Box Turtles: Problems

By Gregory Rich, DVM; Rick Axelson, DVM

Turtles have several unique problems. Understanding these problems will allow you to better care for your pet and minimize future health care issues.

Cystic Calculi

Commonly called bladder stones, these occur when minerals from the diet form crystals in the urinary system. These crystals come together and form stones. They usually result from improper nutrition and/or limited access to fresh drinking water, which leads to persistent dehydration.

If your turtle has cystic calculi, you may see blood in your turtle's droppings. Your turtle may also exhibit straining sounds while trying to defecate. A physical examination, digital palpation, and radiographs (x-rays) allow your veterinarian to diagnose this problem correctly. Treatment often involves surgical instruments to help crush stones and assist with their removal, fluid therapy to prevent kidney damage and flush the urinary system and, oftentimes, antibiotic therapy. Your veterinarian will discuss dietary changes in an attempt to prevent future stone formation and proper hydration via regular soaks or humidity control.

If the stone(s) cannot be reached from the vent opening, surgery may be necessary. The protective shell of a turtle makes surgery difficult. Two techniques are available for performing internal surgery. One technique involves cutting the shell and then repairing it following the procedure. The second technique involves making an incision in front of and through the muscles of the pelvis and hind limbs.


In turtles, a prolapse occurs when an organ (intestine, cloaca, urinary bladder, uterus, or penis) protrudes from the vent (the opening in the underside of the tail from which the turtle eliminates its waste products ). In male turtles, the penis (which is a surprisingly large, black organ with a spade-shaped end) may periodically be everted and become visible outside the body.

"An organ prolapse is a potentially life-threatening problem and must be seen by a veterinarian immediately."

This is not a problem as long as the penis can go back in. If the penis stays out, it can become traumatized or can be bitten by another turtle. Penile trauma is a serious problem and leads to life-threatening infections if not attended to. Regardless of the tissue or organ prolapsed, they can all be traumatized, become desiccated or dried out, or suffer from compromised blood flow. An organ prolapse is a potentially life-threatening problem and must be seen by an experienced reptile veterinarian immediately.

Irregular Shell Growth

If you notice that your turtle's shell is growing irregularly, it may be a sign of malnutrition causing metabolic bone disease (MBD). By the time you notice this, the problem has been going on for quite a while and may have serious long-term effects on the box turtle's health. The shell may be soft, may appear lumpy,” or may no longer be symmetrical. This problem is often caused by an inappropriate diet, which may be too high in protein and fats or may have an incorrect vitamin/mineral balance. The lighting and environment may need adjusting. It is extremely important to bring this problem to the attention of a veterinarian familiar with box turtles.

Shell Fractures or Trauma

A box turtle's shell is remarkably strong, but it can be traumatized. Wild turtles may be found on the side of the road having been hit by a car and they can have serious shell fractures. Turtles may accidentally be dropped, or may fall off a table if they escape from their cage or are left unattended. Pets such as the family dog have been known to chew on a helpless turtle, causing severe damage to the shell (or legs and head). Although these are serious injuries, the shell is bone and can be repaired. Any trauma to the shell should be brought to the attention of a veterinarian immediately, as open wounds can become infected and subsequently cause serious infections. Bacteria from a dog’s mouth can be deadly for all reptile species, even if the bite wound does not appear very serious.


Turtles are commonly incriminated as a cause of salmonella infections in children. Salmonellosis is a zoonotic disease, meaning it can be transmitted from animals to humans. Infected animals and people shed the bacteria in their feces, serving as a source of infection to others. In susceptible people and animals, salmonellosis causes gastrointestinal disease, with symptoms such as nausea, vomiting, diarrhea, abdominal pain, cramping, fever and/or septicemia (blood poisoning). Young children, the elderly and people who are immunocompromised are most at risk for developing severe disease. Although turtles are certainly not the only pet or reptile that can carry salmonella, many turtles carry the infection asymptomatically, which means that they do not show signs of illness.

During the mid-1970s, it was discovered that some infected young children contracted the disease from their pet turtles. Many of these children didn't exercise proper hygiene, such as washing their hands after handling the turtles, and some children were even witnessed placing the turtles in their mouths. Legislation was passed in the US making it illegal to sell turtles with a shell length smaller than 4 inches; apparently, turtles larger than this can't easily be placed in a child's mouth! Before purchasing a turtle, check the laws in your municipality regarding legal ownership of pet turtles.

Prevention, through proper hygiene, is the best way to control this disease. Properly clean and disinfect the cage every time it is soiled. Clean up all feces right away. Have a separate cleaning area for people and reptiles. Most importantly, wash your hands thoroughly with disinfectant soap every time you handle cleanor feed your box turtle to help minimize the risks.

"Most importantly, wash your hands thoroughly with disinfectant help minimize the risks.”

Since most box turtles that carry salmonella are not ill, they usually require no treatment. Additionally, treatment is often unsuccessful in killing the bacteria.

Aural (Ear) Abscesses

A firm swelling on the side of the face at the level of the tympanic membrane is generally an abscess of the tympanic cavity. A vitamin A deficiency is thought to be the underlying cause of this condition, because a lack of vitamin A negatively affects a turtle’s protection against invading bacteria that create abscesses. This condition happens in wild-caught as well as indoor and outdoor domestic-bred box turtles. Treatment requires lancing and flushing the abscess under general anesthesia, antibiotic therapy, and supplementation with a Vitamin A injection.


If given the opportunity, most wild box turtles (depending on the subspecies and its native local) will attempt to hibernate. In captivity, if the photoperiod (day length) is kept at 12-14 hours and the environmental conditions are warm, then hibernation is skipped. While controversial, many veterinarians feel that it is not necessary for the turtle's health to undergo hibernation, but some owners wish to provide suitable conditions for hibernating. If so, you should thoroughly discuss this with your veterinarian. Hibernation is very stressful, and sub-clinical illnesses can manifest themselves during hibernation. Only turtles that are well fed and in good health should be allowed to hibernate. A thorough examination and appropriate laboratory tests including a fecal analysis for intestinal parasites are essential prior to hibernation.

A common problem in turtles is "pseudohibernation". True hibernation requires a constant temperature between 50-60°F (10-16°C). Persistent temperatures above 60°F (16°C) are not cool enough for true hibernation. In box turtles undergoing pseudohibernation, they appear as if they are hibernating; in reality, the turtle's metabolism does not decrease and it slowly starves.


Dystocia, or egg binding, happens when the female box turtle is unable to pass her eggs. It is a reasonably common problem in reptiles, caused by a variety of factors, and can be life-threatening. Egg binding is often associated with poor husbandry, including improper environment, incorrect lighting and temperature, inadequate nesting sites, improper diet (malnutrition), and dehydration. Other contributing factors include the age and condition of the animal, injuries or physical obstruction from deformed or oversized eggs, physical abnormalities of the reproductive tract or pelvis, infections, constipation, abscesses or masses.

A healthy gravid box turtle (one that is carrying eggs) may not eat for several days or weeks, but she will still be bright, active and alert. A gravid box turtle with dystocia is anorexic and rapidly becomes sick, progressing to severe lethargy and may become totally unresponsive. A veterinarian familiar with reptiles must examine this animal immediately. A physical examination, blood tests and x-rays are used to diagnose dystocia. Medical and/or surgical procedures may be needed to help these animals.

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