Already been to Vet and urgently needing assistance regarding vaginal/uterine infections in rabbits

Question
Good morning,

I have a very sick one year old mini rex bunny, and I desperately need some advice as to what questions I should be asking my Vet in order to correctly diagnose her.  I am from the States and have had rabbits all my life.  However, I currently reside in Costa Rica and am facing the reality that the majority of vets here are very inexperienced with rabbits.  

One week ago, my bunny seemed perfectly heathy, eating, drinking, and full of energy.  At that moment, I ran out of her normal food and was forced to offer her another kind for two days while the store restocked with the kind she likes.  She ate a little the first day and then stopped the second day.  When I noticed this, I was sure to offer little pieces of fruits/veggies and her favorite treats to keep her tummy from being empty.

When I finally got her regular food, she would not eat at all...whether it was wet or dry.  She also began to have severe diarrhea.  I took her to the vet.  He felt that this was not caused by the temporary food change and maybe due to parasites.  He suggested giving her trimetoprima and metronidazol (Spanish names) for 5 days.  

By the second day, the diarrhea stopped, but she would still not eat.  That same evening she also left a large puddle in the bottom of her cage, and the color was a dark blood red.  Concerned, I took her back to the vet again the next day with a sample of this dark red liquid.  He felt that it was urine and not feces and that it definitely contained blood.  He turned the rabbit over to examine her and said that she was also excreting a great deal of pus.  He said began to probe gently with a q-tip and removed pus and then eventually some blood.  

Finally, the vet said that he felt that she may have a uterine infection and would need to be spayed.  He decided to do an ultrasound first.  The results of the ultrasound looked normal, so he then concluded that she just had a vaginal infection...which he is now treating with antibiotics and has her at his office for observation.  I very concerned since she has not eaten in 4 days and is bleeding.

Now, my questions are:

-Do rabbits normally suffer from vaginal infections?  If so, why would she have excreted so much blood?

-There is not blood in her urine every time. Sometimes her urine is perfectly clear. However, that one evening, the puddle of blood was substantial.  Is there any reason for this?

-Would a uterine infection show on an ultrasound?

-If she had a vaginal infection, why did she have the diarrhea?  Or, is it possible that they are two different issues?

-What questions should I be asking my vet?  Are there any additional tests that I should request that my vet do to better determine what may be wrong?

-Should I ask that he spay her anyway?

-My bunny weighs about 5-6 lbs.  I am now trying to syringe feed her.  How many mls of puree should I give her in one feeding without over stuffing her?

I don't have the option to find a vet that specializes in rabbits here in Costa Rica, so I am trying to work with the vet I have.  If you could provide me with any additional guidance, I would greatly appreciate it.  

Thank you,

Hilary  

Answer
Dear Hilary,

- Do rabbits normally suffer from vaginal infections?  If so, why would she have excreted so much blood?

This is not common, though I suppose it is not impossible. I've never heard of it in a rabbit.  It is more likely that she has a pyometra (uterine infection), and this might not show up on a radiograph.

-There is not blood in her urine every time. Sometimes her urine is perfectly clear. However, that one evening, the puddle of blood was substantial.  Is there any reason for this?

I would worry that she may also have a uterine tumor, causing the blood.  Please read these two articles for more information on uterine and urinary tract problems that can cause intermittent bleeding:

www.bio.miami.edu/hare/urinary.html

www.rabbit.org/health/spay.html

-Would a uterine infection show on an ultrasound?

Only if the uterus was unusually expanded.  It might not show up if the pus was not very solid.

-If she had a vaginal infection, why did she have the diarrhea?  Or, is it possible that they are two different issues?

A rabbit in pain will often suffer from runny stool, and this is explained here:

www.bio.miami.edu/hare/poop.html

If she is not eating the GI slowdown may have progressed to ileus.  Please read this:

www.bio.miami.edu/hare/ileus.html

and share this with your vet:

www.bio.miami.edu/hare/ileus.pdf

-What questions should I be asking my vet?  Are there any additional tests that I should request that my vet do to better determine what may be wrong?

I think the antibiotics are a good idea, and keeping her on them until she is better and her GI is moving again is important. But once she is stabilized, I would highly recommend the spay, as uterine cancer is a very high risk in unspayed females.

-Should I ask that he spay her anyway?

Yes, once she is better and no longer has an infection (no pus).

-My bunny weighs about 5-6 lbs.  I am now trying to syringe feed her.  How many mls of puree should I give her in one feeding without over stuffing her?

You can probably give her 30-50cc's at a feeding, but don't force it.  If her GI is static, she will not want to eat, so the most important thing is to get her gut moving again.  Once that happens she will want to eat on her own.

Dana