Reptile Digestive Health 1: Constipation, Impaction, Obstipation and Cryptosporidia
Constipation, Impaction and Obstipation
Much confusion surrounds the difference between three of the most common digestive ailments seen in captive reptiles, and other pets for that matter. The difference in practical usage is generally one of degree.
Constipation is generally the condition in which feces in the colon are difficult to pass. This can be brought about in a number of ways. Diet is certainly an issue in many species and diet is one of the major causes in mammals. In reptiles, one of the most common causes is dehydration. Water is absorbed by the colon and the lack of water causes the colon to absorb a large amount of water from the feces. This results in a dry fecal mass that is difficult to pass through the rectum or cloaca. Mammals and reptiles suffer from this form of constipation. If an animal is producing dry feces the first thing to do is to increase the availability of water. If this is unsuccessful in alleviating the problem, the diet must be looked at. In many reptiles, the diet is not an easy issue. Snakes are carnivores and strictly so. Therefore it would seem there is little that can be done to alter the diet, but this is not the case. In the case of snakes or similar animals that devour their prey whole or in its entirety, the diet can be altered by altering the diet of the prey. Fiber can be introduced by allowing the prey species to eat a high fiber diet before feeding it to the predator. The stomach and intestinal contents will be ingested by the snake and the fiber in the gut of the mouse will be incorporated into the feces of the snake. Fiber acts like a sponge and increases the water retention of the fecal mass and allows easier passage. Alfalfa pellets or even bran can be given to the prey to accomplish this. Constipation is uncomfortable, but usually not life threatening if treated. If left untreated, the constipation can progress to the next stages. In summary, the following outlines are provided.
Top 10 Causes of Constipation in Order of Consideration.
Lack of fiber in the diet and/or poor diet quality.
Traumatic injury to the pelvic canal.
Renal disease with enlargement from nephritis, urolithosis or neoplasia.
Presence of eggs.
Abscesses or granulomas.
Nutritional Secondary Hyperparathyroidism leading to collapse of the pelvic canal.
Calcium deficiency leading to presumptive ineffective peristaltic motion in the gut or generalized muscle weakness.
Mild Clinical Signs of Constipation
Straining to defecate.
Irritability - more snappy or more prone to bite.
Fresh stools are drier and/or harder than normal.
Stools are larger than normal.
Moderate Clinical Signs of Constipation
Lack of consistent fecal deposition in the cage.
Treatment of Constipation
The first thing to understand is that constipation is generally a symptom of a larger problem. The best treatment is good diet and regular veterinary care.
Gut load prey items with fiber containing foods or feed greens and psyllium.
Make a dilute psyllium solution and give with dropper.
Give animal warm water soak.
These should be done to end the current bout of constipation and fiber in the diet should be maintained from then on. Giving a light dusting of psyllium powder can work, but it is better to make a dilute psyllium solution and spray it on the food and allow to dry. This can be done long term and help keep your reptile regular.
Impaction is a sequel to untreated constipation in many cases, though it can also be brought about by diets that contain various substances that do not pass through the gut easily. If constipation is allowed to continue and a long period between attempts to defecate is occurring, then the fecal bolus can become immovable in the intestine. Ingestion of sand, calcium sand and wood chips also lead to impaction, since they cannot be passed easily and can literally clog up the intestine. Treatment for impaction is very difficult. Some species can be treated by the application of psyllium. Psyllium is the fiber source that makes up many fiber based laxatives. It has been used with some success to relieve sand impaction in horses and I have used it to relieve calcium sand impaction in lizards, but force feeding psyllium is difficult in reptiles and should be left to a veterinarian. Generally in reptiles, surgical intervention is required to release the impaction. Tips to keep your reptile from getting an impaction include the exclusion of the following cage materials: styrofoam, wood chips, sand, calcium sand and dirt. I have had the most success with recycled paper bedding. The paper, when wet, seems to be easier to pass and I have not had any issues with owners that use it, so long as proper hydration is maintained. Anything can cause impaction if the animal is dehydrated. Terrariums using dirt should cover the dirt with plant material, such as leaves too large to ingest, or mosses.
As a side note, always keep cedar and pine chips out of the reptile cage. Do not even use logs made of these trees. The aromatic compounds are highly irritating and can cause toxicity. I have seen a case of snakes dying in a breeding facility from neurologic disease and traced it back to a log in the cage made from red cedar. Once removed the neurologic disease never came back.
Clinical Signs of Impaction.
Unproductive straining to defecate.
Vomiting - an active process by which the animal actively expels the food bolus from the gut through the mouth, in contrast to regurgitation.
Regurgitation - a passive process where the stomach cannot contain any food and the food is not actively expelled from the mouth, but simply falls out of the esophagus.
Clinical Signs of Severe Impaction with Polysystemic Consequences
Spinal prominence (bumps on the back) - may be due to distention causing spinal processes to become more prominent and/or anorexia and resulting wasting from the effects of the impaction.
Paralysis - due to endotoxemia or impinging on nerves from a mass effect of the large, distended impaction.
Slight leg trembles - neurologic disease resulting from either the
impaction impinging on nerves or due to endotoxemia resulting from the
impaction and the breakdown of the enteric defenses against bacteria.
Contrary to some sources, there is not a correlation between pelvic limb and pectoral limb paralysis and the place the impaction occurs in the gut. Colonic impaction can lead to pectoral limb paralysis. The exact mechanism is not understood, but it may have to do with endotoxemia. Also, those species with large ceca can have pectoral limb paralysis as the cecum distends, fills up the coelomic cavity and impinges on the brachial plexus nerves. How is this possible? Remember that most reptiles do not have a diaphragm. Also many have ceca in the coelomic cavity and the ceca may not be as close to the pelvic canal when distended as to the brachial plesus. Still, any direct pressure on nerves is rare. Labored breathing is a far more likely consequence of distended, large ceca or of impaction in the cranial portions of the gut.
Another sign seen is a blue discoloration on the venter - this is often thought to be bruising, but may be necrosis and blackening of the gut, or the dark impacted material being visible through the coelomic wall.
Difficulty breathing- this can be due to muscle weakness due to wasting, endotoxemia or due to the mass effect of the large, distended bowel in the coelomic cavity.
Gout - this can occur due to a combination of dehydration, endotoxemia, bacteremia, renal failure due to shock and mass effect impinging on the kidneys and ureters.
Causes of Impaction in Order of Commonness
"Rainforest Floor" partially composted wood products
Fine Cut Bark
Orchid Bark (good for small reptiles, but bad for larger ones that can swallow it).
AstroTurf type reptile rugs (animals eat the "grass" and block).
Shiny Newspaper (the shiny, color advertisement sections).
Prolapse of the gut into another segment of the gut. Think of a sock turned partially in on itself. One segment called the intussusceptum actually pushes into the adjacent segment and is folded into it. The outer section containing the intussusceptum is called the
More rarely, fibrosarcomas and other neoplasms
Strangulation of the Gut
Volvulus - the gut twists on itself and involves the mesenteric attachments.
Torsion - the gut twists on itself
Entrapment of the bowel in a mesenteric rent, et cetera.
Treatment of Impaction
Impaction should not be treated by the owner. This condition is sufficiently life threatening that it should be performed by a veterinarian with experience in treating reptiles. Treatment also varies with the specific cause. That being said, there are some things you can do to help.
Place the animal in cage with regular newspaper or recycled paper bedding like "care fresh bedding"
Give supportive care by giving a supplement that is water based and easy to give like pedialyte.
Until the cause is known, there is little more you can do. The most treatable are the blockages from parasites followed by those caused by substrate.
If it is caused by substrate, sand and calcium sand can be treated most easily. The feeding of psyllium has caused some animals to push out the sand, but this is rare. Some success has been reported with mineral oil, but this is also touch and go. The best solution is to find a vet. If none is available, the best course of action would be to use psyllium (dilute) in pedialyte and supplement with mineral oil. These will be totally ineffective if the problem is too advanced or is not due to substrate issues.
Never let an impaction or suspected impaction go more than 4 to 5 days. More than that and the impaction can become an obstipation.
Obstipation is the worst of the lot. Impaction that is allowed to sit and set (like concrete sets) in the gut for an extended period results in obstipation. In obstipation the fecal mass dries out to the point that it literally adheres to the intestinal wall and may become mineralized. Often it is so tightly adhered that the removal of the segment of gut is the only option. This is generally not an option in reptiles, though can be done in some mammal pets. In reptiles, obstipation is almost always fatal, unless a skilled surgeon can remove the offending blockage.
Aside note: The results of obstipation can be cool from the pathological point of view. I have on my desk a fecolith (mineralized rock formed from mineralized feces) that came from the colon of a horse. It is elongate and approximately the diameter of a small cantaloupe.
Summary of tips to avoid constipation, impaction and obstipation.
Note your animals feces every time. When fresh there should be considerable water content in most species.
Make water available to prevent dehydration of the feces.
Avoid cage substrates and items that can be dangerous to your pet's digestive tract.
Gut load prey items with high fiber food like bran or alfalfa pellets.
Feel your animal's belly. If you feel a hard knot that is not a good sign, let your vet take a look.
Seek treatment quickly, do not put it off.
Cryptosporidiosis is the bane of many reptile rooms. The parasite is a small organism of the coccidia group and is related to Isospora and Eimeria. Cryptosporidia in reptiles are different from the ones infecting mammals. In mammals the Cryptosporidia infect the intestine and cause diarrhea. In reptiles the parasite infects the stomach and causes proliferative gastritis.
Essentially what happens is the parasite infects the stomach and the stomach reacts by producing more cells in the mucosa that lines the stomach. The result is the lumen (space) of the stomach gets smaller and the wall gets thicker. Eventually the stomach cannot hold food and the animal begins to vomit after eating. This leads to starvation and death. There are several species of Cryptosporidium. The ones that infect reptiles are not zoonotic, so there is not a danger to the owner, but they can move from one reptile to another. It is unclear at this point if there are separate species of Cryptosporidium for snakes, lizards and turtles. Anecdotal evidence seems to point to the parasite being able to jump from one lizard species to another and even among reptile groups such as from lizards to snakes.
Species of Cryptosporidium known to infect both lizards and snakes
Species of Cryptosporidium known to infect lizards or snakes.
C. muris - reported in Boa constrictor.
Others certainly are out there, but this article is not intended to be an exhaustive review of the parasitology of Cryptosporidium.
Currently there is no really effective treatment for Cryptosporidiosis. Sulfadimethoxine and trimethoprim sulfa have had mixed success and ponazuril has yet to be evaluated as a treatment. Quarantine procedures for new animals are of supreme importance as is sanitation when going from one cage to another. In a herd health situation culling followed by sterilization of the cages is recommended.
The most effective way of disinfecting is with use of ammonia followed treatment of the cage with moist heat between 45 and 60 degrees centigrade. Utensils should be cleaned with an ammonia solution and left to dry for 3-5 days. Of the cleaning solutions readily available only ammonia has been effective in killing the oocysts after 18 hours of contact. Bleach, the standard cleanser is not particularly effective and should be avoided.
It should also be noted that inbred animals, such as fancy color morphs, and nervous animals (like rattlesnakes) seem to have an increased incidence of the disease. Presumably this is due to immune compromise from inbreeding and stress respectively.
Stomach of Elaphe obsoleta lindheimeri. Note the increased rugal folding from proliferative gastritis.
Stomach of Elaphe obsoleta lindheimeri. Coccidia of the genus Cryptosporidium are visible on the surface as small round objects just above the mucosa.