English Bulldogs, first bred in Britain as athletic and aggressive dogs for the sport of bull-baiting (where they get their name), are now a common family pet. In fact, they are often seen ranking high in lists of the most popular UK dogs. However, the breed is also mired in controversy regarding their health, which are numerous. Health problems that are still common in Bulldogs today were first noted by the Victorians. Sadly, little progress has been made to correct these issues since. Many vets claim that the breed should not be considered healthy. And a recent study by the Royal Veterinary Collage (RVC) found that bulldogs were twice as likely to have health conditions as other dogs. Two countries, The Netherlands and Norway, have even banned the breeding of English Bulldogs (and some similar breeds); as they violate their animal welfare laws. 

There are major diseases associated with Bulldogs that should be discussed and considered if you are thinking of getting one as a pet, which is our topic for today. Many of the health issues associated with English Bulldogs are also seen in French Bulldogs, Pugs, and similar breeds. We will not discuss behaviour here as, although Bulldogs are generally considered a placid breed of dog, we know that training and upbringing has a large effect on personality and behaviour, and thus may vary greatly dog to dog. 

Table of contents

Health Considerations

Let’s list some health issues frequently seen in Bulldogs. The most common are skin fold dermatitis, prolapsed third eyelid gland (cherry eye), mandibular prognathism (underbite), and brachycephalic obstructive airway syndrome (BOAS). Bear in mind that not every Bulldog will have all of these issues. And there may be other diseases present in some Bulldogs not listed here. 

Eyes

Bulldogs are at a greater risk for three eye conditions compared to other breeds; these are cherry eye, entropion and keratoconjunctivitis sicca (dry eye).

Cherry eye is a condition where the third eyelid gland prolapses out of its pocket. Cherry eye presents as a pink swelling in the corner of the eye closest to the nose. This can happen in one or both eyes and is more common in younger dogs. Cherry eye causes eye inflammation, dryness, a vulnerability to damage, and pain. Cherry eyes sometimes resolve with topical anti-inflammatories, but most commonly surgery is required to replace the glands. The surgery has a higher risk of failure than other surgeries, so often multiple surgeries are needed. Surgical removal of the glands is generally not recommended, as this can lead to dry eye.

Entropion describes the inward rolling of eyelids, resulting in skin and hair touching the eye’s surface. In Bulldogs, entropion is caused by their excessive skin folds pushing the eyelids inwards. Other nearby facial folds can also rub the eye and cause similar problems. Entropion is a painful condition resulting in eye inflammation, damage, infection and in extreme cases, blindness. Entropion also often requires surgery to correct it and may also need repeat surgeries as the animal grows. 

Finally, dry eye describes where the watery component of tears is not produced. This is generally an immune-driven condition, though can be linked to congenital malformation of tear ducts and others. Dry eye causes the tears to become very thick and sticky, coating the eyes and lids. It causes eye inflammation, vulnerability to damage and pain. Dry eye requires topical lubricants to manage, or powerful immunomodulatory drugs to restart tear production. 

Mandibular Prognathism

Mandibular prognathism – an over bitten lower jaw/underbite with the lower teeth sitting in front of the upper teeth – is not just a common feature of Bulldogs, but actively encouraged by breed standards, including the UK Kennel Club. An underbite results in the teeth not interlocking as they should. This can cause difficulties eating, damage to the teeth or gums, pain in the mouth, and has even been reported to increase the risk of arthritis in the joints of the skull.

However, the RVC study found that English Bulldogs actually had a reduced risk of periodontal disease compared to other dogs. This may be because their underbite is commonly so severe, the teeth do not touch at all, thus avoiding damage seen with milder prognathism. This does not excuse the condition and should not be considered ‘normal’ for any dog. 

Skin Disease

Skin disease is very common in Bulldogs, primarily because of excess skin folds on their face, tail bases and sometimes paws. Folds in the skin trap heat, moisture and debris which allow bacteria and yeast to colonise the area. This results in painful infections. Below the eyes and above the nose are common sites for this to occur. Being obese increases the risk of skin fold dermatitis. Treatment often requires antibiotics and anti-inflammatories, but daily cleaning is needed at home to prevent recurrence. Surgeries may be needed to remove skin folds in some cases.

Bulldogs are also prone to interdigital furuncles (cysts). These are raised painful red lumps between the toes, commonly caused by excessive licking, skin folds, Demodex parasites (also common in Bulldogs according to the RVC) and allergies. Treatment often requires weeks of antibiotics to resolve. 

Also associated with skin disease is ear disease – because of narrow ear canals due to their hereditary facial structures, and often made worse by skin folds, allergies and previous ear disease, otitis is very common in Bulldogs. Otitis is inflammation of the ear canals, a painful condition that often causes ear infections too. Because of the narrowness of the ear canals, treatment can be difficult. Extreme cases may require radical surgery to remove the ear canal.

Breathing Issues and BOAS

Brachycephalic obstructive airway syndrome (BOAS) is a condition commonly seen in Bulldogs, Frenchies, Pugs and other brachycephalic (short-faced breeds) as a direct result of selection for this trait when breeding. Brachycephalic animals have a smaller skull than a normal-shaped dog, but the soft tissues that make up the face remain a normal size. This means there is a lot more tissue crammed into a smaller shape, causing overcrowding. These tissues block airways, causing a reduction of airflow and breathing difficulties – Bulldogs with severe BOAS must spend their lives effectively breathing through a straw.

The four most common tissue abnormalities are narrow nostrils, a long and thickened soft palate, a large tongue relative to their size and a narrow windpipe. Studies have found up to 45% of Bulldogs have BOAS – some studies have found far fewer, but this may be due to ‘normalisation’ where the signs of BOAS are considered so normal for the breed, they are not always picked up as a disease.

BOAS causes loud breathing and snoring sounds, even when breathing slowly (though worsened on exercise), excessive panting, difficulties sleeping and sleep apnoea, lack of heat tolerance and difficulties cooling down, regurgitation issues, gagging and drooling. In some cases, BOAS can result in sudden respiratory distress, heatstroke, collapse, seizures or death. Obesity often makes the signs of BOAS worse. 

To have some semblance of a normal quality of life, many Bulldogs will require major BOAS surgeries to try and improve their breathing. As with other surgeries in Bulldogs, these are risky with higher-than-normal complication rates. Whatever you are told, the snuffly and grunting sounds Bulldogs make when they breathe are not normal, but signs of serious respiratory disease. 

Orthopaedic Problems

Problems with the bones and joints of Bulldogs are not uncommon, mainly as a consequence of their squat shape, curly tail and bowlegs. 

Some of the most frequently seen are spinal deformities. It has been reported that there is a high incidence of hemivertebrae (where only one part of the spinal cord develops) in Bulldogs, as well as other issues with the spine. A screw-shaped tail is seen in almost 100% of Bulldogs, and again is a deformity that is often not noted down as abnormal by vets. Interestingly, despite these deformities, English Bulldogs do not have a higher-than-average incidence of neurological issues as a result of the spinal changes, contrasting to smaller brachycephalic dogs like French Bulldogs. As with an underbite, this does not mean that the Bulldog’s skeletal shape should be considered normal.

Breeding Problems

Of relevance to breeders of Bulldogs are the severe issues these dogs have in copulating and giving birth. 

Starting at the beginning, many Bulldogs have difficulties with, or are even physically unable to, mate. 

This is mainly due to their body shapes preventing the male from appropriately mounting the female. Again, mobility, spinal and obesity issues compound this problem. This issue is so widespread that many Bulldogs must be bred via artificial insemination. 

At the other end of the process, the vast majority of Bulldogs have difficulties giving birth (dystocia). 

This is mainly for two reasons – foetal-maternal disproportion (the foetus is large in comparison to the female and her birth canal) and a narrow pelvic canal. Again, these are issues that are related to the abnormal shape of Bulldogs. Dystocia is painful and traumatic for the mother and offspring, and can lead to death of both if untreated. Breathing issues can make the stress-factor worse. In fact, a huge proportion of Bulldogs physically cannot give birth normally and can only produce live puppies via a caesarean operation. It has been reported that up to 86% of Bulldog pregnancies end in caesareans (though many of these may be elective before a normal birth is attempted). 

Caesareans are major abdominal surgeries performed during one of the most vulnerable periods of a dog’s life. Complications are not unheard of that can result in loss of the puppies and/or the mother. The anaesthetic risk is worsened by Bulldogs’ other genetic problems listed above. Some vets will offer elective caesareans, where pregnant Bulldogs are routinely given caesareans around the time of giving birth – this is a controversial practice, as some argue it encourages the breeding of Bulldogs unable to give birth normally.

When both of these factors are taken together, very few English Bulldogs can reproduce without human intervention. 

Bulldog breeding is thus a very contentious issue. Again, two countries have banned it because of these factors and the health of the breed in general. We would seriously advise anyone considering breeding Bulldogs to spare a thought for the safety of the process and the health of the offspring produced, and whether you can truly claim it is a humane process. 

Anaesthetic Risk

Finally, we have the increased risk Bulldogs undergoing general anaesthetics have. Ideally, dogs should not have to undergo many anaesthetics in their lives. Many will only have a single neutering procedure around a year or so old. However, as we described above, many Bulldogs require multiple surgeries to have a relatively comfortable life, including BOAS surgeries, skin fold removal, surgery to correct entropion, cherry eye replacement and more. Breeding Bulldogs may also need a caesarean procedure. In all dogs, anaesthetics carry risk (though the safety is generally very good), but these risks are heightened in Bulldogs for various reasons. 

Firstly, the stress-factor

Many dogs will be stressed visiting the vets for operations, Bulldogs included. However, due to their brachycephalic heads and BOAS, many Bulldogs cannot cool themselves down effectively when stressed. This results in breathing difficulties that make stress worse, and can lead to collapse, heatstroke or even sudden death in practice. Stress can be minimised by pre-anaesthetic sedative drugs. 

Difficulty in securing their airways

After inducing anaesthesia in dogs, we must secure a safe airway, so we can supply oxygen and anaesthetic gases – this is generally via an endotracheal tube. Placing an ET tube can be difficult in Bulldogs due to their narrow airways. The longer Bulldogs lack a patent airway via an ET tube, the greater the risk of hypoxia and complications – unlike other dogs, most Bulldogs cannot continue to breathe properly once under anaesthesia without an ET tube. In emergency situations where airway management is critical, Bulldogs may need a tracheostomy to access their trachea quickly.

Many Bulldogs are prone to regurgitation during times of stress. If this happens during an anaesthetic, Bulldogs may aspirate vomit into their lungs, causing pneumonia. These factors can make recovery from anaesthetics difficult or even lead to death in some cases. This again can be minimised by pre-operative anti-sickness medication. 

Finally, post-operatively, despite surgery ending, the risks remain

In fact, complications are more common in the recovery period; one study found that most anaesthetic deaths in Bulldogs occurred during this time. These complications are mostly linked to BOAS and regurgitation-related issues. 

In summary, Bulldogs’ complication and death rates during anaesthetics are higher than most dogs, yet they often need more surgeries than average. To mitigate these risks, many vets will recommend extra medication, which can also make surgeries more expensive. 

If You Are Still Considering a Bulldog

We hope that the above article has shown that Bulldogs are a breed where many individuals will have serious chronic and permanent diseases that must be managed. They are not a healthy breed, thus having one as a pet is a challenge. 

If you are still keen on having a Bulldog, we have some advice.

First of all, do your research

The above list is a good starting point, but there is much more information you will need to manage these conditions; please ask your vet for advice. Do the research when purchasing a Bulldog too. We advise you to adopt from a shelter or charity first, as this does not encourage questionable breeding practices. However, if you are set on purchasing from a breeder, ensure the breeder is reputable and does full genetic testing on their animals – but remember that even with testing and ‘good’ genetics, most Bulldogs will have health issues. Consider a crossbred Bulldog instead that has healthier traits, such as a longer snout. 

Regarding health, you must accept that your Bulldog is almost certainly NOT healthy 

Arguably, no English Bulldog can be considered healthy. Unless you are incredibly lucky, most Bulldogs will need regular ongoing veterinary care. This can be time consuming and expensive, but should not be avoided for the welfare of your dog. We highly encourage you to have insurance for your Bulldog, but note that many insurers will have high premiums for these dogs, or may exclude certain conditions that are common in Bulldogs. You should also prepare for multiple surgeries in their lifetime, the costs involved, and the risk of complications under GA. 

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We do not want to disparage those of you who already own Bulldogs – they are often really lovely dogs

This article is more for those considering a Bulldog so that you understand what their care involves. Can we consider Bulldogs good pets? That’s subjective, but they certainly aren’t simple dogs to care for, and having one must not be taken lightly. Can we say Bulldogs are healthy normal dogs? No, and a lot of work must be done to improve the health of this breed to reduce the suffering of thousands of these dogs in future. 

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