follow up question = trouble urinating

Question
QUESTION: Hello Dr. Krempels,

I have a 7 yr. old, neutered male, that is having trouble urinating.  He first had this problem 8 months ago.  He was seen by two different e-vets, both diagnosed him with a UTI and put him on antibiotics, which did not help.  The first e-vet visit, he was wet with urine, had a lot of swelling around his genitalia and he had flystrike resulting from the wet fur.

His regular vet x-rayed him and determined that he had/has bladder sludge. She also put him on an antibiotic and a treatment of 250 mls of subcutaneous sodium chloride (0.9%), once daily for 8 days, x-rayed him and then another 14 days of the fluids.

The rabbit (Jack) seemed to be ok after that.  I changed his diet to timothy pellets and timothy hay, along with his regular staples of greens, carrots, and a bit of fruit.  He is not caged and his appetite is steady, although he is not a big eater or drinker.

It is now Feb. and he is exhibiting the same symptoms of hiking his rear as if to pee, wet fur and a bit of irritation on his underside.  I was able to express approximate. 3 Tablespoons of urine from him this morning - he weighs 9.6 lbs. - followed by a warm 'bum' bath.

I've had him x-rayed 3 times, before, and 2x during the sub-q treatments.  I am leery of having him x-rayed again.  

What can I do to get him to urinate now? (My vet isn't in today or tomorrow). I have a 500 ml bag of sodium chloride, should I give him two treatments of that - until we can see the vet?  I also have Metacam available.

How often and how much should a rabbit of Jack's size urinate each day?  I don't know if expressing his bladder once or twice a day is enough, can you tell me?

Also, what do you recommend to stop a reoccurrence of this?  Is there anything that will "cure" bladder sludge?

Thank you very much for taking your time to answer my questions.  I have been dealing with this for 9 months and I worry so about Jack.

Tamara

ANSWER: Dear Tamara,

Unfortunately, the sludge may be a lifelong problem for Jack.  This is a metabolic disorder, and dietary changes do little to mitigate the sludge.  Some people have claimed improvement by giving the rabbit potassium citrate, but I've never tried this and so can't comment on any personal experience with it.

Subcutaneous fluid therapy followed (about an hour later) with a gentle bladder expression can help control sludge.  But it's important to jiggle the bladder and agitate it well to suspend the sludge, and not let it sit in a cake at the bottom of the bladder.  It then eventually builds up and clogs the whole system, making bunny uncomfortable and able to pee only a few drops at a time.

I'm not a big fan of bladder flushes.  In fact, I'd rather have a bunny go through bladder *surgery* than a flush, the latter being a rather blind procedure that can have disastrous outcome if the vet is inexperienced or just unlucky.  :(

Pain management is important for buns in this condition, so ask the vet about using metacam if you are ever again in a state where you can't reach the vet but need to help your bunny.

I hope he will be well again soon!

Dana

---------- FOLLOW-UP ----------

QUESTION: Hello again and thank you for your previous answer.  

I have been expressing Jack's bladder 4 times a day.  Is that TOO often or NOT often enough?  I don't know how often he should /  or may need to urinate.

Also, if he had the bladder surgery, what exactly does that entail and wouldn't the sludge reoccur if this is a metabolic disorder?

Thanks again.
Tamara McCoy

Answer
Dear Tamara,

If it's easy to express him and he produces urine, then it's probably not too frequent.  As long as you're gentle and careful not to bruise him, all should be fine.

Sludge can re-occur, but there are no sure things.  Our Obie had a bladder stone removed surgically, and though the vet said he'd likely get another one, he never did.  No sludge, either.  

So if he's really full of sludge, this might be something to consider.  No telling how long it took him to get to this stage, and since you now know how to jiggle his bladder to suspend the sludge and express the pee, you might be able to prevent it from becoming bad again.

Also maybe ask the vet about bethanichol and dibenzylene combined to make it easier for him to pee.

Hope this helps.

Dana