20 Jan
It is now estimated that 53% of adults own a pet, with 2% of this figure made up of rabbit owners and an estimated 1.1 million pet rabbits in the UK¹. The popularity of rabbits as pet means it is important to understand common conditions and educate owners on preventive measures to reduce the likelihood of disease and increase the incidences of early diagnosis of medical conditions.
Urine scalding can indicate mobility issues and underlying disease. If left untreated this can lead to a worsening condition, pain and in some cases, development of myiasis and pododermatitis.
Urine scalding is a complaint seen in rabbits. Their alkaline urine is allowed to soak through the fur, which can lead to alopecia, inflammation and ulceration of the dermis.
Urine scalding is usually seen secondary to underlying disease; however, in cases of poor husbandry this may not be the case. Early intervention will reduce the likelihood of developing chronic conditions such as dysuria, pain, pododermatitis, severe ulceration and myiasis.
These conditions could lead to a poor or even grave prognosis. This condition will be painful and treating the primary cause will aid in an overall better outcome.
Several primary conditions can cause urine scalding. These include the following.
OA is a chronic progressive and sometimes debilitating condition causing mobility issues. OA mainly affects rabbits older than six years of age; however, rabbits as young as two years of age may be affected – especially in giant breeds2 . Rabbits may be less inclined to move from soiled areas due to pain, therefore increasing the risk of urine scalding.
It should also be noted that if they are unable to angle their pelvis correctly to pass urine, they may soil themselves2. This may be seen in cases with pelvic, lumbar and stifle OA. It is important to have easy access litter trays and appropriate substrate to allow for wicking of urine away from the fur and skin.
Good pain management is another important factor. Multimodal analgesia with the use of NSAIDs alongside gabapentin or tramadol may be indicated. Paracetamol may also be used. The use of nutraceuticals with glucosamine, chondroitin and Boswellia may also be beneficial. These products are suggested to optimise joint health and aid with natural inflammatory processes.
It should be noted that no trials investigating the anti-inflammatory properties of Boswellia serrata in rabbits specifically has currently been undertaken, but other beneficial properties have been noted3. However, these anti-inflammatory properties have been noted in clinical trials on other species.
The use of treatments such as acupuncture may also be considered. A case in 2020 (published in 2024) discusses a large breed rabbit receiving acupuncture for chronic OA of the pelvis and stifles.
The rabbit had urine scalding from limited movement and the author reports they saw great improvement after several weeks of treatment, regaining the ability to hop4. The use of pain management and good husbandry should be used in the prevention of urine scalding in the OA patient.
Obesity can contribute to multiple secondary conditions in the rabbit. These include cardiovascular disease, hepatic disease, pododermatitis, OA, urinary conditions such as bladder sludge and urine scalding5. Dental disease may also be a risk if the diet is poor.
Obesity will make eating caecotrophs more difficult, in turn they will accumulate around the rear end, also increasing the risk of inflammation in the urogenital region. This will increase the risk of developing myiasis. Not dissimilar to OA cases, the patient may find mobilisation difficult and may sit for extended periods in soiled areas. This can also lead to urine scalding.
It is important to body score patients as part of a health check. The clinician may also use this time to educate owners on appropriate diet and husbandry. It is advisable to remove barley rings and other treats including human food, such as biscuits, from the diet, and only allow fruit as an occasional treat6.
Varying suggestions exist for the amount of pellets to feed rabbits; however, the Rabbit Welfare Association suggest one tablespoon per kg (of the patient’s ideal bodyweight, not their current weight). This may be fed alongside ad-lib hay and a portion of fresh vegetables6.
Although it is common to see more rabbit-savvy owners in the clinic, it is still important to make sure they are feeding pellets rather than muesli, to reduce the risk of selective feeding.
Making sure the rabbit has access to appropriate exercise is also important as some rabbits may still spend much of their time in a hutch. It is important to make sure their run or free roam access is increased and runs allow room for adequate mobilisation.
Poor diet can lead to dental disease and obesity. These factors can contribute to difficulty eating caecotrophs and make mobilisation harder for the rabbit. It is important that a good amount of fibre is available in the diet.
A lack of calcium and vitamin D3 in the diet can lead to dental disease, and while owner education regarding diet is important, it should also be noted a large proportion of dental disease is acquired due to malocclusion. This can especially be seen in brachycephalic breeds such as lop-eared breeds, Netherlands dwarfs and lionheads.
It is important to monitor for clinical signs of dental disease – these can include anorexia, weight loss, bruxism and gastrointestinal stasis.
Diets too high in calcium can lead to an increase in urinary sludge. Green vegetables are often high in calcium; however, up to 90% of these are made of water, therefore the water content is probably going to have a positive impact, rather than the potential negative effect of the mineral content7. Some vegetables including broccoli, beets and dandelion may cause a red orange tinge to urine, which is normal.
Up to 52% of clinically well rabbits tested posited for Encephalitozoon cuniculi, with spores being shed via the kidneys for up to six weeks8.
Symptoms include anorexia, lethargy, cataracts, urine scalding and torticollis; it should be noted E cuniculi is zoonotic and can be transmitted to immunosuppressed individuals8. Treatment consists of a 28-day course of fenbendazole. Owners should take care when cleaning areas contaminated with urine due to the risk of zoonosis.
Renal disease can be both acute and chronic. Contributing factors include uroliths, neoplasia, toxicity E cuniculi, urinary obstruction, hydronephoris and severe stress8.
Biochemistry analysis will show marked elevation in urea, creatinine and phosphorus. Elevated calcium levels will also be seen alongside marked anaemia8. It should be noted blood urea nitrogen in rabbits can be affected by protein intake and liver function; caecal flora, stress and hydration status may also affect these levels9.
In total, 65% to 75% of renal nephrons need to be damaged before an increase in serum creatinine is noted9. It may be beneficial to use more sensitive testing such as enzymuria and gamma-glutamyl transferase in some cases9.
Radiology and ultrasonography may also be indicated – especially if obstruction is suspected. Urine culture and sensitivity may be used if infection is suspected to select the most appropriate antimicrobials to help prevent antimicrobial resistance. However, the clinician will suggest diagnostics based on clinical assessment and presentation of the patient. A holistic approach should be used and owner circumstances discussed.
Deformities may cause dysuria. Juvenile male rabbits may fight causing trauma to the genital region. This can lead to deformities. Early neutering is indicated in male pairings.
Treponema cuniculi commonly known as rabbit syphilis is spread via breeding and may lead to facial lesions, due to the rabbits cleaning infected areas other symptoms include inflammation of the vulva and prepuce, leading to necrosis and atrophy of the seminiferous tubules9. In deformity cases management of the condition is indicated ensuring quality of life is not affected.
Morse is a two-year-old male, neutered mini lop. He was neutered at four months old due to persistently mounting his companion; this ceased shortly after neutering. They were not separated due to his companion (who is also his brother) becoming incredibly stressed without his presence.
This was considered and his brother was neutered first; they were then put in recovery together to reduce stress. No surgical complications were seen; however, trauma to the penis was noted and as scabs and discharge were present, enrofloxacin (10mg/kg) and meloxicam (1mg/kg) were prescribed postoperatively.
Improvement was seen over several days and no complications were noted. Several months later, Morse was presented to the surgery with a small patch of urine scalding in the urogenital region and a small lesion on his ventral caudal abdomen; a minor deformity to the penis was also noted. As body score was 3/5 and no other clinical signs were indicated, it was assumed the abnormality and change in husbandry was the likely cause.
The skin was cleaned with dilute chlorhexidine, care was taken to not make contact with mucous membranes, and enrofloxacin and meloxicam were prescribed for five days alongside probiotics. However, culture and sensitivity may have been beneficial.
The owner continued cleaning and applying barrier cream at home. Both rabbits were litter trained and the owner reported changing the substrate several days prior to a larger woodchip shaving with less absorbency and had also been feeding a new dandelion forage mix.
The shavings were changed to the brand previously used, initially with straw on top to aid in wicking of urine away from the patient and an improvement was seen.
Several days later the owner changed the dandelion mix to a herb and hay-based forage, and clinical signs were completely resolved within several days. The owner continues to check his urogenital region daily to look for signs of urine scalding.
Both rabbits have garden access, so it is important to check for any signs of myaisis (Figure 1).
The owner has noted on the odd occasion there is urine on his fur, which is cleaned (Figure 2). He had one other flare of urine scalding when the dandelion mix was fed again. This has now been removed from his diet. This was resolved with cleaning and the application of a barrier cream (Filtabac with manuka honey). He is currently managed via maintaining consistency in his husbandry and diet.
It is important to find the primary cause of urine scalding for the most effective treatment outcomes, and to reduce the likelihood of exasperation of clinical signs. Diagnostics may be indicated depending on clinical signs and the clinical examination.
It is important to take a comprehensive clinical history. If infection is suspected, culture and sensitivity may be indicated to allow for the prescribing of the most appropriate antimicrobials.
It is important to assess husbandry and make sure an appropriate absorbent and cushioned substrate is used. Although shavings may stick to lesions, they also offer absorbency. A layer of straw over the top may increase the urine’s ability to wick away from the skin, and potentially reduce the amount of shavings becoming stuck to the skin lesions. Towels or absorbent puppy pads and vet bedding may be used; however, monitoring of the patient to prevent them eating this foreign material may be indicated.
The area should be clipped if appropriate and cleaned. Owners may soak the rear in lukewarm water with a rabbit-friendly shampoo or appropriate cleaning agent, drying the area well and applying a barrier cream afterwards. It is important that wetting of the rabbit’s fur is kept to a minimum in non-affected areas.
Discussions with the owner to make sure the rabbit can mobilise in their enclosure adequately to prevent them from having extended ambulatory periods sat in urine. They should also have soiled bedding removed frequently.
Patients may receive antimicrobials and anti-inflammatory drugs; owner understand of administration and common side effects should be assessed. The use of pain scoring will assist in effective pain management, however the use of grimace scales and pain scoring should be used as objectively as possible. Checking for pain indicators such as bruxism, abdominal pressing, anorexia, gut stasis, lethargy and reduced movement should also be considered. Multimodal pain management may be indicated.
The use of products such as cyromazine and other rabbit-safe insect repellents will reduce the likelihood of myiasis, along with frequently checking of the patient.
Various conditions can lead to secondary urine scalding. It is essential to gain a comprehensive history to aid in the diagnosis of the primary condition. Treatment may take time and reoccurrence of clinical signs may occur, so owner compliance and good husbandry, alongside resilient management, will help in a more positive outcome.
This condition can be painful and good pain management is indicated.
Pet health checks to discuss weight, pain management for senior rabbits, and keeping clients up to date on husbandry will potentially allow for a better prognosis and prevention of urine scalding. It will also highlight any other medical conditions earlier. Working with the owner will allow for better compliance and early detection leading to better outcomes.
