Kanfer’s Answers: Bladder Sludge and Stones

Hi, I’m Claudia and my baby bunny boy, castrated, is 8 years old and has been dealing with sludge and bladder stones since he was 6. He had surgery in March 2022 to clean the bladder and since then he’s been taking the Sherwood supplements for urinary tract, he eats 1% of his body weight in pellet food which is Science Selective for Urinary support too. The only fresh green I give him now is fennel and I give him a variety of dry herbs, small amounts per day, like chickweed, plantain, nettle, chamomile, calendula, vine, rosemary, etc. Each day I choose about 3 and I keep changing each day. He always has timothy hay of high quality, not cheap and to drink more water I do a chamomile infusion each night and he’s been drinking about 150ml per day. After surgery he was still gaining sludge, so we tried liquid magnesium supplement in his water, 0.6ml in 200ml of water and apparently it worked since the sludge practically disappeared but now he has his cholesterol really high and we don’t know what could have done this. Anyway, since you’re answering questions about sludge, do I think he has a good diet and Sherwood supplement or is there something else I can do or change?  

I wouldn’t worry about cholesterol levels in rabbits. They are not associated with problems. If his sludge has resolved that is great, keep doing what you are doing. Getting the rabbit to take in more fluids, orally or injectably is very helpful. It is also important that they don’t get overweight and they stay active. You need to prevent future sludge from building up. I recommend performing x-rays a few times a year to monitor for sludge recurrence. 

Please check the label on the pellets you are feeding. If there is alfalfa in the pellets then I recommend switching to a Timothy based pellet. 

Apparently too much vitamin c causes stones in humans. Is this also true for rabbits?

No. It is hard to overdose on vitamin C since excess amounts will get peed out. There are reports of kidney stones in humans from high doses of vitamin C, but it is uncommon. Rabbits can make their own vitamin C, so they do not require supplementation like guinea pigs and humans do.  In rabbits stones can be caused by high doses of calcium in the diet, or a problem with their calcium metabolism. Stones can also occur due to infection. 

One of my rabbits recently experienced urine sludge. I’ve added photos for reference. I have the following questions:

    1. Is urine sludge always a sign of kidney stones?
    2. Can it lead to kidney failure?
    3. Besides water, are there any supplements, vitamins, or medication that should be given to prevent the calcium build up?
    4. How should diet be changed?
    5. When is medical attention needed? 

It is normal for rabbits to have calcium crystals in their urine. Normally they will pee them out. If the rabbit is overweight, inactive, or has arthritis, they may not pee normally, and may retain urine. When they retain urine, the heavier crystals remain in the bladder instead of getting peed out. The crystals build up and become like mud- this is called sludge. Sludge can also occur if there is excessive calcium in the diet or from kidney insufficiency. Most rabbits with bladder sludge do NOT have stones in the bladder or the kidneys. 

Stones are also calcium based. They can occur in the bladder or urethra. They can also occur in the kidneys, and the rabbit may pass them as kidney stones. This is painful, and can sometimes cause a permanent blockage of that kidney. Kidney stones are usually an indication of decreased kidney function.  Stones in the kidneys or bladder can occur due to a bacterial infection. If there are stones in both kidneys, then the rabbit has very decreased kidney function and their kidneys will eventually fail. 

There are no medications that can dissolve calcium based stones. Increased fluid intake can help to prevent the stones from getting worse. There are several supplements that have been discussed to try and decrease stone formation. Potassium citrate works to acidify the bladder in some species (acidic urine decreases calcium stone production). But it is unable to acidify the urine in rabbits. Hydrochlorothiazide is a mild diuretic that is supposed to decrease the calcium levels in the urine. Dissolve KS by Evergreen herbs seems to be helpful. I also like to recommend the urinary supplements by Oxbow and Sherwood. Magnesium has been discussed but there is no data about its effects.

For rabbits with bladder sludge or stones it is recommended to avoid alfalfa based food, kale, and parsley. 

Medical attention is needed if the rabbit is painful when urinating, peeing outside the litterbox, has blood in the urine, or stops eating. Looking at your photos I would strongly recommend that your rabbit have x-rays performed. 

How to deal with the GI disturbance from the education prescribed for bladder sludge and cystitis? 

If the rabbit is on antibiotics for a urinary tract infection, that could cause a GI upset. It is best to avoid antibiotics that cause GI upset. It is ideal for the veterinarian to perform a urine culture to see exactly what the best antibiotic is to use. In some cases of sludge or cystitis vets may recommend Meloxicam. Most rabbits tolerate it well but a few rabbits may have a decreased appetite. Again, anything that causes a decrease in appetite should not be given. 

Antibiotics and anti-inflammatories are often insufficient at treating sludge. For treatment of bladder sludge I usually recommend Sq fluids, oral fluids, make the greens watery, avoid alfalfa, kale, parsley, get the rabbit down to a normal weight, increase exercise, and treat with pain relievers if there is any arthritis. Often the rabbit will need to have the sludge flushed out of the bladder. This can be done under mild sedation using a urinary catheter. 

Do greens high in calcium cause bladder stones? My rabbit loves kale but I am scared to feed it too often. 

If your rabbit does not currently have stones or sludge, then a small amount of kale as part of a healthy diet will not cause problems. 

Can bladder sludge/stones cause a rabbit to urinate blood? 

Yes stones can cause blood in the urine. But if the rabbit is an un-spayed female then it is more likely that there is a bleeding reproductive tumor. Also, rabbit urine can appear brown, orange or rust colored. That is not blood, that is plant pigments and its normal. 

My 11 year old rabbit is going in for bladder stone removal surgery at the beginning of March. Other than preliminary blood work, are there any other precautions to take before she goes in? Also, the receptionist at the vet (an exotics office) asked me to stop all food and water for my rabbit at midnight, the night before the surgery. Is this necessary for this kind of surgery? 

A bunny that is 11 years old needs to have full body xrays performed. We need to check for other problems like evidence of heart disease, cancer in the chest, or kidney stones. Pre- op bloodwork will tell us if the kidney values are elevated or if the rabbit is anemic or has an infection. If the rabbit is eating well, is a normal weight and is acting normally then it has a better chance of getting through the anesthesia. The rabbit should also be on intravenous fluids while under anesthesia. 

Rabbits should NEVER be fasted before surgery, do not remove food and water. We want rabbits to be eating before and after surgery. At a dog/cat/exotic hospital often the receptionists do not realize that rabbits should not be fasted, so they give out that misinformation. Please make sure that your veterinarian is experienced with performing surgery on rabbits. 

What is the difference between bladder sludge and stones? Does one lead to another?

It is normal for rabbits to have calcium crystals in their urine. Normally they will pee them out. If the rabbit is overweight, inactive, or has arthritis, they may not pee normally, and may retain urine. When they retain urine, the heavier crystals remain in the bladder instead of getting peed out. The crystals build up and become like mud- this is called sludge. Sludge can also occur if there is excessive calcium in the diet or from kidney insufficiency. Most rabbits with bladder sludge do NOT also have stones in the bladder or the kidneys. 

Stones are also calcium based. They can occur in the bladder or urethra. They can also occur in the kidneys, and the rabbit may pass them as kidney stones. This is painful and can sometimes cause a permanent blockage of that kidney. Kidney stones are usually an indication of decreased kidney function.  Stones in the kidneys or bladder can occur due to a bacterial infection. If there are stones in both kidneys, then the rabbit has very decreased kidney function and their kidneys will eventually fail. 

What is the first thing I should do when I see white/gritty pee from my rabbit?

An x-ray will tell you if there is sludge in your rabbit’s bladder. Many rabbits will pee out all the calcium crystals, and that’s why their urine appears white and gritty. This is normal. If the rabbit has sludge in the bladder on x-rays, then that is a problem. 

What are the risks of untreated bladder sludge and stones?

Untreated bladder sludge or stones will build up and get larger and larger, and become painful. It can also cause irritation of the bladder wall and infection. Rabbits will get more and more sick over time if stones or sludge are not treated. Also, smaller stones can pass into the urethra and get stuck, causing a life-threatening obstruction. 

Is surgery the only way to dissolve a bladder stone?

Yes, surgery is the only treatment for bladder stones, unless they are small enough to pee out. Stones are calcium based and cannot be dissolved. But there are treatments that can slow down stone formation. 

Are rabbits more prone to sludge/stones as they age?

When rabbits are arthritic and less active, they can build up sludge. Most sludge cases I see are overweight rabbits. 

Are there certain breeds of rabbits who are more prone to developing bladder sludge/stones?

No breed predisposition. 

 I have a question for Dr. Kanfer regarding bunnies molting and getting bald patches. Recently my bunny was molting and suddenly I saw a bald patch on his behind. It was pretty red and I took him to the exotic vet near me who suggested it was due to molting. We grabbed a sample of the skin to look under a microscope and it was negative for fungal infection etc. I was given some antiseptic wipes to use and make sure the wound doesn’t change. A week later, the same patch looks dark purple and the skin is scabby. The bunny is eating fine and active and not scratching or biting the scab. My question is- is this bald patch during molting normal? Is the skin color changing to purple and getting hard/scabby normal? And will hair grow back? I couldn’t find anything about this online so I was curious if Dr. Kanfer can shed some light on this. 

Rabbits do not usually get a bald patch when shedding, unless they were overgroomed. Fur mites may be present and not show up on a microscopic exam. If the rabbit has a lot of dandruff that is usually a sign of fur mites. Is the skin truly scabby or does it just look dark? If it looks dark then most likely the hair follicles are regrowing. If the skin is scabby and purple, that could be a serious wound. Improper grooming could cause a skin wound if the skin was torn or cut with a scissor. 

Kanfer’s Answers: Liver Lobe Torsion

What exactly is liver lobe torsion, and how common is it?

Rabbits have 5 sections, or lobes, of their liver. The lobe on the right is called the Right Caudate liver lobe and is the most likely one to be twisted. The lobe will acutely twist at the base. When it twists this cuts off the blood flow to the lobe and the tissue starts to die. This can be very painful. This causes the liver enzymes to become very high on blood tests. There is also a decrease in the red blood cells, called anemia. Sometimes there is free blood in the belly. The anemia may occur secondary to blood loss if blood is leaking into the belly from the injured lobe, or it could be due to direct damage to liver tissue. We don’t know why rabbits get LLT. It is relatively common. It is getting diagnosed more frequently in the past several years because rabbit vets are getting better at treating rabbits, and are more likely to perform bloodwork and x-rays, and be able to diagnose it. It seems to occur most frequently in healthy middle-aged rabbits.  


What are the symptoms of LLT?

The rabbit will suddenly stop eating and will be lethargic. The temperature may be normal or may be lower than normal. The rabbit may or may not press their abdomen down with pain. The gum color may be pale or white. These symptoms appear the same as a basic GI stasis or bloat. 


How is LLT diagnosed, and treated? Is surgery always needed?

Diagnosis: On bloodwork the rabbit will have elevated liver values and low red blood cells. Sometimes there will also be low platelet numbers. X-rays may show an enlarged liver or decreased detail in the liver area. Definitive diagnosis occurs on ultrasound, the affected liver lobe will be dark and not have blood flow.

Treatment: If the rabbit is not very anemic, is not painful, is not lethargic, has a normal temp and is nibbling on food then they may be able to be treated medically. Medical treatment includes pain meds, intestinal meds, metronidazole liver antibiotic, possibly a second broad spectrum antibiotic, Milk Thistle, SQ or IV fluids, and syringe feeding. The rabbit needs to be closely monitored to make sure the anemia doesn’t worsen. It can take 1-2 weeks on meds for the rabbit to be back to normal. 

If the rabbit is not eating, is painful, or bloodwork looks really bad then it definitely needs emergency surgery. If there is significant anemia then the rabbit will also need a blood transfusion before or during surgery. 

What is the success rate of LLT surgery, and what are the risks?

The success rate is high but depends on how sick the rabbit is as well as how experienced the veterinarian is. If the diagnosis is made quickly and the rabbit goes to surgery within 12-24 hrs then there is a better prognosis. If the rabbit has very low platelets then there may be more risks. They may die during or after surgery from inability to clot or too much clotting, or they may form a clot in their lungs or heart.

If my rabbit is diagnosed with LLT, how long do I have before they need surgery?

If a rabbit has a LLT that is too bad to be treated medically then they should have surgery performed within 12-24 hours of onset of signs. 

Can multiple lobes twist at the same time?

It is uncommon but has been reported. 

What does recovery look like for rabbits with LLT? 

It depends on how sick they are. If they get surgery then they need to be hospitalized for a couple days afterwards. They may be tired, sedate. The veterinarian needs to syringe feed them to get their gut moving again. They will need to be on pain meds, antibiotics and other treatments for at least a week. 

If a rabbit has a mild case and is treated medically they may be able to be sent home sooner, and the owner will need to medicate them for a few weeks and bring them back in for frequent rechecks. 

Is there any way to prevent LLT?

Sadly, no.

What is the chance of recurrence?

Extremely low. 

Are there certain breeds of rabbits more prone to LLT?

Some veterinarians have stated they are seeing it most frequently in lop rabbits. At our hospital we see it in almost all breeds of rabbits and don’t see any one breed overrepresented. 

What is the most common age range of rabbits you see with LLT? 

Usually 3-7yrs old. But recently we had two cases, one was a year old and the other was only 9mos. 

A friend of mine lost her 6 year old rabbit last year to LLT. They did everything right – took her to the emergency vet as soon as she stopped eating, had bloodwork, x rays and a CT scan done. They scheduled the surgery right away and the rabbit made it through just fine. While in recovery a day later, the bunny crashed and passed away. How common is that, and what might have happened to the rabbit?

Most likely the rabbit had a blood clot that traveled to the lungs or heart. 

I wanted to ask Dr Kanfer how we can tell the difference between liver lobe torsion and stasis…. My bun is always twisting his body and rolling over on his back. Is it possible for him to twist his liver doing that? Mahalo!

Stasis and LLT appear similar, the rabbit stops eating and is lethargic. Blood Work will show elevated liver values and anemia, then an ultrasound will give a definitive diagnosis of LLT. 

We don’t know if twisting or binkying causes LLT. Or gas. 

My rabbit had two liver lobe Torsion surgeries before the age of 2. During his second surgery, the doctor noted a grayish color to his liver and suggested he only had 2 months to live. They put him on medication called Sam-E Milk Thistle, and he lived for 10 more months. Peppers passed away last month even though he was showing NO signs of further liver issues or GI stasis. One day he started having seizures and his heart stopped. The doctors don’t know why. My question is there anything we could’ve done to cure the liver lobe torsion and prevent it from returning? What could have caused his liver to do this twice? 

That is unusual. Usually only one lobe is affected. Since your rabbit’s entire liver was discolored, there could have been some other liver disease occurring. Sometimes a biopsy will give more information. There could have been a congenital liver dysfunction, a Coccodia parasitic infection, or a bacterial infection. Milk Thistle and SAM-e are very helpful for liver disease.

Why are Holland lops predisposed to torsion?

We do not know why some rabbits develop a LLT. There could be a genetic cause. Other vets have reported seeing a higher incidence of LLT in lops, but at our hospital we see it in almost all breeds. 

If your bun is diagnosed with torsion – how much time do you have? Do you need to hospitalize your bun?

Rabbits that stop eating should be seen by a rabbit savvy vet within a few hours. They should have x rays and bloodwork done to differentiate if the rabbit has a LLT, a bloated stomach, or just GI stasis. If the rabbit has a LLT they should have surgery performed within 12-24hrs and they need to be hospitalized. 

Why do some exotic vets, even those who see rabbits, misdiagnose torsion?

Many owners cannot afford to pay for bloodwork and x rays, or don’t realize why these tests are so important. Some exotic vets do not keep up with the most recent information. Some vets assume that owners don’t want to spend much money so they won’t even offer x rays or bloodwork. Some  vets don’t realize that an anorectic rabbit may be at risk for death. Some vets don’t have staff that are experienced enough to take x rays or blood on a rabbit. Or they don’t have the ability to run blood work in the hospital or perform an ultrasound. 

Kanfer’s Answers: Bloat

Our two-year-old Harlequin, Pronto, often appears bloated and we’ve been searching for a cause. We give him and his brother unlimited Oxbow Timothy Hay, about a quarter cup of the Oxbow garden organics adult pellets, and veggies (parsley, Romaine, Spinach, some carrot once a week, etc.). I also give both of them an Oxbow Digestive every day which does seem to help. When he gets bloated we will often treat him with 1 ml. of simethicone infant drops and this appears to head it off. I will not give him veggies for a day or two to see if he gets better. Typically his poos are fine (large, round, golden brown, soft) and he has a great appetite. But, about every four months he will show the beginning signs of GI stasis (not eating, drinking, sitting in his litter box) and we do a more intensive intervention–1 ml of drops for each hour for their first three hours, belly massages, critical care, and water syringe fed and sometimes placing him on a towel on a heating pad on medium. Last week we were at our wit’s end, did everything for four hours in the middle of the night and it was the heating pad that appeared to finally help. We’ve had to take him to the vet for emergency appointments. twice in the past two years–one time an hour and a half away at 1 am to a 24-hour vet school hospital because no interventions on our part were working. But with hydration and pain meds he perked right back up. What can we change diet-wise to prevent these issues? Pronto is a healthy, happy, active little guy normally, but his belly blows up like a sausage while his brother Marco is muscular and svelte and eating the same diet.

I would recommend a full work up to see if there is an underlying cause. Full body x-rays, bloodwork and fecal test. He could have an intestinal parasite called Coccidia. He could just be ingesting a lot of hair. Or he could have a scarred area in his gut or something else going on. You can try preventing episodes by giving daily Laxatone hairball remedy (maple or malt flavor). If that doesn’t work some rabbits do well on a chronic intestinal stimulant given every day as a preventative (Reglan). Or giving him an injection of fluids under the skin once a week may help. 

 I recommend the following emergency protocol to follow, that you can start at home at the first signs of a decrease in appetite:

  1. Check temperature using rectal thermometer. Normal temp in rabbits is 100-103*F. If the rabbit is below 100*F you need to warm the rabbit. Place the rabbit on a towel on a heating pad set on low, and lace another towel over them. Recheck the rectal temp every 10 minutes while on the heat pad. Rabbits can quickly become overheated.  You can buy a thermometer at a pharmacy. Get a digital one with a long flexible tip. For lubrication use vaseline or KY jelly. You can purchase a heating pad at a pharmacy as well. 
  2. Administer an injection of warm fluids under the skin. 
  3. Administer a pain reliever like Meloxicam/Metacam. 
  4. Do not syringe feed the rabbit if the temp is below 100*F, or if the belly feels enlarged or firm. If you do syringe feed, do not feed more than 10ml every 3 hrs. 
  5. If the rabbit does not improve within 2-3 hours they need to see a vet right away. 

 You can ask your veterinarian to prescribe SQ fluids and teach you how to administer them at home. And they can also supply you with some pain meds to have on hand for when he has his next episode. Your veterinarian can teach you how to take your rabbit’s rectal temp. Or you can look for videos online.  


Is it possible for a bun to get bloated just from excessive grooming or not drinking enough water?

Yes bunnies often get bloated from excessive hair ingestion. A small chunk of hair exits the stomach and enters the small intestine, getting stuck. This causes the stomach to fill up with gas and fluid. The rest of the rabbit’s body becomes dehydrated, and their blood pressure drops, as well as their body temperature. The most important treatments for bloat are hydration into the veins or under the skin, pain meds, and keeping their temp up in the normal range. In many cases fluids under the skin and oral pain meds may help if given at the first signs of illness. If the rabbit does not improve within a couple hours then it needs to be hospitalized on IV fluids with a rabbit experienced vet. If the rabbit’s stomach is very enlarged then the vet will have to sedate the rabbit and pass a tube down its throat into its stomach to empty out the gas and fluid. With IV fluid treatment the blockage will usually pass. If it doesn’t pass within several hours then the rabbit may need emergency surgery to remove the blockage. 

 Some rabbits don’t drink much water, because they are getting enough water when they eat their greens. If a rabbit was left without water or greens, they could become dehydrated and sick. Dehydration could lead to a bloat. But the most common thing is that the rabbit swallows too much hair and then they become dehydrated. The myth is that it’s a large hairball in the stomach. That is false. The hairballs that cause blockages and bloat are small and get stuck in the small intestine.  


What signs can we look for to tell the difference between stasis and bloat?

 It can be difficult to tell the difference between bloat and stasis unless you get x-rays done. Some vets are unable to identify a mild bloat on x-rays. But a major bloat is obvious on x-rays, and often obvious when the vet palpates the rabbit’s belly. Bloated rabbits almost always have a decreased temperature. GI stasis rabbits are more likely to have a normal temperature. In both bloat and stasis there is often no appetite, and no stool production. They may act painful, or may just be sitting quietly. 

What causes bloat?

A small chunk of hair exits the stomach and enters the small intestine, getting stuck. This causes the stomach to fill up with gas and fluid. The rest of the rabbit’s body becomes dehydrated, and their blood pressure drops, as well as their body temperature. 

 Rabbits can also develop bloat if there is a constriction of the intestines. This can happen in recently spayed female rabbits. They can form adhesions from the surgery (fibrous bands of scar tissue that form between internal organs and tissues, joining them together abnormally). 


How serious is bloat in rabbits? 

Bloat in rabbits is life threatening. If your rabbit doesn’t eat its meal right away, and doesn’t take any treats, be very concerned. For a dog or cat you might wait a day or two to take them to the vet. For rabbits you should not wait more than a couple hours. Their lack of appetite may be just GI stasis, and they just need some SQ fluids, pain meds, intestinal meds, and syringe feeding. Or they could have a life-threatening bloat. Bloated rabbits go into shock and can die. Or their stomach can rupture. Getting rabbits treated right away is very important. The earlier the bloat is treated, the better the prognosis. 

 If your rabbit is not eating, it needs to see a rabbit experienced vet right away. A good rabbit vet will recommend an x-ray, all rabbits that stop eating should absolutely have x-rays done. Bloodwork is very important as well. This tells us how sick your rabbit is, and if there is something else going on, like a twisted liver lobe. 

 Treating a bloated rabbit can be expensive. I recommend being prepared by having pet insurance and a savings account. If your rabbit gets sick it could easily cost $500-5,000. 


What are the early signs of bloat?

Rabbits can be fine, eat dinner as normal, then be lethargic, hunched and not eating treats 1-2 hours later. Often there are no early signs, it is very sudden in onset. You can try and prevent bloat by giving Laxatone hairball remedy every day when shedding and groom them daily when shedding.  

Are certain breeds of rabbits more prone to bloat? 

Bloat occurs in all breeds and sizes. Most common in healthy middle-aged rabbits (3-6 yrs). But can happen at any age. If a geriatric rabbit bloats, there is often an underlying cause, like kidney insufficiency. 


Are rabbits with megacolon more prone to bloat?

Megacolon rabbits are prone to a different kind of bloat, involving the large intestine instead of the stomach. Sometimes they just get a lot of gas in their cecum. That is not truly a bloat, because it is not a blockage, and is instead just excessive gas buildup. 

Many megacolon rabbits have irregular sized poop, that may be fused together or oval in shape, and may get quite large. Because Megacolon rabbits have motility issues and enlarged poops, these poops can get stuck in the colon. This then causes a large intestinal bloat. Hydration, pain meds, enemas and other meds can help but if the blockage is severe the rabbit may not survive. If the rabbit has a large intestinal obstruction and is not improving with medical treatment then they may need surgery. This type of surgery is very challenging. 


What causes recurring bloat episodes in a rabbit?

Could be chronic hair ingestion, intestinal parasites, scar tissue, adhesions, kidney insufficiency, or other issue. 

If I think my rabbit is bloated, is there anything I can do to treat at home in case I can’t get to a vet right away?

I recommend the following protocol to follow, that you can start at home at the first signs of a decrease in appetite:

  1. Check temperature using rectal thermometer. Normal temp in rabbits is 100-103*F. If the rabbit is below 100*F you need to warm the rabbit. Place the rabbit on a towel on a heating pad set on low. Recheck the rectal temp every 10 minutes while on the heat pad. Rabbits can quickly become overheated.  You can buy a thermometer at a pharmacy. Get a digital one with a long flexible tip. For lubrication use vaseline or KY jelly. You can also purchase a heating pad at a pharmacy as well. 
  2. Administer a dose of warm fluids under the skin. 
  3. Administer a pain reliever like Meloxicam. 
  4. Do not syringe feed the rabbit if the temp is below 100*F, or if the belly feels enlarged or firm. If you do syringe feed, do not feed more than 10ml every 3 hrs. 
  5. If the rabbit does not improve within 3 hours they need to see a vet right away. 

 You can ask your veterinarian to prescribe SQ fluids and teach you how to administer them at home. And they can also supply you with some pain meds to have on hand.  


How soon after noticing symptoms of bloat should I get my rabbit to a vet? 

Within 2 hours. 

How is bloat treated at the vet? Will my rabbit need to be hospitalized? 

A good rabbit vet will perform x-rays and bloodwork right away. After bloat is diagnosed the rabbit should be hospitalized and started right away on IV fluids, injectable pain meds and heat support. They may need a tube briefly placed down their throat to relieve the excessive gas and fluid in the stomach. The rabbit should be monitored closely and have repeat x-rays performed every couple hours to see if the GI tract starts moving. Once the GI tract is moving and the small hairball passes from the small intestine into the large intestine, the rabbit is usually out of the woods. If the GI tract doesn’t start moving within 4-6 hrs, or the rabbit gets worse then they need surgery to remove the obstruction. The longer you wait, the worse the rabbit will get.  


How well do rabbits typically recover from bloat? What kind of home care should I be prepared to give once my rabbit comes home from the vet after a bloat episode?

Rabbits usually recover pretty well, if the bloat is treated quickly and properly. Often they will need to continue pain meds, intestinal stimulants, extra hydration, and syringe feeding for 2-5 days afterwards. 


What kind of food should I avoid feeding my rabbit so he/she does not become bloated?

Avoid carbohydrates, large amount of fruits or sugary foods. Keep the pellets and greens limited so the rabbit eats a lot of hay. Rabbits are always grooming and are always ingesting hair. Hay will help keep the intestines moving properly and keep the hair moving through. Exercise also helps the gut move properly. 


Other than a correct diet, what else can I do to minimize the possibility of my rabbit becoming bloated?

You can try and prevent bloat by giving Laxatone hairball remedy every day when shedding and groom them daily when your rabbit is shedding.  


Kanfer’s Answers: Husbandry

I have a 2-year-old, female lop. She has choked on her pellets on two different occasions, causing me to give her the bunny Heimlich maneuver—-traumatizing!! Now I feed her one pellet at a time or none at all, only hay. Is this something she will grow out of with age (eating too fast) or might there be another reason she chokes easily?

This could be due to eating too fast or could be from dental discomfort. Another possibility could be something constricting her esophagus, like a tumor. But this is more likely to occur in a middle aged or older rabbit, like over 5 yrs old.  Avoiding pellets is a good idea. It would be ideal to get x-rays of her head, throat and chest, but she may need a CT scan or fluoroscopy to see if there is anything interfering with her swallowing. Also, when rabbits have a choking episode there is a high chance of them getting food in their lungs and getting an aspiration pneumonia. X-rays are necessary for diagnosis, and the treatment would be antibiotics. 


I wanted to ask Dr. Kanfer how I could encourage my rabbit to drink more water? She has 2 water bowls, a stainless-steel fountain and a waterer with a floating disk to prevent her dewlap from getting wet. She will only drink water with some apple juice or blended veggies. She won’t drink enough water on her own.

Many rabbits do not drink a lot of water. If a rabbit is being fed a big salad, they will get their water from that, and will drink less water. Rabbits that don’t get any greens and eat primarily hay and pellets tend to drink more water. If your rabbit is otherwise healthy and the poops look normal then it is probably getting sufficient water and I wouldn’t worry about it. If your rabbit has GI stasis episodes or bladder sludge then they may benefit from fluid injections under the skin.  


I have a question about pellets… I notice a lot of people recommending a brand of pellets that has a lot of soy in it. What do you think about bunnies eating soy?

Soy is a source of protein. Soy and corn are foods that are GMO (genetically modified organism). Certain foods are GMO to try and increase the crop yield and help the plants resist the effects of the herbicide being used.  There is information in the literature that GMO’s can cause a higher number of allergic reactions and fertility issues in humans. But there is also evidence that animals do fine on a diet containing GMO. 

A proper rabbit diet should be limited amounts of pellets and greens with a large amount of hay. Since the pellets are a small part of the diet, I am not as worried about which pellet brand is used. I do recommend the higher quality brands, but as long as the rabbits are eating a timothy-based pellet without seeds and puffs added, that is the most important thing. Also, the food the rabbit eats is mostly digested by the good bacteria in their cecum, and the bacteria produces the nutrients the rabbit absorbs. Personally, if a rabbit is healthy, I don’t worry about pellets that contain soy. If the rabbit has GI issues, then it may be better to try a non-GMO pellet. 


My vet says that domesticated bunnies do not need pellets, they basically just need hay and some greens, and I can use pellets as a treat. Do you think bunnies can get all the nutrition they need from hay and greens? If pellets are necessary, what percentage of their diet should be pellets?

In the wild rabbits eat grass, dried grass, leaves and branches. Pellets were initially created for rabbits used for meat and in the labs, to allow for complete nutrition of all the required vitamins and minerals, and to promote fast growth. A house rabbit can definitely live on a diet of hay only, without pellets or greens. We feed pellets and greens to make sure the rabbit has all the micronutrients they need, and for variety. Some hays may be grown on fields that are lacking nutrients, but good quality hay providers will make sure that their hay is healthy and not nutrient deficient. Pellets and greens should be fed in limited amounts. Rabbits 5lbs and under should get no more than 1/8-1/4cup of pellets and 1 cup of green leafy vegetables per day. They should be eating primarily hay. This will keep their teeth worn down and keep their gut moving normally. 


I have a few questions on CBD for rabbits, what has been your experience with any CBD products, have you done any studies or recommend a brand? Also how do you think CBD would benefit a rabbit after either a surgery or an elderly rabbit? Have you tried CBD for any of your patients yet and what was their outcome?

CBD can be helpful to relieve pain after surgery or due to arthritis. I am attaching my CBD handout below to answer your questions. I have used it in my bunnies and find some products work better than others. 

Click here to read Dr. Kanfer’s CBD handout


How often should you groom different breeds of rabbits? How do I know if I’ve groomed my rabbit enough?

Some rabbits shed frequently, some only shed 2-4 times a year. In short haired rabbits, if the fur is coming off when you are petting their back, then they need to be groomed. If your rabbit has patches of bare skin then you are grooming too much. You can use the Hair Buster rabbit comb or use your hands to pull off the loose hair.  Long hair rabbits may need to be combed daily or weekly. Sometimes it is difficult to keep up with grooming long haired rabbits, and you can have them shaved by your rabbit vet or rabbit rescue groomer every 1-3 months. If you see hair in your rabbit’s poop then they need to be groomed more frequently. I also recommend using a kitty hairball formula like Laxatone (malt flavor) daily whenever a rabbit is shedding. 


If I don’t have styptic powder at home and accidentally trim my bunny’s nails too short, what else can I use to stop the bleeding?

You can use flour or press the nail into a bar of soap. Or hold pressure with a tissue for a few minutes. 


What is the best flooring to have in a rabbit’s area to prevent sore hocks? How can I care for my existing sore hocks?

All rabbits should be kept on carpet. This provides them with secure footing so they are comfortable and will be as active as they want to be. Many rabbits have thinner hair at the tip of their ankle and the skin looks pink. This is not sore hocks. But should be monitored to make sure it doesn’t get worse. Signs of sore hocks: scabbing and/or swelling, excessive hair loss on the bottom of the rear feet, painful feet. Rabbits can be given soft beds to relax on if the feet are just pink. If the feet are getting worse or are scabbed and swollen, the rabbit can be kept on a large piece of faux sheepskin. You can buy it on Amazon, called Sheepette. You can also use children’s socks or bunny booties. There is someone on Etsy that makes bunny booties. If the rabbit has significant sore hocks, then they may need to be managed by a rabbit veterinarian, and will need antibiotics, pain relievers, may need foot soaking and ointments, and intensive care.


What kind of greens are best to feed a rabbit who has urine sludge?

Rabbits with bladder sludge should avoid parsley, kale, spinach, broccoli, collard greens, and should avoid alfalfa. Many rabbits with sludge are overweight and will improve significantly if they lose weight. 


How often should rabbits be fed fruit (strawberry, banana, watermelon, blueberry, etc.)?

Fruits are treats and should be fed sparingly. I recommend one small treat per day. So 1-2 blueberries OR a quarter sized piece of banana OR a small piece of strawberry OR a half a baby carrot OR a bunny cookie. Too much fruit can cause soft stool and obesity. 


Should rabbits really stay away from carrots?

Yes, carrots act like carbohydrates. Think of them as equivalent to a piece of bread or fruit. Should be used as treats only.  


What is the minimum amount of space a rabbit should have (not counting “play time” space)?

Most places recommend a minimum of 10-15 square feet per 1-2 rabbits, plus an exercise area of 24sf or larger. An 8 panel exercise pen is a good size for 1-2 rabbits. Then they should have a few hours each day to run around outside the pen. 


Is cleaning a rabbit’s scent glands necessary? How often should it be done?

Most rabbits will clean their own scent glands. If a rabbit is arthritic or overweight then they probably need to be cleaned. They probably only need to be cleaned once every few months. 


How much salad should I be feeding my rabbit?

1 cup of salad per bunny per day


What are the most nutritious greens I should be feeding my rabbit?

Overall greens are mostly water. But contain micronutrients. Good greens to feed rabbits: green leaf lettuce, romaine, dandelion, carrot tops, cilantro, parsley, kale, baby bok choy. You can find detailed lists on the rescue group websites. 


What greens are not good for rabbits?

Avoid broccoli, spinach, iceberg lettuce, celery. Feed in limited amounts: kale, parsley. 


My rabbit came from a place where he didn’t have hay available, and now he won’t eat it. How can I get him to eat hay?

He may be getting too many pellets and greens. Or he may have bad teeth. He needs to have his teeth examined by a rabbit experienced vet. If his teeth are normal and he is not skinny, then you may want to try decreasing his pellets and greens. Rabbits should get 1/8-1/4cup pellets and 1 cup of greens each day. Feed a plain green pellet, no puffs or seeds added. Offer a high quality fresh hay that you can get from a rescue group or a feed store. Ideally offer Timothy, Orchard or Oat hay. Offer fresh handfuls every day. SLOWLY decrease pellets and greens by 25% every 2 weeks til you get down to the recommended amount. If your rabbit still won’t eat hay, you can try adding in alfalfa hay to entice him to eat. If he has bad teeth then he may never eat hay, and that is ok. 

It seems that the pellets for older buns, Science Selective and Oxbow’s new 5+ pellets have alfalfa in them. I have an 11 year old bun who has been on Science Selective for years and have had no problems. Should I change?

Alfalfa is higher in calcium and protein. Alfalfa based pellets and alfalfa hay is very helpful for babies and older bunnies. Babies need calcium and protein for growth. Many older bunnies start losing weight and need more nutrient dense food. Alfalfa hay or pellets can also be used to tempt rabbits to eat and help them gain weight. It should be avoided in rabbits that have bladder or kidney stones or bladder sludge. Healthy adult rabbits do not need all that extra calcium and protein, and if they eat it regularly could potentially cause problems. If your 11yr old bunny doesn’t have any issues with stones or sludge then he can remain on the alfalfa based pellets. Your bunny would need X-rays to check for stones or sludge. 

Kanfer’s Answers: RHDV2

1. Do you think it’s important for bunny owners who live in areas that don’t have wild bunnies and are not in an area where there has been the virus to get vaccinated anyways? If so, I’d like to be able to convey these reasons to local bunny owners and give assurance to myself that I’m not unnecessarily vaccinating my own bun.

This virus has spread quickly through the wild rabbits of the western US, and it is now moving eastward. Eventually it will be everywhere throughout the US, Canada and Mexico. The virus has been present in most countries for many years and they have been vaccinating rabbits against it for a long time. This is not going away and eventually all rabbits in the US will need to be vaccinated. We have been vaccinating dogs and cats for years against viruses like Distemper and Parvovirus. It’s a similar situation. 

2. Is it okay for a fully RHDV2 vaccinated rabbit to go outdoors to romp for exercise (under supervision) in an endemic area? non-endemic area?

The vaccine is extremely effective at protecting rabbits against the virus. Yes, vaccinated rabbits can go outdoors to play in endemic and non-endemic areas. 

3. Do you recommend one or two shots of Medgene vaccine for previously vaccinated rabbits with Filavac / Eravac? Can you explain why some veterinarians are giving differing advice about this?

The Medgene vaccine is a new vaccine and it is a different type of vaccine than the Eravac and Filavac. They don’t know yet whether the Medgene will be as effective as a single injection a year after a rabbit gets Eravac or Filavac. Medgene is currently researching that. Their recommendation is for veterinarians to use their judgment. If it’s an indoor rabbit and the risk is low in that area, then boostering with a single Medgene dose should be fine. If it’s a rabbit that goes outdoors, or lives in an area with numerous cases or lots of cottontails, then best to give the 2 vaccine series of the Medgene when switching over. 

4. Many of the recent RHDV2 confirmations (Seattle, Ontario 2x, Kansas, Orange County, FL) have been in indoor-only rabbits. How might you explain this, when one would think outdoor rabbits would be more exposed to the disease? Should those living in RHDV2 endemic areas take any additional special precautions compared to those who live in non-endemic RHDV2 areas?

Outdoor rabbits are definitely much more likely to be infected than indoor rabbits. But a large percentage of pet rabbits in the US are kept primarily indoors. Maybe we are seeing higher numbers of indoor rabbits being reported if the outdoor pet rabbits are not getting tested when they die. 

If your rabbit is not getting vaccinated yearly then you should definitely take all precautions: take your shoes off before entering house, keep fleas, mosquitoes and flies out, avoid associating with other rabbits and especially avoid wild rabbits. The problem is that you cannot prevent the virus from entering your home on greens or on cat/dog feet. 

5. What do you think is the real risk of RHDV2 being transmitted to rabbits via greens/veggies and via hay?

I think it is a real risk, and along with insects or tracking the virus in on our feet, these are probably the main causes for indoor only rabbits getting infected. Vaccination will protect rabbits from the virus if it is present on hay or greens. 

6. Do you think RHDV2 vaccination should become mandatory in the US once the domestic Medgene vaccine is fully FDA-licensed (proven safe and efficacious)? 

It won’t become mandatory. The only vaccine that is currently required by law for dogs and cats is the Rabies vaccine. This is because the disease is deadly to humans. The other vaccines that dogs and cats get are administered regularly by all veterinarians because the diseases they prevent can be deadly to dogs and cats. But I do believe that all rabbits should get vaccinated.  

7. Are there any instances where you would NOT recommend vaccination for RHDV2 for a rabbit, indoor or outdoor?

If a rabbit is actively ill, then it is best to wait until it has recovered. If a rabbit has significant kidney disease or advanced cancer then we may not want to vaccinate it. If a rabbit has heart disease that is well controlled on medications, or has a chronic upper respiratory infection, they can be vaccinated. 

8. Are there any cleaning solutions other than Rescue that I can use to clean my home and rabbit’s area to protect against the virus?

1:10 dilution of household bleach or potassium peroxymonosulfate (1% Virkon-S by DuPont).

9. Why does the price of the vaccine vary from vet to vet? Is it necessary for my vet to perform a wellness exam or can I just ask for the vaccine to save money?

Reasons for price differences: 

Cost for the vet to acquire the vaccine. Exporting the Filavac and Eravac has been expensive. 

Area the vet is located. Costs are higher in cities than in suburban or rural areas. 

Quality of the veterinarian. Higher quality and more knowledgeable vets are often going to charge more than someone who sees only a couple rabbits a week. And these vets are going to be better at finding diseases in the early stages. 

A wellness exam is strongly recommended at least once a year, then twice a year in older rabbits (9yrs and older). The wellness exams allow the vet to find problems that the owner may be unaware of like dental disease, obesity, heart disease, cancer, etc. Also, we don’t want to vaccinate a sick rabbit. Rabbits are really good at hiding illnesses. As veterinarians we are required to perform annual exams in order to treat or prescribe. For young healthy rabbits that have had a normal exam within the past year, it is fine for them to receive the vaccine without getting another exam. For geriatric rabbits it is ideal to check bloodwork and x-rays to make sure they don’t have any illnesses before vaccinating. Vaccines make the immune system work, and if a rabbit is fighting something off, then anything that can affect the immune system can hasten an underlying illness. 

10. Should rescues be responsible for vaccinating their rabbits before being adopted and in foster homes? Should personal rabbits living with foster rabbits be vaccinated also?

Yes, they should be vaccinating all rabbits that come through their rescue. All rabbits that may be exposed to another rabbit should be vaccinated. All rabbits should be vaccinated. 

11. What do you have to say to people who are against vaccinating their rabbits?

For some people it is a financial issue. There are rescue groups and shelters that may be able to offer discounted vaccinations. Or they can call around to different vets and may have to drive a bit farther to get a less expensive vaccination. 

In some cases the rabbits have a chronic illness, and we are afraid that a vaccine would be too much for them. 

Some people may fear if the vaccine is safe enough. The vaccine is very safe and side effects have been minimal. The vaccine is not going to cause the disease, there is no live virus. 

Other people may not think their rabbit is at risk being indoors only. This is false. RHDV2 is insidious. It only takes a few virus particles to cause infection. It is frequently fatal and strikes quickly. It is very hardy and can survive for 3-4 months in the environment. You cannot wash off the virus, it requires special disinfectants. It will survive being in the washing machine, will survive heat and freezing. The virus is being spread by wild rabbits. Anything that a wild rabbit touches can have virus particles. If your dog or cat walks where a wild rabbit was, they can track the virus into your home. If the greens you feed are exposed to an infected rabbit, then that will bring the virus into your home. You can remove your shoes and keep insects out but you cannot disinfect dog/cat feet, or greens.  The only way to fully protect your indoor house rabbit is by vaccination. 

There are some people that don’t care as much as others about their rabbit’s health and safety. 

12. I would like to know if any of the state vets or DOA’s have any plans to conference together, especially in states with pop-up cases of indoor bunny RHDV2, in order to try to identify any commonalities among the cases?  I “do” RHDV pretty much full time; I know that is a question many people, including myself and my team, would like answered.  Not exactly what you’re looking for here with these questions, but we’re all scrambling to figure out how this virus is getting into peoples’ homes where reasonable biosecurity is being maintained.

As discussed above, the virus is very hardy. We may never know how indoor only rabbits are getting infected. There is no RHDV2 conference that I know of. There is an Exotics Conference in August, I’m sure the topic will come up. 

13. What is the current standard of thinking for incubation period after exposure till symptoms occur (getting several answers when I research)?

Three to 9 days according to APHIS.  

14. What is the approximate range window between first symptoms and death?

Death occurs between 1-3 days. There may be no signs and the rabbit may be found dead. 

15. When buns are housed in group settings (such as in the rescue), or even in homes in bonded pairs, if symptoms occur, does it do any good to separate buns at that point, or, since exposure has already occurred, is there any benefit?

Most likely the bonded rabbit has been exposed as well. This is a tough question; do you separate the bunnies at the time when they need emotional support and one or both die alone? Or do you separate them in the hope that one will survive.