Because the rabbit is a prey species and can become easily stressed in an unfamiliar environment, successful treatment of ileus is greatly facilitated if a working partnership can be established between the vet and the client, so that hospitalization can be avoided. A rabbit at home generally recovers more quickly than one hospitalized in an unfamiliar and frightening environment. Separating the patient from a bonded rabbit companion increases stress and can impede recovery. However, the client must be prepared to monitor the rabbit and provide the intensive supportive care required.
Recovery from ileus is often characterized by “fits and starts.” The rabbit will produce fecal pellets, go back into distress and then gradually have greater and greater success at clearing intestinal contents. Patience and persistence are key, and the practitioner is strongly urged not to use physically aggressive measures, which may do more harm than good.
IN THE CLINIC ~
Normalize body temperature (circulating water heating blankets, pet bed heaters or hot water bags; warmed SC {subcutaneous/under the skin} or IV {intravenous} fluids).
Monitor temperature carefully to avoid iatrogenic hyperthermia (an over-heated condition inadvertently caused by a medical treatment)
Administer analgesics ~ pain medications (extremely important). Pain relief is vital to keeping the bunny fighting to live.
Flunixin Meglumine (Banamine® 1-3 mg/kg IM or SC q12-24h up to 3 days) ~ This drug appears to be safe and effective in rabbits and does not appear to cause ulceration of the GI tract as it does in some other mammals. It is contraindicated (do not use) in animals with renal disease. (This is an injectable non-steroidal anti-inflammatory drug)
Sulfasalazine ~ 1/8 to 1/4 crushed 500 mg tablet per rabbit q8-12h (every 8 to 12 hours) (excellent at topically reducing inflammation of intestinal mucosa).
Rehydrate (NOTE: “skin tenting” is not a reliable gauge of a rabbit’s hydration state.)
Lactated Ringer’s Solution – 100-120 ml/kg/day SC (subcutaneous; under the skin) divided q8h (every eight hours). If the rabbit is hypothermic (chilled), fluids should be warmed first. In cases of circulatory compromise, intravenous fluid administration via catheter in the hospitalized rabbit may be indicated. (A rabbit in shock cannot absorb subcutaneous fluids)
Warm water enema may help hydrate lower GI contents. CAUTION: the rabbit colon is extremely delicate; instruments must be pliable, well lubricated and inserted very gently.
Restore GI motility
Cisapride (1.0-1.5 mg/kg q12h) (every 12 hours) ~ and/or ~
Metoclopramide (1.0-1.5 mg/kg q12h) (a brand is “Reglan”; every 12 hours)
These drugs may work better together than separately, perhaps because each has a different mode and site of action in the GI tract. (NOTE: Either drug is contraindicated {do not use} in cases of true obstruction.)
Stimulate appetite
Vitamin B-complex added to the fluids may stimulate the appetite and supplies necessary coenzymes, which the rabbit may not be producing.
Cyproheptadine may also be useful as an appetite stimulant. (Wikipedia: Veterinary Use: is used in cats as an appetite stimulant and as an adjunct in the treatment of asthma. Possible adverse effects include excitement and aggressive behavior.)
AT HOME
Administer liquid pediatric Simethicone to reduce gas pain: 1-2 ml (20 mg/0.3 ml) once an hour for 2-3 doses, then 1 ml every three to eight hours.
Administer gentle abdominal massage several times daily. One of the single most effective ways to stimulate a lazy gut into action is with gentle massage (detailed “how to” instructions are at http://www.bio.miami.edu/hare/ileus.html
Continue SC lactated Ringer’s – 100-120 ml/kg/day divided q8h. (milligrams per kilogram of bunny’s weight; divided by 3 and administered every 9 hours over each 24 hour period).
Administer oral fluids, delivered via syringe 10-20 ml q8h (every 8 hours). Avoid fluids with sugar, which may promote overgrowth of Clostridium spp.
Monitor body temperature via well lubricated, plastic rectal thermometer, and warm rabbit if necessary (heating pad on low, hot water bottles, towel or blanket wrap).
A rabbit with a temperature lower than 100o F should be considered an extreme emergency. Pack the rabbit with warm water bottles wrapped in towels and get him to your rabbit-savvy veterinarian immediately.
Syringe feed ~ if necessary and as instructed by your rabbit-savvy veterinarian
Unlimited grass hay
Fresh, wet leafy herbs and greens
TRADITIONAL TREATMENTS ~ HARMFUL OR HELPFUL? ~
Probiotics ~
Yogurt ~ Do not give yogurt to a rabbit in ileus because the milk starches and sugars provide a high-energy substrate, which may promote overgrowth of yeast and Clostridium spp. (a bacteria).
Lactobacillus ~ Although some practitioners use powdered lactobacillus to try to help restore normal cecal floral balance, at this time there is no clinical evidence to support the hypotheses that this is effective.
Cecotropes ~ Feeding cecotropes from a healthy rabbit might help supply normal intestinal flora, but the stress of this procedure may outweigh the possible benefit.
“Hairball” Remedies ~
Attempts to treat ileus with “hairball remedies” such as pineapple juice and intestinal lubricants are ineffectual and may actually exacerbate the problem.
Pineapple and Papaya ~ Only fresh or frozen pineapple will provide active enzymes (bromelain). However, neither bromelain nor papain (papaya enzyme) dissolves keratin, the main protein component of hair. The sugars in pineapple juice may actually promote overgrowth of Clostridium spp. (a bacteria).
In addition, the stomach of a rabbit is so highly acidic that the enzymes are killed immediately, thus rendered completely ineffective.
Laxatives ~ It may also be inadvisable to use petroleum-bases laxatives* such as Laxatone, as these hydrophobic (prohibit water absorption) products may coat an intestinal mass, making it more difficult to hydrate.
* Carbohydrates inhibit the release of motilin, a protein that (in rabbits and humans) helps regulate upper GI motility by stimulating contractions of the small intestine. Administering products that contain simple sugars and digestible carbohydrates may interfere with restoration of normal GI motility. (Brewer NR, Cruise LJ: Physiology. In Manning PJ, Ringler DH, Newcomer CE (eds): The Biology of the Laboratory Rabbit. Academic Press, San Diego, 1994, p 65.)
Systemic Antibiotics
Unless the ileus is known to be caused by a bacterial infection, antibiotics are not recommended
Gastrotomy ~
The mere presence of a mass of hair and ingesta in the stomach should not be considered an indication for gastrotomy (surgical incision into the stomach)
A mass of ingesta in the stomach is almost always better managed medically than surgically unless a true obstruction is suspected by physical examination and/or radiographs (x-rays).
Survival after surgery of the digestive tract, particularly gastrotomy, is reportedly low in rabbits.
THE ROAD TO RECOVERY ~
Reduce Stress. (“If It Ain’t Broke, Don’t Fix It”)
Patience on the part of the caretaker
Avoid excessive handling
Do not make more trips to the vet’s office than absolutely necessary
Never separate the sick rabbit from his/her partner
Show a great deal of CALM attention and affection
Resist the temptation to force additional, aggressive treatment once the rabbit begins to recover ~ recovery from GI Stasis is sometimes maddeningly gradual
Sources:
* “GastroIntestinal Stasis, The Silent Killer” By ~ Dana M. Krempels, Ph.D., Department of Biology, University of Miami
* “Ileus in Domestic Rabbits” by Dana Krempels, Mary Cotter and Gil Stanzione ~ is copied from ~ “Observations From The Field”, published by Exotic DVM Volume 2.4 2000, pages 20 and 21 at ~ http://www.bio.miami.edu/hare/ileus.pdf
These protocols and practices have been developed by rabbit caretakers (many of whom are professionals in areas such as biology, microbiology, chemistry, nutritional biochemistry and medicinal pharmacology) working in conjunction with interested veterinarians over more than a decade.
We are deeply grateful to the following individuals for their ideas and/or contributions:
Susan Brown, DVM, Westchester, IL
George Flentke, PhD, Department of Pharmacology, University of Wisconsin
Thomas Goldsmith, DVM, Miami, FL
Jeff Jenkins, DVM, San Diego, CA
Maya Menchaca, DVM, Miami, FL
Susan Smith, PhD, Professor of Nutrition, University of Wisconsin
Susan Brown, DVM, Westchester, IL
The authors wish to acknowledge a special debt of gratitude to Susan Kelleher, DVM, Pompano Beach, FL, who has regularly and generously provided feedback and ideas for refinement of the various protocols here, based on her work with hundreds of House Rabbit Society foster rabbits.
Adapted from “GI Stasis: The Silent Killer” by Dana Krempels. For full original text see the web site: <fig.cox.miami.edu/Faculty/Dana/ileus.html
* ”Gastrointestinal (GI) Stasis – Hairballs Syndrome” ~ Long Beach Animal Hospital ~ at
http://www.lbah.com/rabbits/gistasis.htm
