What is feline lower urinary tract disease? 

Feline lower urinary tract disease (FLUTD) is a term used to describe a set of clinical signs associated with abnormal urination in cats. 

What are the clinical signs of feline lower urinary tract disease?

*         Straining to urinate

*         Bloody or discolored urine

*         Frequent urinations, often smaller in size

*         Urinating in unusual locations

*         Urethral obstruction or inability to urinate

*This is more common in male cats.  If you have a male cat that is straining to urinate and/or making frequent trips to the litter box WITHOUT producing urine, have him seen by a veterinarian immediately as this is a MEDICAL EMERGENCY.

What causes feline lower urinary tract disease?

*         Idiopathic cystitis

–          This is the most common diagnosis in cats with lower urinary tract signs.

*         Bladder stones, crystals, or urethral plugs

*         Bladder infections

*         Trauma

*         Neurogenic disorders that alter normal urination by affecting the nerves and muscles of the bladder

*         Anatomic abnormalities such as urethral strictures

*         Neoplasia (cancer or benign tumors of the urinary tract)


How is feline lower urinary tract disease diagnosed?

A thorough medical history, with an emphasis on any recent changes in environment, feeding, stress, etc., and physical examination are essential to the diagnosis of FLUTD.  In most cases, a urine sample is needed so that a urinalysis may be performed.  This allows us to look for evidence of infection, crystals, blood in the urine, or other abnormalities.  The veterinarian will formulate a diagnostic plan based on your cat’s individual clinical signs and needs, but other tests that may be performed include:

*         Blood tests – Complete blood count (CBC) and serum chemistries

*         Urine culture and antibiotic sensitivity tests

*         Abdominal radiographs (x-rays) or contrast radiographic studies

*         Abdominal ultrasound

*         Cystoscopy or endoscopic examination of the urethra and bladder

*         Bladder biopsy

A Note On Urinary Stones and Crystals

Urinary stones and crystals are most commonly diagnosed by urinalysis, ultrasound, or x-rays.  There are several types of stones that your cat may develop, but struvites and calcium oxalates are the two most common that we see.  

Struvite crystals and stones form when the pH of the urine is too high (or too basic).  If your cat is diagnosed with struvite crystals, we will recommend a special, prescription diet for your cat that is formulated to dissolve the stones and/or crystals.  In most cases, the diet is very successful at dissolving the crystals and/or stones, but in some cases surgery may be recommended to allow for removal of the stone and/or crystals. 

Unlike struvite crystals, calcium oxalate stones and crystals can not be dissolved with special diets, but these diets may still be recommended to help prevent reoccurrence.  Often surgery is needed to remove a stone if your cat is suspected to have calcium oxalate stones.  Calcium oxalates form when the pH of the urine is too low (or too acidic).

What is idiopathic cystitis?

Feline idiopathic cystitis (FIC) is the most common diagnosis in cats with lower urinary tract signs.  This diagnosis is only made after other causes have been excluded.  Cystitis is believed to be a painful condition, which usually is the reason for the lower urinary tract signs seen in the cat with FIC.  The cause of FIC is still unknown, but stress is suspected to play a key role, which is a why a number of the treatments are aimed at reducing stress in the cat’s environment.  Feline idiopathic cystitis is believed to resolve on its own within a couple of weeks regardless of treatment, but treatment is often initiated to alleviate discomfort and attempt to prevent reoccurrence of the condition.


What is the treatment for idiopathic cystitis and FLUTD?

Treatment varies depending on the underlying cause of your cats clinical signs. 

  1. Pain medications

Pain medications are often prescribed if your cat is experiencing any signs of discomfort.  Buprenorphine is the most common pain medication that we use and is available in a transdermal form (applied to the inside of the ear) or an oral form that is given under the tongue or along the gumline. 


  1. Antibiotics

Antibiotics are indicated if an infection has been suspected based on your cat’s examination or diagnostic findings.  If we suspect your cat has a urinary tract infection, we often request a recheck examination after finishing the course of the antibiotics to ensure that the infection has cleared.


  1. Increasing Water Intake

Water intake is very important in cats with a history of urinary problems.  Feeding a canned diet is an easy way to incorporate more water into your cat’s diet as canned food has approximately 70-80% water content whereas dry food is only 10% water.  Pet water fountains are a great way to encourage cats to drink more water as cats tend to prefer drinking from a moving water source.  Some cats do not like for their whiskers to touch the sides of their water bowl while drinking, so larger water bowls are often recommended.  Please remember to clean your cat’s food and water bowls regularly and provide fresh water daily. 


  1. Environment Modification

It has been proven that environment enrichment can be used to treat and prevent both behavioral and physical problems in our indoor cats.  It is aimed at making changes within a cat’s environment to attempt to reduce stress, anxiety, and fear.  The Ohio State University College of Veterinary Medicine has a website called the Indoor Cat Initiative (http://indoorpet.osu.edu/), which provides information on keeping your cat mentally and physically stimulated while living indoors.  Below are some common recommendations that we often make to help enrich the cat’s environment. 


  1. Play

An easy recommendation is increasing the amount of time spent interacting and playing with your cat.  This reduces stress as well as builds a bond between you and your cat.  Interactive toys, such as the fishing pole-like toys and laser pointers, are usually big hits with cats! 


  1. Vertical Space

Elevated surfaces are crucial to a happy, healthy feline household, especially the multi-cat household.  The more vertical spaces in a house that a cat may reach, the more their territory is able to expand.  A timid cat in a multi-cat household may feel a sense of security from an elevated position as they are able to observe their surroundings as well as keep an eye on other cats in the household.  Elevated perches and cat trees are also some of the most popular napping spots in a household!


  1. Litter Boxes

The general rule of thumb for the number of litter boxes in your household is one per cat plus one extra.  Most cats prefer large, uncovered litter boxes (covered litter boxes can trap odors, which your cat may dislike).  If you have a larger cat, under-the-bed rectangular storage containers work well.  Litter boxes should be placed in various areas of your house, especially if you have multiple cats in your household.  It is generally recommended that they be placed in quiet areas of your home away from noisy appliances or anything that may suddenly turn on and startle your cat.  In multicat households, placement in an area where the cat using the litter box has an easy route of escape in the event another household cat threatens him or her while using the litter box is important as well.  Some cats have preferences for certain litter types.  It is recommended to test your cat?s preference by providing the different litter types in separate boxes.  Most cats tend to prefer clumping, unscented litters (generally most “multicat litters” are highly scented). And of course, frequent cleaning of the litter box is recommended! 


  1. Feline Pheromones (Feliway?)

Synthetic facial pheromones, such as the product Feliway, are believed to help reduce anxiety and stress related behaviors in some cats by mimicking the cat’s natural pheromones, which they use to mark their territory.  This is believed to create a sense of security in their environment where this product is used.  Feliway is available in both a spray and a wall diffuser. 


  1. Glucosamine Supplements

Some evidence suggests that glucosamine-chondroitin supplements, such as Dasuquin or Cosequin, may help decrease the frequency of episodes of cystitis in cats as well as promote healing of the bladder wall in many conditions that may cause signs of lower urinary tract disease. 


  1. Stress-Relieving Drugs

If the previously discussed methods do not work in your cat’?s case, behavioral-modifying medications may be prescribed for your cat.  These medications are often antidepressants aimed at helping to reduce your cat’s stress and anxiety levels.  These are often a last resort when it comes to medically managing your cat’s lower urinary tract disease.


What is the prognosis for FLUTD?


Most cases of FLUTD improve without medical intervention, however, recurrence of clinical signs is common.  Medical therapy may help reduce the likelihood of recurrence as well as improve clinical signs.  The number of recurrences tends to decline as the cat gets older.  While a frustrating disorder for both the cat and the owner, FLUTD rarely causes long term or serious consequences.