If you were to ask a group of veterinary professionals to share what brings pets into their clinics most often, many would say that for dogs, it’s skin conditions (or eating stuff they’re not supposed to!), and for cats, it’s urinary problems.
Cats are especially prone to a condition called FLUTD, which stands for “Feline Lower Urinary Tract Disease.” FLUTD (previously known as FUS, or “Feline Urologic Syndrome”) is not really a distinct disease in itself. Rather, it describes a collection of conditions that can affect the bladder and urethra of cats.
The Urinary Tract
To better understand how FLUTD affects cats, first let’s take a quick look at how the urinary tract works.
The urinary tract is made up of the kidneys, which filter toxins out of the blood and create urine; the ureters, tubes that connect the kidneys to the bladder; the bladder, an elastic, muscular sac that serves as a reservoir for urine; and the urethra, which connects the bladder to the outside of the body where urine is expelled.
So What Exactly is FLUTD?
FLUTD is a syndrome that can have many possible causes, which sometimes makes it difficult to diagnose. It’s most frequently seen in middle-aged cats (cats age 3-7 years are at highest risk) who are overweight, get little exercise, live in multiple-cat households, and eat a dry diet. Stress and changes in routine have also been linked to cats developing FLUTD.
Any cats can be affected, although Persians and Himalayans seem to be affected more than other breeds. Both male and female cats can suffer from FLUTD, but males are most at risk for developing the most serious condition: urethral obstruction, a life-threatening blockage of the urethra.
FLUTD is NOT the same as a bladder infection. Bacteria are very rarely involved, as most of these are “sterile” inflammations. Some studies have suggested that occurrences seem to happen more often in the spring and fall, and after major holidays (which would support the theory that stress is a factor).
FLUTD is extremely painful. Cats with this condition will typically experience several days of symptoms, then may go several weeks without symptoms before they eventually relapse.
Symptoms of FLUTD include:
- Difficulty and pain when urinating
- Increased frequency of urination
- Decreased output of urine (or being completely unable to urinate)
- Crying out while urinating
- Blood in the urine
- Excessive licking of the genital area
- Urinating outside the litter box in unusual locations (often on cool, smooth surfaces like a tile floor, sink, or bathtub)
- Personality changes such as hiding or aggressive behavior
Any cat exhibiting these symptoms should be seen by a veterinarian immediately.
What Causes FLUTD?
FLUTD can be caused by a variety of factors. The most common include:
1. Feline Idiopathic Cystitis
Feline idiopathic cystitis, or FIC (also known as “feline interstitial cystitis”) is the most common diagnosis in cats with lower urinary tract signs. Cystitis is an inflammation of the bladder, and idiopathic means “of unknown cause”, so no one really knows what causes the inflammation.
FIC is the catch-all term used when tests fail to confirm the presence of another disease (such as urinary stones). Symptoms in cats diagnosed with FIC may resolve spontaneously on their own without treatment, but it’s always best to see your veterinarian for an accurate diagnosis and treatment plan.
Stress seems to play a big part in cats with FIC. Scientists are now studying how FIC in cats may be similar to interstitial cystitis in humans to help determine more effective methods of treatment.
2. Urinary Stones (Urolithiasis)
Urinary stones are solid collections of minerals that form in the urinary tract of cats, and yes, they look and feel like real stones. As you can imagine, these are extremely painful!
The two most common types of urinary stones in cats are struvite (also known as triple phosphate) stones and calcium oxalate stones.
Struvite stones are made up of normal components of urine that clump together under certain conditions (such as when the pH of urine gets too high). Fortunately, these stones are far less common than they used to be due to additives in commercial cat food that helps keep the urine at the proper pH.
Calcium oxalate stones, which were rare years ago, unfortunately are now becoming more common. The formation of these stones is linked to high blood calcium levels and an acidic urine pH.
Urinary stones are diagnosed using x-rays or ultrasound. Since cats that have formed a urinary stone are at a high risk for recurrence, veterinarians often recommend medication or dietary changes for them to help keep urine pH regulated.
3. Urethral Obstruction
Urethral obstruction is a potentially life-threatening condition in which a cat’s urethra becomes partly or totally blocked. This can be caused by a urinary stone getting lodged in the urethra, or by a urethral plug. These plugs are formed by a combination of several types of minerals, cells, and a mucus-like protein that stick together to create a soft, sticky plug that blocks the urethra.
Male cats are at greater risk for becoming “blocked” than females, because their urethra is longer and narrower. Obstruction of the urethra is a true medical emergency! If you suspect your cat is obstructed, time is of the essence and you need to seek immediate veterinary help.
If a cat becomes blocked, his kidneys will lose their ability to remove toxins from the blood (a condition known as uremia). If not treated immediately, electrolytes in the body will become unbalanced, causing heart failure and death. This can happen in as little as 24-48 hours, so it’s imperative that the cat receive immediate treatment to have the urethra unblocked.
A cat who is obstructed will initially have typical FLUTD symptoms: straining to urinate, going in and out of the litter box constantly, and producing very little (or no) urine. If not treated, the cat will become increasingly distressed, stop eating and drinking, cry out in pain, and eventually collapse.
Treatment for FLUTD
Treatment for FLUTD will depend on which condition is actually causing the symptoms.
If the culprit is urinary stones, your veterinarian may be able to help the stones pass through the urethra by flushing your cat’s bladder with sterile fluids. If the stones fail to pass, or if they keep recurring, surgery may be necessary to remove them. This surgery, called a cystotomy, involves going directly into the bladder to manually remove the stones.
For cats with struvite stones, a special diet may be prescribed to dissolve them. However, unlike struvite stones, calcium oxalate stones cannot be dissolved with diet, and may need to be removed surgically.
For urethral obstruction, treatment involves placing a catheter into the urethra to dislodge whatever is causing the blockage, allowing the urine to drain out. Catheterization usually requires sedation or anesthesia. After the obstruction is relieved, treatment will vary depending on the cat’s condition. IV fluid therapy is used to treat dehydration and electrolyte imbalances, while antibiotics are usually given to prevent infection. The cat will then be hospitalized for observation and treatment, usually for at least 48 hours – longer if the obstruction recurs immediately.
Pain management is very important in treating blocked cats, so veterinarians usually administer pain medication. In male cats, medications such as prazosin, phenoxybenzamine, or diazepam (Valium) may also be used to relax the urethra in an effort to reduce the likelihood of another obstruction.
If you have a male cat that suffers from multiple blockages, your vet may recommend an operation called a perineal urethrostomy. This surgery involves removing the penis and shortening and widening the urethra, which is then reattached to the outside of the body. This surgery may prevent further obstructions, but it has potential complications and may not entirely eliminate FLUTD episodes in your kitty, so it should only be considered as a last resort.
Even though bacteria are rare in FLUTD cases, some antibiotics (particularly Clavamox and amoxicillin) seem to have anti-inflammatory or pain relieving effects, so they may also be prescribed. Other anti-inflammatory drugs, such as steroids, are occasionally used when there is severe inflammation, but it has not been definitively proven that steroids are truly beneficial in these cases.
What You Can Do to Prevent Recurrences
If your cat is diagnosed with FLUTD, there are things you can do to try to prevent recurrences. Unfortunately, some cats will continue to experience episodes, but for many others, they may only have one or two experiences and never have the problem again. Recurrences also tend to decline as a cat gets older.
To Help Avoid Recurrences of FLUTD:
- Feed small meals on a frequent basis.
- If you feed dry cat food, switch to a high-quality canned food. In one study, 60% of cats on a single dry food were symptom-free for a year, compared to 90% of cats eating a single canned food.
- For cats with a history of struvite stones, you may want to consider feeding your cat a prescription diet that helps create more acidic urine. However, unless your veterinarian has prescribed urinary acidifiers, avoid using acidifying supplements because over-acidification can cause metabolic problems in your kitty.
- Provide clean, fresh water at all times in multiple locations to make it easier for your cat to drink.
- Increase your cat’s water intake by adding warm water to his canned food. You may also consider purchasing a pet water fountain – many cats are fascinated by these, and since the water continues to circulate, it tastes fresher and is more appealing to them.
- Provide an adequate number of litter boxes (one more than the number of cats in the household).
- Keep all litter boxes in quiet, safe areas of the house, and keep them very clean to encourage your cat to use them.
- Minimize major changes in routine.
- Reduce environmental stress, and provide daily opportunities to play interactively with your cat – especially “hunting” games using wand toys like a feather on a string, so your cat can chase and leap for them.
FLUTD Can Be Successfully Managed
If your cat is diagnosed with FLUTD, it’s important to remember that his condition may be completely resolved with proper care and management. Although there are some unfortunate cats who experience FLUTD episodes repeatedly, for many cats, this may occur only once or twice in their lifetimes.
Cats who have experienced FLUTD may need periodic recheck appointments after the episode to ensure they are no longer in danger of becoming obstructed. During these appointments, the veterinarian will usually collect a urine sample and perform a urinalysis to check for any abnormalities.
Since FLUTD remains a condition whose cause is not entirely known, it cannot truly be “cured” with one simple treatment, only managed. However, with proper diet, a cat-friendly, low-stress environment, and good veterinary care, urinary health for cats who have been diagnosed with FLUTD can be improved dramatically.
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Has your cat ever been diagnosed with FLUTD? How did he or she respond to treatment? Please share your story with us in the comments below!