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Old 10-06-2007, 11:13 PM   #1
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Also see:
Bloat/Gas
Infections
Teeth
Caring for Sick Rabbits


GI Stasis: What it is
Gastrointestinal (GI) stasis, also called ileus, is the name for when the intestines slow down or stop moving. In healthy rabbits the intestines are kept moving by the action of surrounding muscles. Along with water and movement from exercise, these muscles keep food moving through the intestines at a steady rate. A rabbit's GI system is designed to digest and move along large quantities of high-fiber food. If the intestines stop moving, it can not only cause the rabbit pain but can also lead to death.

How To Tell If Your Bun Is In Stasis
Because there are different possible causes, there are also different possible symptoms that will appear if your rabbit's GI system is slowing down or is in stasis. It is a good idea to keep track of your rabbit's normal eating and potty habits and gut soundsas changes could be from illness and/or the beginning of GI stasis. These symptoms include your rabbit pooping less, has smaller, harder, or irregularly shaped fecal poops, poops strung together with hair or other materials, mucous-covered poops, not pooping at all, or eating less or not at all. Another possible symptom is on again/off again diarrhea (bunny may also have irregularly shaped poops).

Your rabbit might also be lethargic (although some rabbits in stasis are still quite active and cheerful), sitting hunched up, pressing his belly to the floor, grinding his teeth (sign of pain), or straining in the litter box. He might be unusually interested in chewing and shredding wood, cardboard, or paper. The sounds in his belly might be unusually loud or silent instead of the normal gentle gurgling. If he is suffering from a large amount of gas, or a more dangerous condition called bloat, your rabbit's stomach might look visibly bloated.

Possible Causes- It's A Symptom, Not A Disease In Itself
Contrary to what you might have heard, GI stasis, also sometimes referred to as "hairballs," is a symptom of a problem. It can be caused by a wide variety of problems which need to be identified and treated to help the rabbit recover and to prevent another episode of stasis.

Common Causes:
  • Lack of water (make sure that water bottle is actually working!)
  • Tooth problems, including malocclusion, molar spurs, and/or tooth/jaw abscesses
  • Infection or parasites in the GI tract
  • Intestinal blockage
  • Gas, which might be caused by veggies a bun is sensitive to i.e. broccoli, etc.
  • Diet low in fiber or high in carbs and fats
  • Stress
  • Long term use of antibiotics, or the use of unsafe antibiotics such as oral amoxycillan
  • Lack of exercise
  • Mobility problems or paralyzation
  • Pain from another underlying disorder or illness

More causes are listed here:
http://www.medirabbit.com/EN/GI_dise...ties_ileus.htm


Treatment

Early Symptoms

Early symptoms are those that happen before the intestines actually shut down. Treating the early symptoms means that the rabbit will be much less likely to go into actual GI stasis. Some of the common early symptoms are fewer or small poops but still pooping, poops that are misshapen, strung together, or covered in mucous, and changes in eating habits. As is always the case for GI stasis, it is very important to find out why this is happening so you can correct the problem or prevent it from happening again.

HYDRATE! Water is very important to proper gut function. Since these are the early symptoms, you shouldn't need to do syringe feeding or sub-q fluids. Get more water into your bun by dipping their regular veggies in water, giving them a water bowl instead of a bottle (most buns will drink more from bowls), offer a second container of lightly flavored water- vanilla, flavored Pedialyte, herbal mint tea, or no-sugar-added apple or carrot juice are popular additions, or offer canned pumpkin which has a lot of water as well as some fiber.

FIBER! Feed more hay. Encourage the bun to eat as much hay as possible. Give them several varities, stuff it in toys, spray some lightly with apple juice, herbal mint tea, or another flavor your buns like. Just make sure the wet hay doesn't go moldy. Replace it after a day. Reduce pellets to encourage the bun to eat more hay too, and take away all treats. Regular veggies are fine, though, as long as the bun is used to eating them.

EXERCISE! Get those bunny butts moving! The more they move, the more their intestinal muscles move. Give the bun as much exercise time as possible. They may need a little encouragement if they are feeling a little sick.

Clean the litterbox and cage often so you can see how much your rabbit has pooped and peed recently.

Your rabbit might require veterinary attention, especially if you suspect that the culprit is due to a health problem that needs to be treated such as tooth problems or infection (especially if the bun has diarrhea).

Treating GI Stasis
Now it gets harder to tell whether your rabbit needs to see a vet or not. When in doubt, go to a vet. Trust me, you're better safe than sorry. If your rabbit appears to be in distress- grinding or chattering teeth in pain,
breathing unusually fast, body temperature too high or low (check with plastic rectal thermometer, normal is 101-103 F), you have been doing home treatments with no improvement, or if you just feel that your rabbit needs more help than you can give him- go to a vet.

Home Treatments

- Simethicone: the active ingredient in gas medicines. You can also give gas meds made in tablet form for adults although it might be harder to get a rabbit to take it. The gas might either be the main cause of the stasis- large bubbles blocking the intestine and causing pain- or it can develop because of the stasis. Either way, it is uncomfortable for the rabbit and is easy to treat.
Give approximately 1ml (1 cc) per hour for first three hours, then 1ml every 3 – 8 hours, as needed. Yes, rabbits require more than babies! Simethicone is very safe and it does not get absorbed into the body, although it should not be used with certain pain meds such as opiates. You should be able to get it at any pharmacy.

- Tummy Massage
: massaging or vibrating your rabbit's tummy can help gas bubbles move out and help get solids moving through the intestines too. To help gas get out, lift your rabbit's rear up slightly sometimes during the massage. Pay close attention to your bun during the massage. If you see any signs of pain, stop. More likely, your bun will relax a bit. You can vibrate the bun's tummy with a gentle electric back massager, vibrating toothbrush, or even a ride in the car.

- Heat: Just like when we're sick and snuggle under blankets, rabbits might need heat to feel comfortable when they are sick. Painful conditions like stasis and gas can also cause a bunny's temperature to drop due to shock. You can offer your bun a sock stuffed with dry rice and heated in the microwave, a warm towel, or a plastic Snuggle Safe heating pad.

- NutriCal: a nutritional supplement for cats and dogs that is found in many pet stores. Other brands are fine too. Squish a small amount on your rabbit's paw so he has to lick it off. Some rabbits like the taste and will take it from the tube. Nutrical not only provides a little bit of energy from calories, but also B vitamins for energy and as an appetite stimulant, and Vitamin E which may soothe the intestines.

- Probiotics: The rabbit's GI system is dependant on beneficial bacteria. During stasis the "bad" bacteria might grow more than the good ones and cause problems. This can also be a cause of stasis, for example if the bad bacteria are getting lots of sugary or starchy treats from the rabbit's diet. Although probiotics don't provide the same types of bacteria that rabbits actually need, they may still help some. Some people suspect that probiotics might help the good bacteria grow. A popular brand in the US is called Benebac and can be found in many pet stores, feed stores, and vet offices. Acidophilus tablets might also be useful. Please do not use yogurt because many rabbits are lactose intolerant and the yogurt might upset their stomachs even more.

-Syringe feeding: if your rabbit isn't eating or drinking, you may need to syringe food and fluids into their mouths. Before you do much syringe feeding, make sure a vet checks for any intestinal blockages. As already stated, fluids are very important. Good fluids to give are room temperature or lukewarm water, flavored or unflavored Pedialyte (drink for dehydrated children- adult drinks have too much sugar), and chamomile or mint herbal teas, both of which are known to be good for upset stomachs. Although some people like to use fresh pineapple juice for it's enzymes, keep in mind that it is very sugary and might cause more problems because of that.


For food, the easiest basic things to feed are products made for syringe feeding: Oxbow's Critical Care and American Pet Diner's Critter Be Better. Mix the powder with water, let it soak for at least 10 minutes if not longer, and it's ready to go! Some rabbits love it. However, not all rabbits will be happy about eating a strange new food while they are sick. In that case, you can grind up their pellets as finely as possible then soak them in water before feeding. You can also add to the pellets, such as NutriCal for vitamins, canned pumpkin or shredded fresh herbs for taste, probiotics, mint or chamomile tea instead of some of the water for taste and to soothe the stomach, whatever your bun likes as long as you think you can get it through a syringe.

-Sub-Q Infusion: Although not traditionally considered a home treatment, providing a 'drip' orinjection of fluids subcutaneously (under the skin) can be literally a life saver. More vets and other professionals are now recommending that the apparatus and supplies, along withdetailed andpreciseinstructions from your vet about their use,be part of home emergency kits.

- Enzymes: Enzymes from fresh pineapple and papaya have previously been recommended because it was thought that they would help to digest and break apart "hairballs" or food/hair masses in the GI tract. However, the enzymes do not actually digest hair as previously thought. There are some suspicions that the enzymes can help break down the mucous covering the masses, making it easier for water to penetrate and soften them, but this has not been proven. However,fresh pineapple juice (not canned or bottled, the preservation process destroys the enzymes) does provide somebenefits, including hydration. But be aware that fresh juice and many enzyme tablets are very high in sugar and so might actually cause more problems.

- Hairball Remedies: these are not recommended any more, although some vets still suggestthem in the hope that the oils will help slide things through the intestines. The problem is that the thick oils can coat dried-up masses in the stomach and intestines, preventing water from getting into them and breaking them up. If you want to use them, make sure the rabbit is well hydrated before giving the hairball remedy.


Veterinary Treatments

When you take your rabbit to the vet, he should give him a full exam and check him for health problems that aren't directly related to the GI stasis, as they could be causing the stasis due to pain. He will palpate (feel) the abdomen carefully to see if he can feel blockages or gas and to see if there is anything in the intestines and stomach. Hopefully he will do an xray too, as that can show problems that can't always be felt.

- Hydration: Even if you have been giving your rabbit oral fluids, your vet might give your rabbit sub-q (subcutaneous) fluids. He might also teach you how to do it and send everything you need home with you. This can be scary for some people, but do it! Sub-q fluids get fluids directly into the body, whereas oral fluids might not be absorbed into the body if they are blocked in the stomach. It can also be less stressful for your rabbit, especially if he doesn't take to syringe feeding very well.

- Pain medicine: Necessary! If your vet doesn't give you any, ask for them. And if he gives Metacam, ask about the possibility of stronger meds such as Tramadol or B
uprenex.

- Gut Stimulants: Some vets swear bygut motility drugs like Cisapride and Reglan, and some areopposed to their use. They force the intestinal muscles to move more. There are mixed feelings on these as some believe them to be painful, and they can also cause problems. If your vet is going to prescribe these, make sure he does an xray to check for blockages. If there is a blockage, a gut stimulant can make it worse and might even cause the intestine to rupture and kill the rabbit.

- B Vitamins: your vet might give a B vitamin shot to stimulate the appetite and to replace vitamins that your bun would normally be getting from eating his cecals.

- Cholestyramine (Questran): Especially if there is mucous in the stool or the vet has another reason to suspect Clostridium (bad bacteria) problems. Questran binds to the dangerous toxins produced by Clostridium, preventing them from harming the rabbit.

- Antibiotics: these may be given if the vet suspects a bacterial infection. Flagyl is commonly prescribed for Clostridium, although other antibiotics might also be used.




Prevention


The best way to prevent GI stasis is with proper diet and exercise. Encourage your rabbit to eat lots of hay, feed high-fiber pellets, limit the treats, and give them lots of exercise. Veggies are good for rabbits that tolerate them, but be aware that some rabbits don't do well on veggies, and some don't do well on pellets. Pay attention to your rabbit to see what kind of diet works best for him. Brush him a lot and watch him closelywhen he is molting. Rabbits are more likely to go into stasis when they are molting, either from the increased strain on the GI tract from all the indigestible fur or from stress. And keep an eye out for early warning signs of stasis.


May your litterboxes always be full!



*In memory of Sprite, Spice, and all others who have left us too soon*





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Old 11-12-2007, 01:00 AM   #2
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Articles

GastroIntestinal Stasis, The Silent Killer
http://www.bio.miami.edu/hare/ileus.html

Ileus in Domestic Rabbits (D. Krempels, Mary Cotter and Gil Stanzione)
http://www.rabbitcare.org/ileus.pdf

Listings in Rabbit References: Gastrointestinal System and Problems
http://homepage.mac.com/mattocks/morfz/rabrefs.html#gi

Listings in Rabbit References: Taking Care of Sick or Disabled Rabbits
http://homepage.mac.com/mattocks/mor...refs.html#care



My Bunny Won't Eat!
http://www.islandgems.net/noeat.html
(Broken link)

When A Rabbit Stops Eating: Gas Remedy
http://vrra.org/gasremedy.htm

Differential Diagnosis For Ileus in Rabbits
http://www.medirabbit.com/EN/GI_dise...ties_ileus.htm

Nursing Your Rabbit Through GI Stasis
http://www.mybunny.org/info/gi_stasis.htm

Babybunnywrigley's Vet Handout on Stasis
http://www.my-precious.org/gis1.pdf
http://www.my-precious.org/gis2.pdf

Hairballs
http://members.aol.com/bcwooly/hairballs.html


Rabbit Hairballs: Fact or Fiction:
http://www.veterinarypartner.com/Con...&S=0&C=0&A=484


Petrolatum-based Laxatives and Hairball Remedies:
http://www.peteducation.com/article....articleid=1425

Frequent, long-term use could result in vitamin deficiencies. Do NOT force feed, since the petrolatum could be aspirated into the lungs and cause serious effects.


RO Threads

Chippy - GI Issues
GI Stasis
Stay Slert
Rabbit on Hunger Strike (has good syringe feeding instructions)
Viral Link to GI Stasis
Interesting Stasis Remedy
Wrigley Isn't Eating or Pooping
Another Tall Tale - Enzymes
Poopie Butt (Stasis from infection of GI tract)


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Old 04-12-2008, 01:12 AM   #3
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http://veterinaryrecord.bvapublicati...act/161/12/409

Papers and Articles
Gastric dilation and intestinal obstruction in 76 rabbits
F. M. Harcourt-Brown, BVSc, FRCVS[suP]1[/suP]

[suP]1[/suP] 30 Crab Lane, Harrogate, North Yorkshire HG1 3BE
Eighty-four incidents of gastric dilation (bloat) were investigated[suP] [/suP]in 76 pet rabbits, and an intestinal obstruction was confirmed[suP] [/suP]in 64 of them. In 49 the obstruction was due to pellets of compressed[suP] [/suP]hair, in four to locust bean seeds, in five to neoplasia, in[suP] [/suP]two to postspay adhesions, and in one case each to carpet fibre,[suP] [/suP]tapeworm cysts, a strangulated hernia and diverticulosis. In[suP] [/suP]all but four cases, the obstruction was in the small intestine.[suP] [/suP]The condition affected a variety of breeds fed on a variety[suP] [/suP]of diets. Radiography was a useful diagnostic tool because gas[suP] [/suP]and/or fluid in the digestive tract outlined the dilated stomach[suP] [/suP]and intestines. Twenty-nine of the rabbits died or were euthanased[suP] [/suP]without treatment, and 40 underwent exploratory surgery; of[suP] [/suP]these, 10 died during surgery, three were euthanased because[suP] [/suP]of intestinal neoplasia, eight died postoperatively and 19 recovered. Fifteen[suP] [/suP]rabbits in which radiography indicated that a foreign body had[suP] [/suP]passed out of the small intestine did not undergo surgery; of[suP] [/suP]these, 13 recovered and two died.[suP] [/suP]

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Old 11-30-2008, 03:56 AM   #4
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Article from Dana Krempels in event hair mass accumulation:

Quote:
1. Hydrate bunny *well* with subQ Lactated Ringer Solution and continue hydration support throughout treatment.

2. Administer proteolytic enzyme (this must be done with caution, as it can burn the oral and esophageal mucosa; we give a little bit of simethicone suspension first, to coat the surface of the mouth and esophagus a bit. But even a little bit of mouth/esophagus soreness will go away in a day or two.)

3. Administer lactulose at a dose of 0.5cc per kg of body mass every 8 hours. This is an osmotic laxative, and will draw liquid into the gut. As the proteolytic enzyme dissolves mucus (and possibly some fur, depending on which supplement you use--pancreatic enzymes will blast fur, too.) holding the mass together, the hydration drawn in by the lactulose will help hydrate it, making it easier to pass through the gut.

(NOTE: I do NOT recommend using mineral oil *at all* in a case like this. It can coat the mass, making it nearly impossible to re-hydrate, and can make matters worse if the mass is too big to pass, even with lubricant. The best way to do this is to break up the mass as much as possible, and then it will pass more easily, with or without lubricant.)

If the rabbit is eating anything at all, keep up with *wet* fresh greens. Fragrant ones sometimes will entice an inappetent bunny to eat, but it's important to get even a *little* bit into her now and then.

If the mass has moved into her intestines, it may be possible to gently massage it, once it's hydrated, and knead it into a smaller, more passable mass. This must be done carefully, to avoid injuring the intestine, but I've done this myself with good success.

Hydration of the *intestinal contents* is paramount for a problem like this: subQ hydration is not sufficient, as a lot of that will simply pass out via the kidneys without entering the intestine. Lactulose (or super-saturated epsom salts, which tastes nasty) is great for ensuring hydration of intestinal contents.

If this situation is not improving, then a careful enema of saturated epsom salts and warm water will help hydrate the lower GI tract, sort of "lubing" things up and helping them come down the chute. The enema also seems to stimulate lower GI muscle contractions, which can only help in a situation like this.

In short, this *can* be treated, depending on how much synthetic fiber there is inside the mass she's created in her intestines. It's always best to try medical treatment (such as those described above) before resorting to surgery.

Gastrotomy (stomach surgery) seems to be tolerated far less well in rabbits than enterotomy (intestinal surgery). We've had good survival in bunnies who've had to undergo an intestinal resection, but not so great with stomach surgery.

If you *do* resort to stomach surgery, one vet up in NJ who has an incredibly high survival rate ascribes his success to his filling the surgically emptied stomach with well-hydrated Critical Care (http://www.oxbowhay.com) before closing it up. This seems to "jump start" the system. A rabbit is an herbivore whose stomach and intestine is normally *always* containing some food, and it does seem that a completely empty stomach somehow contributes to the shutdown of the entire intestine. If you can stimulate it to move with a bit of food inside, the survival rate is better, at least from the few data points we have!
It is also a good idea to hold back on pellets when a rabbit is presenting symptoms or xray evidence of hair accumulation. Basically what happens with the pellets when there is a hair/mucous accumulation is that the pellets become dried and stick to that hair/mucous. It forms into a hard mass that is hard to pass. The same applies to rabbits that get frequent accumulations and blockages, they may need to have their pellet diet cut down significantly.
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