Feline Lower Urinary Tract Disease: To Pee or Not to Pee

 


One of the most common reasons that cats need to go to the veterinarian is urinary problems. Nothing gets an owner’s attention more than not using the litterbox correctly! But besides being an inconvenience, urinary disease can be a serious health issue. Feline Lower Urinary Tract Disease, or FLUTD, is an umbrella term for problems involving the bladder and the urethra (the tube by which urine exits the body). Signs of lower urinary tract disease in cats include increased frequency of urinating, urinating outside the litterbox, straining to urinate, and bloody urine.

Regardless of the underlying cause of FLUTD, it can have a dangerous consequence in some cats: urinary obstruction. This generally occurs in male cats, because of their longer urethra. Urinary obstruction, or the inability to urinate, is a life threatening emergency. It will rapidly cause the buildup of toxins and certain electrolytes in the blood, and can cause death within hours. The main sign of obstruction is unproductive straining to urinate, and can also include vocalization, overgrooming of genitals, and depression or lethargy. If a male cat is exhibiting any signs that could indicate obstruction, he should be seen by a veterinarian as soon as possible.

Whether FLUTD results in obstruction or not, it can be caused by a variety of underlying problems. In general, these cause inflammation of the bladder and urethra, resulting in pain. Urinary stones, infection, crystals in the urine, or even cancer can all cause similar clinical signs. However, by far the most common cause of FLUTD is a syndrome known as Feline Idiopathic Cystitis (FIC).

Idiopathic is a term which means that there is no clear underlying cause, and cystitis refers to inflammation of the bladder. FIC involves defects in the lining of the urinary system, as well as an inappropriate physiologic response to stress. Episodes of FIC are often triggered by a stressful event, such as adopting a new pet or moving to a different house. Cats that are overweight, indoor only, fed dry food, are part of multi-cat households, and have nervous temperaments are at higher risk for developing FIC. Regardless of treatment, signs will typically resolve in about five days (unless obstruction occurs). If a cat has one episode of FIC, he or she has a fifty percent chance of having a recurrence of symptoms within a year.

Diagnosing FIC can be challenging, as it is a diagnosis of exclusion. This means that other causes of urinary tract disease must be ruled out in order to diagnose it. Since the treatments for a urinary tract infection, bladder stones, or FIC are all different, diagnostic tests are vital to ensure appropriate therapy. If your cat has signs of urinary tract disease, your veterinarian may recommend different tests depending on your cat’s age and previous history. In general, a urinalysis will be recommended for all cases. This helps pinpoint abnormalities in the urine, such as bacteria, white blood cells, or high levels of certain metabolic compounds. He or she may also suggest a urine culture and susceptibility. This test essentially grows bacteria which were present in the urine, and then finds out which antibiotics will kill them. Other tests may include radiographs (x rays) to look for urinary stones, or bloodwork to assess for underlying metabolic disease or organ dysfunction.

Treatment for lower urinary tract disease depends on the identified cause. For non-obstructive idiopathic cystitis, no treatment has been shown to substantially shorten an episode once it is occurring. Therefore, treatment is largely supportive. This typically includes pain control, and sometimes fluids to dilute the urine and make it less irritating to the inflamed bladder. Several medications have also been used in order to decrease stress. If urinary obstruction is present, treatment consists of relieving the obstruction by passing a urinary catheter, as well as fluids and therapy to treat secondary issues like electrolyte disturbances. Depending on how long the cat has been obstructed, more intensive care may be needed. If a cat has experienced multiple urinary obstructions, a surgery to create a larger opening in the urethra may be considered.

At this point, owners may be wondering how they can help to prevent episodes of FIC before they happen. While there is no perfect prevention for this disease, certain environmental modifications may reduce the frequency of symptoms. The main goal of these adjustments is to decrease stress and encourage hydration. For most cats, competing for resources is inherently stressful. Resources include litterboxes, food, water, and desirable resting places. Especially for litterboxes, it is important to have one more litterbox than the number of cats in the house. This means that if you have three cats, you should have a minimum of four litterboxes in the house. All boxes should be easily accessible and in non-stressful locations. For instance, elderly cats that have trouble with stairs may not use a litterbox in the basement, and other cats may find the noise of a washing machine aversive enough to avoid a litterbox in the laundry room. If possible, food and water should be offered in multiple locations as well. Cats that do not get along may feel vulnerable if they are forced to interact with each other in order to eat. Feline pheromone sprays or diffusers can also be added to the environment. In addition to stress reduction, increased water consumption may be helpful. Many cats will drink more if flowing water is available, such as a fountain bowl. Feeding canned food, which has a higher moisture content, can also improve hydration.

Diet can also be important in managing FIC. Multiple prescription diets are available to decrease the formation of crystals in the urine. While urinary crystals themselves are not irritating, they can contribute to obstruction when inflammation is present. Cats with urinary crystals which have had a urinary obstruction should ideally be fed a lifelong urinary diet. There are also other commercial diets which may help decrease symptoms of lower urinary tract disease even in cats without urinary crystals. If you are planning to switch your cat’s diet, do not do so abruptly, as this can be stressful and potentially cause gastrointestinal upset. Instead, the new food should be offered alongside of the old food, and the diet should be gradually transitioned.

Urinary disease in cats is not always easily fixed. However, improvement is possible. If you would like to learn more about managing your cat’s urinary health, talk to your veterinarian today!

References

Acierno, M. (2017). Help! Help! I Can’t Pee! Feline Lower Urinary Tract Disease. Pacific Veterinary Conference 2017. Retrieved February 27, 2018, from https://www.vin.com/doc/?id=8025978.

Mattox, E. (2015). Trouble in the Urethra: Feline Lower Urinary Tract Disease. AAFP 2015. Retrieved February 27, 2018, from https://www.vin.com/doc/?id=7388393.

Scherk, M. (2017). Untangling the Complexities of the FLUTD Complex. Atlantic Coast Veterinary Conference 2011. Retrieved February 27, 2018, from https://www.vin.com/doc/?id=5119159.