Feline Lower Urinary Tract Disease

Laurie Anne Walden, DVM

Photo by Manja Vitolic on Unsplash

Urinary tract disorders are common in cats. Feline lower urinary tract disease (FLUTD) is a general term that describes disorders of the bladder and urethra. A number of disorders cause FLUTD, so cats with any changes in urination or litter box behavior need to see a veterinarian.
 
Signs
Cats with FLUTD have similar signs regardless of the underlying cause:

• Frequent urination
• Straining to urinate (can be mistaken for constipation)
  Note: for male cats, straining without producing more than a few drops of urine is a medical emergency.
• Crying in the litter box
• Urinating outside the litter box
• Blood in the urine
• Overgrooming around the urethral opening (can cause hair loss under the tail)
• Nonspecific signs of cat discomfort: decreased activity, decreased appetite, grumpiness

 
Causes
Idiopathic Cystitis
The most common cause of FLUTD is idiopathic cystitis. Idiopathic means “of unknown cause,” so this condition is diagnosed when tests don’t reveal another cause. Chronic stress appears to be a major risk factor. An abnormality of the bladder lining could also be involved. Idiopathic cystitis is managed rather than cured. The signs tend to come and go over time. Flare-ups often improve on their own regardless of treatment, which makes it hard to tell if a particular treatment has actually had any effect. Cats with idiopathic cystitis are treated with stress-reducing measures like environmental enrichment and antianxiety medication. Some cats benefit from other medications or special diets.
 
Urinary Tract Infection
Urinary tract infections are uncommon in young and middle-aged cats. Cat urine is normally so concentrated that bacteria can’t easily survive in it. However, diseases that affect urine concentration and chemical composition (like kidney disease and diabetes) are very common in older cats, so cats in this age group are much more likely to have urinary tract infections. A diagnosis of urinary tract infection requires urinalysis and ideally a urine culture to identify the specific bacteria. Older cats with urinary tract infections should also have bloodwork and radiography or ultrasonography of the abdomen to find the underlying cause. Bacterial urinary tract infections are treated with antibiotics, ideally chosen according to culture results.
 
Uroliths (Bladder Stones)
Uroliths are rocklike mineral collections that form in the bladder or any other part of the urinary tract. Uroliths are found with radiography or ultrasonography. Some types of uroliths can be dissolved with a prescription diet; others require surgical removal. Even the dissolvable types often need to be removed surgically because they can be painful, cause infection, and block the urethra of male cats. Uroliths that form in a kidney or ureter (the tube connecting the kidney to the bladder) usually warrant referral to a veterinary surgery specialist.
 
Urethral Obstruction
Urethral obstruction is a life-threatening condition in which a urolith or mucus plug blocks the urethra. Male cats are at much higher risk than female cats because male cats’ urethras are narrower and longer. Cats with urethral obstruction initially have the same signs as cats with FLUTD from any other cause. If the obstruction isn’t removed, the bladder becomes large and painful and can rupture. The kidneys can no longer function normally, and the cat can die of toxin buildup and electrolyte imbalance. Cats with urethral obstruction need emergency care and usually at least a few days of hospitalization.
 
Other Causes
Cancer, injury of the spinal cord or urinary tract, and anatomical problems with the urinary tract can also cause FLUTD.
 
Image source: https://unsplash.com/photos/black-and-white-cat-lying-on-brown-bamboo-chair-inside-room-gKXKBY-C-Dk

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