Feline Lower Urinary Tract Disorder (FLUTD)

Cystitis In Cats

Feline Lower Urinary Tract Disorder (FLUTD) is a general term used to describe all causes of cystitis (an inflamed urinary bladder) in cats. Cystitis can be due to infection, crystals or stones, stress, tumours or idiopathic (unknown cause), all of which are incredibly uncomfortable and disrupt the normal flow of urine.

The cause of FLUTD is not well understood but there are several factors that can play a role in the development of cystitis. Some factors include stress, diet, genetics and activity levels. These may lead to the development of crystals in the urine, which irritate the bladder wall. True urinary infection with a build up of bacteria is uncommon in otherwise healthy cats but must be ruled out by urinalysis.

FLUTD cats are often incredibly painful and in cases where there is an outflow blockage of urine due to an obstruction, cats can potentially die, as the inability to excrete urine can be life threatening within 24-48 hours.

Symptoms of FLUTD

  • Straining to urinate
  • Passing only small amounts of urine
  • Frequent squatting
  • Blood in urine
  • Smelly or cloudy urine
  • Urinating in inappropriate places
  • Excessive vocalising
  • Excessive licking of the genital area
  • Loss of appetite
  • Lethargy
  • Change in behaviour eg. hiding

Diagnosis

After your veterinarian has gathered a thorough history of your cat’s symptoms they can confidently diagnose FLUTD with various diagnostic tests. This may include urinalysis, blood tests, bacterial cultures, ultrasound imaging and radiology.

Treatment

Your veterinarian may prescribe medications for any infection, pain and inflammation. They also may recommend changing your cats diet and eating habits.

What can I do as a cat owner to prevent FLUTD?

Depending on the diagnosis made by your veterinarian, certain recommendations can help prevent recurrent cystitis episodes.

Water

Most cats will benefit from increased water consumption and therefore dilution of urine – the more dilute, the less irritant and less likely they are to form crystals in their urine. You can encourage cats to ‘drink’ more water by feeding wet food, adding extra water to their diet, offering broths to lap and using cat water fountain bowls which provide freshly circulated water all day long.

Diet

  • Cats with very concentrated urine or crystal formation will benefit from being on an all wet food diet to help dilute urine.
  • For cats that have struvite crystals we highly recommend feeding your cat a good quality pet food that is low in crystal forming minerals such as magnesium, phosphate and calcium.
  • Some diets, such as Royal Canin Urinary S/O, contain a urine dilution complex that decreases the formation of urinary crystals and provides the bladder with a larger volume of fluid to essentially flush it out.
  • A good quality diet also helps maintain the correct pH levels to prevent the formation of crystals.

Stress Management

Stress plays an important role in the management of FLUTD. Cats that are stressed are less likely to eat or drink, which means they wont be getting the right amount of hydration that their body needs to remove harmful waste products. Stress in the home (such as aggression between cats or changes in furniture and family members) can often bring on an episode of cystitis.

Things you can try:

  • Talk to your veterinarian about your cats stressful behaviour
  • Identify what that may have brought on the stress and avoid the situation
  • Minimise changes in the house such as moving furniture around
  • Try Feliway Spray– A synthetic pheromone that helps reduce stress in cats

Toileting Habits

Cats can be very particular about their bathroom! The golden rule for litter trays is one for each cat in the house plus a spare. So if you have two cats, the ideal number of litter trays is three.

Your cat may not like the substrate used in the litter tray. Try different types of litter (eg. crystals, clumping, pellets, soil) as they may prefer one over another. Make sure the litter is always clean – cats will ‘hold on’ if the tray is dirty. Ensure the toileting area is private and there is no competition that is preventing the cat getting to the tray, such as a grumpy feline housemate or scary dog in the way!

It’s important to remember cats are very resilient creatures and they often deal with an enormous amount of pain and discomfort before they let out something is wrong. Keep an eye on your pet’s behaviours and if you notice anything out of the ordinary please contact us for advice.

Blocked Bladder in Male Cats

What does a blocked bladder mean and why is it a life threatening condition?

When a male cat is experiencing a blocked bladder it means that they are unable to expel urine due to an obstruction of the urethra (the tube that drains the urine from the bladder, out through the penis). Male cats are more prone to this condition due to their physical anatomy. Their urethra is very narrow, allowing for a blockage to occur easily.

The role of the kidneys is to remove metabolic waste and regulate the balance of electrolytes in the body. Obstruction of the urethra results in reduced urinary excretion of potassium which leads to hyperkalaemia (increased levels of potassium in the blood). Hyperkalaemia results in a disturbance to the electrical activity of the heart, causing fatal cardiac arrhythmias. This is one reason why a blocked bladder is an emergency life-threatening condition.

Causes:

  • Feline lower urinary tract disease (idiopathic cystitis)
  • Urinary tract infection
  • Urethral plug (accumulation of debris)
  • Uroliths (bladder and urethral stone formation)
  • Trauma
  • Spinal cord damage

Symptoms:

  • Straining to urinate
  • Vocalising, howling, meow
  • Licking the genital area
  • Blood in the urine
  • Loss of appetite
  • Depression
  • Vomiting
  • Lethargy

How is a blocked bladder diagnosed?

During the initial examination of your cat the vet will palpate the bladder. If blocked, the bladder is likely to feel enlarged and firm. The vet will ask questions regarding your cats urinating habits such as when they last urinated, how much urine was there, what colour was the urine and was it easily passed or was your cat straining or in pain. A blood test will confirm any electrolyte imbalances or toxin accumulation (such as high potassium or urea) and check your cat’s overall health. An x-ray may also be performed to confirm the enlarged bladder, assess any trauma or identify the presence of bladder stones.

How is a blocked bladder treated?

Immediately your cat’s bladder needs to be unblocked. This is achieved by passing a urinary catheter through the urethra under general anaesthetic. The urethra is usually full of inflammatory debris and/or crystals, and the muscles surrounding the cat’s urethra may spasm, making it very difficult for the catheter to be passed. A general anaesthetic also ensures that the cat does not suffer any pain during the insertion of the catheter.

If placing the catheter is initially unsuccessful, the vet may at first remove some urine directly from the bladder using a needle and syringe. This procedure is called cystocentesis. A urine analysis and sometimes urine culture will also assist with the assessment of kidney function, the presence or absence of crystals, and the presence or absence of urinary tract infection.

A different type of catheter (intravenous catheter) will be placed in your cat’s front leg to administer supportive fluid therapy and they will also be given pain relief and antispasmodic medications. In most cases a blocked bladder patient will spend several days in hospital under close observation.

Long-term management

Once your cat has recovered from a blocked bladder its very important that certain lifestyle changes are made to prevent further episodes. In the case where the obstruction involved the presence of crystals or was the result of a urolith (bladder stone), there are specific diets that your cat can be fed to reduce the formation of these and increase urine dilution.

Cats that have reoccurring episodes may require corrective surgery called perineal urethrostomy to widen and shorten the urethra, preventing future episodes of obstruction.

Indoor toileting problems in cats

Marking or toileting?

Indoor marking behaviour can be confused with a breakdown in toileting behaviour.  Territorial marking by urine spraying which usually occurs against vertical objects such as chairs or walls and can be distinguished from urinating where a greater volume of liquid is deposited from a squatting position by both male and female cats.  However, sometimes a small volume of concentrated urine is also deposited from a squatting position as a mark, and faeces can also be used to mark territory in a behaviour known as middening.

Why do cats toilet indoors?

One of the reasons cats make good pets is that they usually learn very early and with little effort from us that our homes are not toilets.  Kittens almost instinctively head for the litter tray at even a few weeks of age and usually make the transfer fully to the garden once allowed out.  Some individuals take longer to learn than others and some longhair breeds can be notoriously difficult to establish as house trained.  Yet others develop clean indoor behaviour normally and then suffer a breakdown, perhaps as a result of illness and then fail to re-establish their previous clean behaviour.

Treatment

Several aspects of the cat’s environment can be altered to try and treat the problem.

The litter tray

(a)          Number of litter trays

One tray per cat is a good rough guide, as many cats do not like to share trays.  Having tray in geographically separate areas, e.g. kitchen and laundry also helps.

(b)          Type of litter

Several types of cat litter can be offered, such as Fuller’s Earth granule types, wood chip pellet, re-usable waxed granule varieties or finer grained litters.  Cats often prefer finely grained substrates such as sand or a proprietary brand with sand-like texture.  If the cat is to be allowed outdoors the litter can be mixed with soil from the garden to help transfer toileting behaviour completely to the outdoors later (ensure vaccinations are up to date).

(c)          Cleaning

The litter tray should neither be allowed to get too dirty as this will discourage most cats, nor should it be cleaned too often as the presence of the cat’s own smell on the litter will help to develop the idea of a latrine. Solids can be removed regularly but  the more cats use a tray, the more often it will need to be cleaned, but one per day per cats is recommended.  (Cats don’t like litter that reaks of ammonia!)

(d)          Security and position

An open litter tray in a busy part of the room may make some cats feel very vulnerable and they may prefer to eliminate (urine or faeces) behind the furniture or in a quite corner.  Place the tray in a secure quiet place and either cover with an inverted cardboard box with a hole cut in it for entry and exit or buy a proprietary litter covered litter box. for those that seem anxious, although many prefer an open tray.  Cats may usually be most unwilling to use a litter tray placed too close to a feeding area.

Encouraging use/preventing accidents

Confine the cat in a kittening pen in a small room with only enough space for a bed and a litter tray.  The desire to avoid soiling the bed is established early in life and he or she should move as far away from the bed as possible to eliminate and this will mean using the litter tray.  Hopefully within a few days the cat should again being to associate toileting with the litter tray.  The cat should be kept in the cage indoors at all times when the owner is unable to supervise.  After a couple of days of ‘good aim’ the cat can be allowed out of the cage only into the room where it is kept and the litter tray moved progressively further away from the bed.  Access to the rest of the house should be allowed one room at a time and only under supervision for the initial introduction to each room.

Cleaning up

Before allowing access to any room, all previous unwanted toileting areas should be thoroughly cleaned using a proprietary ‘urine digester’ or a warm solution of a biological washing powder or liquid followed by a light scrubbing with an alcohol such as surgical spirit.  (check that cleaning does not remove colour from carpet etc.) The area should be left to dry thoroughly before supervised access is allowed. 

Other ways of increasing security

  1. Board up the cat flap where appropriate to help redefine the indoors from the outdoors and the safety of the home. This will also help manage the cat’s access to the indoors and aid supervision when there. It may help to put the cat out immediately after feeding as toileting sometimes follows.  The cat should generally be encouraged to spend more time outdoors as the more he is out the greater the chance of needing to go to the toilet in a suitable place and its development as a latrine.
  2. Never punish cats. If caught in the act they can be picked up and placed on the litter tray, stroked and calmed.  Never ‘rub the cat’s nose in it’ as this will make a nervous cat even more likely to toilet indoors.
  3. The speed and success of treatment may be assisted by the use of certain drugs, particularly with nervous or agoraphobic cats. This option should be discussed with your vet and only used in conjunction with  the above suggestions.

Finally, in difficult cases, consultation with a veterinarian with a special interest in animal behaviour can be rewarding, because he/she has vast experience with these cases and many special tips that may help.

Bladder Stones (Calculi)

What are bladder stones?

Bladder stones, more correctly called uroliths, or cystic calculi are rock-like collections of minerals that form in the urinary bladder. They may occur as a large, single stone or as collections of stones the size of large grains of sand or gravel.

Are these the same as gall stones or kidney stones?

No. Gall stones are in the gall bladder, and kidney stones are in the kidney. Although the kidneys and urinary bladder are both part of the urinary system, kidney stones are usually unrelated to bladder stones.

What problems do bladder stones cause?

The two most common signs of bladder stones are haematuria (blood in the urine) and dysuria (straining to urinate). Haematuria occurs because the stones mechanically irritate the bladder wall, causing bleeding from its surface. Dysuria occurs when stones obstruct the passage of urine out of the bladder. Large stones may cause a partial obstruction at the point where the urine leaves the bladder and enters the urethra; small stones may flow with the urine into the urethra and cause an obstruction there.

When an obstruction occurs, the bladder cannot be emptied and this is very painful. Your dog may cry in pain, especially if pressure is applied to the abdominal wall.

Haematuria and dysuria are the most common signs seen in dogs with bladder stones but with obstruction there is usually pain as well. We know this because when bladder stones are removed surgically, many owners tell us how much better and more active their dog feels.

Why do they form?

There are several theories to explain the formation of bladder stones.  Each is feasible in some circumstances, but there is probably an interaction of more than one of them in each dog. The most commonly accepted theory is called the Precipitation-Crystallisation Theory. This theory states that one or more stone-forming crystalline compounds is present in elevated levels in the urine. This may be due to abnormalities in diet or due to some previous disease in the bladder, especially infection with bacteria. Sometimes the condition may be due to a fault in body chemistry. When the amount of this compound reaches a threshold level, the urine is said to be supersaturated. This means that the level of the compound is so great that it cannot all be dissolved in the urine, so it precipitates and forms tiny crystals. These crystals stick together, usually due to mucus-like material within the bladder, and stones gradually form. As time passes, the stones enlarge and increase in number.

How fast do they grow?

Growth will depend on the quantity of crystalline material present and the degree of infection present. Although it may take months for a large stone to grow, some sizeable stones have been documented to form in as little as two weeks.

How are they diagnosed?

Most dogs that have bladder infections do not have bladder stones. These dogs will often have blood in the urine and will strain to urinate, the same symptoms as a dog with bladder stones. Therefore, we do not suspect bladder stones just based on these clinical signs.

Some bladder stones can be palpated (felt with the fingers) through the abdominal wall. However, failure to palpate them does not rule them out.

Most bladder stones are visible on radiographs (x-rays) or an ultrasound examination. These procedures are performed if stones are suspected. This includes dogs that show unusual pain when the bladder is palpated, dogs that have recurrent haematuria and dysuria, or dogs that have recurrent bacterial infections in the bladder.

Some bladder stones are not visible on radiographs. They are said to be radiolucent. This means that their mineral composition is such that they do not reflect the x-ray beam. These stones may be found with an ultrasound examination (if available) or with special radiographs that are made after placing a special dye (contrast material) in the bladder.

How are bladder stones treated?

There are two options for treatment. The fastest way is to remove them surgically. This requires major surgery in which the abdomen and bladder are opened. Following two to four days of recovery, the dog is relieved of pain and dysuria. The haematuria will often persist for a few more days, then it stops. Surgery is not the best option for all patients; however, those with urethral obstruction and those with bacterial infections associated with the stones should be operated upon unless there are other health conditions that prohibit surgery.

The second option is to dissolve the stone with a special diet. This avoids surgery and can be a very good choice for some dogs. However, it has three disadvantages.

  1. It is not successful for all types of stones. Unless some sand-sized stones can be collected from the urine and analysed, it is not possible to know if the stone is of the composition that is likely to be dissolved.
  2. It is slow. It may take several weeks or a few months to dissolve a large stone so the dog may continue to have haematuria and dysuria during that time.
  3. Not all dogs will eat the special diet. The diet is not as tasty as the foods that many dogs are fed. If it is not consumed exclusively, it will not work.

Can bladder stones be prevented?

The answer is a qualified “yes.” There are at least four types of bladder stones, based on their chemical composition. If stones are removed surgically or if some small ones pass in the urine, they should be analysed for their chemical composition. This will permit us to determine if a special diet will be helpful in preventing recurrence. If a bacterial infection causes stone formation, it is recommended that periodic urinalyses and urine cultures be performed to determine when antibiotics should be given.

 

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