Ailments of the lower urinary tract in cats

Cats are frequently brought to the veterinarian because they are having difficulty urinating, which may be accompanied by urinating outside of the litter box, urinating more or having blood-tinged urine, writes veterinarian Roxanne Vandermeer. A common issue is idiopathic feline lower urinary tract disease, writes Dr. Vandermeer, who points out that other conditions, such as cystitis, urinary tract infection and cancer, must be ruled out before diagnosing FLUTD. Any cat straining to urinate should be evaluated by a veterinarian who will perform an exam and an analysis of the cat’s urine and may recommend further testing. Fitness Goop (4/3)

One of the most common reasons cats are taken to their veterinarians is because they are straining to urinate. In addition to the straining, these cats are often showing other clinical signs like increased frequency of urination, urinating in inappropriate places and passing only small amounts of urine at a time. Sometimes the owners also report noticing blood or a red/pink discoloration to the urine. All of these signs can be seen for multiple different reasons including bladder stones, crystals in the urine, cystitis (bladder wall inflammation), urinary tract infections, urethral plugs, trauma, neoplasia (cancer) and idiopathic (cause unknown) feline lower urinary tract disease (FLUTD), to name the most common.

The majority of cats presenting with the above-mentioned clinical signs fall into the idiopathic FLUTD category. Before a cat can be said to have idiopathic FLUTD the other recognized causes of urinary tract disease have to be ruled out. Even after extensive work up and diagnostics more than half of these cases yield no specific cause and can thus be classified as idiopathic FLUTD.

In order to diagnose a cat with lower urinary tract disease your veterinarian will want to do at least a physical exam and a urinalysis. Additional testing that may be indicated include: a urine culture, blood work, x-rays and ultrasound imaging.

Treatment of feline lower urinary tract disease depends on the underlying cause, if one can even be identified.

Bladder stones either need to be removed surgically or may be amendable to dissolution with an appropriate therapeutic diet depending on what the stones are composed of.

Some crystals in the urine can be normal but if they are found at abnormally high levels or if an abnormal type of crystal is identified then diet modification may be all that is needed to resolve the problem.

Cystitis (bladder wall inflammation) in cats is usually idiopathic, in other words we can’t identify a specific cause. It’s believed that stress plays a major roll in its development and that is why we often see a flare up of cystitis in cats that have recently moved to a new home or if a new family member/pet/roommate has come into the picture. Minimizing stress, optimizing litter box hygiene, encouraging water intake, diet modification, changing the type/location of the litter box and litter can all be beneficial. This can be a painful condition and these cats are often given some pain medication initially. Weekly subcutaneous (under the skin) injections of medication that promotes the protective lining of the bladder can be given once per week for at least 4 treatments.

Bacterial urinary tract infections (UTI’s) are actually quite rare in young to middle aged cats. Cats appear to be innately more resistant to bacterial UTI’s than dogs due to their differences in anatomy and the higher concentration of their urine. Urine also has substances that inhibit bacterial colonization. A urinary tract infection can be diagnosed via a urine culture and then treated with an appropriate antibiotic based on the culture results.  Urinary tract infections are more common in older cats that have other conditions that predispose them to UTI’s such as diabetes or kidney disease.

Urethral plugs are usually composed of either crystals or a proteinaceous substance and can cause a life-threatening blockage of the urethra (the duct by which the urine is conveyed out of the body from the bladder). This obstructive form of feline lower urinary tract disease is seen almost exclusively in male cats.  If you notice your male cat straining to urinate but producing no urine you must get him to a veterinarian immediately. The veterinarian will have to sedate or anesthetize your cat to remove the blockage and hospitalize him for at least 24 hours to make sure that he does not re-obstruct. 50% of these cats will have a recurrent obstruction in their lifetime.

Trauma to the urinary tract can be sustained in many ways, the most common of which is cats that are hit by cars or that fall off balconies. A bladder rupture requires surgical intervention whereas less severe trauma may be amendable to more conservative medical management.

Cancer can affect the urinary tract and needs to be properly characterized and staged before the best treatment options can be determined.

Idiopathic feline urinary tract disease, which is the most common form of disease affecting the lower urinary tract in cats, is treated in much the same way as cystitis. Diet modification, pain medication, stress reduction, anti-inflammatory agents, glucosaminoglycans (promote the protective lining of the bladder), and litter box hygiene are all used to treat and manage this disease. This can be a very frustrating disease for owners and veterinarians alike because of the lack of an identifiable cause and the high rate of recurrence despite treatment.