Feline Lower Urinary Tract Disease Syndrome: Litter Box Blues

Many cats today can suffer from cystitis, an inflammation in their urinary system. There can be several causes of cystitis, therefore it is also referred to as Feline Lower Urinary Tract Disease Syndrome or FLUTD.

The urinary system is made up of the kidneys, ureters, bladder and urethra. The kidneys are the organs that produce urine. It then travels down tiny little tubes; the ureters to the bladder. The bladder can store urine until the animal consciously urinates. The urine exits out the bladder through the urethra.

Male cats tend to have more problems with the urethra as it curves at the end in a male cat. This makes them more prone to obstructions. In female cats, it tends to be a simple “straight shot” from the bladder to the litter box. The syndrome of FLUTD describes any problems that cats may have in the bladder and urethra, considered the “lower part” of the urinary system.

The causes of FLUTD are several. In the past, it was all thought to be due to a single type of crystal or sediment that formed often in response to diet. Over the last 10 years, veterinarians have determined several causes of FLUTD. Crystals are probably the most common cause. There are several different types of crystals that can form in our felines. Diet is just one factor in many. Other factors include the cat’s own metabolism, drinking habits as well as litter box habits. Ideally, a cat should urinate at least 2-3 times daily. If a cat urinates less frequently, crystals are more likely to form. The crystals can be smooth to jagged, often forming a sand like sediment. This can obviously cause some discomfort when the cat urinates. An obstruction can result when there are so many that they stop the urine outflow all together or they cause inflammation that narrows the outflow so severely that the urine cannot pass. Other causes include stress-induced inflammation, bladder stones (crystals that gather to form a solid mass), bacterial infections, tumors or idiopathic (no known cause).

The signs of FLUTD can be all or just one specific. It is more common and serious in male cats but can happen in either. Spayed and neutered cats are at risk as well as “intact” cats.

The most common sign is urinating inappropriately. This means urinating outside the litter box or urinating very frequently. Other cats may howl during the trips to the litter box or spend several minutes in the box. In cases of an obstruction, the cat may vomit and be lethargic. If your cat is showing any of these signs, seek veterinary care right away.

If a cat is showing any of these signs, an exam is very important. The veterinarian will examine the cat and check the cat’s bladder to see if it is full or not. In the case of an obstruction, the bladder can become very large and is painful. It must be treated immediately by sedating the cat and relieving the obstruction. When there is an obstruction, the urine continues to collect in the bladder. The urine is made up of wastes that the body does not need. If it remains in the bladder, it can seep back into the bloodstream and cause life threatening changes. Intravenous fluids and other medications are used to help the cat as the urine flow is restored. If the cat is not obstructed, medical management of the signs is advised.

To determine treatment, a urine sample is the first specimen evaluated. This may be done in the hospital or you may be able to collect it at home using a non-absorbable kitty litter. The urine is evaluated for color, ph, sediment (red blood cells, white blood cells, crystals). Based on these results, recommendations may be made to alter the cat’s diet. Additional tests such as blood tests or ultrasounds and radiographs may be indicated. At times, no cause can be determined from these tests. These types of cystitis cases are called idiopathic, meaning no known cause. It is frustrating for all involved!

Treatment depends on the cause as well as the severity of the problem. Again, an outflow obstruction must be treated as an emergency. If a cat cannot urinate, it can die from the urine wastes within hours. It is best to overreact rather than take a wait and see approach in these cases. If there is no obstruction, medical management is the first approach. This is most often diet but may also include drugs and supplements to decrease the formation of crystals, inflammation, etc. Homeopathy can be very helpful as well. Various remedies can be used and are recommended based on the cat’s individual symptoms. Some cats become very irritable while others become more clingy. These as well as other symptoms can help prescribe the right remedy to help relieve the problem. In some cases, surgical management is indicated if medical management doesn’t resolve the problem. Surgery would be to remove bladder stone(s) or to alter the outflow of a male cat that reblocks (perineal urethrostomy).

To help decrease the risk of your cat having urinary problems, a few recommendations:

  • Keep the litter boxes clean. There should be one litter box per cat ideally. They should be cleaned (urine and bowel movements removed) at least daily.
  • Use a cat litter that the cat likes. There are dozens of litter available now, use what works best for you and your cat!
  • If the cat has had any history of urinary problems, try to feed it a canned diet. The canned diets have a large amount of water to encourage more frequent urinations. If the cat doesn’t like canned food, be sure to have at least two drinking stations in the home. Some cats like the novelty of having a second water dish in a bedroom or bathroom. Be sure to change the water daily.