Gastro-Intestinal Stasis: Causes, symptoms & Treatment

Gastrointestinal stasis (GI stasis) in rabbits – an owner’s guide

Author, Jay, with contributions by Sooz and the members of Happy Hoppers forum.
Edited by John Chitty, BVetMed CertZooMed MRCVS
and Dr Anne McBride, Bsc, PhD, FRSA

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In the UK, Rabbits are classified as an ‘exotic’ species, partly because they are non-native, and also because their digestive system is unusual and fragile. In domestic rabbits, this requires careful management to ensure a healthy gut transit (motility). A wild rabbit – whose diet comprises of grasses, herbs, leaves, twigs and occasional vegetables and fruit – is unlikely to experience dietary derived gut stasis and anorexia (lack of interest in food and water), because their diet almost entirely consists of crude fibre, which is the main component for a healthy digestive system. The dietary needs of a domestic rabbit are no different in this respect.

GI stasis (Ileus) is not an illness as such, but a symptom and manifestation of another underlying problem or problems. However, it can quickly become an emergency, and if left unnoticed or untreated, fatal.

Common underlying causes of GI stasis are:

1. Inadequate diet
   Rabbits need high volumes of crude fibre to ensure a healthy gut motility, and maintenance of the delicately balanced microbiology in the ceacum. The ceacum is the large appendix that produces high energy, vitamin and nutrient rich soft stools, which are ingested directly from the rabbit’s anus. Rabbits are supreme converters of low quality food into muscle, nutrients and energy. It is for this reason that it is recommended that the diet for a domestic rabbit comprises of at least 70% hay (ideally 80%) and includes some grasses and wild leaves.
   
   
2. Dehydration
   Rabbits use a lot of their water intake from their intestines to support and maintain other bodily functions and organs. They also need water in the intestines to prevent dehydration of food, which has the potential to become an intestinal blockage. Water lubricates the passage of food through the digestive system. Evidence now suggests that rabbits drink more water from a bowl than from a bottle. Owners report that their rabbits usually have a preference for one or the other, but to be safe, both should be available. Bowls and bottles should be washed and replenished daily.
   
   
3. Compaction
   Usually caused by dehydration within the intestines, compactions are not that common in a rabbit that receives adequate fibre and water. They occur when the lack of water solidifies some of the contents of the intestines, such as dry food and hair. Mucus in the GI tract can effectively glue this together to form a mass. Rabbits are perfectly capable of passing hair through their digestive system. However, certain long haired breeds of domestic rabbit are at risk of developing masses if they do not drink enough water, and are not frequently groomed. These breeds should be groomed daily to remove excess hair, or clipped regularly, to prevent this potential problem. All rabbits will benefit from being brushed and combed weekly. More commonly, a compaction is in itself a symptom of another underlying problem, as the reduction in gut motility and anorexia cause the GI stasis, which in turn can cause compaction. House rabbits that have a liking for chewing carpets or rugs can ingest these undigestible fibres, which can contribute to a compaction, especially if gut motility is already slowed.
   
   
4. Bloat
   A build up of gas that can occur very quickly, especially if left unnoticed. Bloat is an extreme form of GI Stasis and usually occurs after the rabbit has experienced slowed gut motility and anorexia for some time. It is very uncomfortable and ultimately very painful for the rabbit. An inexperienced owner may not recognise that their rabbit has bloat, and mistake the symptoms for GI stasis. When a rabbit has bloat the abdomen becomes hard. Eventually it will expand and become distended. The prognosis for bloat is not a good one, and it is notoriously difficult to treat. A rabbit with bloat needs to see a vet immediately. Some owners who recognise the onset of bloat will orally administer infant colic medicine that contains Simeticone – in the UK, many owners use ‘Infacol’, before taking their rabbit to the vet, however, these medicines are designed for frothy bloats that occur in babies (and cattle!). If they have any benefit to rabbits it is probably the fact that some fluid is entering the solid bits in the stomach. The vet is a must!
   
   
5. Stress

• Pain/injury/illness – Possibly the most common cause of GI stasis in rabbits who are fed an appropriate diet and are adequately hydrated. A rabbit in pain or that is unwell is susceptible to anorexia. Where there are no visible signs of injury (such as limping, head tilt, immobility, blood, inflammation or fluid around the eyes, anus or genitals) then it is likely that the problem is within. Common problems such as dental issues, arthritis, urinary tract infections and abscesses (infections), can cause a rabbit to stop eating. Rabbits are vulnerable to infections after surgery, so need attentive care to prevent this (this is covered in more detail later in this article). Rabbits are also vulnerable to GI stasis after surgery. The general anesthetic can itself slow gut motility. In this instance, ask your vet for a timescale as to when the rabbit should be eating normally, and when to return the rabbit for a further examination if it remains anorexic.
  
  
• Weather stress – it is not uncommon for rabbits to experience GI stasis after extreme changes of weather. Hot and cold snaps are often followed by GI stasis a couple of days later.
  
  
• Extreme stress - rabbits can die of fright and can be prone to anorexia and GI stasis from extreme stress. Owners will often refer to their rabbit being ‘spooked’ or ‘on edge’ when describing mild trauma, but a terrifying experience can be far more threatening to your rabbit’s health and survival. Rabbit’s are extremely prone to having a fatal heart attack when they are stressed. This is possibly a good thing in the wild, as the main cause of stress is likely being caught by a predator, and a heart attack will quickly end the unfortunate rabbit’s suffering. Stress causes increased heart rate, changes in blood pressure and stress hormones which can collectively induce a heart attack. Rabbits that have come near to having a heart attack may not be able to overcome the effects on their body and enter a state of extreme stress which can have effects that last several hours and cause gut stasis.
  
  For domestic rabbits, stressors may be exposure to very loud noises (fireworks for example), unfamiliar dogs / cats / children amongst other things. A fight with another rabbit could also induce extreme stress. Bee or wasp stings have also been known to induce a state of extreme stress.
  
  Outdoor rabbits are vulnerable to the presence of predators and/or a failed attempt on the rabbit’s life. With house rabbits, another pet may behave unexpectedly, threatening and frightening the rabbit. It may have been frightened by excitable children or have bitten through a live electrical wire – if the rabbit survives this, it may have visible marks around the mouth and face, and may be unconscious.
  
  A rabbit that is experiencing extreme stress is vulnerable to shock - a medical term referring to an inability to be able to fill the available blood vessel space with blood. It can be due to lack of blood volume, toxin production etc. Shock is more often seen as a consequence of stasis rather than a cause of it, but the stasis may well have been caused by a fear provoking episode.

N.B. Experienced owners may know the difference between bloat and GI stasis, but it’s important to note that the home treatments that some owners administer for GI stasis can be fatal to a rabbit with bloat, or at best, worsen the condition.

The author learned this lesson the hardest way.

"I did not recognise bloat in my last rabbit. After successfully treating him for recurring GI stasis over a six month period, I didn’t want to/didn’t see the need to rush him to the vets immediately. The delay was fatal. It is my biggest regret that I left it too late to save him - a mistake that I will never repeat, and an experience I would not wish on anyone else."

If you are at all unsure about what to do with a rabbit that is not eating or producing stools, book a veterinary appointment at the earliest opportunity...
...Your rabbit’s life may well depend on it

This image is Copyright © Happy Hoppers Forums Uk - October 2011 - ALL RIGHTS RESERVED

Recognising the signs

A rabbit’s natural reaction to pain or injury is to conceal it and thus prevent a potential predator picking them off as the weak rabbit and an easy meal. This can make detecting a rabbit experiencing GI Stasis difficult, and can often lead to an emergency situation as the first indicator that there is a problem, and in many cases, the rabbit has already died. GI stasis can be develop slowly over many days and owners may not be aware that there is anything wrong until their rabbit refuses food, or has entered the more serious stages of GI Stasis. However, by careful and habitual observation there are indicators available to us.

1. Observe stools – As owners, we feed, water, clean accommodation, groom, clip claws, spot check and inspect our rabbits for a variety of potential conditions. The one thing many owners do not do is inspect their rabbit’s stools – yet these are a window into their intestinal health, and are a very useful tool in spotting problems early on, and should be inspected daily.
   
   Rabbits produce two forms of stools. The first known as caecotrophs are not usually seen as they are re-ingested immediately by the rabbit. The hard stools you see on the floor or in the litter tray we can call waste stools. Waste stools should be round, and of a decent size, around 5-7 mm in diameter. They should crumble easily between the fingers, and consist of very short greenish crumbs.
   
   Consistency is paramount. Any changes to your rabbit’s waste stools are an indication that their digestion is under stress. If stools are mis-shapen, small and hard, soft, strung together or you are seeing caecotrophs in your rabbit’s hutch, pen or litter, then you should be on alert.
   
   In the case of a rabbit on the edge of GI stasis, waste stools are more likely to be small and compact, and difficult to break apart. They may also be very dark and/or black. If the rabbit is still accepting food, then this can be treated at home with water and pro-biotics (Bio Lapis is available from your vet, and other pro-biotics are available from larger pet stores). 10 ml of water mixed with pro-biotics and syringed into the rabbits’ mouth each hour will provide hydration, and strengthen/support the gut flora, which may be undergoing changes as a result of the dehydration. If you are at all unsure or not confident about syringing water into your rabbit, or how much and often, you should contact your vet for advice. It is worth letting them know that your rabbit may be going into stasis, as it is also likely that you will be paying them a visit soon. Many owners also use Critical Care formula instead of probiotic as it contains a wider range of valuable nutrients to support the rabbit.
   
   If you are unable to administer fluids orally, then you should contact your vet for advice, and they may want to examine the rabbit. If it is close to closing time, the vet may request that you bring your rabbit in for examination, or they will provide you with an out-of-hours surgery number. We will look at this in more detail later on.
   Soft and runny stools are an indication that the rabbit’s delicate gut flora is out of balance, and should be seen as a warning sign. These stools are formed in the caecum, and are sticky, dark and pungent. Causes can vary and are often attributed to inadequate fibre in the diet, a slowing of the GI motility - allowing harmful bacteria to overwhelm the healthy bacteria. With an overweight or obese rabbit, it may not be able to reach down to re-ingest primary stools, consequently vital nutrients and bacteria do not re-enter the system.
   Soft, sticky stools must be removed from the rabbit’s rear, as they will attract files. In warmer months, this leaves the rabbit vulnerable to Flystrike.
   
   
2. Anorexia – Rabbits are creatures of habit and routine, and this is a helpful behaviour to us as owners, as we are quickly able to spot anything unusual in their normal patterns. This is most helpful when a rabbit stops eating and drinking. Ideally, rabbits should be fed their vegetables, herbs and pellets in the morning and early evening, with hay and fresh water available at all times. Being most active in the early morning and evening, rabbits rest for most of the day, and this is when the nutrient rich ceacotrophs are formed in the caecum, emerge from the anus and are eaten (ceacotrophy) immediately by a healthy rabbit.
   
   A rabbit that is normally enthusiastic for its food, and is less so, or completely ignores it, is a rabbit at risk and owners should be on high alert. Encourage the rabbit to eat by providing its favourite food, and passing it in front of the mouth.
   
   In the case of dental issues, rabbits may eat some foods and not others – hard and abrasive foods such as pellets or hay may be painful to eat and chew and may be ignored by the rabbit. Soft herbs, grass and vegetables may be eaten instead. Ensure that any wet foods that your rabbit will eat are rinsed with residual water remaining on the food. This will help keep the rabbit hydrated. Seek veterinary advice as without dental treatment your rabbit will not be able to return to eating properly.
   
   If you do not know when your rabbit became anorexic, it is difficult to gauge the time required before you seek veterinary help. To be safe, always go with the longest possibility, i.e. if you last saw your rabbit healthy and eating at 8pm, and by 7am the next morning it is anorexic - assume that it has been so for 11 hours.
   
   At this point, the clock is ticking, and you should prepare for a trip to the vet as soon as possible.
   
   
3. Lack of waste – If your rabbit hasn’t produced any waste stools and/or urine for some time, its survival is in a precarious position. Guts that have stopped working for 12 hours or so can produce their own side effects and problems, which serve only to compound and worsen the rabbit’s chances of survival. Leaving your rabbit longer than this in the hope that it will come through is not recommended, and a veterinary call is required – the sooner that your rabbit can receive veterinary help and medication, the greater its chances of surviving.
   
   
4. Immobility, posture and body signals – GI stasis causes pain in rabbits, and rabbits that are experiencing overwhelming pain will retreat to a place that they feel safe, a corner of the hutch or cage, or even their litter tray. They may seek out a place that they would normally not rest in. Their movement will be significantly reduced (partial mobility) or they may not move at all (immobility), and they will often sit hunched up with their ears flattened against their back.
   
   N.B. Owners of Lop-eared and some fancy breeds require extra vigilance, as their rabbits ears may not move at all, or have limited movement, so this signal can be missed.
   Their eyes may seem bigger then usual, and they may be producing loud teeth grinding or crunching noises, which are significantly louder than the teeth ‘purrs’ rabbits make when being stroked or groomed. Sometimes they will flop down onto their belly, and seem completely lifeless.
   
   With GI stasis and bloat, they may also shuffle around occasionally and look as if they are trying to get comfortable. These postures and other indicators are not normal, and this communication from the rabbit to you is one that should receive your full attention. Spending time with your rabbit(s) when they are well is time well spent. The chance to observe and learn their postures and movements when healthy will raise the alarm bell sooner when they are unwell. This could save your rabbit’s life.
   
   
5. Stress – Transporting a sick rabbit to the vet is stressful to the rabbit. Many rabbits recognise the experience as one that has negative associations, and this does little to help them relax. Increasing the stress levels in a rabbit that is experiencing GI stasis is detrimental to the rabbit and condition. It is for this reason that many owners try to avoid taking their rabbit to the vet until the rabbit is in an emergency state, although this approach is not generally recommended, as time is short with this condition.
   Some rabbits are prone to pain and consequential GI stasis, particularly ones with recurring dental or infection problems. Owners can build up a bank of experience that can help them to decide when is the right time to go to the vet, if all attempts to resolve the problem have failed.
   
   N.B. Not all rabbits will have the same sequence of events, or the same responses to home remedies. In the case where owners have more then one rabbit, knowing when each individual rabbit is acting ‘normally’ whilst in the first stages of GI stasis can help owners to better asses the rabbit and decide when to call for veterinary help.

Home remedies can include:

• Massaging (palpating) the abdomen. This should only be attempted in the early stages of GI stasis and by experienced or veterinary advised owners. Owners should not attempt this if a rabbit is experiencing bloat. Care needs to be taken as stomach/ caecal rupture is possible. During routine veterinary appointments, ask your vet to show you how to palpate the abdomen, and when to know whether this is effective or dangerous.
  
  
• Encouraging the rabbit to move around, the intention is to get the guts moving naturally.
  
  
• Orally administering water, pro-biotics, recovery food and/or Critical Care with a syringe.
  A rabbits’ stomach is rarely empty, and GI stasis itself can cause further problems for the rabbit, such as gastric ulcers and fatty liver disease. Keeping the stomach full and the intestines hydrated can help a rabbit survive until it can be helped by the vet.

N.B. Administering anything orally is not without potential problems, especially without knowing the cause behind the GI stasis. For example, a compaction in the GI tract can cause orally administered foods and fluids to back up behind it. Rabbits cannot vomit, and so may be prone to asphyxiation or drowning, depending on the size and location of the compaction.
If a rabbit is mistakenly ‘diagnosed’ by their owner as having GI stasis, when it actually has bloat, these home remedies will worsen the condition and could even be fatal.

When to call the vet

This is an owner’s decision and they should asses each rabbit on an individual basis.

If you are at all unsure, call your vet for advice

Not all rabbits will have the same sequence of events, or the same responses to home remedies. Knowing when each individual rabbit is acting ‘normally’ whilst in the first stages of GI stasis can help owners to better asses the rabbit and decide when to call for veterinary help. Knowing when it is acting ‘abnormally’ is usually the time to contact the vet for advice and/or an appointment.

If your rabbit is in a bonded pair, both rabbits should be taken to the vet. Not doing so can lead to permanent disruption of the bond.

Examples:
These examples assume that the rabbit has not produced any stools or passed urine for some time. If the rabbit:

• Is still occasionally eating something, and moving around, this is less serious than complete anorexia and immobility.
  
  
• Is completely refusing food and fluids, but still moving around normally, this is less serious than if it is immobile.
  
  
• Has refused food for 3-4 hours, but is still moving, call your vet for advice, who may well want to examine the rabbit.
  
  
• Has refused food and has been immobile for 3-4 hours, make an appointment, irrespective of previous experiences.
  
  
• Has a hard or distended abdomen, is grinding its teeth, its eyes are bulging and it is looking uncomfortable, call your vet immediately.

After the veterinary surgery

Sometimes the vet will keep your rabbit in overnight for observation. After the vet has examined and treated your rabbit, in most cases you will be sent home with some recovery food to quickly restore nutrients and to hydrate the rabbit. This is administered orally, and your vet can show you how. You may also be sent home with some pain relief, again to be administered orally.

Ask your vet when you should expect to see signs of recovery, and what to do next if there are none. Depending on the time of day that they see your rabbit, they may ask you to contact them directly or provide you with an out-of-hours surgery telephone number. Taking a rabbit to the out-of-hours surgery can be stressful for you both; ask your vet what to expect, and what the next course of action will be. If you have a good relationship with your vet, seeing a strange vet can be quite disarming.

Not out of the woods yet…

You will need to keep a close watch on your rabbit over the next few hours and days. Set up a nursing cage indoors where the rabbit can stay warm. Avoid putting it in draughty or noisy areas and eliminate any environmental stresses that may affect them. If you have children, advise them to be quiet around the rabbit. Restrict other pet access to the rabbit. Provide plenty of fresh hay and water, some favourite foods, and a litter tray, if it is trained to use one. Offer somewhere dark to help the rabbit feel safe, maybe a box or part cover the cage with a blanket or towel. If your rabbit is one of a bonded pair, you could either put the other rabbit in the cage or in a cage or secure area (pen) next to your sick rabbit. Bonded rabbits comfort each other in times of adversity. However, as you need to keep a close eye on the ill rabbit’s stools having them able to see each other and nose each other but actually be separated may be the better option.

You are looking for elimination of stools, and eating/drinking. Stools may initially come out very small, or mis-shapen, or soft. If your rabbit uses a litter tray, this should be emptied regularly to give you a clearer assessment of the state of the stools. If not, remove soiled bedding frequently. Encourage your rabbit to eat by offering its favourite food. Any signs of eating and drinking are positive ones. Whatever your rabbit wants to eat, it should eat – even if you are normally strict about their intake of pelleted or mix food, this should be overlooked if that is all that your rabbit wants to eat. You could soften the pellets with warm water first. Healing herbs can be given, such as Mint and Basil, and if you have bramble leaves in your garden, these may also help.

If your rabbit is not showing any signs of recovery within the advised timescale, then you need to call your vet for further advice.

Either in the first instance or subsequently, you rabbit may need an X-ray to determine the cause of the GI Stasis, enabling your vet to prescribe a more relevant treatment. In cases of hidden conditions, such as arthritis, an X-ray is the only chance your vet has to discover this. X-rays are not something to worry about; modern techniques and sedation/anesthetics have improved enormously over the last few years, and made the process a lot simpler and safer. Your vet will discuss the options with you.

It is possible that you may be asked to administer subcutaneous fluids (sub-Q’s) at home. This is when fluids are placed directly in between skin layers (usually in the loose skin at the back of the neck, the rabbits scruff), in the form of an injection. This forms a pocket of fluid between the skin layers which will sit as a small bubble, which will feel like a hard lump, whilst it is gradually absorbed into the blood stream, removing the need for the digestive system to absorb fluids and guaranteeing hydration. Your vet can show you how to do this at home if necessary but you will not be required to do anything you do not feel confident with.

GI stasis is rarely fatal if recognised and treated promptly. It is a condition that can deteriorate very quickly and the longer the rabbit is left without treatment, the slimmer the chances of a full recovery. Even with a recovery, there may be other problems that occur because of the delay, which can be avoided.

Prevention is the best cure!

Provide the correct diet for your rabbit(s), and ensure that they receive plenty of fibre with hay, vegetables, herbs always being available. Use only high fibre pellets, if you choose to feed dry food. High fibre foods especially hay, herbs and vegetables, are also essential to the natural process of appropriately eroding your rabbit’s ever growing teeth, and thus help prevent dental disorders.

Prevent your rabbit from becoming fat, and be vigilant at all times.

Know your rabbit

As previously mentioned, get to know the natural ways, postures, rhythms, feeding and drinking patterns of your rabbit(s). By doing so, when your rabbit is unwell, you won’t even ‘think’ there is something amiss, you will just ‘know’. All rabbits are different, and behave differently. This knowledge could save your rabbit’s life.

Find a rabbit-knowledgeable vet

Often referred to by owners as a ‘Bunny savvy vet’ this is possibly one of the most important things you can do for your rabbit. Because rabbits are an exotic species, vets need to acquire extra training in exotic medicine to treat more difficult and complex rabbit illnesses effectively. For more information on this, please see this article, written by our exotic veterinary expert, John Chitty, BVetMed CertZooMed MRCVS, ‘What is a specialist?’

First aid kit

Many owners have an emergency kit at home. For GI Stasis, this could include Pro-Biotics, Recovery food, Critical Care and syringes. Check every few weeks that the products are still in date, and replenish if not.

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This article is compiled from the experiences of Happy Hoppers members, and the author has also referred to the following resources:

GastroIntestinal Stasis, The Silent Killer, Dana M. Krempels, Ph.D.

The Mystery of Rabbit Poop Dana M. Krempels, Ph.D.

Bloat in Rabbits, L. Seeman