Two months of urine incontinence, GI scare, ongoing urinary problems.

Question
A quick background of Trigs..  9 month old, neutered holland lop.  He was fixed in mid September this year and recovered quickly and easily.  In mid October he stopped using his litter box and had a wet bottom.  I took him to an emergency/extended hours vet clinic that deals with a lot of rabbits because it was the beginning of a long weekend.  Trigs had an empty bladder so they couldn't take a urine sample, but they checked for sludge and stones using an xray, no sign of either on the xray. The vet prescribed a week of Baytril.  The problems cleared up within a few days and he finished all the medication.

A few days after he finished the Baytril he again stopped using his box.  I took him to my regular rabbit vet this time, who gave him two weeks of Baytril. (Again, empty bladder so no urine sample/test). It seemed like he was slowly improving during the first few days, but again got worse after this.  Six days into the second round of Baytril and he had very sudden diarrhea.  I took him to the emergency vet right away.  He had a low temp, I think about 37.6 degrees and was not interested in food.  He spent four nights there, two in an incubator with subQ fluids and other motility drugs.  They took him off the baytril when I brought him in, so his second round was 6 days and not the 14 days.

I brought him home on November 4th with 5 days of metronidazole, metoclopramie and cisapride.    He's GI issues resolved over a few weeks and have been normal since. He had a recheck at my regular vet during this time.  Incontinence issues were not resolved.  He had a blood test for E.C. and I collected a urine sample for analysis during the evening, refrigerated it and brought it to the vet the next day for testing.  Urine sample showed no signs of bladder infection.  He tested positive for EC antibodies, and was put on 28 days of Fenbendazole (0.5 cc  morning and night).  

The 28 days is now up, and Trigs still has ongoing incontinence and urine dribbling.  He's constantly got wet legs or bottom despite my attempts to keep him clean and avoid urine scald.  Poor thing.

At this point, I'm a little lost as to what is really going on with him and don't know what to do anymore.  I am waiting for a call from my vet for what the next step should be.  I think she mentioned a specialist out of town.


I am wondering if you have any ideas of what else this could be.  Could the urine test have been compromised because it was exposed to air, and at least 15 hours old before it got to the lab?  Could the X-ray have missed sludge or a stone if not performed properly?  

Thanks for your help,
Diana

Answer
Dear Diana,

It sounds as if all the right things have been done so far, but something is being missed.  Urinary tract infections sometimes do involve anaerobic bacteria that are very difficult to culture, but many of those are sensitive to metronidazole, and I'm guessing the vet was trying to cover the anaerobic possibility with that drug.

It's possible that you have a resistant strain of something in the bladder, and collecting a anaerobic sample and sending it off for culture and sensitivity might yield something.  But it's *very* hard to get such a sample.  Ask your vet if she thinks this might be a next step to consider.

Also, there are apparently a few types of stones that are radio-translucent.  I don't know if they even occur in rabbits, but I suppose it's not impossible.  But if the vet can't palpate a stone, then that is not likely the problem.

I wonder if ultrasound might reveal a tumor in the bladder?  And it's also possible that the E. cuniculi has already caused enough damage to the bunny's innervation and urinary tract that this might cause incontinence.  But I'm just throwing out some ideas here--there's no way to know this without extensive testing.

I hope your vets will be able to get to the bottom of this problem, and hope your bunny will be in full recovery soon.

Dana