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What is Feline Lower Urinary Tract Disease?
Please understand the following information is offered as a courtesy and is not intended to provide a diagnosis or medical recommendation for your pet.
As the bladder has limited means to demonstrate disease processes, the signs of bladder and urethral disease are always quite similar. These disease processes include idiopathic cystitis (inflammation of the bladder), cystic calculi (bladder stones), bladder infections, and neoplasia (cancer). All of these diseases may show some or all of the same signs. The most common signs include blood in the urine (hematuria), straining to urinate (stranguria), inappropriate urinations (periuria), and increased frequency of urination (pollakiuria).
In some male cats, the urethra will become obstructed with a stone or inflammatory debris or be swollen closed with inflammation; this is called urethral obstruction and prevents the cat from urinating (quickly becoming a life-threatening condition). By far the most common causes of lower urinary tract signs in young (<7 years old) are stones and idiopathic cystitis. Cancer of the bladder is very rare in cats (even older cats).
Primary bacterial urinary tract infections in young cats occur in less than 1% of cases unless the cat has been catheterized or had surgery (perineal urethrostomy) to relieve urethral obstruction. If there are no stones seen on radiographs (x-rays) and no bacteria grown on culture, idiopathic cystitis is suspected. Most episodes of lower urinary tract signs resolve spontaneously within 5-7 days without treatment, but these episodes generally recur. If an episode persists for longer, then further evaluation is often warranted possibly including abdominal ultrasound or cystoscopy.
Idiopathic Cystitis
What is feline cystitis?
The term "cystitis" literally means inflammation of the urinary bladder. Although this term is rather general, there is a common form of cystitis that occurs in male and female cats. This disease is sometimes referred to as Feline Urologic Syndrome (FUS) or Feline Lower Urinary Tract Disease (FLUTD), but these terms technically include urinary tract infections and neoplasia, in contrast to idiopathic cystitis. The only way to confirm idiopathic cystitis as a diagnosis is to exclude the other disease processes, and then visualize the bladder with cystoscopy.
What causes feline cystitis?
We are not completely sure of the cause of this problem. Bacterial infections are the most common cause of cystitis in dogs and humans, but most cats with cystitis do not have bacteria in their urine. Neutering of male cats and feeding of dry cat food have been proposed as potential causes, but these have been disproved as initiating factors. It is true, however, that many dry foods may aggravate the problem after it begins. Crystals in the urine have also been shown to possibly worsen signs of cystitis, but not create the cystits. A herpes virus has been incriminated as a cause and but this could not be proven. Current research is attempting to characterize environmental stress as a percipitating cause. Despite extensive research, the cause remains elusive to the frustration of veterinarians, owners, and cats.
Are bloody urine and straining to urinate the main problems?
Most cats with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort is usually mild but can become much worse if it is not treated. Female cats may develop l/2 inch diameter stones in the bladder that must usually be surgically removed. Male cats may develop enough crystals or inflammatory debris in the urethra (the narrow tube carrying urine out of the body) to cause an obstruction. This obstruction prevents elimination of urine from the bladder. If the obstruction is not relieved within 48 hours, most cats will die from kidney failure and the retention of toxins that were not removed by the kidneys. Because the urethra is relatively larger in the female cat, the emergency posed by complete obstruction is almost always found in male cats.
How is cystitis treated?
Each cat with cystitis is treated according to the changes in the urine (pH, crystals, blood, etc.), the type of crystals present, the presenting clinical signs (straining, increased frequency, etc.), and the presence or absence of a bladder stone or urethral obstruction.
If neither a bladder stone nor urethral obstruction is present, increasing the water intake can often reduce clinical signs. By creating more dilute urine, we feel that the health of the bladder wall may be improved. A urinalysis is necessary to determine the proper diet or medication. A special diet, explained below, will help to dissolve crystals in the urine and hasten recovery.
If the cat has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting anesthetic. The catheter is frequently left in place for about 24 hours. The cat is discharged from the hospital when it appears unlikely that obstruction will reoccur, usually 1-2 days later. If he is experiencing kidney failure and toxemia, intravenous fluids and additional hospitalization are needed.
Are there ways to prevent recurrence?
Increase water intake, through all available methods (see section on increasing your cat’s water intake).
Restrict the cat's intake of dry cat food. Though dry foods do not cause cystitis, several studies have shown that the cat's total fluid intake is decreased when dry diets are fed. When the fluid intake is decreased, the urine is more concentrated with minerals and other materials that can cause future episodes of cystitis. Canned foods can result in increased fluid intake and more dilute urine. A recent study has shown that the rate of recurrence of signs was diminished by 50% simply by feeding a canned food.
If there are bladder stones or a large amount of crystal in urine, a special diet may be recommended, but this is not needed in all cases.
If these changes do not prevent recurring urinary tract signs, additional medical treatment may be indicated. Several medications have recently been evaluated and helped relieve signs in some cats.
Reduction in environmental stress helped 70% of cats to prevent recurrence of idiopathic cystitis. See the following website: http://vet.osu.edu/indoorcat
My male cat has had several urethral obstructions. Can this be prevented?
Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the obstruction. Although this prevents future obstructions, some of these cats will still have an occasional recurrence of cystitis, though usually not as severe. Surgically changing the cat's urethra makes him more prone to bacterial infections in the bladder.
Increasing Your Cat’s Water Intake
The most important thing you can do to help your cat avoid another urinary problem is to increase its water intake. To help you help your pet, we offer the following ways to increase water intake. These tricks can be used by themselves, or in combinations. Please feel free to try the way(s) that are most appealing to you. If you find a way that works well that isn’t on the list, tell us!
- Add water to the food, whether it’s dry or canned. Start slowly, and proceed as your pet’s appetite permits. If you have food available all the time, feeding your pet two meals a day before you start adding water will help it accept the water more readily.
- Place water next to the food. Some animals prefer a full, shallow dish; others seem to like reaching down into a container. You can experiment here to find out what your pet likes best.
- Add “wet” foods to your pet’s food, like water packed tuna, clam juice, (low salt) gravy mixes, etc.
- Offer distilled or bottled water.
- Leave some water in the bottom of a sink, bathtub or shower. Putting a shallow bowl under a slow drip ensures a drink of fresh water whenever your pet wants one.
- Try a pet “fountain” that can be purchased from pet stores.
- Make ice cubes out of meat or fish broth. You can bring the contents of a 6 oz can of tuna or salmon, or a cup of ground meat, to boil in 2 cups water, simmer for 10 minutes, and strain through cheesecloth into an ice tray. A broth cube in your pet’s water bowl will flavor it, and increases water intake in some animals.
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