A terrible sound comes from the other side of the house: your cat yowling in his litter box. Or, maybe its a puddle of cat pee on the couch. Perhaps it’s a cat who keeps running to use the litter box instead of cuddling. All of these signs can indicate the same thing – your cat has developed a urinary problem. The broad term used to describe problems with urination in a cat is Feline Lower Urinary Tract Disease (FLUTD). The reason the name is general is that there are several very different reasons your cat is having problems urinating. Each requires a different treatment, and therefore seeing your veterinarian and having the appropriate diagnostic tests performed is very important.
Symptoms of Feline Lower Urinary Tract Disease:
The symptoms are similar for nearly all causes of FLUTD.
• Inappropriate urination – A cat going anywhere except the litter box usually indicates either a medical or behavioral problem. Cats who experience pain when urinating may associate that pain with being in the litter box and so choose to go anywhere else in an attempt to avoid pain. Of course, your cat may also be trying to tell you that the litter box needs to be cleaned or that she is stressed by something in her environment, such as houseguests or construction.
• Vocalizing in the litter box – when a cat makes noise in the litter box, it is a sign of pain
• Spending extra time in the litter box – Frequent trips to the litter box or spending extra time trying to urinate is a common sign of FLUTD. Struggling to urinate is usually due to irritation or inflammation of the bladder. This irritation or inflammation makes a cat feel like she has to go to the bathroom even if her bladder is empty.
• Blood – If there is blood in the urine (pink or red urine) or if you notice drops of bloody discharge, your cat as FLUTD.
• Excessive licking/grooming – Cats are very good at keeping themselves clean. A cat who spends extra time licking around the vulva or penis (where urine exits the body) may have FLUTD.
• No Urine – Time in the litter box without producing any urine may be a medical emergency. Mostly seen in male cats, if your cat goes more than 12-18 hours without urinating, he may have a urinary obstruction and require immediate medical care.
Diagnosis of Feline Lower Urinary Tract Disease:
It is usually fairly straightforward for your veterinarian to determine what type of FLUTD your cat. The first step is a comprehensive history, which includes discussing all of the symptoms you have seen in your cat as well as assessing her environment. Your veterinarian will ask whether there have been any recent changes in the house. Changes can include something significant like a new baby or less apparent changes like a new laundry detergent or the change in schedule at the start of the school year.
Your veterinarian will perform a urinalysis to test for the presence of bacteria, blood, or crystals in urine. Your veterinarian may also recommend x-rays or an abdominal ultrasound. An x-ray or ultrasound might be necessary, especially if your cat develops frequent FLUTD signs, or they won’t go away. Your veterinarian may also recommend culturing your cat’s urine to confirm there is no infection or if your cat frequently has urinary signs.
Causes of Feline Lower Urinary Tract Disease
If there are bacteria, that indicates a urinary tract infection. Most healthy, adult cats do not develop urinary tract infections. It is more common for senior or geriatric cats or those with other diseases such as diabetes.
Some cats form urinary crystals. Crystals may cause irritation, leading to signs of FLUTD. Sometimes crystals in your cat’s urine indicate that there are also bladder stones.
Blood indicates irritation or inflammation. It is possible to find blood without bacteria or crystals. The blood, in this case, indicates sterile cystitis, which means inflammation of the bladder with no infection. Blood in the urine is typically not the primary cause of urinary signs but rather develops because of frequent straining or irritation to the lining of the bladder.
Debris such as pieces of cells, mucus, in urine can be enough to cause FLUTD signs and even urinary obstruction.
Rarely, cats can develop kidney infections (pyelonephritis) or have polyps or tumors in their bladder that are causing their FLUTD symptoms.
The most common cause of FLUTD in cats less than ten years old is stress. Understanding your cat’s current living environment is so essential to providing your veterinarian with a detailed description of your cat’s environment and any recent changes.
Some other conditions make FLUTD more common. These include diabetes, kidney disease, and problems that lead to inadequate water intake, such as when joint pain makes your cat less willing to walk to the water bowl.
Treatments for Feline Lower Urinary Tract Disease
The treatment that your veterinarian recommends will depend on the cause of your cat’s FLUTD.
Urinary Tract Infection
Your veterinarian will prescribe antibiotics for a urinary tract infection.
Crystals or Bladder Stones
If your cat has crystals or bladder stones, your veterinarian will recommend a special diet that helps to dissolve crystals and prevent new crystals from forming. Your cat may need to be on this permanently. This type of food is available in both wet and dry formulations to meet your cat’s needs. Royal Canin and Hill’s are the diets most veterinarians recommend. Depending on the type and size of stones your cat has, surgery may also be required.
Pain management is the primary treatment for stress-induced FLUTD. It can also be beneficial in quickly relieving your pet’s signs, no matter the cause.
It is very important to address the cause of your cat’s FLUTD. Try to make your home as cat-friendly as possible to reduce the likelihood that this becomes a recurrent problem. The first things to try are to make sure that your cat has a safe, quiet place to rest like a closet or under the bed. Next, keep one more litterbox than the number of cats in your house. The boxes should be placed so that one cat cannot guard them all. Litter should be scooped daily. All litter boxes should be emptied and washed at least monthly. Be mindful that the litterbox is not next to machines that make noise or turn on suddenly, which could scare your cat. Feliway® diffusers strategically placed can add helpful pheromones to help calm your cat. Some formulations of prescription urinary diets also contain ingredients to help cats with stress-induced FLUTD, specifically Royal Canin Calm.
The worst-case scenario for FLUTD is urinary obstruction meaning that your cat cannot urinate. Urinary blockage is a medical emergency that happens mostly to male cats. The tube that carries urine from the bladder to outside the body (the urethra) is very narrow and can become blocked by crystals, debris, or even a small blood clot. Urinary obstruction is an excruciating condition that requires immediate action by your veterinarian. Your veterinarian will sedate your cat, place a urinary catheter, and keep your cat in the hospital on fluids and medications for several days. It is recommended that cats who develop an obstruction be put on prescription urinary diets to reduce the likelihood of obstructing again.