Bladder stones develop when calcium crystals in the urine combine with each other and oxalate and other particles in the urine, including protein, mucous, and bacteria. Symptoms range from blood in the urine, straining to urinate, frequent urination, and sometimes just acting uncomfortable. Diagnosis is by bladder x-rays and urinalysis and culture. Treating the infection and correcting any dietary or general healthy conditions is important. You would think it would be a simple fix - surgically remove the stone(s) and treat the infection, reduce calcium in the diet - but it’s actually much more complicated. Studies show that most bladder stones recur, sometimes within 1-2 months of surgery, evey with the best preventative care. Dietary changes lower calcium, medications such as potassium citrate, increasing water consumption by feeding fresh greens which are rinsed well and fed with the water on them, and even diuretics in some cases are used to slow the growth of the existing stone and reformation of new stones post-surgery. Dietary changes include feeding primarily timothy hay or grass hay, along with a very small amount of Oxbow rabbit pellets (⅛ for rabbits under 3.5 lbs and ¼ for rabbits over 3.5 lbs), and 1-2 cups of fresh greens per day. Good greens are cilantro, celery leaves, dark leaf lettuce, endive. Bad greens are kale, parsley, broccoli leaves, and collard greens. There is a full list of calcium content of vegetables listed on rabbit.org put together by Dr. Harkness.
Abdominal surgery and bladder surgery in rabbits has more risks than with dogs and cats, due to their sensitivity to surgery’s stress and its effects on recovery. A stressed rabbit will develop problems such as poor appetite, decreased motility and functioning of their gastrointestinal tract (GI stasis), leading to complications. The healthy bacteria in the GI tract that are needed for digesting the plant foods can be affected by the antibiotics needed to treat the infection in the urine. Metoclopramide to promote healthy GI motility, along with good pain control with Metacam, and supplemental feeding with Critical Care Herbivore are helpful, but do not prevent all complications. Rabbits are also known to pull out the sutures, and they don’t accept wearing a protective cone such as used with dogs and cats. Consequently, if the bladder stone is small and treatment for the bladder infection, along with other medications results in a happy rabbit, we can often go years without surgery. If on the other hand, the rabbit is not doing well and/or the stone becomes very large, then surgery is recommended - at this point we are concerned about quality of life and getting the stone out is worth the other surgical risks mentioned earlier. Each rabbit is an individual patient in our eyes and requires a plan tailored to their needs and health.