Drinking/Urinating Excessively and Anemia

[lalalika]

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:

 

[JBun]

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.