Feline lower urinary tract disease

Feline lower urinary tract disease (FLUTD) includes a group of disorders that affect the bladder and urethra of cats.

This includes urinary tract infections, crystals, bladder stones, cancers, urethral plugs and a condition called idiopathic or interstitial cystitis.
Regardless of the cause the symptoms are very similar:

-Increased frequency of urination
-Passage of only small amounts of urine
-Straining to urinate
-Blood in the urine
-Distressed meowing and pain while urinating
-Increased grooming of the genital region
-Urinating in inappropriate locations (bathtubs or skins, tiles, etc)
-Other symptoms include lethargy, loss of appetite, vomiting, hiding or avoiding contact with the family.

Diagnosis

Diagnostic tests are necessary to elucidate the cause of FLUTD and exclude other diseases. After a complete medical history and physical examination a urine analysis and culture is mandatory. This will help to identify urinary tract infection, inflammation, bacteria, and to detect the presence of blood, crystals or cancer cells in the urine.
According to those results radiographs or an ultrasound of the bladder might be recommended to rule out the presence of bladder stones, cancers or anatomical defects.
In older animals a blood test might also be suggested to rule out any underlying conditions such as kidney problems, diabetes, liver disorders and others.
Finally a cystoscopy and bladder biopsy can be performed but is rarely necessary.
When diagnostic tests fail to identify a cause for the symptoms we conclude that the cat suffers from idiopathic or interstitial cystitis.

Idiopathic cystitis

Idiopathic cystitis is the most common cause of FLUTD in cats. Unfortunately, after many years of research the cause remains unknown and is believed to be multifactorial.

Potential causes include:

-Stress and anxiety
-Indoor, sedentary life style and obesity
-Genetic factors
-Type of diet and water intake
-Deficient glycosaminoglycan protective layer of the bladder
-Use of indoor litter tray
-Multi-animal house hold where there is often tension between cats.
-Viruses
-Others

Regardless of the cause stress can precipitate an episode of cystitis.

Suggested stress factors for cats include:

-Living in a multiple animal household, especially when there is tension and conflict between cats.
-Moving house, changes in the environment or building work in the house.
-New addition to the house (new animal, new baby, visitors, etc)
-Competition for using a litter tray or using a box that the cat does not like.
-Providing a dirty litter or placing the box in an unsuitable location.
-New cat moving into the neighbourhood.
-Change in the owner’s schedule or stresses in the owner’s life can be picked up by the cat.

Treatment 

When a specific cause can be found the treatment consists of treating that condition. Unfortunately in cases of idiopathic/interstitial cystitis there is no specific treatment but a lot of measures can be undertaken to reduce the severity and frequency of the episodes.

1-Diet

-We recommend feeding a diet formulated for cats with urinary tract problems. A moist diet is ideal as it contains more water and will encourage production of more diluted urine. Royal Canine Urinary S/O is an excellent diet as it will encourage your cat to drink more and contains ingredients keeping the inner glycosaminoglycan lining of the bladder in good health. It also helps keeping the pH of the urine close to neutral.
-If your cat does not like to eat tinned or moist food you can try to add water to his or her dry kibble.

2-Increase water intake

-Cats prefer to eat and drink in different places of the house so water and food bowls should not be placed next to each other and use of double bowls with food on one side and water on the other is not advised.
-Cats usually prefer drinking from metal, glass or ceramic rather than plastic bowls.
-The bowl should have a large diameter as cats do not usually like their whiskers to touch the side of their water bowl.
-It is also advised to place a water bowl on each floor of the house, in a quiet place, easily accessible and never too far from where your cat may be sitting or sleeping.
-The bowl should be filled to the brim. Cats rarely drink from bowls that are not completely full.
-Some cats like drinking moving water so providing a pet water fountain can be helpful.
-It is also a good idea to try water from different sources.
-Sometimes adding ice cubes to the water will stimulate cats to drink.
-Offering flavoured water may encourage your cat to drink more but it must not be salty. For example you can poach chicken or fish in unsalted water and offer the liquid to your cat as a drink. You can also offer juice from a drained can of tuna or salmon in spring water (not brine as this is very salty). Liquifying fish or prawns in water to create a fishy broth can also help. This can be frozen in form of ice cubes and later added to a bowl of fresh water. Do not use stock cubes as many of these contain onions that are toxic for cats. Flavoured water might help encourage your cat to drink more but must not consist of their main water supply. Normal fresh water is still the best for your cat.

3-Litter boxes

-Make sure you have enough litter trays in the house (usually at least one for each cat) and make sure they are placed on each floor of the house, in a quiet and accessible area.
-Covered litter boxes can be unpopular with some cats so provide different forms and shapes.
-Litter box hygiene is essential. Ensure daily scooping of the urine and faeces and full cleaning of the box with replacement of the litter should be performed once a week. The litter type should be selected to be one that the cat likes. Perfumed or uncomfortable litter should be avoided..
-Deep litter should be used and filled enough so that the cat can dig and bury its urine and faeces.
-Stress
-Environmental enrichment is an excellent way to reduce stress especially for strictly indoor cats. Please refer to our hand out for further information.
-Feliway (feline pheromones) are chemicals which cats use to communicate with each other. Feliway decreases the perception of threat and increases feeling of safety in the home. It is available as a spray or leave in diffuser and is usually highly recommended in cats suffering from idiopathic cystitis.
-In severe cases anxiolytic medications can be prescribed.

4-Glycosaminoglycans

In chronic cases glycosaminoglycan supplements can be prescribed. It has been shown to be beneficial in certain cases and help to protect the inner lining of the bladder. It is believed they might also have some anti-inflammatory property. There are possible side effects that include loss of appetite and problems with blood clotting.

Glucosamine and chondroitin supplements can also be beneficial in certain cases. They are also believed to protect the inner lining of the bladder.

5-Pain relief

Acute episodes are very painful and distressing. Very commonly pain relief, anti-inflammatories and spasmolytics will be prescribed to increase your cat’s comfort.

6-Antibiotics

If there are any signs of bacterial infection a course of antibiotics will also be prescribed.

Hopefully this guide will help you dealing with your cat’s urinary tract problem but if you have any questions do not hesitate to contact our team.