Section: Veterinary Care In-depth
Diagnosis in-depth
Urinalysis should be performed to look for bacteria, white blood cells, or crystals. Your veterinarian may ask you to bring this sample or may collect it during the examination. Sometimes your veterinarian will want a sterile urine sample, which is collected from the bladder either by a catheter or directly from the bladder with a needle. Most rabbits tolerate this well without anesthesia.
Radiographs (X-rays) of your rabbit's abdomen can help show sand or stones, either in the bladder or kidneys. These can also be used to monitor progress, particularly with calciuria.
Ultrasound might be recommended to look at the bladder and kidneys, as well as the other organs in the abdomen (body cavity). Some types of stones will not show up on radiographs, and can only be seen on ultrasound. Dilation of the ureters and some types of damage to the kidneys can also be seen. Your veterinarian might refer your rabbit to a specialist if there is not an ultrasound in their practice.
A culture and sensitivity should be performed on the urine sample if there is evidence of bacteria and/or white blood cells in the urinalysis. The white blood cells are the cells that respond to infection. This will also help your veterinarian to choose the best antibiotic to specifically treat the bacteria infecting your rabbit.
A blood profile may be helpful to look at kidney function, blood calcium levels, and the white blood cell count to evaluate for the body's response to infection.
Therapy in-depth
While most stones require surgical removal, calciuria and urinary tract infections can often be treated with prompt, aggressive medical management. Treatment in your rabbit will initially be directed at resolving the problem, and at the same time will focus toward preventing future problems if possible. Initial treatment will likely include fluid therapy to help flush the kidneys and bladder. Antibiotics may be given if infection is suspected.
In some cases, the bladder will require more direct flushing with a catheter. However, these conditions will reoccur in nearly 100 percent of cases unless predisposing factors in the diet and environment are corrected. Predisposing factors include obesity, lack of exercise, and excessive dietary calcium in the form of feeding solely pellets or feeding pellets with alfalfa hay.
If a urinary tract or bladder infection is diagnosed, your veterinarian will prescribe antibiotics to kill the causative bacteria. These antibiotics may be changed once the results of the urine culture are available.
Fluids may be given to your rabbit, either subcutaneously (under the skin) or intravenously (into the vein). This will help flush the kidneys and bladder.
If calcium sand is diagnosed, your rabbit may need to have his bladder flushed. This involves placing a small catheter (flexible soft tube) into the urinary bladder through the penis or vulva, and flushing to remove some of the crystals. Some rabbits require sedation for this procedure, although this step is not always necessary.
If bladder stones are present, your veterinarian will recommend surgery. Some very small stones may pass, but the larger stones create a risk of obstruction, in addition to pain and discomfort. These stones should be removed surgically.
Rabbits with calciuria or calculi (stones) must be placed on very restricted pellets (maximum 1/4 cup per 5 to 8 pounds of body weight). Complete elimination of pellets may be necessary in severe cases. This will help lower blood calcium and will decrease the amount of calcium that passes through the kidneys and bladder.
Alfalfa hay should be replaced with lower calcium hays such as timothy or other grass hays.
Leafy vegetables should be offered in abundance to increase dietary fiber content. It is usually not necessary to restrict consumption of calcium-rich vegetables once the rest of the diet is corrected, but may be important in severe cases.
Follow up radiographs and bloodwork are recommended to monitor progress and prevent further problems. Close monitoring and follow up visits will be required in all cases.
Follow Up
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 as directed. Alert your veterinarian if you are experiencing problems treating your pet.
Repeat radiographs are recommended; your veterinarian will probably suggest initial repeat radiographs in four to six weeks, and once the condition is resolved, once to twice a year to check for calcium accumulation or stones.
If the diagnosis was a urinary tract infection, repeat urinalysis will be recommended prior to stopping the antibiotics; to be sure the infection is gone.
If calcium sand or stones are part of the problem, follow-up monitoring of blood calcium levels will also be helpful. This may initially be done in four to six weeks, then once or twice a year once levels are controlled.
Be sure to follow diet instructions very strictly. Limit or eliminate pellets as directed by your veterinarian, and provide plenty of timothy or other low-calcium hay at all times. Fresh leafy vegetables should also be provided in abundance.
Continue to pay close attention to your rabbit's urination habits.
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