice as a remedy for gastric stasis might be due to the introduction of liquid into the stomach that softens the hairball and aids its passage out of the stomach." It is also postulated that enzymic treatments may help dissolve the mucous that binds or coats the hairball, helping to break them up and be passed. This is discussed in the article below that this file is based upon, by Dana Krempels Ph.D (note that the use of Simeticone as discussed in this article is also now seen as an outdated approach by rabbit specialist vets in NZ).

So - although Pineapple juice will help rehydrate the gut it will also potentially overload an already compromised gut with sugar which can lead to overgrowth of undesirable bacteria, further compromising a very sick rabbit. If you are going to use pineapple you would need to use the core of fresh pineapple which has the highest level of bromelain. But ... feeding solids to a rabbit that has a fur block is not safe. A rabbit that is passing 'string of poops' has a gut that is processing the fur already - it does not need the overload of sugar that giving pineapple juice will cause. It needs additional fibre, fluids and grooming to ensure the amount of fur does not exceed the guts ability to process it. A better approach is to use a veterinary electrolyte in addition to ensuring the diet is high in fibre and to increase grooming.

Further discussion can be found in this paper - Gastrointestinal Diseases of Rabbits which states :
"Do not feed pineapple, pineapple juice, or papaya, because these are ineffective and can be detrimental "
"Caution owners against the use of protein-digesting enzymes, because these can be irritating to oral and potentially gastric mucosa. The risk of gastric ulceration is increased in anorectic rabbits, and use of these enzymes may exacerbate this."

Further Reading -
The Myth of Pineapple Juice and Hairballs

GASTROINTESTINAL STASIS, THE SILENT KILLER
Source - Dana M. Krempels, Ph.D. with minor content edits for NZ and to reflect current practices recommended by rabbit savvy vets in NZ.

It's an all too familiar story. "My bunny stopped eating, and then she just died."

When we ask for details, we often learn that not only did the bunny stop eating, but she had been producing extremely small or even no faecal droppings, or showed symptoms of "runny stool." True diarrhoea (unformed, liquid faecal matter) is uncommon in rabbits. The runny stool sometimes misidentified as "diarrhoea" in rabbits is more often composed of unformed, almost-liquid cecotrophes.

Rabbits produce two types of pellets: faecal pellets (left in the litter-box) and cecotrophes (soft, pungent, normally shaped like a cluster of grapes and reingested by the rabbit to obtain essential nutrients). Liquid or mushy cecotrophes can result from an imbalance of the normal bacterial and fungal flora of the cecum (the bunny's intestinal "fermentation vat"). The floral imbalance can be caused by a number of factors, such as the wrong antibiotic (oral penicillins and lincosamine antibiotics can be very dangerous to rabbits for this reason!) or a diet too rich in digestible carbohydrates and too low in crude fibre. Often, however, it is caused by a slowing of the normal peristaltic muscular contractions which push food and liquids through the intestines. The slowdown or cessation of peristalsis of the intestine is known as gastrointestinal (GI) stasis or ileus.

What Causes GI Stasis?
A rabbit's intestine can become static for a variety of reasons, including
- stress
- dehydration,
- pain from another underlying disorder or illness (such as gas) dental problems, infections or urinary tract disorders
- an intestinal blockage
- insufficient dietary crude fiber.
Left untreated, the slowdown or complete cessation of normal intestinal movement (peristalsis) can result in a painful death, in a relatively short period of time. If your rabbit stops eating or producing faeces for 12 hours or more, you should consider the condition an EMERGENCY and GET YOUR BUNNY TO A RABBIT SAVVY VET IMMEDIATELY.

An intestinal slowdown can cause ingested hair and food to lodge anywhere along the GI tract, creating a potential blockage. Also, because the cecum is not emptying quickly enough, harmful bacteria such as Clostridium species (related to the ones that cause botulism and tetanus) can proliferate, their numbers overwhelming those of the normal, beneficial bacteria and fungi in the cecum. Once this overgrowth occurs, gas emitted by the bacteria can cause extreme pain. Some Clostridium species also produce potentially deadly toxins. It is the liver's job to detoxify these poisons, at a high cost to that all-important organ. Damage to the liver can be a serious--even life-threatening--side effect of GI stasis.

How Can GI Stasis be detected?
Symptoms of GI stasis include very small (or no) faecal pellets, sometimes clinging to the bunny's bottom. In some cases, very small faecal pellets will be encased in clear or yellowish mucus. This potentially serious problem (enteritis, an inflammation of the intestinal lining) should be treated as an emergency.

With GI stasis, the normal, quiet gurgling of the healthy intestine may be replaced either by very loud, violent gurgles (gas moving around painfully!) or silence. The bunny may become lethargic, have no appetite and may hunch in a ball, loudly crunching his teeth in pain.

GI Stasis and the "Hairball" Myth
Sometimes, a rabbit suffering from GI stasis is diagnosed as having a "hairball." In reality, an apparent hairball usually is a result of GI stasis--not the cause. A vet who has not palpated many rabbit abdomens may be unfamiliar with the normal, sometimes "doughy" feel of the healthy rabbit stomach. A "doughy" stomach is usually cause for concern only when accompanied by an empty lower GI and symptoms of abdominal discomfort.

Like those of most herbivores, the stomach and intestines of a healthy rabbit are never empty. A rabbit may eat relatively normal amounts of food, almost up to the time the GI tract shuts down. Because of this, the stomach may contain a large bolus of food when stasis occurs. Unlike the typical cat hairball, which usually consists entirely of hair, a mass misidentified as a "hairball" in a rabbit is usually composed mostly of food held together by hair and mucus. Such a bolus, even if it is dehydrated and unable to pass out of the stomach when initially found, usually can be broken down slowly with plenty of oral fluids. However, if the mass is there as a result of chronic GI stasis, simply treating the mass without addressing the GI stasis will be unproductive in the long term.

If you suspect that your bunny is experiencing GI stasis, you must take him/her to your rabbit-experienced veterinarian without delay. Tell the vet your suspicions. S/he will probably listen for normal intestinal sounds and palpate the bunny's abdomen. The vet also may wish to take radiographs (x-rays) to see whether the various parts of the digestive tract contain normal ingested matter, faeces or foreign objects - or are empty and gassy. The appearance of the digestive tract will help the vet determine whether there is an obstruction and, if so, where it is located.

If a true intestinal obstruction (almost always accompanied by severe bloating and acute pain) is present, the use of intestinal motility drugs (described later) could make the situation worse by pushing the blockage into a narrow area where it completely obstructs the intestine. However, if the mass is not causing an acute, complete blockage, medical alternatives to surgery should be considered first. A gastrotomy--surgical opening of the stomach--may be performed to remove a gastric obstruction, but rabbits who undergo this procedure have an abysmally low survival rate. Those who survive the surgery itself often succumb a few days later to peritonitis or other complications, even when under the care of the most practiced, skilful rabbit surgeon. Surgery on the rabbit GI tract should be considered only as a last resort.

Can GI Stasis Be Successfully Treated?
If your vet has determined that there is no intestinal obstruction, there are several treatments s/he may wish to use to help your bunny in distress. As always, do not perform any of these procedures or try to administer any of these medications without the supervision of a veterinarian experienced with rabbit disorders and treatments.

Treatments
A. The Abdominal ‘Jiggle’.

This video demonstrates how to safely give your rabbit a belly jiggle

Giving a Belly Jiggle to Help Relieve Gas
Gently lift the rabbit's hindquarters a few inches (with the bunny's head safely tucked into the massager's elbow, and the spine firmly supported) and gently jiggling helps gas to pass more easily, and seems to be comforting to the bunny. Once s/he gets over the initial surprise of being held this way, a rabbit will often allow his/her legs to droop in comfort and relief as the massage helps gas pockets move towards the exit.

A rabbit's internal organs are very delicate; care must be taken to avoid bruising them and making the situation worse. After a bit of jiggling, try an electric vibrating massager. It is worthwhile to invest in some type of massager with a large, flat surface that can be held against the bunny's tummy for relatively long periods. Press the massager firmly against the abdomen, start on low and work your way higher. The bunny may be a bit taken aback at first, but almost every bunny on whom we've tried massage has settled down and enjoyed the soothing vibrations. In addition to stimulating the muscles, the massage seems to help break up gas bubbles and ease colic. Massage as long and as often as the bunny will allow and enjoy.

B. Rehydration & Support Feeding

Giving your rabbit electrolytes before anything else helps to rehydrate them. It also helps to prevent organ failure and acidosis. Try to give at least 10mls, preferably 20mls of Electrolytes. Once you have given 10mls of Electrolytes you can mix a small amount of Critical Care in with it and keep administering it until you have given a total of 10mls per kilo of rabbit.

After about 30-60 minutes, mix more Critical Care or Dual Care with Electrolyte at a rate of 1 part CC/DC to 2 parts water and aim to feed 10mls per kilo every 2-4 hours (to a total of 60mls per kilo per day). You may need to feed smaller amounts more often if this is too much in one go. Encourage your rabbit to move around to stimulate its gut. Keep an eye on your rabbit’s temperature through this time.

Anorexia can cause gastric ulcers and hepatic lipidosis (fatty liver disease) relatively rapidly in rabbits. Even 12 hours without eating is cause for concern. As long as your vet has determined that there is no actual blockage, and that there is enough slow movement of the GI to keep the stomach from becoming overly full, keep the bunny eating! some excellent ready-to-mix emergency foods for compromised rabbits are Oxbow Critical Care or Burgess Dual Care. However, if you do not have ready access to Critical Care, one quick and easy recipe is to soak about 2 - 3 tablespoons of pellets in about 1/2 cup of warm water, chamomile tea or electrolytes until they are soft and fluffy. The pellets will fluff more quickly in slightly warmed solution, but overheating may destroy some of the nutrient content of the pellets. Mix the pellet fluff with additional water or tea until it forms a somewhat liquid paste with the consistency of pudding. Allow to cool before using a large-bore feeding syringe (available at most pharmacies) to deliver the goods.

Insert the tip of the syringe into the space behind the incisors and squeeze gently sideways to avoid squirting food down the trachea (windpipe). Give only 1-2 cc at a time, allowing the bunny time to chew and swallow. Aspiration of food can be life threatening, so do this with great care!

C. Monitoring Body Temperature.

Of utmost importance is careful monitoring of body temperature via (plastic, unbreakable) rectal thermometer. A rabbit’s normal temperature is between 38.3°c - 39.4°c. A higher temperature  means your rabbit has hyperthermia and needs to be cooled down. It may indicate either stress or an infection, the latter requiring immediate veterinary attention. If your rabbit’s temperature is below 38.3°c it has hypothermia and needs to be warmed up. This is of even greater concern than a mildly elevated temperature. Abnormally low body temperature (hypothermia) may indicate shock or septicaemia, a bacterial infection that has entered the bloodstream. A rabbit with a temperature lower than  37.8°c should be considered an extreme emergency. Pack the rabbit with warm water bottles wrapped in towels and get him to your rabbit-savvy veterinarian immediately. Medications often will not be effective when given to a rabbit suffering from hypothermia, so the first step in saving your bunny's life is to get his body temperature back into normal range. Warm water bottles and warmed subcutaneous fluids can be used to achieve this end, but it can take an hour or more if the bunny is severely hypothermic.

*** PLEASE NOTE - Simethicone/Infacol has historically been recommended but its efficacy is not proven to help rabbits with gas. This product is designed to consolidate frothy bubbles into larger bubbles which can be burped up or passed as ‘wind’. However, rabbits cannot burp and do not form frothy gas. In addition current thinking by experienced exotics vets does not support or recommend its use. Whilst it may do no harm, there is also no proof that it is beneficial or effective so WW does not support its use.

Baby food has also historically been used to syringe feed but Critical Care and/or Dual Care are far superior and provide your rabbit with balanced nutrition and essential fibre, which baby food cannot do. ***

C. Unlimited grass hay.

Provide plenty of fresh grass hay. Even if the rabbit won't eat Meadow or Timothy it is probably best to avoid offering alfalfa hay. Alfalfa is too high in protein and calcium to be a healthy part of the rabbit’s regular diet. It also is more likely to cause bloat, and more likely to harbour the parasitic fungi that produce potentially deadly mycotoxins than grass hays.

D. Fresh, wet, leafy herbs.

The fibre and moisture in fresh greens also will help stimulate the intestine. Puha is a good choice. If the rabbit refuses to eat, try fragrant, fresh herbs such as mint, basil, dill, cilantro, tarragon, sage, fennel, parsley and others. Sometimes it helps to nip off the ends of the stems and wave the fresh, juicy stems under the bunny's nose or even gently insert the stem into the corner of the bunny's mouth. You can even lightly pat the herbs against the bunny's face until she gets annoyed with you and grabs the offending sprig. Sometimes all it takes is a little taste to get the bunny nibbling. Try a variety until one of them gets the bunny to eat. You never know which herb will stimulate the appetite, so it's best to have a variety on hand.

E. Cecotrophes

Some veterinarians believe that cecotrophes from a healthy rabbit, although difficult to obtain, can be used to re-establish normal cecal flora in a compromised rabbit. However, other veterinarians and experienced rabbit caretakers are of the opinion that administering cecotrophes to a sick rabbit may do more harm than good for two reasons: (1) force feeding cecotrophes is very stressful to a sick rabbit, since no one likes being force-fed someone else's poop and (2) even a known, healthy donor rabbit could harbour microorganisms in the cecotrophes that could become pathogenic in an already compromised rabbit.

Also, because the normal cecotrophe is coated with mucus that protects the bacteria while they travel through the stomach, mashing the cecotrophes into a pellet mush might well render them useless. Given time and the proper supportive care, your rabbit will be able to re-establish a healthy cecal flora on his own, without the stress of being force fed foreign cecotrophes.

However, if you and your vet absolutely insists on trying this, you can obtain cecotrophes from a donor rabbit by diapering the donor, or briefly placing an E-collar on him/her during the late afternoon when cecotrophy usually occurs. Don't use the E-collar if the donor rabbit seems very stressed or upset by it. (You don't need two rabbits suffering from GI stasis!)

Prescription/veterinary treatments
A. Intestinal motility agents/ Appetite Stimulants

Metoclopramide and Ranitidine (currently unavailable) will help get a static intestine moving again. Both of the aforementioned drugs are safe and effective for rabbits. However, as with any drug, your veterinarian should be aware of any potential drug interactions between  any other medications your rabbit may be taking.

It may take as long as two weeks on metaclopramide before the intestine is fully motile again, and patience and careful nursing for the duration are essential. In severe cases of GI stasis, both drugs can be used simultaneously. Because they work on different areas of the digestive tract, they may have a synergistic effect.

Conventional wisdom holds that if there is a possibility of an intestinal obstruction, these drugs should not be used. However, more and more rabbit-savvy veterinarians are noting that unless there is a problem with the pyloric valve or an acute and true blockage of the stomach, motility drugs generally do not make the problem worse. So far, there is no consensus on this aspect of the problem, and it will be up to your veterinarian (and you, as your bunny's health advocate) to determine the course that seems right for your bunny. Once again, it is imperative that you not take matters into your own hands. Have an experienced rabbit vet diagnose the problem and prescribe proper treatment!

In addition - B vitamins, administered orally or injected, or Periactin (cyproheptadine) can be used to stimulate appetite. The former not only help stimulate appetite, but might also help supply what the bunny is missing by not producing or eating his cecotrophes. Periactin is available in 4 mg tablets or a 1 mg/ml liquid suspension. An average-sized (4 - 6 lbs.) rabbit can be given 1mg by mouth, twice per day. It is vital to keep the bunny eating, even if you must force-feed. Anorexia can rapidly result in gastric ulcers and serious liver degeneration.

B. Subcutaneous Fluid Therapy.

Note that examining a rabbit's skin turgor (via "tenting" the skin) will often not give an accurate indication of the animal's hydration status. A more useful diagnostic procedure for rabbits is palpation of the intestinal tract, which will feel very "doughy" throughout if the rabbit is dehydrated. Because rabbits absorb large amounts of water into their tissues from the intestine to drive other bodily functions, a rabbit whose skin feels well-hydrated may still have an intestine packed with a dehydrated mass. Keeping the tissues well-hydrated via appropriate administration of subcutaneous Lactated Ringers Solution (LRS) by your vet will not only keep the bunny well hydrated, but will also help with electrolytes balance and make the bunny feel better in general.

A dehydrated rabbit will feel tired and ill, and may not have as much will to live as one who is well-hydrated. Rabbits in GI stasis tend to be unwilling to eat or drink, so it may be a good idea to administer subcutaneous fluids as a precaution, unless the rabbit has known kidney or heart malfunctions, or other problems that your vet will be able to determine that would contradict administration of subQ fluids.

C. Antibiotics: Use with caution, if at all.

Some vets routinely prescribe antibiotics for a rabbit suffering from GI stasis, either to combat the overgrowth of Clostridium spp. (metronidozole [Flagyl] is often used for this purpose) or to prevent secondary bacterial infection in the compromised rabbit (other rabbit-safe antibiotics such as the fluoroquinolones or sulfas might be used for this purpose.) While such cautionary measures may be taken, the practitioner should recall that unnecessary use of antibiotics is a prime reason that so many resistant strains of bacteria are evolving even as we speak. Unless the rabbit shows signs of bacterial infection (which can sometimes be the reason the intestine shut down in the first place), we urge a conservative approach: don't use antibiotics unless they are absolutely necessary.

Pain Relief: The key to keeping the bunny fighting to live.
Meloxicam (metacam) an NSAID, is the most commonly used pain relief for stasis buns in NZ  and has been used with good results in rabbits.

The following guidance re pain relief in Stasis treatment is provided by Martin Earles a NZ Rabbit specialist.

”Meloxicam shouldn't be given with dehydration so therefore after fluids and syringe feeding. It's useful as an analgesic for low grade stasis or after the acute signs have reduced. Butorphanol (Torbugesic) isn't a very effective analgesic. Buprenorphine is probably the number one analgesic to use initially as it is safe, effective and doesn't reduce GI motility”

More information about recognising and treating pain can be found below.

The Road to Recovery: Reduce Stress. ("If it ain't broke, don't fix it.")
It is essential that the caretaker faced with a rabbit in GI stasis be patient, allowing the treatments and medications to work. Rabbits are easily stressed, and excessive handling should be avoided. It may take several days before any faecal pellets are seen, and it may take two weeks or more of motility therapy before the intestine is moving normally again. We know of one case in which a rabbit produced no faecal pellets for 14 days, but finally did respond to gentle, consistent administration of the above treatment regimen. Patience and persistence are key.

Do not make more trips to the veterinarian's office with the rabbit than absolutely necessary (the stress of travel can slow recovery), but DO contact your veterinarian frequently to report on progress and any changes. Whenever possible, administer medications at home, where the rabbit feels safe and secure.

While you are treating your sick bunny, NEVER separate him/her from his/her bonded partner(s). The stress of separation itself can make the problem worse. We have known bunnies who seemed at death's door to recover when they were provided with the love and constant attention of their bonded mate. If your bunny does not have a mate, it is even more important that you, his best friend, show him a great deal of calm attention and affection during his ordeal. Rabbits seem to understand when they are being fussed over, and it may help them recover more quickly to know that they are not being abandoned in their misery. But do this within reason. Many a rabbit can sense a caregiver's fear for his safety, and this in itself can cause stress. Visit and love your bunny, but also give him time to himself to recover.

Every bunny parent should have a stethoscope (not necessarily an expensive one) to monitor intestinal sounds. The gradual return of gentle gurgling is a very good sign: once this begins, the rabbit is on the road to recovery, even if faecal pellets don't begin pouring out the chute. Administration of intestinal motility agents, gentle massage and supportive care as recounted above should be continued, and gradually tapered as faecal pellets slowly begin to come through the system.

Do not be alarmed if the first batch of faecal pellets is small, hard and misshapen, and even accompanied by some mucus. This is to be expected. Also do not be surprised if the rabbit produces a small bunch of pellets, nothing for a day, and then a bit more. The intestine sometimes seems to regain its function in fits and starts, rather than all at once. Consistent, gentle nursing and reduction of stress are essential at this time.

PLEASE RESIST THE TEMPTATION TO FORCE ADDITIONAL, AGGRESSIVE TREATMENT ONCE THE RABBIT BEGINS TO RECOVER. RECOVERY FROM GI STASIS IS SOMETIMES MADDENINGLY GRADUAL.

MOST IMPORTANT OF ALL: Backtracking to the Cause

Remember: Ileus is not an illness in and of itself. It is a SYMPTOM of an underlying disorder that has caused the bunny enough stress or pain to cause the GI tract to slow down or stop. Hence, ileus may be your first clue that something else is wrong that needs proper diagnosis and treatment.

Once your bunny is recovering from the immediate GI stasis threat, it's time to look for the ultimate cause of the problem.

• Does your rabbit get insufficient fiber in her diet?

• Are you giving her too many starchy treats?

• Does she have an underlying infection or illness that's causing enough pain/stress to shut down her intestine?

• Does she have overgrown molars or an abscessed tooth? (NOTE: It is wise to check this possibility at the first sign of any change in your rabbit's eating habits. If your bunny has overgrown molars, this alone can cause an unwillingness to eat certain items, or even result in complete anorexia.)

• Have there been major changes in the household that are causing psychological stress to the bunny (loss of the bunny's bonded partner, a new pet in the house, visitors, construction, etc.)?

Any of the above could trigger an ileus event, and must be diagnosed and corrected if your bunny is not to suffer a chronic recurrence of the ileus problem. If your rabbit does not seem fully normal, even after the GI tract is moving well again, it's time to ask your vet to do some blood work, a deep oral exam (to check for molar problems), radiographs (don't forget the head!), a complete check of the urinary tract, and any diagnostics your rabbit-experienced veterinarian deems necessary to get to the root of the problem.

DO NOT wait for an emergency to find a veterinarian who is experienced and good with rabbits. Unfortunately, many emergency clinics will not even see rabbits, let alone know how to properly care for one in acute distress. A veterinarian who treats a rabbit as if s/he were a dog or cat might do more harm than good. Plan now and avoid heartache later! Find a good rabbit vet in your area via the Vet Section.

Prevention: The Best Medicine
The best cure for GI stasis is prevention. Be sure your rabbit companion gets plenty of dietary fibre from fresh grass hay. Feed high fibre (ideally 20% or higher crude fibre) pellets. Be sure your rabbit is drinking sufficient water to keep ingested food hydrated and moving smoothly. It helps to offer 1c of packed greens per 2.5kg of rabbit daily. And don't forget that regular exercise not only keeps the skeletal muscles strong: it also keeps the smooth muscles of the intestines well-toned and active.

Regular visits (including a molar check!) to your rabbit-experienced veterinarian will ensure that your bunny pal doesn't develop health problems that go undetected. Once such a problem becomes serious, it may manifest itself as GI stasis.

So here's to healthy peristalsis! May your home be blessed with great, big, healthy piles of gorgeous bunny poops. All in the litter-box, of course.

GI Stasis  - Further Reading
GI Stasis in Rabbits: A Deadly Condition - My House Rabbit
Gas & Stasis - Special Bunny
Disorders of the gastro-intestinal system in rabbits - MediRabbit

‘Fur Block’  
GI Stasis (hairballs) in Rabbits - Long Beach Animal Hospital
Sluggish Motility in the Gastrointestinal Tract - House Rabbit Society

Taking Your Rabbit’s Temperature

How To Take Your Rabbit’s Temperature

The use of PeptiSoothe/Ranitidine in the Treatment of Ileus/Stasis
Metoclopramide works on the stomach/upper gut and Ranitidine works on the fundus/lower gut/Cecum. If using both and the Metaclopramide is being given orally, the drugs need to be spaced 2 hrs apart...

BLOAT
True bloat is a distressful and dangerous condition in rabbits. It should not be confused with stasis or ileus – a condition that takes a few days to develop and is characterised by reduced motility of the intestine, or the presence of some gas in the digestive system caused by food. Bloat is a dreaded condition in rabbits, with poor prognosis, causing excruciating pain. Most rabbit savvy vets often opt to humanely put the rabbit to sleep, to spare it more suffering.

Bloat is caused by an abnormal accumulation of gas that leads to an extreme distension of the stomach. The stomach feels hard and the rabbit looks like a “balloon”. The rabbit shows signs of terrible pain and may have difficulties to breath properly. When bloat reaches a certain point in rabbits, it becomes irreversible. This is due to the facts that the stomach wall of rabbits is not as elastic as in many other animals. The distended stomach (its volume can double) will, furthermore, compress the main blood vessels that lead blood to and from the heart, causing secondary cardiovascular collapse and heart failure. Blood electrolyte imbalance also leads to convulsions. At this stage, the condition is fatal.

Causes of bloat remain unknown. It may related to overeating, exercising immediately after eating are suspected in most animals, lack of fibre in the diet, change of diet, excessive drinking or stress, or result from a pyloric blockage, gastric ulcers or other digestive problems.

There is no treatment available for true bloat in rabbits. Administration of corticoid drugs, antibiotics or subcutaneous fluids does not bring relief. Introduction of a rubber catheter in the stomach in order to aspirate the gas and the content is not very efficient. Some rabbits have survived this emergency treatment but died within 24 hours following this procedure. Laying the rabbit on its left side does also not bring much relief.

Rabbit-savvy veterinarians often suggest euthanising the rabbit after diagnosing bloat, in order to shorten its sufferings.

Bloat is a veterinary emergency. A rabbit that suffers from bloat does usually not survive longer than a few hours.
Further Reading:
“Bloat” and Gastrointestinal Blockage in Rabbits
Carmela: acute bloat in a 3 years old rabbit - MediRabbit
Acute onset of bloat can affect any rabbit - MediRabbit

PAIN

Recognising Pain in Rabbits
The following PDF has clear photos and descriptions to help identify whether your rabbit is in pain.
Rabbit Grimace Scale (RbtGS) Manual

Pain Management
Rabbits in the wild are at the bottom of the food chain. It’s hard-wired into them not to show any sign of weakness. If they show any sign of illness or disability, to make them look slow and vulnerable, they’ll end up as somebody’s dinner. This instinct is present in our pet rabbits too.

This makes it very hard for us to know when they are in pain and we have to watch carefully for unusual behaviour.

Wherever the pain is coming from, it’s likely to affect their appetite. This is vitally important because to keep a healthy gut rabbits need to be constantly grazing. This is one reason why they must always have a constant supply of fresh hay.

Look out for

* runny eyes - possible dental problems

* head tilted to one side - possible ear infection or EC

* stiffness after lying still - possible back problems or arthritis in joints

* difficulty walking (possibly arthritis, sore hocks, a back problem or EC

To read further - Pain Management for Rabbits

How to Give Your Rabbit Medication / Force Feed / Syringe Feed

You MUST ensure the rabbit does not have an intestinal blockage or bloat before syringe feeding.
It is vital that rabbits keep eating steady amounts throughout the day and night, however sick rabbits or those that are recovering from an anaesthetic or in pain may be reluctant to do so. This is where assisted feeding is needed. A rabbit’s system can shut down very quickly in cases like this.
Syringe Feeding Guide - RAWF