Feline lower urinary tract disease (FLUTD) is one of the most common problems seen in cats. Investigators have tried to isolate a single cause for this disease syndrome but have been unsuccessful. Theories proposed and studied include dietary factors, viruses, urinary tract calculi (stones), early neutering, and environmental factors. In each case of FLUTD we try to determine the cause of a cat’s lower urinary tract disease, and treat that specific problem. In some cases we may not be able to determine a specific cause. Causes of FLUTD that can be diagnosed include urinary tract calculi, crystals in the urine, bacteria, anatomic abnormalities, and tumors. The most common diagnosis is Feline Idiopathic Cystitis (FIC), which may account to 65% of the cases.
FIC is a chronic, sterile, inflammatory process of unknown cause. FIC is likely a syndrome which may have many underlying causes. It is thought to involve interactions between the central nervous system, bladder, and the endocrine (hormonal) system. Cats that get FIC may be unusually sensitive to stressors which may include changes in environment, diet, and weather, moving to new homes, and conflict between cats. An indoor lifestyle can be stressful to some cats, and may contribute to this syndrome. Any type of change may be perceived as stressful by cats.
The most common signs of FLUTD include painful urination, blood in the urine, and inappropriate urination (urinating outside the litter box). Cats are observed to be urinating frequently, straining to urinate and not passing any or only small amounts of urine. This behavior is frequently confused with constipation. Other symptoms may include frequent licking of the genitals, vomiting, weakness and depression. FLUTD is most common in young cats with episodes decreasing in frequency as the cat gets older. It is seen in both male and female cats. Female cats are uncomfortable but not seriously ill, whereas FLUTD can be life-threatening in males. The diameter of the urethra in the male cat’s penis is very narrow, and can easily become obstructed by crystals, stones, or inflammatory debris found in the urinary tract. When this occurs the cat is unable to urinate and quickly becomes toxic on his own waste products.
In managing FLUTD the first thing we will need to find out is if your cat is obstructed. We can do this by performing a physical examination. Urethral obstruction is very serious and requires immediate treatment. The most important thing is to relieve the urethral obstruction by sedating the cat and passing a urethral catheter. Urethral obstruction can cause the body’s kidney enzymes and electrolytes to become dangerously high. Fluid therapy is administered in order to correct these problems and to promote production of urine. It will help flush the bladder of crystals, mucus, or cellular debris that may have caused the obstruction. This process will require your cat to be hospitalized for several days. When he goes home he may need to have medications and a special diet in hopes of preventing reoccurrence. Although the symptoms of frequent urination and straining to urinate may persist for up to a week, it is important to observe if the cat is able to pass urine. A large percentage of cats that have had one episode of FLUTD will have other episodes. They will not necessarily become obstructed again, but the owner should be aware of this possibility.
In the cat that is not obstructed we will try to determine the underlying cause of the lower urinary tract disease by performing a series of tests. A history of urinary tract problems will dictate a more extensive workup than an initial episode. For an initial episode we may only need to perform a physical examination and urinalysis. A urinalysis will demonstrate the kidney’s ability to concentrate and dilute the urine. We will also check for the presence of blood, glucose, bacteria, white blood cells and crystals in the urine. We will start a treatment plan based on the results of this test. Treatment frequently includes a prescription diet, pain medication, and non-steroidal anti-inflammatory medication. Episodes will usually last 5 to 7 days.
A cat that has recurrent episodes of FLUTD should have diagnostic tests performed in an attempt to determine an underlying cause. We may need to perform a urinalysis several times in order to monitor changes and progress. A urine sample may be taken for culture to determine if a bacterial infection is present. Blood may be drawn to monitor kidney function as well as to eliminate other diseases that can cause similar symptoms. Radiographs (X-rays) can be done to see if uroliths (stones) are present in the bladder, urethra, or kidney. At times we may need to perform an ultrasound examination of the abdomen to check the kidneys and urinary bladder. This exam can demonstrate calculi as well as structural abnormalities and tumors. Some cats may need to have exploratory surgery in order to examine and biopsy the urinary tract.
Treatment for FLUTD will depend on the results of diagnostic tests and underlying causes found. When an underlying cause is found, treatment is aimed at that problem. It may include dietary changes, antibiotics, medications to decrease inflammation, and even surgery. Specific diets may be needed to change the ph of the urine in order to prevent formation of crystals.
Part 2 will focus on prevention and what steps you can take at home to help prevent reoccurrence of FLUTD.