A Tale of FLUTD

Feline Lower Urinary Tract Disease  

Think about the things that cause you stress.  What is on top of your list?  Is it change?  If you are a cat, the top of your stress list is change.  And if you are a cat, the most likely part of your body to experience a negative response to that change, is your lower urinary tract.  The most common reason for cats to be returned to shelters or abandoned is inappropriate urination.  The most common reason for cats to be hospitalized is urinary obstruction due to lower urinary tract disease.  It is one, if not the, most important topic in feline medicine.  Let’s learn more.   

Feline Lower Urinary Tract Disease (FLUTD) is an umbrella term for anything that causes inflammation to the urinary tract.  This includes urinary tract infections, bladder stones, blader cancer, and sterile cystitis.  Let’s talk briefly about the first three, and then talk a LOT about the last one.   

True urinary tract infections are actually quite uncommon, especially in young, otherwise healthy, male cats.  The male urethra is designed to resist infection, and without an underlying cause, it just doesn’t happen very often.  Female cats do have a higher risk of infection, but in young healthy cats without underlying disease, it is still fairly uncommon.  Underlying disease factors include: diabetes, kidney disease, and bladder or kidney stones.  Some medications, especially oral steroids, can also increase the risk of a true urinary tract infection.  Medical procedures, such as urinary catheterization and perineal urethrostomy increase the risk of infection, but are generally only done in cats who are already undergoing treatment for urinary obstruction.  Cats with a urinary tract infection will experience discomfort which leads to straining to urinate, frequent trips to the litter box, small and frequent urination, urinary accidents and blood in the urine.   

Bladder stones are relatively common.  Bladder stones are caused by an accumulation of crystals in the bladder.  Crystals might start to form due to high urine concentration (routinely not drinking enough water) and urine pH.  The accumulation of these crystals causes a stone to form.  Stones can range in size from very small to very large, and can vary in number.  Cats with a urinary tract infection will experience discomfort which leads to straining to urinate, frequent trips to the litter box, small and frequent urination, urinary accidents and blood in the urine.  Treatment is most commonly done with surgical removal.  Sometimes the stones can be dissolved, but this takes a long time and puts the patient at risk for urinary tract infection, discomfort, and urethral obstruction.   

Bladder cancer is quite rare in cats.  There isn’t a lot to say on the topic, as the diagnosis just really isn’t very common.  Bladder cancer is more common in dogs.  As frequently as cats are seen for lower urinary tract problems, it’s a HUGE win for cats to have such a low incidence of bladder cancer.   

From the very rare bladder cancer, let’s move to the very common, idiopathic cystitis.  Idiopathic cystitis or sterile cystitis is an inflammation of the bladder wall.  Idiopathic means something that happens spontaneously and does not have a clear cause.  Cystitis means inflammation of the bladder wall.  Sterile means no bacteria present.  In other words, sometimes cats develop a very inflamed bladder wall spontaneously, and without clear explanation as to why!  This can happen to both male and female cats, but male cats have a much higher risk of developing a urethral obstruction. This is without a doubt, the most common reason for cats to urinate outside of the litterbox, and is the most common reason for cats to spend the night in a veterinary hospital.  It may be idiopathic, but we know that it has a correlation with stress.  Cats who are undergoing or have undergone a recent move, change in ownership, vacation, boarding, pet sitter, change in owner’s job, new baby in the house, new puppy, or new cat   will experience stress, and sometimes this leads to bladder inflammation.  (remember how we started this conversation?  Cats don’t like change!).    

No discussion of FLUTD would be complete without an in depth discussion of urethral obstruction.  This occurs when something obstructs the urethra, and the cat cannot urinate.  A cat who cannot urinate, almost always a male, is experiencing an emergency.  The obstruction is relieved by passing a urinary catheter.  The catheter is left in place for 2-3 days to allow the inflammation of the urethra to come down, and to flush the kidney and bladder with IV fluids.  The obstruction can be caused by any of the things we discussed above!  Urinary tract infection, stones, cancer, or most commonly, sterile cystitis.  Yes, inflammation alone is enough to cause the urethra to constrict and prevent the cat from being able to void his bladder.  The more quickly the obstruction can be relieved, the better the outcome.  Obstructions that are not relieved quickly can cause damage to the kidneys, cardiac arrythmias, and death.   

So what can we do about it?  While nothing is 100%, there are some very good things we can do to help keep our cats safe and healthy.   

1. Be aware of the impact of change, transition and stress on cats.  Watch them closely during times of change or transition, and catch problems early on.   

1. Take steps to head off stress.  If you are anticipating a transition, talk to your veterinarian about a mild sedative.  Tools like Feliway, an artificial pheromone spray, can help to mitigate the stress of transition.   

1. Give great attention to litterboxes in the home.  Most experts recommend one more litterbox than the number of cats in the home.  In other words, a three cat home would have four litterboxes.  These should be in quiet, low traffic areas.  At least one litterbox should be open (without a top) and should be regularly cleaned.   

1. Provide environmental enrichment.  Toys, bird sounds, attention from their humans, play time etc.   

1. HYDRATE!  Cats have a low drive to drink water.  We have to encourage them.  The top way of doing this is to feed a canned food.  If acceptable to the palate of the cat, water can be added to the canned diet.  Provide multiple water bowls, some of which should be wide enough for the cats whiskers.  Offer running water to those cats who still need encouragement.   

1. Canned food.  Canned food deserves its own line!  Canned food is preferred to dry due to its high moisture content, lower carbohydrates, and higher protein.  Many cats will benefit from a prescription urinary diet.  Prescription urinary diets are preferred to over the counter urinary diets.  Canned diets are preferred even to prescription diets.     

1. Keep cats at a healthy weight.  Overweight cats are more likely to experience a urethral obstruction.  (check out the canned food note!  Canned food is lower in carbohydrate, higher in protein.  It’s a better diet food than dry).    

1. Consider enrolling in pet insurance.  A urethral obstruction is very costly.  Look in to pet insurance, and see if it would be beneficial for your family.  Remember to ask questions about pre-existing conditions.  Some pet insurances will be very stringent on pre-existing conditions, which can impact the coverage your pet is able to receive.  

Although there is nothing that is 100%, making a few small changes in your household can be very beneficial to your cats.  This disease is far too common to ignore.  Talk to your veterinarian if you have questions or concerns over your cat’s lower urinary tract health.