Friday, February 20, 2015

Urinary Issues In Cats

Most of the time, we expect a cat to take care of its own toilet needs. Most of the time, we pay little attention to when a cat urinates, how many times, time in the litter box, etc. The attention getter is when your cat urinates on your freshly folded laundry or in your favorite chair.

Your cat is having trouble urinating in the litter box when he or she spends more time than expected urinating or is having accidents around the house. As a cat owner, you should be aware of a urinary disease that could have several different names, but are in fact the same disease.

Feline lower urinary tract disease (FLUTD) was formerly called 'feline urologic syndrome' or
FUS, and is now more commonly called 'feline idiopathic cystitis' or 'FIC'. 'Cystitis' is the term commonly used to describe bladder inflammation. 'Idiopathic' means the cause is unknown or more accurately, us idiots don't know the precise cause. Idiopathic cystitis in cats is similar to interstitial cystitis in humans. FLUTD affects the cat's urinary bladder and sometimes the urethra (the tube-like structure that leads from the bladder to the outside of the body).

Since it can be confusing at best, we will refer to it as Feline Urologic Syndrome or simply as FUS

FUS in cats is a serious disease. It can kill a cat. Signs of FUS include:

  • Prolonged squatting or straining in or out of the litter box and not producing urine or only a small amount (some owners may confuse this with signs of constipation) 

  • Frequent urination or straining 
  • Pain while urinating (meowing or howling) 
  • Urinating outside of the litter box 
  • Blood in the urine

  • Frequent licking of the genital area

It is thought that stress may play a major role in the development of FUS. Stressors may include changes in the number of family members (both human and animal); changes in the litter box location, litter type, or cleanliness; changes in diet; a new neighbor cat in the back yard or changes in the routine (e.g., no longer goes outside, owner no longer plays with cat). Remember to think like a cat, not a human. Cats do not need to file taxes on April 15th! That is not the stress I am talking about. What may seem unimportant to you may be the stressor for your cat.

Although the exact cause of FUS is not completely understood, it encompasses four common disorders:

  •  Cystitis: Inflammation of the lining and wall of the bladder.
  • Infections: Blood or mucous in the inflamed urinary tissues indicate bacterial infections.
  • Urethral Blockage: Crystallization of minerals in the bladder plug up the urethra leading to blockage of urinary outflow. This is a life threatening condition.
  •  Uremia: Buildup of toxins in your cat's blood stream when wastes are prevented from  being eliminated due to a blocked urethra.
The most serious symptom of this feline medical problem is caused when small crystals made up of calcium and magnesium form in the bladder. Occasionally these crystals or stones will pass from the bladder to the urethra. When the urethra is blocked, the situation can become critical very rapidly. If left untreated, a feline with a blocked urethra who is unable to urinate can die within 48 hours (worth repeating). If you have a cat who shows signs of painful urination (they will usually cry inside the litter box), or blood in the urine, your pet should be taken to the animal hospital for examination immediately.  

If your cat shows signs of FUS it will always be considered a medical emergency. A completely blocked urethra can lead to death in as little as two days.

At your veterinarian or animal hospital, the following steps will most likely be taken:
  • Catheterization to remove the stones and crystals causing the blockage so the urine can flow again.   
  •  Antibiotics to kill any bacteria that may have formed in the bladder. Known as cystitis, a bacterial infection in the bladder is often noted in cats with FUS.  

  •  Oral urinary acidifiers are often prescribed to maintain your cat's urinary health. Crystal formation is less likely to form in urine that is more acidic and more likely to form in urine that has a high pH (alkaline). Cat owners can use pH sticks to test urine in the cat box to monitor levels for cats who have exhibited FUS  
  • Chronic urinary obstruction in male cats may require surgery to widen the urethral opening. This procedure is known as a perineal urethrostomy, and while it will not prevent the reoccurrence of crystals in cats who are prone to FUS, it will lessen the possibility of a life-threatening blockage.
As a note of interest, we have been using Cold Laser Therapy (January 3, 2015 Blog) as an instrument to decrease inflammation and pain with good success in addition to the standard treatments.

We will send these cats home on a strict diet to address urinary pH, stress, and minerals in the urine. Some of the prescription diets we use are Hill's Science Diet products and Royal Canin.
What ever you want to call it, FUS is a disease you should be aware of if you own a cat. Too many times, the words, "if I had only known sooner" is muttered by the owner when a patient is brought in to the hospital in renal failure or has irreversible damage to the bladder caused by FUS.
 The Providence Veterinary Hospital Blog is a publication of Peter Herman, VMD, at the Providence Veterinary Hospital, 2400 Providence Ave. in Chester, PA. Contact Dr. Herman at 610-872-4000 or visit us at