Feline Lower Urinary Tract Disease (FLUTD)

Feline Lower Urinary Tract Disease (FLUTD) is a common condition in cats. The lower urinary tract refers to the bladder and urethra (tube from the bladder to the outside), while the kidneys and ureters make up the upper urinary tract. 

Cats with urinary disease may exhibit one or more of the signs described below:

• Blood in the urine

• Urine with a strong odour

• Pain when urinating (crying or vocalizing)

• Straining to urinate, with or without urine production

• Frequent or small volume urination

• Excess licking around the penis or vulva

• Over-grooming the abdomen over the bladder

• Inappropriate urination outside the litter box (on the floor, in the tub, etc.)

• Fine crystal/powder material in the fur around the opening to the urinary tract

• Hiding

• Reduced appetite

In some animals, especially in males, obstruction may occur which may manifest as vomiting, weakness, collapse, and lethargy. Note that in some cats, obstruction is the first urinary sign that is noted.

Different Causes of Urinary Disease

1. Feline Interstitial Cystitis (FIC), also termed “Feline Idiopathic Cystitis,” is a commonly seen inflammatory disease of the bladder resulting from stress, genetic factors, and other conditions that stimulate inflammation and damage to the bladder wall. Indoor cats with sedentary lifestyles, anxiety, or lack of stimulation are at highest risk. Risk factors also include obesity, concentrated urine, and poor diet. Urine from cats with FIC is sterile (no infection) with no crystals or stones either, however severe inflammation and pain is present. This is probably the most common cause of lower urinary disease that we see at Urgent Paws Veterinary Clinic.

2. Stones (uroliths) and crystals (crystalluria) may form in the urinary tract. These may cause obstruction, but if not large enough to block the urethra they may produce significant inflammation and irritation to the bladder (cystitis) and urethra (urethritis). Sometimes very small stones accumulate, which may be called “sand”. Stones and crystals cause: physical irritation from moving and rubbing against the lining; damage to the normal mucous layer of the bladder; and irritation from urine which is outside the normal acid/base balance. Crystals and stones form when urine is concentrated (high specific gravity), too acidic or basic, or contains too high a concentration of minerals.

3. Urinary Tract Infections (UTIs) are not common in cats, especially young or male animals. When they occur, they may be present alone, or more commonly along with one of the other described conditions as a complicating factor.

4. Bladder cancer (usually Transitional Cell Carcinoma), though uncommon, can lead to irritated tissues around the growth, bleeding, or infection.

5. Congenital diseases (birth defects) such as malformed urinary tracts, misplaced ureters, underlying kidney diseases, or others may also occur.

6. “Spraying” is not truly a urinary disease, but a normal behavior of intact male cats or cats exposed to testosterone. This involves peeing a fine mist on vertical surfaces with the tail raised as a territorial marking tool.

“Blocking” or Lower Urinary Tract Obstruction

Blockage of the lower urinary tract can be caused by any of the above conditions and may be preceded by any or none of the discussed signs. It can also occur if a scar tissue ring forms, inflammation or infection causes the urethra to swell closed or spasm, or if stones/crystals/mucus/blood clot plugs the urethra. Male cats are overwhelmingly more likely to experience obstruction due to their longer and thin urethras. 

Cats with lower urinary obstruction often strain repeatedly and express little to no urine. They experience a lot of pain and may vomit or go into hiding. Cats may collapse and show extreme weakness in the late stages of disease. Additional signs may include howling while straining, distressed attitude, loss of appetite, and progression to inability to move. A urinary blockage can cause kidney failure, electrolyte changes which may lead to stoppage of the heart in some cases, and bladder rupture. 

This condition is extremely painful and life threatening — do not delay seeking veterinary care if you suspect this issue is occurring!

DIAGNOSIS- what to expect when you bring your cat to the vet

Medical history collected from the cat’s caregiver and a full veterinary physical exam may give us an indicator to look for lower urinary tract disease. The veterinary team will also recommend a urinalysis to be able to see what is in the urine that may be the source of the symptoms. We may also recommend a urine culture, X-rays, or ultrasound to diagnose and characterize disease. Blood work is also recommended to further assess kidney function, electrolyte levels, and rule out secondary or underlying disease. Some diseases, such as FIC or behavioral inappropriate urination, may be diagnosed based on the exclusion of other diseases or require advanced testing.

PREVENTION STRATEGIES

Stress Reduction: Reducing stress is very important as cats often develop urinary tract issues when they feel threatened, bored, or generally anxious. This may include increased playtime, removal of sources of anxiety, and stress diets or supplements. Increased enrichment (doing more things or spending more time with your cat doing things they like!) is possibly the most important of these. There are medications and more natural supplements that can also be used to help reduce stress levels.

Diet and Water: Cats should always be fed a balanced feline specific diet. Moist (canned) food is preferred to kibble as it increases hydration and minimizes mineral content that may be excreted in the urine and predispose crystal or stone formation.

Ask your veterinarian about urinary tract diets that are available—many of these are prescription only. Diets may help dissolve or prevent stones and crystals, minimize stress and anxiety, promote weight loss, restore normal mucous barriers, and balance pH.

Fresh water should be made available at all times. Change the water and clean the bowl often. Some cats like water to be chilled, while others prefer it at room temperature, while still some others like running water (out of the tap or toilet bowl after a flush). Large bowls and cat fountains may encourage drinking in some cats. Adding water to food is also a good option to increase intake- cats generally do not drink enough water normally.

Obesity and Exercise:

Cats that are physically fit and receive sufficient exercise are less likely to develop urinary disease (and many other systemic issues). A careful nutrition plan and attention to exercise can minimize risks of lower urinary disease or recurrence.

Litter Boxes:

Clean litter boxes frequently and monitor closely for any unusual signs, particularly blood-tinged urine or a change in urine volume. Most cats prefer open boxes (though some may like a covered box), and as a general rule larger and shallow boxes are better. Avoid the use of strongly scented litter and ensure there are enough litter boxes. One litter box for each cat plus an additional box is a good starting point. Keep boxes physically separated and do not change locations frequently. Boxes should be in calm areas away from laundry machines, doors, and high traffic areas.

Elimination Behavior:

Observe your cat and pay particular attention to its elimination habits. Early signs of problems are similar to those associated with constipation (frequent straining). Peeing outside of the litter box, frequent trips to the box, and straining to pee are all causes for concern. If in doubt, contact your veterinarian.