Feline Lower Urinary Tract Disease (FLUTD)

 In Medical News

Cats can be afflicted with a number of painful (for the cat) and frustrating (for the owner) conditions that affect the lower urinary tract (bladder and urethra). These include cystitis, bladder stones and lower urinary tract obstruction. Symptoms of lower urinary tract diseases in the cat include excessive grooming of the hind end, straining to urinate, crying in the litter box, repeated trips to the litter box, excessive time spent in the litter box, urinating only small amounts or urinating out of the litter box. Owners sometimes notice blood in the urine. These symptoms are grouped into the term “Feline Lower Urinary Tract Disease” or FLUTD. Cats may act sick or depressed but often act normal other than their litter box habits. If you observe your cat displaying any of these symptoms, it is important to bring him/her to the Cat Hospital or a veterinary emergency room quickly, as lower urinary tract obstruction (blockage) is a life threatening condition.

Causes of FLUTD

A number of disease processes can affect the lower urinary tract and cause the symptoms listed above. These include:

  • Bladder infection due to bacterial growth in the bladder which causes inflammation.
  • Urine crystals can irritate the bladder and urethra and cause urethral obstruction.
  • Bladder stones can also irritate the bladder and urethra and cause urethral obstruction.
  • Bladder tumors can develop and cause discomfort or interfere with normal urination.
  • Urethral Obstruction can occur due to inflammation, stones or crystals. In this case your cat will not be able to pass any urine or may only dribble small amounts when he strains.
  • Idiopathic cystitis – This means inflammation of the bladder wall for unknown reasons. This is listed last because it is diagnosed by ruling out the other specific causes of cystitis. It is, by far, the most common cause of FLUTD. If the urethra becomes inflamed as well, urinary tract obstruction can sometimes occur.

Diagnosis of FLUTD

  • Physical Exam – allows us to determine if your cat is blocked, if his bladder is painful, and if he has any other health issues that we need to take into consideration.
  • Urinalysis – allows us to determine the presence of abnormal red or white blood cells, bacteria or crystals in the urine. We also check the urine concentration, pH and other parameters that help us to treat your cat.
  • Bladder Radiograph – allows us to check for stones in the bladder or urethra and to assess the shape of your cat’s bladder.
  • Blood Chemistry and Blood Cell Count – allows us to identify any metabolic problems that may cause or contribute to your cat’s problem.
  • Urine Culture and Sensitivity – allows us to determine if a bacteria is growing in your cat’s urine and, if so, what antibiotics will be effective against it.
  • Ultrasound – if we cannot find the cause of the problem with the preceding tests, we may recommend an ultrasound to help us identify anatomical abnormalities in your cat’s urinary tract.
  • Bladder Biopsy – may be performed in severe cases or in patients with bladder stones that require surgery.

Treatment of FLUTD

The treatment strategy for your cat depends in large part on the findings of the above tests and should be discussed with your doctor but may include several of the following treatment options:

Increasing your cat’s water consumption – this results in more dilute urine that is less likely to cause bladder wall irritation and makes crystal and stones less likely to develop. It can help alleviate symptoms for most causes of feline lower urinary tract disease. Here are some ways to accomplish this:

  • Feed your cat a predominantly canned food diet. You can even add extra water to the food.
  • Keep water fresh and filled to top of bowl, leave multiple bowls around house.
  • Consider bottled or filtered water if your tap water tastes funny.
  • Try a water fountain that filters and circulates water (available through some pet supply catalogs).
  • Some cats will drink from a tap if you leave it dripping.
  • In severe cases, cats can be administered fluids via subcutaneous injection.

Remove stressors that can contribute to bladder discomfort and inflammation. Try as many of the following as possible:

  • Add new litter boxes. You should ideally have one more box than the number of cats in the household.
  • Change the type of litter box and/or litter. For example, add an uncovered litter box if your current boxes have covers and try a litter with a different texture.
  • Keep litter boxes very clean.
  • Determine if affected cat is being bullied by other cats or is stressed out by multicat environment.
  • Use Feliway, a synthetic pheromone spray that has been shown to minimize some stress behaviors in cats. This can be sprayed in various places in the house where the affected cat spends time and is also available as a plug-in diffuser.

Medications may be prescribed based on the results of diagnostic tests:

  • Pain relievers – may help keep your cat more comfortable
  • Antibiotics – may be prescribed if a urine culture indicates it is appropriate, if your doctor suspects an infection or for their anti-inflammatory properties.
  • Prednisolone – a small number of patients may improve with steroid treatment including blocked cats who have sustained urethral trauma from the event.
  • Muscle relaxants – may alleviate the urethral spasm that can occur with cystitis and helps prevent urethral obstruction.
  • Amitriptyline – may help some cats with recurrent idiopathic cystitis
  • GAG Supplements – may help repair bladder wall deficits and ease discomfort
  • CereniaA new drug that has anti-inflammatory properties

Surgery may be necessary

  • to remove bladder stones (cystotomy)
  • for cats who have had repeated urethral obstructions (perineal urethrostomy).

A Prescription Diet may be recommended by your veterinarian to decrease the chance of stone or crystal formation. These diets can be found at the hospital or via our online pharmacy which is accessible through our website.

If your cat is “blocked” he will need to be sedated, unblocked and treated in the hospital for several days. Once he’s recovered, the above treatments (1-5) may apply.

Prognosis and Follow-up

Uncomplicated urinary tract infections usually resolve after treatment with an antibiotic. It is important that you bring your cat in for a recheck urinalysis one week after antibiotics are finished. If infections persist or recur, testing to identify a predisposing condition need to be performed.

Crystals can usually be controlled by switching your cat to an appropriate diet. Some cats require medication. Your doctor will let you know when your cat needs a recheck.

Bladder stones can sometimes be dissolved with a diet change, but often require surgical removal. Following treatment, it is important to implement any dietary or medical changes suggested by your veterinarian to prevent the stones from reforming.

Urethral obstruction is a life threatening condition. However, once the patient is stabilized, the prognosis is excellent. After your cat has recovered, is critical that you follow your veterinarians advice for long term management, as cats who have “blocked” are prone to this condition recurring. If you ever notice your cat showing any of the symptoms listed in the first paragraph of this handout, call the Cat Hospital immediately. The earlier an obstruction is detected, the easier (and less expensive) it is to treat. Your doctor will recommend a recheck exam and urinalysis in the weeks following his discharge.

Cats who have had a history of FLUTD should have a urinalysis checked yearly at their annual exam.

Website Resources

https://indoorpet.osu.edu/cats

http://www.catvets.com/cat-owners/disease-and-conditions/flutd

http://www.vet.cornell.edu/fhc/health_information/brochure_urinary.cfm

http://www.feliway.com/us/

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