Diarrhea in Rabbits

Diarrhea in rabbits can be intermittent, where soft or liquid stools are found along with normal fecal pellets, or constant, with soft or liquid stools occurring in the absence of normal fecal pellets. It is important to distinguish between these two types, as constant or "true" diarrhea in the absence of normal fecal pellets can be a serious, life threatening disease, requiring urgent veterinary care. In contrast, intermittent diarrhea, known as "cecal diarrhea" is less urgent, but nevertheless should be evaluated by a veterinarian if diet changes alone are not effective.

Diarrhea should not be confused with the normal, soft cecotropes (night feces) that are produced and ingested by the rabbit primarily in the early morning hours. Normally, rabbits will eat their cecotropes directly from the rectum, and you will rarely, if ever see them. However, if your rabbit cannot consistently reach its rear end to eat these, you may find them periodically. If your rabbit has not stepped on sat upon the cecotrophs, they typically look like a large clump of dark, soft round fecal balls. People often describe them as looking like a large blackberry. But if they are smashed or adhered to your rabbit's rear end, they loose this form and can be confused as diarrhea. The most common causes for uneaten cecotrophs are obesity or spinal/arthritis pain, both of which prevent the rabbit from consistently reaching its rear end to eat the cecotrophs.

Causes

• Inadequate amounts of roughage in the diet (in the form of grass or timothy hay)
• Stress
• Infectious agents (bacterial, viral, fungal, parasitic)
• Weaning
• Drugs (especially antibiotics) and toxins
• Dietary indiscretion (eating inappropriate food or material)
• Metabolic diseases

True or constant diarrhea can cause dehydration and electrolyte disturbances, and is a serious disorder. Intermittent, or Cecal diarrhea is due to alterations in the normal cecal and intestinal pH (acidity or alkalinity) leading to disruption of normal bacterial flora that leads to abnormal bacterial growth. Untreated, both types can become life-threatening.

What to Watch For

• Small, watery, soft, mucus-like, scant or misshapen fecal pellets
• Soft or liquid feces intermixed with normal fecal pellets
• Foul odor to feces
• Soft feces adhered to fur around the rear end
• Sudden loss of appetite (If you rabbit is unwilling to eat anything at all, this is potentially an emergency)
• Loud gut sounds (owners often say they can hear the "tummy rumbling"
• Decreased or lack of water intake
• Lethargy – excessive sleepiness, or decrease in activity
• Abdominal pain or discomfort – rabbits will often act as though they can't get comfortable by frequently changing body positions from lying outstretched and switching from side to side, to sitting hunched and breathing rapidly.

Diagnosis

Veterinary care is aimed toward determining the cause of the diarrhea so that appropriate treatment recommendations may be offered. True or constant diarrhea requires aggressive treatment, and even with this, may carry a poor prognosis. Many cases of cecal diarrhea are short-lived and can be easily treated, but unless the cause of the diarrhea is elucidated, serious consequences may occur.

• Diagnostic testing includes a very thorough history and physical examination by an experienced veterinarian. Be prepared to list all food types that your rabbit eats.
• Radiographs (X-rays)
• Examination of the feces (flotation, direct smear and grams staining)
• A complete blood count (CBC) and serum chemistry panel
• Abdominal ultrasound

Treatment

Treatment is based on the cause of the diarrhea and may include:

• Dietary modification
• Fluid therapy
• Motility drugs that change the rate the ingesta (food) is passed through the intestinal tract
• Pain medications – diarrhea is often accompanied by painful gas and gut contractions
• Antibiotics
• Deworming

Home Care

If your rabbit has a normal appetite (is eating and drinking normally), is passing normal (round, firm) fecal pellets with occasional soft stool mixed in with the normal pellets, and otherwise acting normally, you can try modifying the diet. Feed only grass or timothy hay and a high quality rabbit pellet (with no seeds, nuts or colored nuggets mixed in). Eliminate all vegetables, fruits and other foods, and provide fresh water constantly. If soft stools are still mixed in with normal fecal pellets after 1 week of feeding hay and pellets only, see your veterinarian. If your rabbit stops eating, or stops producing normal fecal pellets, see your veterinarian immediately.

Administer only prescribed medication and provide fresh water at all times. Encourage your rabbit to eat frequently.

Closely monitor fecal output and ensure adequate food consumption. Observe your rabbit's general activity and appetite and notify your veterinarian immediately of any worsening of signs. Keep the environment stress free.

Preventative Care

Always keep diet consistent by offering free choice of timothy or grass hay (fresh and free of molds) and a limited quantity of plain, high quality rabbit pellets (no seeds or nuts)

Avoid abrupt changes of brands of pellets and make all changes or additions of foods very gradual – keeping your pet on a consistent and regular diet is imperative. Avoid feeding of pellets only

Have all new pets checked by a veterinarian, and then annually or bi-annually thereafter.

There are many causes of diarrhea in rabbits. Diarrhea may be caused by diseases directly affecting the gastrointestinal tract, or by metabolic disturbances in other organs such as the liver or kidney. Be prepared to provide in-depth information to your veterinarian including all types of food offered, contact with other animals, and possible stresses in the environment.

Causes

• Diet. Inadequate amounts of roughage in the diet (in the form of grass or timothy hay) is among the most frequent cause of cecal diarrhea in rabbits. The lack of roughage also predisposes the rabbit to other problems such as Gastrointestinal Stasis Syndrome (GI Stasis), abnormal bacterial colonization of the gastrointestinal tract (clostridial enteritis and gram negative enteritis), inadequate tooth wear, and hypercalciuria (too much calcium excreted in the urine), to name a few. Adding new types of greens, or adding new greens, fruits or other vegetables too quickly can also cause cecal diarrhea.
• Stress factors. New pets in the house, changes in the environment or diet, heat and humidity, crowding, breeding, poor hygiene, inadequate roughage, and lack of visual security (places to hide) may alter the normal pH or motility of the gastrointestinal tract and cause diarrhea.
• Infectious agents. Overgrowth of bacteria such as E. Coli, pseudomonas, campylobacter–like species, and some clostridium species may cause diarrhea. Examples of viral causes of diarrhea include a corona virus, rotavirus, and possibly a calicivirus, but these are usually only problems in breeding facilities or shelters.
• Parasites. Many species of coccidia are a cause of illness and diarrhea in young rabbits. Other gastrointestinal parasites rarely cause symptoms in rabbits.
• Toxins. Heavy metal toxicity, plant toxins, fungal toxins and bacterial toxins from contaminated food may cause diarrhea by directly affecting the gastrointestinal tract or by affecting other organ systems.
• Drugs (especially antibiotics). Many antibiotics that are commonly used in other species can cause a fatal gastroenteritis in rabbits. If diarrhea ever begins with the administration of any drug, the drug should be discontinued and your veterinarian immediately notified.
• Dietary indiscretion. Eating inappropriate food or material irritates the lining of the intestines or contains toxins which may cause diarrhea.
• Metabolic diseases. Kidney, liver and pancreatic disease may all cause diarrhea.
• It is important to distinguish cecal diarrhea from constant diarrhea. If your rabbit is having soft, liquid, bloody, or foul smelling feces, and not producing any of the normal, solid round feces, this is urgent, and should be evaluated by a veterinarian immediately. In contrast, rabbits with cecal diarrhea produce occasional soft, liquid or strong-smelling feces along with normal, solid, round fecal pellets. This may be less serious, but should be evaluated by a veterinarian if it lasts longer than a week, or is accompanied by a decrease in appetite, lethargy, blood or mucus in the stool.
• Diarrhea should not be confused with the normal, soft cecotropes (night feces) that are regularly produced and ingested by the rabbit primarily in the early morning hours. Cecotrophs are soft, dark-colored strong-smelling feces that may resemble shiny blackberries. They are eaten (coprophagy) directly from the anus during the night or early morning hours, so most owners rarely, or never observe them. However, if your rabbit is overweight, painful or otherwise not able to consistently reach his hind end to eat these, you may observe them. More often, the rabbit sits or steps on them, so they lose their characteristic shape. It is when they are stepped on, or stuck to the fur of the hind end, that they most often are confused with diarrhea.
• One of the most common causes of diarrhea in rabbits is disruption of the cecal bacterial population (cecal flora). Rabbits can digest food that we cannot, such as hay and grasses, because they have a cecum. The distinct population of bacteria within the cecum acts as a bacterial fermentation vat to digests these foods. If the cecal bacteria are altered in any way, gas and toxin-forming bacteria overgrow. Inadequate roughage in the diet is a primary cause of disruption of the cecal bacterial population.

Veterinary care is aimed toward determining the cause of the diarrhea so appropriate treatment recommendations may be offered. Diagnostic testing includes a very thorough history and physical examination by an experienced veterinarian. The veterinarian will recommend specific tests depending on the severity of the diarrhea and the condition of the rabbit.

Diagnosis

• A careful physical examination to evaluate the motility of the intestines or the presence of gas in the intestinal tract, to look for sources of pain, and an oral exam to evaluate the teeth will be performed.
• Radiographs (X-rays) give an overall look at the rabbit's internal organs and skeleton. Abnormal gas patterns in the stomach, cecum or the intestines are extremely valuable in determining the cause of diarrhea. Radiographs may also help to find painful conditions that may cause your rabbit to stop eating cecotrophs, such as arthritis. Occasionally, other conditions, such as tumors, or changes in the size and shape of the liver and kidneys may be found.
• Examination of the pet's feces (flotation, direct smear and grams staining). The fecal flotation and direct smear may identify parasitic or bacterial causes of diarrhea. The gram stain will determine if the rabbit has abnormal types of bacteria, such as clostridia in the intestinal tract.
• A complete blood count (CBC), the number of circulating red and white blood cells, may help differentiate between infectious and non-infectious causes of diarrhea. Some rabbits with serious alterations in cecal bacteria flora may develop septicemia, where dangerous bacteria gains access to the general circulation. The CBC is very helpful in diagnosing this.
• Serum chemistry panel will detect any electrolyte abnormalities, and give evidence of other systemic involvement such as malfunctioning kidneys or liver.
• Barium studies/contrast studies. The rabbit swallows a special dye and X-rays are taken over a period of time. This study will look for tumors or foreign bodies, and may identify ulcerations or thickenings of the intestinal tract. This study also helps determine if the ingesta is passed through the intestinal tract at the appropriate rate.
• Pasteurella test. Determining the pasteurella status of the rabbit may be helpful in gaining an overall picture of the health status of the rabbit. A positive test means the bacteria is directly or indirectly contributing to the diarrhea.
• Abdominal ultrasound allows visualization of the abdominal organs for evidence of masses, abnormal organ densities, intestinal wall thickening, and foreign bodies within the intestinal tract.

Therapy In-depth

Diarrhea is a symptom that can be caused by many different diseases or problems. Cecal diarrhea can be mild, with the rabbit otherwise appearing healthy, or can lead to painful bloating or occasionally, life threatening bacterial septicemia. Constant, true diarrhea causes life-threatening changes in hydration and electrolytes, and warrants aggressive treatment. The diagnostic tests described above should elucidate the cause of diarrhea so that proper therapy can be instituted. Pending the results of the diagnostic test the therapy is directed toward preventing further consequences such as dehydration, cecal bacterial changes, and spread of disease to other parts of the body.

• Dietary modification is necessary for diarrhea that is the result of inadequate amounts of fiber. All greens, fruits and other vegetables are withheld. The ration of pellets is reduced and the amount of timothy or grass hay is increased. Unlike the treatment of acute diarrhea in cats or dogs, withholding food from rabbits for a period of 12 or 24 hours should NOT be instituted. Unless directed by your veterinarian, rabbits should never go without food. If a rabbit is not eating, food is given in the form of a specific high-fiber gruel (available from your veterinarian), and assist-fed via syringe. If food is not accepted by assist feeding, a tube may be passed through the nasal cavity into the stomach for forced feeding of gruel.
• Fluid therapy. Many rabbits that have diarrhea become dehydrated and require fluid therapy. The route the fluid is given (under the skin, through the vein or orally) is dependent on the severity of the diarrhea and the health status of the rabbit. Fluid therapy is an important part of supportive therapy that is used until a definitive diagnosis can be found.
• Pain medication is often a very important part of treatment. Many rabbits with diarrhea develop painful gas bloat or intestinal cramping. Painful rabbits refuse to eat, worsening the disruption of bacterial flora. Pain medications can be given by injection or an oral route.
• Motility drugs that change the rate the ingesta (food) are passed through the intestinal tract are sometimes given.
• Antibiotics aimed at the infectious cause of diarrhea may be used based on the grams stain and/or culture or observation of large amounts of gas in the cecum. In critically ill animals, these are usually administered via an intravenous route.
• Deworming will be performed based on the positive identification of diarrhea-causing parasites. This is usually only a problem in young or recently weaned rabbits.
• Administration of a commercial product that absorbs bacterial toxins is often administered.

Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.

• Administer all prescribed medication(s) as directed. Alert your veterinarian if you are experiencing problems treating your pet.
• Return for future appointments as requested by your veterinarian. Follow-up with CBC's, X-rays, and other diagnostic tests may be useful in assessing the response to therapy.
• Notify your veterinarian immediately if the diarrhea worsens or if new symptoms arise. New symptoms such as lethargy, decreased appetite, and hiding may be an indication that the pet is worsening. If your rabbit stops eating entirely and refuses all food, seek veterinary care immediately.
• Keep the home environment as stress free as possible for optimum healing.