Category: gastrointestinal-conditions-rabbits


Peritonitis is the term used to describe inflammation of the peritoneum, the membrane that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis can be very severe in rabbits and life threatening in many cases. For this reason it is essential to identify and treat the cause as soon as possible.

The most common cause of peritonitis is faecal contamination of the abdominal cavity due to perforation of the gastrointestinal tract, often due to severe obstruction. Other causes are rupture of other internal organs such as liver, bladder or uterus, abdominal injuries due to external trauma and predator bites, infectious diseases and wound breakdown following surgery.

Peritonitis can be acute or chronic; acute when it has a sudden onset, and chronic when it occurs over a period of time. Acute peritonitis is normally the result of infection due to bacteria, namely E. coli. This is a severe form of peritonitis and the vast majority of rabbits do not survive this form. If the rabbit does survive then they often develop chronic peritonitis in the coming days. Chronic peritonitis may result from an after effect of acute peritonitis, abscesses within the abdomen, or complications following abdominal surgery.

A rabbit with peritonitis is generally lethargic with reduced appetite and faecal output. Other clinical signs are severe pain and abdominal distension. Due to the pain, the rabbit is generally reluctant to move and often grinds the teeth. The respiratory rate is also likely to be high due to the amount of discomfort. In severe cases, the rabbit also has a fever and can even be in a state of collapse due to the shock.

However, all of these symptoms are non-specific and also analytic of many other problems, so it is important to take your rabbit to see your vet straight away and do not wait to see if they improve.

An initial diagnosis of peritonitis is based on clinical signs and physical examination. Your vet will then confirm diagnosis by performing an abdominocentesis. This technique involves inserting a needle into the rabbit’s abdomen to see if there is any evidence of ‘free fluid’ and, if possible, collect a sample. This is often performed in the conscious rabbit, but it may need to be sedated to reduce the stress caused by the pain. The sample collected can be tested for bacteria if an infection is suspected.

X-rays, ultrasound and blood tests are also likely to be performed in order to determine the cause of peritonitis and evaluate the severity of the condition.

An exploratory laparotomy, which involves giving the rabbit a general anaesthetic to surgically operate on and open the abdomen, may be performed by the vet to better evaluate the abdominal organs and determine the cause of peritonitis.

Intensive medical and supportive treatment is generally necessary. This consists of fluid therapy to treat the shock, broad spectrum antibiotics, strong painkillers, and assisted feeding. In severe cases, abdominal lavage under general anaesthesia is also performed. Abdominal lavage consists of profuse flushing of the abdominal cavity with warm sterile saline in order to remove the contaminating material and ‘clean’ the abdominal cavity as much as possible.

As part of treatment, it is also necessary to identify the cause of peritonitis and remove or treat it when possible. It is often a waiting game to see if the rabbit responds to treatment, which can take many days or weeks of intensive treatment.

The prognosis depends on the severity of the peritonitis, however it is generally considered poor.

In order to have a better prognosis, it is important that treatment is started as soon as the rabbit shows the first signs of illness. Due to the acute onset and fact that most rabbits are only presented once they are extremely ill, means that even with intensive veterinary care, the vast majority do not survive.

Mucoid enteropathy

Enteropathy refers to any condition affecting the intestines. There are several types of enteropathy, but the most common type that seems to affect rabbits is referred to as mucoid enteropathy. Despite having been around for decades, the condition remains confusing and is still not fully understood.

Mucoid enteropathy is a disease of the intestinal tract, causing inflammation, hypersecretion and accumulation of mucus in the small and large intestines. Signs of the disease include lethargy, diarrhoea, anorexia, weight loss and caecal impactions.

Mucoid enteropathy is often known as mucoid enteritis or just ME. It is still not known why some rabbits develop the condition and what role diet, stress, caecal microflora or pathogens play, although in all likelihood they all play some part.

Young rabbits at weaning age are by far and away the most common group affected. The condition is much more common in large groups of rabbits and is not generally found in the wild rabbit population. Adult rabbits can be affected, especially after an extremely stressful incident, such as transportation, giving birth, loss of a companion, attach by a predator, etc.

The defining feature of mucoid enteropathy is the presence of a large amount of mucus in the colon, which also results in mucus diarrhoea. The stomach and small intestines often become distended with gas and fluid. Constipation is often also found (normally on post-mortem), since a plug of mucus may be found obstructing the colon.

Clinical signs in adult rabbits include abdominal distention, depression, a low body temperature, excessive and ‘wet’ gut sounds. The rabbit will stop producing normal hard droppings and diarrhoea may be present. The rabbit may produce some form of faecal material which will be mixed with large amounts of mucus. Many rabbits will have some or complete loss of appetite and painful tooth grinding is often seen.

Diagnosis is made often on clinical symptoms and radiographic findings, since gas shadows can often be seen in the caecum and small intestines. Sadly, many cases may also be diagnosed during a post-mortem examination, since the condition is often rapidly fatal.

The prognosis for these cases is often poor despite aggressive treatment consisting of prokinetic medication, pain relief, anti-ulcer medication, antibiotics, probiotics, aggressive fluid therapy and nutritional support.

Treatment may be successful in older rabbits who are taken to a vets in the very early stages, but as the disease often affects very young rabbits who have just undergone a home change, the prognosis is very poor.

The prognosis for these cases is often poor despite aggressive treatment consisting of prokinetic medication, pain relief, anti-ulcer medication, antibiotics, probiotics, aggressive fluid therapy and nutritional support.

Treatment may be successful in older rabbits who are taken to a vets in the very early stages, but as the disease often affects very young rabbits who have just undergone a home change, the prognosis is very poor.

Feeding a diet high in digestible fibre and reducing stress as much as possible seem to be the most sensible option. If acquiring baby rabbits, then getting them from good breeders who will have been feeding lots of hay, grass and weaned the babies at the correct age, is also a wise idea.

Intestinal obstructions in rabbits

Rabbits are frequently diagnosed with gastrointestinal (GI) stasis. However, some of these rabbits may be suffering from an intestinal obstruction, which has an acute onset and requires rapid and very different treatment to GI stasis in order to have a chance of a successful outcome. Although intestinal obstruction is rare in pet rabbits, it is considered an emergency and should be addressed promptly.

House rabbits may have access to many items such as small pieces from children’s toys, carpet, cables, plastics and buttons on remote controls, etc. Any of these can seem appealing to rabbits and may not be noted as missing by owners until closer inspection after the rabbit starts showing clinical signs of being unwell.

Clay based clumping cat litter, if used in litter trays, can also be ingested and cause obstruction. For this reason only non-clumping cat litter, such as compressed wood shavings should always be used in rabbits litter trays.

Rabbits may also eat items that are part of their daily diet which could cause an obstruction. The seeds from apples, locust beans which used to be common in muesli type rabbit foods, and pieces of sweet corn have all been cited as causes of intestinal obstruction in rabbits. However, in order to develop an obstruction a concurrent underlying disease, such as dehydration or reduced gut motility must be present.

Nowadays though, apples, muesli and sweet corn are not considered part of a healthy diet for rabbits.

It was long thought that hairballs were a primary cause of gastrointestinal stasis and obstruction in rabbits. However, it is now believed that the vast majority of rabbits have some degree of hair matter within their stomach. This is a normal finding and occurs during usual grooming, especially during moults.

If the rabbits gastrointestinal tract remains healthy, and the motility is not compromised, this hair is passed out with the faeces in small quantities and doesn’t cause any problems.

If the rabbits gastrointestinal tract slows down as a consequence it begins to dehydrate, then the accumulated hair can begin to matt together and has the potential to cause an obstruction. Therefore the primary issue is why the rabbits gastrointestinal tract has slowed down, but the secondary problem of the hairball causing a blockage needs immediate veterinary attention.

Often the rabbit will exhibit normal behaviour and then suddenly develop an acute and rapid onset of clinical signs. Rabbits with an intestinal obstruction present severe abdominal pain and as a result will become anorexic, unwilling to move and grind their teeth in pain (bruxism). They will also press their abdomen on the ground, have a bloated and distended abdomen, and cease production of faecal pellets.

Sometimes all of these symptoms may be apparent, but this is not always the case, and for this reason it is not always possible to immediately make a diagnosis of intestinal obstruction.

Clinical examination can show an enlarged part of intestine. This is often made on radiographic findings, which will show a large halo of gas or collection of fluid proximal (before) the site of the obstruction. Sometimes it may be possible to see the item causing the obstruction, but this depends what the object is made up of as certain materials do not show up on x-ray. In this case, it is possible to perform a contrast study. A liquid that will show up on x-rays is introduced to enhance the gastrointestinal tract and identify the type and the location of the obstruction in order to facilitate the surgical removal of the object.

The radiographic examination is generally taken under sedation unless the rabbit is very quiet and unwilling to move. Sedation also helps to reduce the stress caused by the handling in such stressful and painful situations.

In severe cases, sometimes exploratory laparotomy (surgical abdominal exploration) under general anaesthesia is performed in order to evaluate the nature and severity of the obstruction that otherwise will not be possible to investigate.

Once a diagnosis of intestinal obstruction is made, the rabbit will need emergency medical and surgical treatment to remove the offending blockage.

Medical treatment consists of administration of painkillers (analgesia), fluid therapy and gastric decompression to release the trapped gas using a tube that is passed through the mouth into the stomach. The use of gut motility stimulants (prokinetics) in this case is contraindicated. Prokinetics encourage movement of the gastrointestinal tract, resulting in a rupture of the intestines or stomach which is likely to prove fatal.

Surgical treatment consists of removal of the obstruction under general anaesthesia. This procedure is performed once the rabbit is considered stable from a medical point of view in order to reduce the risk of the general anaesthesia and increase the success of recovering.

The prognosis is generally guarded and is dependent upon several factors. The time elapsed between the occurrence of the obstruction and surgery to remove it is possibly the most important factor. If the obstruction just happened and the intestine has not deteriorated, the prognosis is guarded but favourable. If, however, part of the intestine needs to be removed, the prognosis is generally poor.

However, if the problem is addressed promptly and the intestinal obstruction is not too severe, there is a good chance that once the surgery has been performed, the rabbit will survive.

Hairballs in rabbits

Rabbits are very clean animals and groom themselves constantly, which means the stomach contents always contain hair. This hair is normally passed through the digestive system and excreted with the faecal pellets.

True hairballs are very rare in rabbits since it is a normal finding for a rabbit to have some hair within their stomach and digestive system. Problems occur when excessive amounts of hair are ingested or the hair already within the stomach dehydrates. True hairballs are called trichobezoars.

Normal grooming should not cause a problem, but excessive grooming or hair chewing can occur as a result of a low fibre diet. These problems can also be a bad habit (vice) which is usually associated with boredom or stress.

Problems normally creep up slowly and you will notice over several days or weeks that your rabbit will eat less, produce fewer and smaller droppings, move around less, produce droppings which are strung together with hair and possibly tooth grind in pain.

If you notice any unusual behaviour regarding your rabbits eating habits you should contact your vet immediately, as rabbits who stop eating for any length of time are often very sick rabbits. Since a rabbits digestive system is designed to have a constant supply of food going through it, any disruption to this will quickly send the rabbit into gastrointestinal stasis (GI stasis), where the digestive system stops or slows down completely. This is serious and life-threatening and requires immediate veterinary attention in order to have any chance of saving the rabbit.

Feeding hay ad lib, thus ensuring that the rabbit has a high-fibre diet and a constant source of food to nibble on to reduce boredom, is the single and best way to help prevent hairballs.

However, hairballs are often associated to a primary cause which has meant that the rabbit has reduced its food and water intake and the hair within the stomach has become dehydrated. Any form of pain (dental, spinal, abdominal etc), stressful occurrence (new companion, loss of a companion, vet visits, predators within the garden, sudden changes in environmental temperatures etc) can mean a rabbit will eat and drink less, resulting in a hairball. However, it must be remembered that the hairball is a secondary condition and the primary cause needs identifying and treating correctly.

To ensure that your rabbit doesn’t ingest excess quantities of hair, try and groom them regularly especially during a moult. Long-haired rabbits are more susceptible to suffering from a true hairball since they will naturally ingest more hair through grooming. Try and groom them daily or get an experience person to clip the rabbits long hair.

Since the hairball is a secondary finding and often not the true cause of the problem, then the treatment needs to be aimed at the primary cause.

Whilst this is being identified it is imperative that the rabbit receives adequate fluid therapy (often intravenous fluids are the best route) syringe feeding or naso-oesophageal tube feeding if the rabbit is unwilling to accept syringe feeding, pain killers (analgesia), medication to keep and encourage the digestive system to start or keep moving (prokinetic medication) and encouragement to eat by offering lots of fresh hay, grass, greens, etc.

Investigations to identify the primary cause may include: a thorough dental examination, often requiring sedation, x-rays of the spine and hips/pelvis to look for arthritic or spondylosis changes, skull x-rays to assess the tooth roots, blood tests and a thorough history from the owner to ascertain if any stressful occurrence has happened recently to explain the rabbits condition.

If a true hairball is diagnosed (which is very rare), then mineral oil and laxatives are often ineffective in treating hairballs. Pineapple juice which contains the digestive enzyme bromelain has been reported as helping to dissolve the hair but no scientific evidence has ever been produced to prove this, and all pineapple juice will do is help to rehydrate the rabbit.

Surgical removal is an option but is a last resort and carries a very poor prognosis.

The only way to try to treat true hairballs is with fluids to hydrate the stomach contents, analgesia and syringe/ naso-oesophageal feeding. Prokinetic medication is often not advised when there is a blockage due to the risk of the stomach rupturing. Roughage (hay or grass) should be fed during the treatment to help carry the hair fibres through the digestive system and out with the faeces.

Gastrointestinal stasis

When a rabbit’s digestive system is compromised, because of illness, pain or stress, then their hydration and food intake is likely to be reduced. This can lead to a reduction in gut motility – known as gastrointestinal (GI) stasis.

Rabbits are unable to go any significant amount of time without food in their digestive system. If a rabbit stops eating or reduces its food intake then the gastrointestinal tract will go into stasis or ileus, where it slows down or comes to a complete standstill. This in itself can prove fatal within just a matter of hours.

Rabbits require a high-fibre (+25%), moderate protein (12-13%) and low carbohydrate diet in order to maintain optimum gastrointestinal function.

The majority of pet rabbits are overfed on concentrated mixes and don’t eat enough hay and grass, which should make up the majority of a rabbit’s daily food intake.

Added to this, rabbits who are fed a mix and pick out their favourite pieces of food, which often contain high levels of sugar and minimal amounts of fibre, frequently suffer with dental problems and GI stasis episodes.

Selective feeding can be prevented by changing the rabbit onto an extruded nugget type feed that prevents selective feeding. This type of feed is high in fibre and contains the correct amount of protein and carbohydrate in order to maintain good GI tract health.

The average size pet rabbit should have a small handful of concentrated food, unlimited amounts of hay and grass and a mound of fresh vegetables the size of their own body each day. Treats, such as those bought from pet shops, should be avoided.

A rabbit’s digestive system is designed never to be empty and constantly contains food, caecal pellets and hair ingested during grooming. Fur-blockage is still thought, by some vets, to be a primary cause of GI stasis, but in truth it is normal to find some hair in a rabbit’s digestive system. Problems occur when the hair dries out due to a decrease in appetite and hydration and as such should be treated as a secondary problem due to the stasis and not a primary cause of stasis. The exception to the rule may be in long-haired rabbits, where true fur-blockage may be a primary cause of GI stasis.

The colon is responsible for sorting digestible and indigestible fibre. The rabbit eliminates the indigestible fibre as the hard; round droppings as these have no nutritional value to the rabbit.

The digestible fibre components are moved into the caecum where microbial digestion takes place.

The digestible fibre is excreted in the form of caecotrophs; small, clumps of smelly droppings covered in mucous. These are usually eaten directly from the anus by the rabbit and contain amino acids, fatty acids and vitamins B and K, from previously undigested foods. Consumption of the caecal pellets is important for the GI tract and overall health of the rabbit. The mucous protects the caecal pellets from the acidic pH of the rabbit’s stomach.

There are many potential reasons for a rabbit to reduce or cease eating and drinking, and are just some of the more common causes:

  • Dental problems causing pain
  • Illness
  • Not enough fibre in the diet
  • Dehydration
  • Toxins
  • Foreign body
  • Stress from the loss of a partner, a sudden change in diet, a change in the environment or transportation, extreme heat or cold or being around a predator.

It is all very well and good treating GI stasis but the route of the primary cause needs to be identified and addressed to stop the rabbit suffering from another episode. This may include a thorough dental examination, looking at the rabbits housing and social status, examining the diet, and looking back over recent events to see if a stressful occurrence can be identified.

Normally the symptoms will have a gradual onset and owners may notice the rabbit eating slightly less, being slightly less active and perhaps see droppings that are strung together on hair and the rabbit producing less droppings.

The symptoms may gradually worsen over the coming week or so, until the rabbit may completely stop eating and drinking altogether, pass no droppings at all and not want to move. The rabbit may also grind its teeth in pain.

Treatment needs to be started immediately and in an aggressive form.

The rabbit should be syringe fed or an oesophageal feeding tube fitted if the rabbit is unwilling to take syringe feeds; aim for 20-50 ml/kg per day, split into several, regular feeds. Offering tempting foods, such as freshly picked grass, fresh greens and sweet smelling hay may encourage the rabbit to begin eating again.

Medications to kick-start the GI tract, known as prokinetics, should be commenced and intravenous fluid therapy should also be started. Pain relief (analgesia) must also be included in the treatment regime as rabbits that are in pain will not eat.

If a blockage of some description is suspected then this much be ruled out before any prokinetic medications are given.

If the rabbit is treated at an early stage, i.e. within a couple of hours of not eating, then the prognosis for recovery is good. If treatment is delayed for a number of hours then a full recovery is less likely.

Some rabbits may take several days of treatment before any improvement is seen, so it is worth persevering with treatment if the rabbit can be kept comfortable during its recovery.

Dirty bottom syndrome

There are a variety of reasons why rabbits may suffer with a dirty bottom, either with faeces or urine, both of which are potential attractions for flies, especially in warmer months of the year when flystrike is a common occurrence.

If your rabbit is suffering from a dirty bottom it is imperative to find the cause and treat the underlying problem, to ensure that your rabbit is clean, happy and comfortable, and arent an attraction for flies.

The following are some of the most common reasons for a rabbit to suffer from a dirty bottom.

A poor diet may be the single, most common problem in causing a rabbit to have a dirty bottom.

Rabbits who are fed too much concentrated mix and therefore dont eat enough hay or are too full to eat their caecotrophs are likely to get a mucky bottom from the uneaten caecotrophs as they build up around their bottom.

Feeding too many greens has often been cited as a cause of diarrhoea in rabbits. It may be a cause of true diarrhoea (liquid faeces), but feeding greens doesnt cause the production of too many caecotrophs.

A rabbits diet should consist of a small amount of a good quality extruded nugget food (to prevent selective feeding), unlimited amounts of fresh grass and hay and a mound of fresh vegetables the size of their own body each day.

An awful lot of pet rabbits are overweight to some degree. If a rabbit cant physically reach its back end to clean itself or eat the caecotrophs as they are produced from the anus, then they will build up around the rabbit’s bottom.

Losing weight is the only answer, but no rabbit should ever be put on a crash diet as rabbits must have a constant supply of food going through their digestive system at all times.

Instead cutting down on the amount of concentrated rabbit food that the rabbit is given and increasing the amount of hay and greens they eat, whilst also increasing the amount of exercise they do, should see them losing weight at a steady and slow rate, and being able to keep themselves clean.

Rabbits who find it painful to clean themselves or eat their caecotrophs due to dental disease will often present with a dirty back end, as well as the classic symptoms such as excessive salivation, loss/lack of appetite and weight loss.

The rabbit should have a thorough dental examination, under sedation or general anaesthesia, which should also include skull x-rays to assess the tooth roots. If the rabbit isn’t well enough to undergo an anaesthetic immediately then supportive treatment in the way of syringe/tube feeding, intravenous fluid therapy, analgesia (pain relief) and prokinetic medication (to encourage the digestive system to keep moving) should be implemented until the rabbit is deemed fit enough to cope with an anaesthetic.

If dental disease if found to be the cause of the rabbits dirty bottom, this may prove to be a lifelong problem as the rabbits teeth will continue to grow throughout its life.

Strict preventative treatment for flystrike should be implemented, especially during spring, summer and autumn months of the year, which should include checking the rabbits back end 2 or 3 times daily, cleaning it straight away if it is dirty and using a product such as Rearguard for extra protection.

Those rabbits that are physically unable to get away from their droppings and urine as their housing is too small, have no option but to sit in it.

Ensure that your rabbit has access daily to a run or enclosed and predator proof garden and has housing that is big enough (minimum of 5ft x 2ft x 2ft for the average sized pet rabbit), so they can use one corner as a toilet corner and have the rest of the hutch as a clean and dry area to sleep, rest and eat in.

Large, overweight and senior rabbits are commonly affected by arthritic and spinal conditions, such as spondylosis. Such conditions often go under-diagnosed in rabbits as they tend to hide signs of weakness and pain due to their prey species instinct. X-rays can detect problems and non-steroidal anti-inflammatory medications (NSAIDs) often help to ease the rabbits discomfort and improve the clinical symptoms.

Rabbits suffering from stones or sludge in their urinary tract (kidneys, ureters bladder or urethra) often have urine scalding/staining as a symptom. This makes them constantly wet, sore and very smelly.

To diagnose a problem often x-rays will be needed. If stones are detected then surgery may be an option to remove them.

Many rabbits can be found to have a degree of sludge in their bladder and show no clinical symptoms, but if the rabbit has no other diagnosis then sludge may be the cause of their problems.

A change in diet to reduce the amount of calcium that the rabbit consumes, and increase the amount of water in the diet should be implemented and your vet may also recommend surgery to flush the bladder and remove stones.

Often rabbits with bladder sludge/stones are overweight, so weight loss may be needed to.

E. cuniculi is a protozoal parasite. The parasite primarily affects rabbits, but cases have been reported in sheep, goats, dogs, cats, monkeys, guinea pigs, foxes, pigs and humans. It is a recognised zoonosis (can be transmitted to humans), but the zoonotic risk seems to be minimal to healthy individuals observing basic hygiene.

Urinary incontinence and scalding are a common clinical sign with rabbits suffering from an active E. cuniculi infection.

A blood test can determine if the rabbit has at some point come into contact with the parasite, but only a rising titre from two blood samples taken a few weeks apart would indicate an active infection.

Often rabbits are treated without a definite diagnosis on clinical symptoms alone, using Fenbendazole (Panacur) for 28 consecutive days and assessing the patient’s response.

Often the rabbit will suffer from recurrent flare-ups during stressful occurrences and treatment will need to be repeated.


In adult rabbits, diarrhoea is quite uncommon. Several conditions can cause diarrhoea, with infections more common in young rabbits (kits/kittens). It is important to check your rabbit daily for diarrhoea as it could be due to a rapidly-progressing disease that requires early treatment or could lead to other problems such as flystrike.

Diarrhoea is the production of abnormally loose stools. When a rabbit has diarrhoea it will not only become dehydrated due to fluid loss, but will also lose other important substances such as electrolytes (salts like potassium and chloride) and nutrients, including vitamins.

Clinical signs of diarrhoea include dirty fur around your rabbit’s bottom, which may lead to secondary skin problems, as well as weight loss, lethargy and a reduced appetite. The stools may be soft, semi-fluid or watery, and may contain mucus or blood in some conditions, and the rabbit may have a painful abdomen.

Pain in rabbits can be difficult to determine, since as a prey species they are programmed to hide signs of discomfort. Signs of abdominal pain may include bruxism (teeth grinding), pressing their abdomen on the ground or a hunched posture.

General treatment involve rehydrating the rabbit and re-establishing a healthy gut microbial environment. Nursing also includes care to prevent secondary skin problems.

Rabbits normally produce two types of stool, hard pellets and soft ‘caecotrophs’. These soft stools look like a small bunch of grapes and contain essential nutrients that the rabbit needs to eat every day. They are usually produced at night and eaten directly from the anus, so owners don’t see them. If your rabbit doesn’t eat their caecotrophs, it can be due to several reasons:

  • A sore back making it painful to be down.
  • Dental pain.
  • Inappropriate diet.
  • Excessive weight, particularly around the dewlap or hindquarters.

If the rabbit doesn’t eat their caecotrophs, you may see them collecting at the anus, sticking to the rabbit’s fur and causing ‘clagging’.

Caecotrops are produced one to three times daily. They are soft but formed, and covered in a layer of clear mucus. Hard pellets are also produced in normal rabbits. Kits don’t produce caecotrophs until weaning age at 3-6 weeks old.

Conversely, diarrhoea occurs throughout the day, and stools are unformed and foul-smelling. The rabbit is usually depressed and off its food.

Some agents cause diarrhoea on their own, but many only cause problems in rabbits with other conditions, including other infections, digestive upset due to a low-fibre/high-carbohydrate diet, or with general poor health affecting the rabbit’s immune system.

Bacterial causes of diarrhoea are more common in young rabbits, e.g. SalmonellaEscherichia coli (E.coli) and Clostridium piliforme (Tyzzer’s disease).

Some species of coccidian parasites (pathogenic Eimeria spp) can cause diarrhoea around and after weaning

Viruses, such as retroviruses and coronaviruses, may cause mild diarrhoea on their won or more serious diarrhoea with bacterial co-infections.

Identification of the cause may require faecal tests to be performed, and often general treatment is started before laboratory results are available.

Besides the supportive treatment outlined above, specific antimicrobial medications may be required to treat these infections.

Adult rabbits have microbes in their gut to help digest food. Before weaning, kits have almost no microbes along their digestive tract. At weaning, the rabbit’s digestive tract changes significantly and it is particularly susceptible to infections around this time.

Antibiotics can affect the healthy microbes in the rabbit’s digestive system. Some antibiotics, especially those in the macrolide and lincosamide groups, alter the balance of microbes and allow overgrowth of organisms that can cause disease, eg clostridial bacteria. Giving certain antibiotics by mouth is more likely to affect the gut microbes than giving them by injection. Rabbits on a poor diet, which is low in fibre, and more susceptible to the adverse effects of antibiotics.

Milder cases of antibiotic-induced diarrhoea may have altered stools and reduced appetite, but in severe cases the altered microbes can lead to a generalised toxic state in the rabbit which may be fatal.

Flies like to lay their eggs in moist warm areas. If your rabbit has diarrhoea on its skin and in its fur, flies will attack this area, especially in warm weather. When the fly eggs hatch, the maggots will feed on material nearby. In some cases the maggots enter deeper tissues, and a toxic reaction can occur which is sometimes fatal.

It is very important to check your rabbit’s bottom frequently to ensure it is clean and dry. If your rabbit has diarrhoea, you will need to wash it to reduce the risk of flystrike.

Rabbits with diarrhoea rapidly become dehydrated, and need to take in additional fluid to replace those lost. You can encourage your rabbit to drink by offering fresh water in a convenient location. In some cases, fluids can be given via a dropper syringe into the rabbit’s mouth. More severe cases will benefit from veterinary administration of fluids, e.g. by injections under the skin or via a drip into a vein.

It is important to keep the rabbit’s digestive tract moving. In conditions affecting the tract such as diarrhoea, normal motility is often reduced. For this reason, medications called ‘prokinetics’ can be given to stimulate movement in the tract. One of the easiest ways to encourage movement is to give high fibre nutrition. If your rabbit is not eating, you can give a supplement by syringing special high fibre food paste mixes into their mouth.

Rabbits need a high fibre to aid digestion; this stimulates gut motility and also helps wear down the rabbit’s teeth in a natural way. This should be made up of lots of good quality grass hay making up 80% of the rabbits diet, 5% good quality extruded nuggets and 15% fresh greens. Such a diet will help reduce the risk of digestive tract disease, including diarrhoea.

Diabetes mellitus

Diabetes mellitus is a dysfunction of the pancreas. The pancreas is an endocrine organ that possesses clusters of cells known as islets of Langerhans. These secrete insulin into the blood circulatory system in order to control the glucose level in the blood, and stimulate absorption of glucose into cells. Diabetes mellitus is an entirely different condition to diabetes insipidus, which this article does not focus on.

Diabetes mellitus is thought to be extremely rare in pet rabbits, although it is relatively common in cats, dogs and humans. It is mentioned in rabbit textbooks but the vast majority of vets have never seen a true case in a rabbit.

The most commonly seen symptoms that may indicate diabetes mellitus include:

  • Excessive thirst
  • Excessive urination
  • Excessive eating
  • Lethargy

These symptoms can appear suddenly or have a slow onset and vary in severity from animal to animal. It is also important to remember that these symptoms can be attributed to many other disease processes that are more likely to affect rabbits, so although diabetes mellitus is always on the differential list of possible causes, it does not normally feature near the top of the list.

It is relatively easy to diagnose diabetes mellitus; a simple drop of blood on a glucometer (a device for determining the approximate concentration of glucose in the blood) showing a high blood glucose may indicated diabetes mellitus.

However, when rabbits are stressed their blood glucose can rise dramatically and blood glucose levels in rabbits are often used, in conjunction with clinical signs in anorexic rabbits to distinguish between rabbits with GI stasis and those with true blockages who require surgical treatment.

Therefore, a high blood glucose in a rabbit needs interpreting with care and alongside clinical signs.

Rabbits that indicate clinical signs and have high blood glucose levels may be suffering with diabetes mellitus. A further blood test can be undertaken (fructosamine), which measures the blood glucose levels over a couple of weeks, which gives a much better indication of diabetes mellitus than a snapshot which is what a spot test blood glucose level gives.

Urine analysis to look for glucose in the urine is also advised alongside blood analysis. This is performed quickly and easily on a dipstick test.

If diabetes mellitus goes untreated then the rabbit may become hypoglycemic, whereby there is not enough glucose in the blood. This is extremely dangerous and can be fatal. Symptoms include tremors, twitching, collapse, unconsciousness and death.

Obese rabbits are thought to be at a much greater risk of developing diabetes, which is another reason why a good diet plays a vital role in keeping your rabbit fit and healthy.

The treatment of choice with rabbits who do have true diabetes mellitus is often a healthy diet. Most rabbits that have been diagnosed with diabetes mellitus have been overweight, which has been a trigger factor. Encouraging a healthy diet can reverse the process or at least control it.

All rabbits, including those with diabetes mellitus, should be fed a diet of the following:

  • Unlimited, good quality hay – this should make up 80% of the diet.
  • Fresh vegetables – this should make up 15% of the diet.
  • A small amount of good quality pellets – approximately 1 egg cup full per rabbit per day making up no more than 5% of the diet.
  • No junk food or treats should be given as these are often rich in carbohydrates.

Insulin injections are not generally needed in a rabbit with diabetes mellitus, since they do not metabolise insulin like cats, dogs and humans, but you should be guided by your vet. Those rabbits that are obese or overweight should naturally start losing weight, at a slow rate, on a healthier diet.

If clinical signs are evident then these need appropriate management. Rabbits with excessive thirst and urination need their litter tray and environment cleaning more frequently. Those with an excessive appetite can be offered extra hay and grass, but this should be available ad lib regardless.

So few rabbits have been diagnosed with diabetes mellitus, that it is impossible to give a long-term prognosis.

However, rabbits that are fed a healthy diet, regardless if they have diabetes mellitus, stand the best chance of a long and healthy life.

Cerebrospinal nematodiasis

Cerebrospinal nematodiasis is an invasion of the central nervous system by nematode (roundworm) larvae and a cause of neurological disease in rabbits that have access to the outdoors. Infected rabbits may show a variety of clinical signs. These can also be attributed to many other disease processes.

Cerebrospinal nematodiasis occurs when rabbit ingest material, e.g. grass, that is contaminated with faeces containing the eggs from Toxacara canis (canine roundworm) or Baylisascaris spp eggs.

When the eggs are ingested they migrate through the central nervous system and damage surrounding tissues, causing encephalomalacia, a degenerative disease of the brain which causes softening of brain tissues. The eggs can remain dormant in the environment for months or years at a time before being ingested.

Signs can vary and may have a slow onset (chronic) or be acute (have a sudden onset). The signs will vary depending on the level of infection, the damage done and the route which the larval migration takes.

Clinical signs may include:

  • behavioural changes
  • torticollis (head tilt)
  • circling
  • seizures
  • vertical nystagmus (eye flicking/twitching)
  • swaying
  • falling over
  • paralysis
  • ataxia (loss of co-ordination).

There seems to be no evidence that sex, breed or age of the rabbit makes it more predisposed to the effects of the parasite.

Diagnosis is made on blood sampling. Toxoplasma serology and examination of the rabbit’s faeces are the normal way that a diagnosis is made. Samples for these tests will normally have to be sent to an external laboratory.

Anti-parasitic medications, such as albendazole or fenbendazole, together with anti-inflammatory medications, to help inflammation is the usual treatment of choice.

Rabbits that are not eating well will also require supportive feeding, intravenous fluids and prokinetic (improves gastrointestinal motility) medication to ensure they do not go into gastrointestinal stasis.

The prognosis for successful recovery is poor, although some rabbits may have a resolution of clinical signs. Treatment can be expensive and on-going so cost considerations should be discussed with your vet.

Rabbits act as the end host for the parasite and do not shed the parasite in their faeces. However, if the rabbit contracted the parasite from an infected host in an environment shared by humans, then there is a risk that humans could contract the infection from a similar means, although not directly from the rabbit. Therefore, cerebrospinal nematodiasis is classed as a zoonotic risk to humans.

If an infected rabbit is eaten after death, the risk to predators consuming the rabbit (potentially humans), and other vertebrate predators who may therefore contract and spread the infection, is a serious risk.