Gastrointestinal stasis, ileus or hypomotility refers to the slowing down and possibly the complete cessation of gastrointestinal motility characterized by a decreased or no fecal output, reduced appetite, lethargy, abdominal discomfort,  among other symptoms.
This condition is said to have occurred when a rabbit’s digestive system slows down, and the digesta is unable to move as usual through the gastrointestinal tract. This is primarily due to the slowing or cessation of the “normal peristaltic muscular contractions which push food and liquids through the intestines.” .
It is often referred to as a ‘silent killer’ as it a fatal condition that can cause sudden death to your pet within a short time. It is common in middle-aged to older rabbits under poor diets, but it can affect a rabbit of any age, breed, and gender.
What happens when a rabbit has GI stasis
When the slowdown begins, water absorption in the gut will make the ingesta dehydrated, forming a dry mass that cannot move with ease.
The dry mass of ingesta including any swallowed hair can reside anywhere within the gut with a possibility of the harmful bacteria such as Clostridium overwhelming the beneficial bacteria. These bacteria can produce endotoxins as well as gases.
Some of the possible side effects of GI stasis include endotoxin shock, liver damage with the possibility of hepatic lipidosis if the rabbit cannot eat at all.
How digestion occurs
To understand what GI stasis, its causes, and management, you should understand how a rabbit’s digestive system works. We have covered rabbit digestion in great depths. However, let us give you a summary.
To being with, these animals are hindgut fermenters that rely on plant matter with digestible and indigestible fibers both playing a very crucial role.
Digestion begins in the mouth with a mechanical food breakdown. The food goes to the stomach, small intestine where some nutrients are absorbed and afterward to the colon.
At the colon entrance, there is a separation of smaller soluble fibers that go to the cecum for fermentation by bacteria, yeast, and other microorganisms to produce more nutrients including vitamins. Some of the nutrients are absorbed on the cecal walls while others are formed into cecotrophs.
The large indigestible fiber goes directly to the colons where water is absorbed, and dry symmetrical fecal pellets are formed. The indigestible fiber may not provide nutrients to the rabbit, but it is essential for the GI tract to function normally and supports motility.
Usually, there is a rapid transit of indigestible foods since bunnies eat a lot of food and they cannot carry it for a long time. However, the stomach of a rabbit, like other herbivores, should never be empty.
Causes of ileus
Ileus or gut stasis causes could be directly or indirectly related to diet. Some of the common reasons include but not limited to the following:
Poor diets and dehydration
This folivore “requires large amounts of crude fiber in the diet for the physiologic digestion process as well as for dental health.”  Therefore, diets high in starch, fats and low in fiber are detrimental as they do not promote a healthy gut and mobility. A diet high in fiber will ensure continuous digesta movement.
Avoid diets with a lot of protein, fiber, including cereals, nuts, muesli mixes, low fiber pellets, baked foods, among other unhealthy foods. Therefore bread, cakes, and other baked foods are not healthy for your furry friend.
Instead by good quality grassy hay brand such as Kaytee Timothy Hay, Small Pet Select 2nd Cutting Timothy Hay, Oxbow Timothy Hay, among many others.
Also, a sudden change in diet can potentially cause gut motility issues. Therefore you are always advised to introduce new foods slowly.
Finally, dehydration due to providing little amounts of water which is essential in gut motility.
Physiopathology factors including stress, pain, dehydration, trichobezoars (furballs or hairballs), and anorexia can be another possible cause.
For instance, a small cage, change in environment, loss of a long-time mate, the introduction of new pets, illness, trauma or surgery can be a stressor and could make the rabbit not to eat.
Also, some of the painful conditions include dental problems (overgrowth, malocclusion), facial abscessation, pododermatitis, emotional stress, arthritis, heavy metal toxicity, liver or renal disease, and upper respiratory infections can trigger this problem as they will make your bunny not to eat. Also, urolithiasis and fractures can cause pain.
Poor care and grooming
Hairballs are one of the results of GI stasis and not a cause. Hair ingestion, especially for the dense coated ones like rex and angora if not well-groomed, could be one of the results of ileus.
Inactivity and obesity in rabbits
Rabbit movement aids in gut motility. Therefore, inactive or obese bunnies are at high risk of suffering for this condition.
Other causes include long-term antibiotic use, intestinal blockages, the partial paralysis that affects mobility, any other condition that reduced appetite.
Being prey animals, rabbits have a self-preserving instinct to hide illness often as the sick ones are often targeted. Therefore, you need to have a strong bond and monitor this pet to notice any changes in behavior that may indicate he or she is unwell.
Some of the common symptoms that might indicate your rabbit is suffering from GI stasis include the following:
- Reduce or no food intake as well as anorexia (reduced appetite). Try giving them their favorite fresh greens to see if they will eat.
- Painful bloating due to the growth of harmful This will discourage your rabbit from eating or drinking.
- None or small, irregular, dry fecal pellets that may cling to their bottom. Sometimes, the fecal pellets may be encased with yellowish or clear mucus indicating enteritis that needs emergency treatment.
- Excess gas production characterized by ‘very loud, violent gurgles (gas moving).”  unlike the healthy intestinal movement sounds.
- Discomfort especially during abdominal palpation as well as tensed walls of the abdomen.
- Presence of a hard mass in the abdomen or behind ribs. If intestines are affected, they may feel dough-like.
- Reduced rabbit mobility and hunched posture. Your pet may also stay in one place for a long time.
- Bloating and blockages can cause excruciating pain characterized by your bunny grinding their teeth
- Elevated respiration and heart rate. However, the mucous membrane will be normal
- Depression and loss of appetite
- Gaseous dilations of cecum, stomach, and intestines
- Mushy cecotropes due to an imbalance in the good and bad bacteria inside the cecum
Some rabbits may hide
Note that it is possible for some people to assume their pet rabbit is constipated. Therefore, you must get a professional vet to diagnose your rabbit.
Diagnosis will involve several things include radiology including X-ray and ultrasound. However, these might be able to determine whether it is normal ingesta or blocked ingesta and hair. They may appear alike.
The presence of a distended stomach full of ingesta and gas as well as distended cecum and the cecal gas might be shown in radiographs. You will notice a solid ingesta that is radio-opaque and its top will have a gas cap.
Blood work may also be used for differential diagnostic purposes and to see if there may be other health problems.
Treatment and home management
Once this condition has been positively diagnosed, the treatment option will depend on how severe the GI stasis is. This life-threatening condition should never be left untreated. It can also cause secondary such as hepatic lipidosis.
The primary objective of treatments is to reduce pain, restore appetite, restore electrolyte balances to normal, correct dehydration, and stimulate normal gut motility and emptying. It should also soften the impacted food, hair as well as provide lubrication for gut draining to be less painful.
These treatments will include pain medications (analgesia), assisted or forced feeding (syringe feeding), fluids therapies such as (IV route), rehydration, and simethicone to help reduce bloating.
- Mechanical massage – They will help stimulate gut movement. Be gentle and knead the stomach gently while ensuring your furry friend is comfortable. Avoid bruises as this will stress it and worsen the situation. An electric vibrating massager can also be used.
- Simethicone – Important in relief of the gas pain and it comes in liquid, tablet, capsule or pediatric suspension. It will help reduce bloating and gas.
- Monitor temperature – Normal temperature should be between 101o- 103o A higher change could be an indication of infection or excessive stress, and it will need a vet’s immediate attention. Low temperatures or hypothermia may indicate septicemia or a shock and if the temperature goes below 101oF, consider an emergency treatment. Also, keep it warm as you get emergency treatment. A rabbit heat pad to keep it warm.
- Warm enema – It involves administering a mixture of clean water and a small amount of laxative mineral oil that is unscented with little Epsom salt to hydrate impacted matter. Let your vet guide you.
- Petroleum-based laxatives - Laxatone or Petromalt which are laxative grade mineral oil may not help much and may impede rehydration. Ensure gut rehydration before trying it.
- Oral fluids - Use water, or unsweetened Pedialyte intended for kids to help hydrate their intestines. Avoid anything with much sugar or Gatorade as they may increase bad bacteria growth.
- Forced feeding – To avoid hepatic lipidosis and gastric ulcers due to anorexia, you may cause consider syringe and tube feeding with hay products including Oxbow Critical Care, Herbie Care Plus, Emeraid Herbivore, and Oxbow Pet Products to ensure your rabbit gets the critical nutrients they need.
- Cecotropes – whereas they may help restore the gut flora balance, do not force them to eat as this might cause stress and worsen the situation. Also, if the cecotrophs get mushed, they may also not be helpful since they will lose their mucous that protects the bacteria and microorganisms they may be having.
- Lactobacillus acidophilus – It does help a rabbit survive this condition until its GI motility is restored to normal. Try dried Lactobacillus However, it is not part of the healthy floral microorganism found inside a rabbit’s gut.
Also, ensure they get unlimited grassy hay and some fresh leafy herbs that are wet some of which we will mention under the prevention part.
Prescription treatment by a vet
Some prescribed medications may include meloxicam and Flunixin Meglumine ( an NSAID and for pain),) and cisapride or Metoclopramide or (if the obstruction has been ruled out to improve gut motility). Note that some medications may have side effects including gastric ulcers.
Also, there might be the use of Cholestyramine as well as the use of enzymatic digestive aids include bromelain found pineapple juice, papain from papaya extracts, or proteolytic enzymes in case of trichobezoars caused by ingested hair as well as the various appetite stimulants such as Periactin.
If your pet has smaller droppings but still eating small amounts of foods, your vet may recommend hand feeding and/or fluid injections. .
Finally, oral or systemic antibiotics like enrofloxacin in case of bad bacterial overgrowth but the use is controversial as they can disrupt the presence of good bacteria. 
- Surgery in case of total blockage and not gut stasis. It is risky with low survival rates
- Hospitalization for extreme cases with it not eating for advanced care. However, this might worsen their stress.
Do not forget to give them a lot of fresh hay, some greens with a pleasant smell such as cilantro to entice them to eat and be patient with your rabbit.
Prevention of GI stasis
Provide your rabbits with a healthy diet which must be consisted of unlimited long-stemmed hay. Hay can help in ensuring not only a healthy gut but also motility and healthy teeth as their teeth grow rate of 2-3mm a day . Reduce pellets to a quarter a cup for a rabbit weight 4-5 pounds 
Also provide some moisture loaded fresh greens including romaine lettuce, carrot tops, dill, sage, fennel, tarragon mint, spinach, cilantro, parsley, collard greens, kales, and so on since they are a source of essential vitamins for rabbits as well as minerals
Do not forget the fact that rabbits need water. Provide them with an unlimited amount of fresh, clean water through bowls and water bottles. Usually, bowls represent a more natural way for rabbits to drink water and they may encourage them to drink more.
While your pet is still recovering, do not give them fruits and non-leafy vegetables such as carrots since they are high in carbs and sugars that will only worsen the situation.
Also, provide the right size of a rabbit cage as well as a place to exercises such as a bunny playpen or run. Including a few rabbit toys will ensure it remains active and enchanted.
Do not forget regular checkups by a vet to ensure your rabbit is in perfect condition
If your rabbit goes for 12 hours without eating, you need to consider an emergency intervention. This condition can quickly kill your rabbit.
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