FLUTD: Feline Lower Urinary Tract Disease

FLUTD covers disorders affecting the urinary system of cats. Typical symptoms include inappropriate urination (unusual location, vocalization, or posturing to urinate), straining to urinate, urinating small amounts, and blood in the urine. These episodes can be very stressful for both the affected cats and their owners. In some cases these cats can become obstructed (unable to pass urine) which is a very serious and potentially fatal condition if not treated. Urination problems are among the most common reasons that cats are surrendered to shelters or euthanized. Fortunately the attention of many animal care professionals is very focused on identifying possible contributing factors to this disease and to the development of ways to diagnose and better treat this frustrating condition.

The most common causes of FLUTD vary with a cat’s age. Up to 65% of cats below the age of ten are most likely to have signs resulting from idiopathic cystitis which is inflammation of the bladder wall without a known cause. Other common causes for this age group include bladder or kidney stones, and urethral plugs (balls of inflammatory cells, mucus, blood clot that can become lodged in the urethra). Cats above the age of ten are more likely to have a urinary tract infection, or in rare cases bladder neoplasia (cancer). Other much less common causes include strictly a behavioral disorder or anatomic abnormality.

Unfortunately there is no test for the most common cause of FLUTD: idiopathic cystitis. The diagnosis of idiopathic cystitis depends on ruling out other known causes of urinary tract signs. After the physical exam two very important tests used to make this determination are urinalysis (possibly with an accompanying urine culture depending on the situation) and survey x-rays. The urinalysis tells us many things like urine concentration (which can be evidence of good kidney function), the presence of different types of crystals, and inflammatory cells, and urine pH. Older cats, cats with kidney disease, or cats that have had previous surgery or trauma to their urinary tract are more likely to have an infection at the root of their clinical signs and should have their urine cultured. A urine culture reveals what type(s) of bacteria are present and which antibiotics will be effective. The x-rays can help us visualize things like kidney and bladder size and shape, as well as the presence of stones. For cats who have very severe or recurrent signs or who fall into the over ten age bracket abdominal ultrasound may be warranted. Ultrasound can offer a more sensitive look at the kidneys, ureters, bladder, and urethra to help identify specific problems and help your veterinarian create the best possible treatment plan.

If you find yourself with a cat who suffers from idiopathic cystitis there are some things you should know. First of all most episodes last only a few days. Your veterinarian can dispense medications that can help make the episode less uncomfortable for your cat. Minimizing stress may not be entirely curative but has been theorized to reduce the number and severity of future episodes. Factors that can contribute to feline stress include multi-cat conflict, noisy households, poor litter box hygiene or too few boxes, and boredom. Some suggestions for the environment are providing safe spots for your cat to rest uninterrupted, cat condos for perching and climbing, vertical and horizontal scratching posts, window seats with views of outside activity for indoor only cats, interactive toys, cat videos, and regular sessions of whatever mode of human interaction your cat most prefers. Stress hormones are also reduced in cats that have a consistent and predictable feeding routine. Feline facial pheromones (Feliway®) seem to be effective in decreasing stress. The most recent recommendations regarding litter pans are a litter box for each cat plus one. The pans should be in areas out of the line of everyday household traffic. Cats generally prefer large open top litter pans with unscented clumping litter. (This author’s cats prefer Arm & Hammer clumping litter). Pans should be scooped daily and cleaned completely once to twice a week. In cases where cats are urinating outside the box one specialist also suggests filling a large sweater box with litter and making it deeper on one side with a gradient to the shallow side to see what depth of litter your cat most prefers.

There is some thought that adding glycosaminoglycans such as glucosamine may help. There have been promising results using this product in women with idiopathic cystitis. Another medication used in both humans and cats with this condition is Amitriptyline. Amitriptyline is a tricyclic antidepressant that has analgesic and antinflammatory properties. Both of these medications appear only to be beneficial for long term management.

Many of the recommendations discussed above are based on anecdotal evidence but there is one thing that has been statistically proven to help these cats and that is to increase daily water consumption. Gradually (in a non-stressful manner) starting to offer a well liked canned food over a period of 4-6 weeks over which you slowly reduce the amount of dry food offered is likely to help. Feeding canned food three to four times a day will also help increase overall water intake. You may also consider adding chicken broth or tuna juice to the food along with adding a bubbler fountain or offering bottled water instead of water from the tap.

As this discussion described, FLUTD is clearly a multifactorial disease and each factor may contribute to each patient’s condition to varying degrees. Your veterinarian is prepared to help you identify risk factors in your home and will help tailor an appropriate management plan for your beloved feline.