Painful Urination in Rabbits

Although complete blockages are rare in female rabbits, partial incomplete blockages in male rabbits are common. This condition can lead to self-trauma, enlarged bladder, firm abdomen, severe pain and permanent damage causing loss of bladder tone. In cases of complete blockage, the prognosis is guarded without surgical correction, therefore it is vital veterinary attention is sought.

Pain during urination is a common, potentially fatal condition in rabbits, often caused by partial or complete blockages of the urinary tract. There are many causes, however, high calcium diets and inadequate water intake are often factors that lead to the deposition of mineral sediment (also known as bladder or kidney stones).

You may notice your pet showing the following signs:

• Self-trauma to the genital area
• Firm abdomen 
• Enlarged bladder
• Signs of pain such as hunched posture 
• Anorexia
• Depression
• Urine trickling
• Urine scalding

There are a number of factors that may predispose your pet to suffer from pain during urination:

• Insufficient diets such as inadequate water content, particularly in rabbits whose diet consists purely of pellets, high calcium diets 
• Obesity or poor exercise habits prevent the re-suspension of urinary sediment 
• Urinary retention caused by inability to access litter tray or arthritis

Conditions that may cause pain during urination include: 

• Sediment deposits causing blockages commonly occur due to calcium oxalate, calcium carbonate and ammonium magnesium carbonate in the urine in rabbits
• Crystal buildup and deposits in the bladder of the rabbit, creating a sludge in the bladder which forces frequent, small amounts of thick urine to be passed
• Inflammation secondary to “urine sludge” which may cause further obstruction
• Trauma from repeat catheterization 
• Calciuria 
• Fibrosis

Your veterinarian will perform a full clinical examination of your rabbit and carefully palpate your pet’s abdomen and bladder. Your pet’s clinical symptoms, distended bladder, and evidence of pain on abdominal palpation will likely cause your veterinarian to suspect pain relating to urination. 

Radiographs of your pet’s urinary tract may be taken to visualise crystal build up that may be contributing to your pet’s pain. A urinalysis may also be performed to rule out the diagnosis of urinary tract infection.

Hospitalisation

Although it may be possible to treat this condition with pain relief alone the chances of repeat obstruction are much higher. To provide the best prognosis your pet’s bladder will be emptied via either cystocentesis or catheterisation. If catheterisation is being performed your rabbit may require sedation using benzodiazepines. Although there are risks involved with sedation, your rabbit will be monitored carefully throughout the procedure. In order to prevent repeated obstruction, the bladder will require repeated flushing with warm saline until no evidence of crystals are seen. 

Following this procedure, to encourage the elimination of calcium, your rabbit may require intravenous fluid therapy. During your companion’s hospital stay his urine output will be closely monitored and regularly checked for hematuria and sediment build up.

Medication 

Your pet will be given nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids for analgesia if pain is suspected. As NSAIDs are metabolized by the hepatic and renal systems your vet may take a blood test to check the function of these systems. If the urinalysis performed during the diagnostic investigation indicated infection or hematuria, systemic antibiotic therapy will be needed.

Supportive Care

Your pet will be encouraged to eat during his hospital stay, as rabbits will often refuse food due to stress or pain syringe feeding may be necessary to prevent complications occurring from anorexia.

The prognosis for your pet is good with normal urination expected following surgery, although there is a fair chance of reoccurrence. Treatment success is improved with excellent owner compliance regarding diet. In order to reduce this the following steps should be taken 

• Encourage exercise by changing the environment to allow them more exercise space and encouraging movement through energetic, engaging activities and play 
• Provide a diet that is high in water content and low in calcium, avoid food such as alfalfa sprouts which are high in calcium
• If possible completely remove dried pellets from the diet and introduce good quality grass or timothy hay and rolled oats 
• Fresh, clean water should be provided for your pet at all times along with high water content foods
• Ensure your pet’s litter area is easily accessed and is regularly cleaned

Revisit appointments and urinalysis monitoring may be indicated in order to allow for  early treatment or dietary change if evidence of mineral formation or blood in the urine is found.