Feline lower urinary tract disease (FLUTD) is a general term used to describe several different conditions that affect the bladder and urethra of cats. It is usually seen in middle-aged, overweight cats that get little exercise, use an indoor litter box, or eat only a dry food diet. Factors such as environmental stress, multi-cat households, and abrupt changes in daily routine may also increase the risk that a cat will develop FLUTD.
Straining to urinate
Frequent and/or prolonged attempts to urinate
Crying out while urinating
Excessive licking of the genital area
Urinating outside the litter box
Blood in the urine
Please note that cats with a urethral obstruction will also show these signs, but will pass little or no urine and become increasingly distressed. A urethral obstruction is an emergency and requires immediate veterinary medical attention. If you notice any of these signs please call the Merrick Veterinary Group immediately at 516-379-6200.
There are many causes of FLUTD and it can therefore be difficult to diagnose. Initially a physical examination, urinalysis and urine culture will be performed. If the cause is still not identified, tests such as bloodwork, abdominal x-rays and/or an abdominal ultrasound may be performed.
Feline Idopathic Cystitis (FIC)
Feline idiopathic cystitis (also called interstitial cystitis) is the most common diagnosis in cats with lower urinary tract disease. This disease is not fully understood and is very difficult to treat. Stress and changes in diet can increase the risk of idiopathic cystitis.The disease can be chronic and very frustrating for the cat, the owner, and the veterinarian.
Veterinarians have noted many similarities between FIC and a bladder disorder affecting humans called interstitial cystitis. Studies are ongoing to determine whether the human and the feline disorder are truly the same, and whether therapies helpful for humans will be of benefit to cats as well. In humans, a psychologically stressful event often precedes the onset of lower urinary tract discomfort due to interstitial cystitis, and stress also seems to be an important factor in the development of FIC in cats. Possible sources of stress in a cat’s life may include environmental changes, changes in food schedule, and changes in the number of animals in the household. Environmental enrichment and modification can reduce stress and decrease the severity and frequency of FIC episodes. To reduce environmental stress, cats should be provided a safe, clean area in which to urinate, as well as opportunities to express natural predatory behavior. These opportunities may include climbing posts and toys that can be chased and caught.
The goal when treating cats with idiopathic cystitis is to decrease the severity and frequency of episodes. The inflammation in the bladder is usually NOT associated with infection and therefore antibiotics are of little benefit. Sometimes the antidepressant amitriptylline is used to relieve bladder inflammation and pain by acting an antihistamine and also as an antispasmodic. Psychologically, it may diminish some anxiety associated with the condition and therefore reduce stress. Finally, the use of glucosamine/chondoroitin supplements may be of benefit because the lining of the bladder contains cells similar to those that line the joints. The glucosamine may help rebuild the protective lining of the bladder.
Urolithiasis (Urinary Stones)
Another possible cause of FLUTD is urinary stones (uroliths or calculi) which are rock-hard collections of minerals that form in the urinary tract of cats. Cats with urinary stones will exhibit many of the common signs of FLUTD. X-rays or ultrasound are usually needed to make a diagnosis of urinary stones. The treatment of a cat with urinary stones depends on the mineral composition of the stones; however, surgical removal of stones is often required. The two most common stone types in cats are struvite and calcium oxalate.
For cats with struvite stones, a special stone-dissolving diet may be prescribed to eliminate the stones. If the diet fails to dissolve the stone, then surgical removal may be necessary. Struvite stones are becoming less common in cats, as most commercial feline diets are now formulated to reduce the likelihood of struvite formation by limiting the amount of dietary magnesium and by promoting the production of urine that is more acidic. Unfortunately, the percentage of stones composed of calcium oxalate has increased.
Unlike struvite stones, calcium oxalate stones cannot be dissolved with special diets, and more aggressive treatment is needed. If these stones fail to pass, or if they recur, then surgery may is needed. The surgery to remove bladder stones is called a cystotomy and involves making an incision through the belly and then the bladder to get to the stones.
Cats that have formed a bladder stone at increased risk for recurrance and need to be monitored closely.
This is the most serious problem associated with FLUTD and occurs when a cat's urethra (the tube that carries urine from the bladder to outside the body) becomes partially or totally blocked. Urethral obstruction is a potentially life-threatening condition caused either by small urethral stones or urethral plugs.
THIS IS A TRUE MEDICAL EMERGENCY, AND ANY CAT SUSPECTED OF HAVING AN OBSTRUCTION MUST RECEIVE IMMEDIATE VETERINARY ATTENTION!
Male cats are at a greater risk for urethral obstruction than female cats because their urethra is long and narrow. Once the urethra becomes completely blocked, the kidneys are no longer able to remove toxins from the blood and fluid and electrolyte balance in the body is disturbed. Without treatment, death frequently occurs when these imbalances lead to heart failure often in less than forty-eight hours.
Treatment of urinary obstruction involves placing a urinary catheter that is usually left in place for 24-48 hours. Once the obstruction is removed, further treatment consists of intravenous therapy for dehydration and electrolyte imbalances. Antibiotics may be given to prevent or treat infection, and drugs that help restore bladder function are sometimes required.
For cats who experience multiple episodes of urethral obstruction despite medical treatment, there is a surgical procedure called a perineal urethrostomy which will allow urine to permanently bypass the area of obstruction. There are many side effects of this surgery and it is usually considered only as a last resort.
Some cats that recover from FLUTD never develop it again. However, in some cats, the condition often recurs. To help reduce the chances of recurrence
Consider feeding a canned food diet instead of a dry food diet
Some urinary conditions respond better to prescription diets
Provide clean, fresh water at all times
Provide an adequate number of litter boxes (1 for each cat, plus 1 more)
Keep litter boxes in quiet, safe areas of the house.
Keep litter boxes clean
Minimize major changes in routine
If your cat is exhibiting any of the signs of FLUTD please call 516-379-6200 to schedule an appointment as soon as possible.