Drinking/Urinating Excessively and Anemia

Hi Everyone! I'm looking for some advice/thoughts on my rabbit who has been drinking excessively (~30-40 oz daily) and having many accidents for the past couple months (up to 4/5 a day). He recently went to the vet and we were told he has anemia based on his bloodwork (attached) but that it is not related to his drinking issue. They think his excessive drinking/peeing is due to behavioral issues since he is not neutered. Also, in the past two months, he lost weight; he was 5.5 lbs, and is now 4.7 lbs. I'm very anxious about him all the time and since I'm a first time rabbit owner, I'd love some additional perspectives!

I'm going to go into a lot of (probably irrelevant) detail in case anything in his situation relates, so I'll separate my post into sections.

LIKELY IRRELEVANT BACKGROUND INFO:

I adopted my rabbit mid July and was told he is about 3 years old. His previous owner fed him 1-2 cups of pellets a day with seeds and dried veggies and he did not eat hay at all. He also had poopy butt and weepy eyes. The previous owner said he did not have those issues with her but I think she just didn't notice. We took him to a (supposedly rabbit savvy) vet to solve these issues and were told it likely had to do with his teeth, and that we needed to do a CT scan. A few days later he went into stasis so we took him to an emergency vet (that accepted rabbits but did not have a exotics specialist) but they didn't find anything wrong with him. But by the time we got home he was eating critical care on his own and moving around again, thankfully. The next day, I was calling a rabbit savvy vet to compare estimates for dental work and they said I should take him in that day due to his stasis episode. The vet said he likely just had gas the night before, his teeth were fine, and did a lacrimal flush. So three vets in one week! It was a stressful time but I am glad to have gotten a chance to go to the best rabbit vet in my area (it was fully booked out for months so I was only able to go since it was an emergency appointment). He made a quick recovery from his stasis episode and seemed to be doing ok for a while.

Here are changes we implemented in his diet:
1) I tried a million types of hay but finally got him to eat haystacks and now he eats hay! Probably not as much as most rabbits but we're working on it.
2) I immediately separated the "junk" from his original pellets and slowly transitioned him to Science Selective Adult (1/4 cup a day). The vet recommended to switch him to the House version but now she's saying keep him on Adult due to his anemia. His poopy butt resolved shortly after his pellets were changed out.
3) We started giving him about 3/4 cup fresh veggies every day (usually cilantro, green leaf lettuce, and basil).

MORE RELEVANT INFO:

Towards mid-August, he started drinking a lot more water than the first few weeks we had him. Before, he would barely finish his bowl every day (~4 oz) and he started drinking at least 20 oz per day. It was hard to tell exactly how much because his water bottle leaked and sometimes he would splash his bowl. He seemed to be more interested in his bottle so we started taking it out during the day and just refilling the bowl so we could see if it was just because he wanted to play with the bottle. But he would still be emptying bowl after bowl. Then he started having accidents outside his litter box. He peed like 5 times in various places in the same day and he had never peed outside his litter box before. So I called the vet that day and she said just to monitor him for now. We started taking notes on his water intake and he kept peeing in certain places so we tried to prevent him going to those areas. Basically we tried to differentiate between actual accidents and him just peeing where he felt like peeing.

In September his drinking seemed to calm down a bit and his accidents too so I thought he was fine. Then in October he started drinking 30-40 oz of water and peeing 4/5 times outside his litterbox every day both inside his pen and outside of it. He also started leaving little pee spots where ever he sat for a little while. So we made an appointment at the vet but had to wait a week. So in the meantime, I started giving him Sherwood Urinary tablets (4-5 a day) and the tablet instructions said to stop pellets and veggies so we mostly just gave him hay for a few days. We also gave him two additional litter boxes inside his pen in a couple of his favorite spots and started putting pee pads everywhere to help with the clean up.

As I said at the beginning of the post, the vet doesn't think he has any kidney/urinary issues and thinks he is just marking his territory. He had a urine test, blood test, and X-ray done (the x-ray did not show his kidneys though). But I suspect there is more to it since the change in drinking was so fast (within a few days) and because of the little pee spots he was leaving. Also its worrisome that kidney issues can go undetected for a while.. He's fine in terms of eating/pooping (some of his poops seemed a bit large and wet last week but nothing crazy) and he's always been a lazy fellow - as seen in the picture I've included. He also seems to be doing a lot better now with peeing with his three litterbox system so maybe the Sherwood tablets are doing something.

The vet prescribed Vetri DMG for his anemia and she said she would be sending iron supplements. She also said to try feeding him oat hay and alfalfa. I asked if she recommends a follow up after making the diet changes and am waiting on an answer.

MY THOUGHTS:
- Drinking more could have been from boredom, heat, shedding, eating more fiber, hunger since we limited pellets, or just from becoming more comfortable with us.
- Drinking more could be because of illness, possibly something with the kidneys or liver.
- Accidents could just be a result of the excessive drinking or could be due to some infection or bladder weakness.
- Excessive thirst and anemia are connected to EC.
- The anemia could just be from us taking away his pellets and veggies for a few days.

Thank you to everyone who made it through my lengthy post Let me know what you guys think, hopefully I'm just being my usual anxious self and he is completely fine!

Here is the bun in question being his floppy self:

That is one comfy bun

So your vet didn't say there were any abnormal kidney or liver values at all? Did the vet happen to rule out diabetes? Though it's uncommon in rabbits, it's not impossible. And a urinalysis came back clear of excessive crystals or signs of blood in the urine? Nothing abnormal showing on the xrays? If the blood test was after you removed veg and pellets, it's possible it could have impacted the results. The sodium levels would likely have been affected. And depending on hay cake nutrients and how well your rabbit was eating them, if he wasn't eating them really well or they are low in nutrients, this certainly would have had an impact on the blood test. Was your rabbit eating really well prior to, and at the time the blood test was done?

Did this increased thirst and urination seem to coincide with when you started making changes to his diet? How much pellets was he getting per day, and what is the weight in hay cakes he was actually consuming per day when this all started, and what is he currently being fed? What is his body weight?

What I'm considering is the possibility of the change and reduction of pellets, along with insufficient hay eating, being the cause of the increased thirst/urination. The reason being is that he's not feeling full, so is trying to feel full by drinking more. It's one possible explanation.

I had the exact same thing happen with a new rabbit of mine. He was on a diet of basic pellets in his previous home, and didn't really eat hay. So I got him transitioned onto my pellets (very limited), free fed good quality grass hay, and select greens (same diet his future bun wife was on). He was also neutered right before he came to me.

A few weeks later I noticed he was drinking and peeing a lot more. He was also losing weight. I was thinking possible kidney issues, EC, dental issues, or diabetes, since these would be the most common causes of sudden increased thirst/urination in rabbits, aside from heat stress (not applicable here). He was 5 yrs old, so he easily could have developed a health issue at that age. He was acting perfectly normal otherwise.

I was on the verge of taking him to the vet when I had the thought that maybe it was related to his diet changes and reduction of pellets, but I'm not sure why I thought this as it's not a common explanation that I'd ever read about, and I thought he was eating well at the time. But what I didn't realize was, though I saw him eating hay, he was scattering it around but not really eating very much of it.

I decided to increase his pellet amounts over the next week, just to see if it made any difference. Sure enough, as his pellets were increased, his drinking and peeing amounts gradually decreased, so I knew that was the answer. That he might not have been actually eating enough hay and was filling up by drinking more water. He eventually did start eating hay better, but still not the best. I still had to feed him more pellets than my other rabbits. But the increased pellet amounts cleared up the problem completely.

So that is one possibility you might want to consider, and try out if you think it could be what's going on with your rabbit. Another possibility that I've come across, is lack of pellets or reduced pellets in the diet, also decreases dietary sodium intake. A lack of sufficient sodium might be a cause for increased thirst (too much sodium can as well, but this usually only happens with pellet manufacturing issues). Increasing pellets will increase sodium intake. A salt wheel is also an option. One I used for my rabbits that couldn't have pellets in their diet due to health issues.

If you try this and don't find increasing pellets helps at all, it's more than likely a health issue that the vet will hopefully be able to pinpoint soon. EC is a possibility, though this will usually be because it's affecting the rabbits kidneys and should show up in abnormal kidney values on the blood test. But still possible, even with the blood test looking normal. I think I read about a similar case. A rabbit peeing everywhere, vet couldn't determine a cause, rabbit was treated for EC just in case, and the treatment worked. You could ask your vet about trying Panacur for a month. If it's EC, this may help.

You mentioned the poop being abnormal recently. Does your rabbit usually have normal round fecal balls? I'm asking because there's a digestive nerve issue that can sometimes affect rabbits with the type of coloring your rabbit has (charlie coloring), causing abnormal fecal poop (consistent daily basis) and other digestive problems. And it's possible the current bladder issues could be linked to it, if your rabbit has this.

https://bunssb.org/bunnies/guide-bunny-poops/

With the sherwood tabs, the suggestion to remove pellets confused me, as I give the tabs to my rabbit and definitely didn't remove her pellets. So I double checked and it doesn't specifically say to remove pellets, just foods with grain/soy, and veg/fruit. If the pellets you're feeding contain grain/soy, I can understand why you thought this, but this seems quite a drastic suggestion on their part, as well as completely removing veg/fruit. If their concern is excess calcium from those foods altering the urine ph, why not just specify this.

I certainly didn't remove my rabbits pellets or veg who I give those urine tabs to as well, though I do limit excess calcium in her diet. If an owner is adding the urinary tabs to their rabbits diet due to bladder sludge issues, it's more than likely they've already made the necessary diet changes working with their vet. Which is the best course when dealing with a health issue. I don't think a feed company should be suggesting to owners, such a drastic diet change, without a more detailed explanation or proper precautions, particularly not mentioning this is best done under a vets supervision. Rabbits that don't eat hay well, can have serious health complications if other foods are suddenly eliminated from the diet and the rabbit continues not to eat sufficient amounts of hay, or the hay is poor quality. I like sherwood, but this isn't good to be giving this type of feeding instruction, in my opinion.

Aside from that, just know that if you add some alfalfa hay as your vet suggests, it is very high in calcium, which is pretty much the opposite of what is recommended with the urinary tabs. But this is really only an issue if your rabbits problems are being caused by bladder sludge or stones, or kidney issues. Otherwise, the higher calcium may not be a problem, at least short term. But it would also mean the urinary tabs aren't necessary, as bladder sludge issues is what their primary use is for.

https://wabbitwiki.com/wiki/Bladder_sludge_and_stones

I'm glad you found a better vet and didn't end up having to pay for a CT scan your rabbit didn't need. Anyone very knowledgeable about rabbits, knows that dietary issues are the most common cause of mushy cecotropes. So I'm glad you got that sorted.

Thank you so much for your response!

No, the vet didn't say there were any abnormal kidney or liver values and the urinalysis came back clear. I tried including his results as an attachment to the original post, can you see it? Basically his WBC count was low and a few other parameters which indicated anemia and some nutrients. Nothing abnormal on the xray, but the vet was not able to see his kidneys on the xray because his cecum was blocking them. The vet didn't really talk about diabetes, just that rabbits don't really get it. I'm not sure exactly what could indicate diabetes, but his glucose was within normal range.

Sodium was indeed low, I agree the nutrient deficiencies were probably from him being off his normal pellets a few days before the blood test. I forgot to mention we have these 100% timothy hay pellets we have been giving him. To make sure he was eating throughout the day after removing his normal pellets, we gave him 1/4 cup of the timothy pellets spread into a few meals. He eats hay here and there, but nowhere near his body size as I've seen recommended.

His body weight is 4 lbs 11 oz as of the vet visit last week. He was 5.5 lbs in August. He usually has round fecal pellets, his poops just looked larger than normal and had a wet appearance. Now they seem back to normal.

His increased thirst and urination was during the time we were changing out his diet, probably around the same time we finished transitioning him fully to the new pellets. We were giving him 1/4 cup Science Selective Adult daily since then, and are now giving him 1/8 Science Selective Adult and 1/8 Oxbow Garden Select since the vet recommended trying other pellets or mixing. We also give him a few timothy pellets as treats and about a cup of veggies daily (lettuce, cilantro, and basil). For hay, he gets timothy (hay stack and loose hay) and meadow hay right now. I tried oat hay but he has only eaten the little seeds from it. I also have some alfalfa cubes but haven't given him any recently, I might give one tonight. And we've still been giving him 4 of the Sherwood tablets and the DMG supplement recommended by the vet daily. I know the Sherwood tablets might not be doing anything, but I'm still giving them for now because he has been a lot better using his litterbox since we started them.

What is strange, is that we are back to his normal diet now, but now his incontinence seems to be worse again. Since we had started on the Sherwood tablets (on 10/13) and cut out his pellets/veggies, he basically had no accidents. But today and yesterday he started to have some pee dribble where he sits sometimes and he had two accidents. His water intake has remained around 30 oz though.

So I'm a little hesitant to try increasing his pellets in case there's any relationship between the pellets and his pee issues. But I do think there's merit to your idea. Especially because when we gave him an oxbow tunnel chew toy one day over the weekend, he ended up eating a lot of it and drank less water that day. (I didn't realize it had sugar or else I wouldn't have left it with him so long lol.) Maybe I can just try increasing the timothy pellets?

Have you happened to try the Oxbow urinary tablets as well? I got some of those that I thought I'd try giving to him just to see if it would help but it has a diuretic (marshmallow root) which I think he doesn't need so not sure if I should.

The vet recommended a follow up blood test in a couple months so I guess we'll see if the anemia was due to the lack of pellets or not. But in the meantime, I'm worried that his symptoms might get worse especially if there's an underlying infection or disease.

Oh and I forgot to add the vet said I can do an EC test at the time of the next blood test if I want to. After I brought it up, she agreed it was a possibility.

Ok, I see the attachment. If glucose is normal, it's not diabetes.

I'm wondering if maybe he actually does have a bladder sludge/calcium sediment issue, even though the urinalysis showed normal. Him dribbling urine when going back on higher calcium foods, could be an indication of bladder irritation. UTI would be the other common reason for a rabbit dribbling urine.

But you'd need to determine if this is actually him dribbling urine from incontinence, or the hormonal flinging and spraying of urine as a marking behavior that unneutered males often do. Spraying urine is usually flung out as a buck flings his butt around, dribbling would be little spots of urine right under him as he hops around normally.

It might be worth trying him on either reduced pellets or no pellets again, to see if there's an improvement again. I'd also suggest free feeding those timothy hay pellets. Just let him eat as much of those as he wants. At his normal weight of 5.5lbs, he should be eating approximately 5-7oz of dry weight food. This is just an average, but it's usually about 1oz per lb of body weight, in dry food with 12-16% protein and 18-28% fiber (not accounting for veggies fed). But I wouldn't limit them at all. He should be allowed to eat as much of the timothy hay pellets as he wants.

Those hay pellets are just compressed chopped grass hay, so basically has the nutrients and fiber he needs right now. It's not as good as loose hay for dental health, but that's something to focus on at a different time, once you get the current issue sorted. You just need to get him eating plenty of food with the right balance of protein, nutrients, and lower calcium, to get weight back on him but also less calcium to irritate the bladder, which a good quality timothy hay pellet should meet these requirements (check the label for nutrition info).

I had a new rabbit that I couldn't feed normal rabbit food pellets to because of digestive issues he developed, and he wasn't used to loose hay, so wouldn't really eat it. So I used those plain timothy hay pellets for my rabbit too. And that's pretty much what he lived on for the first few months, free fed, until he gradually started eating some loose hay too. So for a non-hay eating (loose hay) rabbit, those hay pellets can be a good alternative and supplement to the diet, until loose hay can get worked into the diet.

Along with the free fed hay pellets, continue offering the hay cakes and loose grass hay. If he eats veggies, I'd just limit the high calcium ones. And continue the urine support tabs. I'd also suggest offering a salt block or wheel, so he's getting his dietary sodium. Then see if there's an improvement again. If there is, I think it's likely there's a bladder calcium issue causing the urine dribbling.

https://rabbit.org/health/lowering-blood-calcium/

If you don't see an improvement again, with stopping the feed pellets and any high calcium veg, and just free feeding the timothy hay pellets for at least several days (and the other foods I mentioned above), then I'd start with having a urine test again (cheaper than an EC blood test), just to make sure it's not a UTI or calcium crystals. Though maybe get him transitioned back onto his regular diet before having any new tests done, just so it might be more accurate this time. If the urine test is clear again, maybe opt for the EC test, or you can also ask to try treating for EC based on symptoms, if the test is too expensive.

I'm not as impressed with the ingredients in the oxbow urinary tabs. The ingredients in the sherwood seem better to me, which is why I'm trying them for my bladder sludge prone bun. Seems to be doing good so far. But this is just my personal preference.

I'm pretty sure its dribbling because it will be like a little puddle under where his butt was after sitting for a while. I'll try reducing the pellets again. Do you think its worth a try transitioning him completely to the Oxbow and stopping the Science Selective altogether for a bit?

I got the timothy pellets here: https://www.amazon.com/gp/product/B0996BRTLV/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&th=1
The calcium actually looks a little higher for these timothy pellets (min 1%, max 1.5%) than the Science Selective & Oxbow pellets I have, which is strange. Although he was eating those before the blood test and his calcium was low so maybe it doesn't matter. Would you still suggest free feeding those? What brand do you use?

As for the Sherwood tablets, I've still been giving 1 tablet per 1 lb of body weight day which the instructions recommend for "severe" cases. For your rabbits, do you give them the "mild" or "severe" dosage if you're giving it to them on a long term basis? I know it probably won't be harmful to overdose but just wondering if I am doing overkill with them. And would you mind explaining why you prefer the ingredients in the sherwood tablets to the oxbow ones? Just curious.

Thank you so much for your time and advice! I really appreciate it. I love my bun so much but these past couple months have been a bit of a rollercoaster, and its nice to hear someone else's thoughts on everything.

The label on their website says 0.84%. Is your label different? Feed pellets are slightly different with their calcium, in that some of the listed amount isn't natural from the hay, but is an added calcium supplement to the pellet mixture usually. Maybe that's the difference.

I was feeding Standlee timothy pellets from my local feed store. If you're interested in trying them, see if a local feed/farm supply has them. Tractor Supply usually carries it, or has it online, for $19. Petco does too, with free shipping over $35. If not, Amazon does, though for at least 2x the cost. But still cheaper than what you paid, $40 for 40lb vs $15 for 4lb. If you have to feed hay pellets long term, it would be a lot cheaper cost wise. Though just be aware, these are much larger size pellets, so maybe your rabbit won't care for that. But my rabbits never had issues eating them.

I don't know if calcium is the issue with your bun. Just kind of making a guess based on what you say is going on and what results you're seeing. Maybe it was going off the veggies, and now he's back on them, and they're causing it. Maybe it's other ingredients in the feed pellets causing the problem. Maybe it's not diet related at all and it was just coincidence that his peeing improved at the same time you removed feed pellets and veg. When you have potential diet related health issues with an unknown cause, it often becomes a matter of trial and error to figure out what the exact offending foods are.

I went through a similar process for two of my rabbits with genetic digestive illness. I had to work through what foods worked best and what caused problems. The risk was that they could go into GI stasis if a food didn't agree with then.

So it's usually best to go very slowly and gradually when trying something out. Start with small portions, so if there is a problem, it will usually only cause minimal upset that doesn't end up with a vet trip, and then you know not to feed that food again.

Like for my rabbit, I would feed just a pinch of feed pellets I was trying out, to see if he could tolerate any particular type (feed pellets). But even with just a pinch of any type, he would develop slight digestive discomfort. So I ended up knowing he couldn't have any feed pellets and could only have a hay (hay pellets in this case) and select greens diet. But this was a process that went on several months, for me to figure this all out. Similar process for another one of my rabbits with genetic digestive issues. Whether you should switch to one pellet or the other, or only try the hay pellets, is something you'll only know if you try it out and see the results.

But always gradual new food introduction and one food at a time. Which is really how any new food should be introduced into any rabbits diet, to minimize digestive upset and to know if a rabbit has a sensitivity to a particular food. The exception to this is usually grass hays. Those are usually well tolerated, without causing digestive issues when suddenly introduced into the diet. Though with the exception of some grain hay (excess carbs from grain) and some third cut hay that can be too rich (in nutrients) for some rabbits.

For the urinary support tabs, I only give 2 tabs a day for a 5lb rabbit, as that amount has worked fine for her. She was only showing signs of minor calcium sludge in her urine. I like the msm and cranberry being the main ingredients, with added vit. C. I don't like the grain flours and molasses in the oxbow, as that is adding more carbs into a rabbits diet, which I'm a proponent of less carbs in a rabbits diet, as I've had several rabbits with sensitivities to excess sugars/carbs causing, sometimes serious, digestive problems. So I always opt for less sugars/carbs, and prefer fruit when there is a source of sugar, in limited amounts.

This is all just based on my own experience with the issues I had to deal with and learned from, with my own rabbits. And also accounts of issues from people here on the forum, having health problems with their rabbits. But it may be completely different for your rabbit. It's a process, and sometimes lots of things not working, until you stumble across the answer.

That's what I saw on the amazon product description, I didn't see that on the website. It looks like the 0.83% is a sample though, so maybe it's fine. Thank you for the Standlee pellet recommendation. I was having trouble finding timothy hay only pellets and ones that I found were super expensive.

I guess I'll try out some different things with his diet slowly and see how it goes. Thank you for sharing your experiences!