rabbit cramp attacks?

Question
Hi Dana,

Hopefully you'll be able to help me with this. It all started a few weeks ago when I noticed that my bunny (4yrs old, male, always been completely healthy until now) Vijfje (Fiver in Dutch) hadn't eaten much of his morning feed a few hours after I gave it to him (he normally attacks his food like he is starved).
I watched him for a while but nothing else seemed to be out of the ordinary until I took him out of his cage (he stays in the living room, the cage door is open when we are at home but he doesn't come out all the time) and I noticed a bad smell and when I looked at his bottom the hair around his genitals was very dirty and got stuck together and parts of his genitals were red.
So I tried to clean him a bit and went to the vet to have him checked out. The vet shaved his butt and genital area and cleaned it some more, gave him an antibiotic shot (duplocillin) and a pain shot (metacam) and told me he might have had a urinary infection (I hope that is the right translation), told me to keep the area clean and gave me some cream to put on the red spots, all of which I did.
His genital area started to look better after a few days, but he still wouldn't eat. Because it was the weekend I didn't know what to do and searched online, where I found your article on GI stasis. I then immediately started force feeding him. After the weekend I went back to the vet who gave him another round of antibiotics and gave me cisaral drops and carprofen dorps for the pain. I administered those as I was told, but apart from a very little bit of hay he still wouldn't eat much every time his pain medication wore out. So I force fed him regularly, and he also got another pain shot (medicam).
This time there was a different vet at the practice, who also checked his teeth and filed his molars a bit. The vets also checked his temperature every time.
Then after a bit more of force feeding him he started to eat some hay and parsley, and after that also some carrot tops.
I did notice then that he seemed to be having some sort of cramp attacks, which come and go. His poop at this time was still very small and he still didn't eat as much as usual. I again went back to the vet, who examined some of his recent poop and told me that there seemed to be a lot of hair in it and he might have a hairball stuck in his intestines and gave me some sort of intestinal lubricant to help get it out.
That probably did help a bit, because after a while he started eating more bit by bit. He still doesn't eat with the same fervor as before, but he eats ok amounts and his poop looks normal size again.

I NOW GET TO THE ACTUAL PROBLEM, I ONLY INCLUDED THE PREVIOUS IN CASE IT MIGHT BE RELEVANT SOMEHOW

When he has these cramp attacks (I don't even know for sure they are cramps, but thats what they look like to me) he goes and sits straight up with his butt in a corner of his cage and kind of softly sqeaks while completely cramping up for a second and then relaxing again, which repeats quite a few times (sometimes just twice, but sometimes these attacks last half an hour of on again off again at a time). This happens between 4-8 times a day (I don't check at nights, after nights of force feeding I am happy he is eating normal again and I can't afford to loose any more sleep if not absolutely necessary)
The only other thing out of the ordinary is that Vijfje used to be very well litter trained but now has let go of his manners completely, peeing and pooing all over the place, where ever he seems to be sitting at that moment. He also pees small amounts at a time (I don't know whether he did that before because he always used to pee in the same spot).
The hair around his genital area is starting to grow back and although I sometimes notice there is a little pee stuck in it (I always clean it when I notice it) it otherwise seems normal again.
I am planning to make another appointment at the vet one of these days but it didn't seem like they knew all that much about what is going on with him (my story about the cramps last time got pretty much ignored because our main aim was to get him eating again) and the other vet even told me to give him yoghurt which I read online is actually not a very good idea.
He has been eating only hay and a little bit of feed, and an occasional carrot, carrot tops, spinache, and parsley (he has always been very picky with his vegetables).
I have already tried simethicon in case it might be gas, but that doesn't seem to help either, what else could it be and how do I help my bunny get better? I know this was a very long story, but I really hope you can help me as I have tried other vets in the area (I live in the Netherlands) but none of them seem to be specialized in rabbits.

Thanks so much for taking the time to answer our questions!

Kind regards, Ellen

Answer
Dear Ellen,

Everything about the description of Vijfje's problem strongly suggests that he has a painful urinary tract condition.  It could be an infection, but it also could be a bladder stone (urolith) or bladder sludge.  Please read:

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

And try to find a more experienced vet with the lists linked here:

www.rabbit.org/vets

Vijfje's inappetence is undoubtedly related to his pain, so he MUST have pain medication while the condition is being correctly diagnosed and treated.

As for the antibiotics:  they should not be given in such an erratic manner.  Please see:

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

and ask for a full course of antibiotics that can be given for at least two weeks. To do otherwise is really to invite breeding resistant bacteria.  The fluoroquinolones (e.g., zeniquin/marbofloxacin) generally give excellent results, and are broad-band antibiotics that will be effective against more different kinds of pathogens than duplocillin alone.

I hope this helps you get your friend on the road to recovery.  But I would get him to a good vet ASAP.  Straining to urinate means he's in pain, and that can mean something serious.

I hope he will be fine soon!

Dana