Urinary Tract Problems in Cats
By Jean Hofve, DVM
What is Feline Lower
Urinary Tract Disorder?
Few conditions strike greater fear into
the heart of a cat guardian than "urinary tract problems." Myths and
misinformation abound, and many people know at least one other person who
has a cat with this problem or who has lost a cat because of it.
"Feline lower urinary tract disorders"
(commonly referred to as FLUTD, LUTD, or FUS--feline urologic syndrome)
come in at least three distinct varieties. All of them put together affect
less than 3% of cats, but for those who are affected, it can be a major
problem. Bladder diseases occur in both male and female cats, although
males have a higher risk of life-threatening blockage of the urethra. It
is usually first seen in cats between 2 and 7 years of age (though some
very young and very old cats may develop signs). Episodes of FLUTD are
usually triggered by stress, such as home remodelling, severe weather, or
loss or addition of a family member.
What are the symptoms
of Feline Lower Urinary Tract Disorders?
The clinical signs of all the FLUTDs are
very similar. Cats may go to the litterbox frequently, strain to urinate,
pass very small amounts at a time, lick their genitals more frequently or
more intensely than usual, or have blood in the urine. The cat may
associate the burning sensation of cystitis (bladder inflammation) with
the litter box itself, and look for another place to go where it won't
hurt. This leads to squatting in corners, in sinks or tubs, on rugs,
laundry piles, or beds.
Blockages can lead to
Most cats brought to the vet for FLUTD do
not yet have blockages. However, it's important to act quickly when you
see any of these signs, because if a blockage does occur, the backup of
urine toxins and pressure can lead to kidney failure and death in as
little as 24 hours.
Cystitis and Bladder
About two thirds of FLUTDs are classified as
"idiopathic cystitis", meaning "bladder inflammation of unknown cause." It
is rare for bacteria to be involved--most are "sterile" inflammations.
Less common causes of these signs include behavior disorders, kidney
stones, anatomical defects in the bladder wall, other systemic diseases,
and bladder cancer.
Only about 20% of FLUTD cases involve
bladder stones, about half of these are struvite, and half are calcium
oxalate stones. Crystals are not the same as stones. Male cats who block
usually do so with crystals held together in a gel-like matrix with mucus
from the irritated bladder. This "plug" can get stuck at the narrow end of
the urethra. Crystals may be present by themselves or at the same time as
a stone. Occasionally, multiple types of crystals may be present at the
Struvite, or "triple-phosphate" stones,
are made from normal components of urine that clump together under certain
conditions. Calcium oxalate crystals and stones, which were rare in cats
10 years ago, have become much more common due to increased feeding of
highly acidified struvite-treatment diets. Some stones can be dissolved by
diet, though it can take a long time. Any stone can be surgically removed,
and sometimes this is the most expedient solution. Stones are usually
diagnosed either by radiographs (x-rays) or, ideally, ultrasound (which
can "see" stones that x-rays might not reveal, and provides valuable
information on condition of the bladder and kidneys). Cats with FLUTD signs
lasting more than a week in spite of treatment, or if the problem recurs
after treatment is discontinued, should be evaluated for stones or other
Feline Lower Urinary Tract
There are many medical diets made to
dissolve struvite stones and to prevent recurrence of struvite and calcium
oxalate stones. These include Hill's s/d, c/d(s) and c/d(o), Purina CNM-UR,
Waltham's Control pHormula, and others. These are only available through
veterinarians since they create specific acid-base conditions in the cat's
body that should be monitored by your vet. Canned versions of these foods
are preferable to dry.
In one study, 60% of cats on a single
dry food were symptom-free for a year, compared to 90% of cats eating one
canned food. Homemade, organic, natural diets are always on the top of the
"good" list for treating this and other chronic disease conditions, but
only if they can be fed consistently. Diet changes must always be made
gradually to minimize stress on the cat.
Diet is a component of FLUTD, though
usually not the sole cause. Dry cat foods, particularly high-fiber "light"
or "senior" foods, contribute to overall dehydration and high urine
concentration. Cats with FLUTD should not be fed any dry food at all if
possible. Canned or homemade foods help keep the urine dilute, minimizing
irritation and the risk of crystal or stone formation. Feed in timed meals
rather than leaving food available.
Treatment of Feline
Lower Urinary Tract Disorders
Antibiotics are often used to treat
feline FLUTDs and are a standard first-line of conventional treatment. Even
though bacteria are rare, some antibiotics have anti-inflammatory or
analgesic (pain relieving) effects. Other anti-inflammatory drugs, such as
steroids, are occasionally used when there is severe inflammation. Urinary
acidifiers are sometimes given if the urine pH is very high. Steroids and
acidifiers should not be used long-term. The anti-depressant amitriptyline
is commonly used as a long-term treatment, but its effectiveness and
safety are being questioned. For male cats who block repeatedly, there is
a surgery to widen the urethra. This is a last-ditch option, and some
males will still block even after this surgery.
Many herbal and nutritional treatments
have been tried with varying success. Certainly, antioxidant vitamins such
as C and E, which are also helpful in times of stress, are indicated
(Vitamin C as sodium ascorbate or Ester C, and Vitamin E). Other
antioxidants such as
BioSuperfood may also be helpful, because of their anti-inflammatory
action. Herbs such as slippery elm, horsetail, and couch grass have helped
some cats. Many cats have done well with Co-Enzyme Q10, which prevents
inflammation at the cellular level.
Cranberry extract is beneficial for many animals,
especially dogs, who tend to have actual infections of the bladder.
Cranberry is thought to prevent the attachment of the E. coli
bacteria to the bladder wall. Because bacteria are not present in most
cases FLUTD, it may be less beneficial for cats. However, cranberry has
still been helpful in many cases, even those without any evidence of
bacteria. Cranberry capsules are available at the health food store
(typically in 250 mg strength which is a good once-a-day dose for cats),
and are very safe to give long-term.
Flower essences are often very helpful for FLUTD.
Because the problem is so highly stress-related, addressing any
underlying emotional imbalances and susceptibilities can be critical for
long-term resolution. A specific formulation based on your cat's
particular personality is best. Holistic veterinarians believe that
FLUTD is a sign of underlying chronic disease. Homeopathy, acupuncture,
Chinese herbs, western herbs, and other holistic therapies may be
valuable in rectifying the hidden "causes" of FLUTD and bringing your
cat's health into balance and well-being.
There are lots of diets and treatments
out there. An individually tailored treatment program is needed for each
patient. But, if I had only one rule I could make for all of them, it
would be "no dry food."
Kidney Disease in Cats. Chronic Renal Failure
Cystitis in Cats can cause inappropriate urination
Common Health Problems in Cats
This copyrighted article is courtesy of Little Big
For an in-depth, 7-page report on this
frustrating syndrome, including information on preventing and treating
FLUTD (with feeding recommendations and specific supplements and dosages),
see "Feline Lower Urinary Tract Disease" in the Little Big Cat Bookstore!
For more great articles on important
feline health, welfare, nutrition, and behavior topics, visit the
Publications Page at