Gastrointestinal hypomotility and gastric stasis is an extremely common condition in rabbits. In fact, it is one of the most common reasons rabbits go to veterinarian and veterinary emergency clinics.
Hypomotility is defined as a decrease in the contractions in the gastrointestinal (GI) tract (the “gut”). Stasis refers to little to no movement in the GI tract. Both can lead to severe life-threatening complications, and generally are simply referred to as “GI Stasis”.
Gastrointestinal hypomotility and gastric stasis in rabbits is most common in middle aged to older rabbits but can be seen in any age, sex, or breed rabbit.
GI Stasis is often associated with inappropriate diets and feeding regimens, specifically overfeeding of pelleted foods, foods with a high carbohydrate content (grains, sweets) and lack adequate indigestible fibrous foods, particularly hay. Rabbits with GI Stasis commonly have diets that lack adequate hay, are being fed primarily commercial pellet diets, are fed too many sweet foods, or are fed too many cereals such as crackers, breakfast cereals. Inappropriate diet is a major cause of GI stasis because a rabbit’s intestinal tract is different than other pet mammals. Rabbits can digest foods like hay and grasses that we (and our dogs and cats) cannot. This is because rabbits have a specialized area of the intestinal tract, the cecum, which digests these grasses for them. The cecum acts as a fermentation vat, fermenting indigestible grass and hay in to digestible food for the rabbit. In fact, approximately 60% of a rabbit’s nutrients come from the cecum. To digest hay, the cecum relies on a complex balance of bacteria. If not enough hay and/or too many carbohydrates go into the cecum, the bacteria die off, and toxin-forming or gas-producing bacteria overgrow. The toxins slow down the intestines, causing GI Stasis. This is often accompanied by painful gas. Painful rabbits don’t eat, so the bacteria in the cecum are no longer being fed, leading to more gas and toxin-forming bacteria growth. This vicious cycle can be fatal if not broken with appropriate treatment.
Anything that causes a rabbit to stop eating will result in GI Stasis. Stress alone can do this in sensitive rabbits. Other factors that make a rabbit not want to eat include dental problems, pain for any reason, liver or kidney malfunction, cancer, toxins, and infections.
Typically, clinical signs of gastrointestinal hypomotility and gastric stasis include loss of appetite or not eating at all. Often rabbits will stop eating pellets and hay but will continue to eat treats. This may gradually be followed by a total lack of appetite. Rabbits that suddenly refuse all foods and are passing no feces may an intestinal obstruction, not GI Stasis. An intestinal obstruction is an immediate, life threatening emergency.
Anorexia (no appetite) – if your rabbit suddenly refuses all food, see your veterinarian immediately. This may be a life-threatening intestinal obstruction.
Diarrhea, which may be intermixed with normal or small, formed fecal pellets
Decreased fecal production (small to very few fecal pellets)
Small, misshapen dark fecal pellets
Pain (rabbits often show hunched posture, grinding of teeth)
Decreased activity, or hiding (often a sign of pain)
As the disease progresses, rabbits may become lethargic, weak, dehydrated. This is an emergency.
Rabbits that don’t eat or produce feces for 24-hours are considered to be an emergency.
The tests may include the following:
Your veterinarian will perform a physical examination including feeling the abdomen and an oral exam.
Radiographs (x-rays) of the abdomen are recommended. These are critical to differentiate GI Stasis from gastric “bloat” which is life-threatening.
Blood tests may be recommended to determine if underlying organ malfunction is causing the hypomotility and stasis.
Treatment is symptomatic and aimed at rehydration, medications that stimulate the GI motility and dietary therapy.
Fluids are an important component of the treatment. When food stops moving through the intestinal tract at a normal rate, the food material can become dried out, furthering the stasis process. Depending on the severity and duration of illness, rabbits can become severely dehydrated.Severe dehydration results in a drop in blood pressure which decreases the blood supply to major organs and contributes to the hypothermia and shock. Fluid replacement to treat the dehydration can be given subcutaneously (under the skin) in many cases. In severe cases, in which patients are too debilitated to absorb the fluids by a subcutaneous route, an intravenous (in the blood vessel) or intraosseous (in the bone) catheter is needed.
Exercise is encouraged when possible as activity helps encourage gastric motility.
Dietary therapy is key. It is important to get your rabbit eating as soon as possible. Generally a large selection of fresh greens (romaine lettuce, parsley, spinach, collard greens and/or cilantro) are offered as well as a good quality grass hay (such as timothy hay). For patients that refuse to eat, a gruel is offered and gently syringe fed. A common gruel is Critical Care for Herbivores (Oxbow Pet Products) or Emeraid Herbivore (Lafeber). Another option is to grind pellets and mix with fresh greens to form a gruel.
Oral water intake is encouraged by offering fresh water, or wetting the fresh greens.
Drugs to stimulate the gastrointestinal motility are key. These drugs may include cisapride, metocloparmide or ranitidine. Initially, medications are usually given by injection. If GI stasis is severe, medications given orally are not absorbed well. Once feces are being produced regularly, oral medications are begun.
Analgesics (pain medications) help alleviate abdominal discomfort. Stasis will cause gas production and intestinal bloating which can be extremely painful. Pain causes rabbits to become even more anorexic and lethargic. The lack of ingested food and activity worsens ileus (slowing or stasis of the gastrointestinal tract) which allows for an increased absorption of the toxins. A commonly used drug to treat gastrointestinal pain is meloxicam, which is a non-steroidal anti-inflamatory drug (NSAID). Opiods (butorphanol, buprenorphine) are also commonly used.
Early and aggressive medical care with dietary modification carries a good to excellent prognosis.