Feline lower urinary tract disease (FLUTD) is a
collection of conditions that affect the bladder and urethra of cats. This
syndrome can have many possible causes with similar, signs. Cats have
difficulty and pain when urinating, increased frequency of urination, and blood
in the urine. Affected cats tend to lick their genital area excessively, and
sometimes they will urinate outside the litter box.
How is FLUTD diagnosed?
Although cats with lower urinary tract disease
behave in similar ways, the potential causes are multiple. Urinary tract
infections, urinary stones, urethral plugs, cancer, and other disorders can
affect the lower urinary tract of the cat. Because FLUTD can have many causes,
it can be difficult to diagnose.
What are the most common causes of
FLUTD?
Feline Idiopathic Cystitis Feline
idiopathic cystitis (FIC)-also called interstitial cystitis-is the most common
diagnosis in cats with lower urinary tract signs. FIC is a diagnosis of
exclusion, meaning that the term FIC is used if all diagnostics fail to confirm
the presence of another disease such as urinary stones. Cats suffering from FIC
make frequent attempts to urinate, probably as a result of bladder discomfort,
and often are found to have blood in their urine.
Psychologically
stress seems to be an important factor in the development of FIC in cats.
Possible sources of stress in a cat's life may include environmental changes,
changes in food schedule, and changes in the number of animals in the
household.
Environmental enrichment and modification can
reduce stress and decrease the severity and frequency of FIC episodes. To
reduce environmental stress, cats should be provided a safe, clean area in
which to urinate, as well as opportunities to express natural predatory
behavior. These opportunities may include climbing posts and toys that can be
chased and caught.
Many pet food manufacturers market diets formulated
for "urinary health." While these "special diets" may
reduce the likelihood that cats with FIC will develop a urethral obstruction,
there is no evidence that they reduce the incidence of idiopathic feline lower
urinary tract disease itself.
Urolithiasis (Urinary Stones) Another
possible cause of FLUTD is urinary stones-or uroliths-which are rock-hard
collections of minerals that form in the urinary tract of cats. Cats with urinary
stones will exhibit many of the common signs of FLUTD. X-rays or ultrasound are
usually needed to make a diagnosis of urinary stones. The treatment of a cat
with urinary stones depends on the mineral composition of the stones; however,
surgical removal of stones is often required. The two most common stone types
in cats are struvite and calcium oxalate.
For cats with struvite stones, a special
stone-dissolving diet may be prescribed to eliminate the stones. If the diet
fails to dissolve the stone, then surgical removal may be necessary. Struvite
stones are becoming less common in cats, as most commercial feline diets are
now formulated to reduce the likelihood of struvite formation by limiting the
amount of dietary magnesium and by promoting the production of urine that is
more acidic. Unfortunately, the percentage of stones composed of calcium
oxalate has increased. The role-if any-that diet plays in the formation of
calcium oxalate stones is actively being studied.
Unlike struvite stones, calcium oxalate stones
cannot be dissolved with special diets, and more aggressive treatment is
needed. Your veterinarian may be able to induce the stones to pass by flushing
the bladder with sterile fluids. Surgery may be needed to remove bladder stones.
This involves making an incision through the belly. The bladder is lifted into
view, opened, and stones are removed.
Urethral Obstruction The
most serious problem associated with urinary function is urethral obstruction.
Urethral obstruction-when the cat's urethra becomes partly or totally blocked-is
a potentially life-threatening condition and one of the most serious results of
FLUTD. Urinary stones are only one of the causes of urethral obstructions.
Another common cause is urethral plugs. Urethral plugs consist of a soft,
compressible material that contains variable quantities of minerals, cells, and
mucus-like protein.
Male and neutered male cats are at greater risk for
obstruction than females, because their urethra is longer and narrower.
Urethral obstruction is a true medical emergency, and any cat suspected of
suffering from this condition must receive immediate veterinary attention. When
the urethra is completely blocked, the kidneys are no longer able to remove
toxins from the blood and maintain a proper balance of fluids and electrolytes
in the body. If the obstruction is not relieved, the cat will eventually lose
consciousness and die. Death most frequently occurs as a result of electrolyte
imbalances, which ultimately cause heart failure. The time from complete
obstruction until death may be less than twenty-four to forty-eight hours, so
immediate treatment is essential.
A cat experiencing a urethral obstruction behaves
similarly to any other cat with FLUTD: straining to urinate, frequently
attempting to urinate, and producing little, if any, urine. However, as time
passes, an obstructed cat typically becomes much more distressed-often crying
out in pain.
Treatment of urethral obstruction usually involves
catheterization, which is the passage of a narrow tube up the urethra, but other
procedures are sometimes necessary. Unless the cat is comatose, catheterization
usually requires sedation or anesthesia. After the obstruction has been
relieved, treatment varies depending upon the condition of the cat. Dehydration
and electrolyte imbalance are treated with intravenous fluid therapy.
Antibiotics may be given to combat bacteria, and drugs that help restore
bladder function are sometimes required. Hospitalization may range from a few
days to several weeks, depending on the severity and duration of the
obstruction.
For cats who continue to experience urethral
obstruction despite proper medical management, a surgical procedure called a
perineal urethrostomy may be suggested. The surgery involves removing much of
the penis and the narrow portion of the urethra, leaving a wider opening for
the remaining portion. Side effects of surgery can include bleeding for up to
ten days after surgery, narrowing at the surgical site, urinary incontinence,
and a greater incidence of other kinds of bladder diseases. For these reasons,
perineal urethrostomy is usually considered to be a last resort.
What can I do at home to prevent
future occurrences?
A few unfortunate cats who have suffered from lower
urinary tract disease will experience frequent recurrences of bladder
inflammation, re-obstruction, or formation of uroliths. Fortunately, most
others rarely experience the problem again or will have only occasional
recurrences. Home care of cats who have suffered from lower urinary tract
disease is determined by the cause, and varies depending on the cat's condition
and history. Some steps can be taken, however, to help reduce the frequency of
attacks and both the severity and duration of signs when the problem occurs:
Steps to Reduce Occurences and Signs of Lower Urinary
Tract Disease
1.Feed small meals on a frequent basis.
2.For cats with a history of struvite formation,
owners should feed diets that promote the formation of urine that is acidic.
Most commercial diets meet this criteria. Avoid supplementing such diets with
additional urinary acidifiers, because over-acidification can cause metabolic
acidosis, impaired kidney function, and mineral imbalance.
3.Provide clean, fresh water at all times.
4.Provide an adequate number of litter boxes (usually
one more than the number of cats in the household).
5.Keep litter boxes in quiet, safe areas of the
house.
6.Keep litter boxes clean.
7.Minimize major changes in routine.
Signs of Lower Urinary Tract Disease
1.Straining to urinate.
2.Frequent and/or prolonged attempts to urinate.
3.Crying out while urinating.
4.Excessive licking of the genital area.
5.Urinating outside the litter box.
6.Blood in the urine.
***Cats with a urethral obstruction will show the
above signs but will pass little or no urine and will become increasingly
distressed. A urethral obstruction is an absolute emergency, requiring
immediate veterinary treatment.***
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