Introduction
Feline lower urinary tract disease (FLUTD) is a common condition in cats that affects the bladder and urethra. It refers to disorders characterized by clinical signs like hematuria, dysuria, pollakiuria, and stranguria. FLUTD can be a painful and potentially life-threatening disease in cats.
Studies estimate that 1.5% to 3% of all feline veterinary visits are related to FLUTD 1. It is more prevalent in middle-aged cats between 2-10 years old. Domestic cats have a higher risk than purebred cats. Indoor cats are also more prone to FLUTD since they have decreased water consumption and urine dilution 2.
Common Feline Urinary Issues
Cats can develop several urinary tract problems that can impact their health and quality of life. Some of the most common feline urinary issues include:
- Feline Lower Urinary Tract Disease (FLUTD) – This refers to a group of conditions that cause inflammation and blockages in a cat’s lower urinary tract. It often causes painful urination, straining, and blood in the urine. FLUTD can be caused by bladder stones, infections, anatomical defects, and stress/anxiety. Treatment focuses on addressing the underlying cause and relieving symptoms through diet change, medications, and sometimes surgery (https://www.avma.org/resources-tools/pet-owners/petcare/feline-lower-urinary-tract-disease).
- Kidney Disease – Kidney disease is common in older cats and can lead to kidney failure. It causes buildup of toxins in the blood, dehydration, and urinary tract symptoms like increased thirst and urination. Treatment focuses on managing clinical signs through diet, IV fluids, and medications.
- Bladder Stones – Minerals and compounds like struvite and calcium oxalate can crystalize in the bladder and form stones. This leads to irritation, bleeding, obstruction and difficulty urinating. Surgery may be needed to remove large stones. Preventative diets can help minimize recurrence (https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/feline-lower-urinary-tract-disease).
- Bladder Cancer – Feline bladder cancer is uncommon but can cause blood in the urine, straining, and frequent urination. It is typically treated with surgery, chemotherapy, and medications.
Symptoms
Cats with feline lower urinary tract disease (FLUTD) often exhibit the following symptoms related to urination:
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Straining to urinate – Cats will strain and struggle when trying to urinate, sometimes crying out in pain. They may frequently go in and out of the litter box attempting to pass urine. This symptom indicates obstruction or inflammation of the urinary tract (AVMA).
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Blood in urine – The presence of blood in a cat’s urine, known as hematuria, can indicate FLUTD. Causes may include bladder stones, tumors, or urinary tract infections (Cornell Feline Health Center).
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Frequent urination – FLUTD cats will often make frequent trips to the litter box to urinate small amounts. This urgency and frequency indicates discomfort and irritation of the urinary tract (Greensboro Veterinary Hospital).
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Crying when urinating – The pain and difficulty urinating may cause cats to vocalize and cry out while attempting to pass urine. This is a clear sign of lower urinary discomfort (Cornell Feline Health Center).
Causes
There are several potential causes of urinary issues in cats:
One of the most common is the formation of crystals or stones (uroliths) in the urine, which can irritate the urinary tract or even cause blockages. Struvite and calcium oxalate crystals are frequently seen in cats with FLUTD (1). These crystals form when the urine is too concentrated or alkaline.
Bacterial urinary tract infections can also lead to inflammation and dysfunction. Common culprits are E. coli, Staphylococcus, and Proteus mirabilis (2).
Stress is another major factor, especially in cats with idiopathic cystitis. The stress and anxiety causes them to strain and have difficulty urinating (3).
Finally, anatomical defects like urethral strictures can obstruct urine flow and contribute to urinary dysfunction.
Diagnosis
There are several diagnostic tests vets use to diagnose urinary tract issues in cats:
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Urinalysis involves examining a urine sample under a microscope to look for crystals, bacteria, blood, and other abnormalities. This is one of the first diagnostic tests performed when a cat has urinary signs. Changes in the urine can help identify infection, inflammation, crystals, tumors, and other problems (Cornell Feline Health Center).
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Blood tests check kidney function, look for signs of infection, and help rule out other diseases. Bloodwork may reveal issues like kidney disease that can secondarily cause lower urinary tract signs (VCA Hospitals).
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Imaging like x-rays or ultrasound allow vets to visualize the bladder and urethra. This can detect stones, masses, anatomical abnormalities, and thickening of the bladder wall indicative of inflammation (AVMA).
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Cytology involves microscopic examination of cells collected from the bladder wall. This can help identify cancer or inflammation (VCA Hospitals).
Treatment
Treatment for cats with urinary issues will depend on the underlying cause and may involve a combination of approaches1. Common treatment options include:
Dietary Changes: Veterinarians often recommend feeding cats with urinary issues wet food or adding more moisture to dry food. This helps increase water intake to dilute urine and allow crystals or stones to pass more easily. Prescription urinary or stress formula diets may also help manage pH levels in urine.
Medications: Antibiotics treat bacterial infections while antispasmodics relax the bladder muscles to improve urination. Pain medications provide relief while stones pass. Long term medications that acidify urine or prevent crystal formation may also be prescribed.
Surgery: For recurring UTIs or blockages that do not resolve with other treatments, surgery may be recommended to remove bladder stones or tumors or to widen the urethra.
Addressing Behavior: If inappropriate urination or litter box avoidance are factors, behavior modification techniques like adding more boxes, using preferred litters, or reducing stressors can help.
Prognosis
The prognosis for cats with urinary tract issues depends on the underlying cause of the condition. In cases of urethral obstruction, the prognosis is good if the blockage is identified and treated quickly before kidney damage occurs. With prompt treatment, most cats will recover fully and not have any long-term kidney issues (Cornell Feline Health Center, 2022).
For recurring feline idiopathic cystitis (FIC), the prognosis is also generally good. One study found over 75% of cats with FIC had no recurrence of clinical signs in the 12 months after diagnosis when treated with environmental modification and medication as needed (NCBI, 2020). With proper management of diet, enrichment, and stress, many cats can live normal lives despite periodic flare ups.
Overall, many cases of feline lower urinary tract disease can be well managed long-term through treatment, medication, dietary changes, and environmental modifications to reduce stress and increase water intake. Working closely with a vet helps optimize care and monitor for any changes in condition over time.
Life Expectancy
Feline lower urinary tract disease (FLUTD) is a common condition in cats that causes issues like urinary blockages, bladder stones, and blood in the urine. However, studies show that FLUTD alone does not necessarily reduce a cat’s lifespan if managed properly.
One study found the median lifespan after a FLUTD diagnosis was 5 years, with some cats living 9 years or longer (Retrospective interview-based long-term follow-up study of feline lower urinary tract disease in cats). So FLUTD itself does not directly impact longevity.
However, frequent UTIs or unrelieved obstructions can cause kidney damage over time. Kidney disease is a common cause of premature death in cats. Therefore, proper veterinary treatment of urinary issues is important to preserve kidney function and lifespan.
With medications, dietary changes, and monitoring from a vet, many cats with FLUTD can live a normal lifespan with good quality of life. Prompt treatment of UTI symptoms and removal of urinary obstructions are key. Overall, FLUTD does not have to reduce lifespan if properly managed.
Improving Quality of Life
There are several ways to improve the quality of life for cats with urinary issues:
Environmental enrichment is important to reduce stress and anxiety. Provide plenty of vertical space for climbing and perching, places to hide, toys, and opportunities for playtime and exercise. Rotating toys can help keep cats engaged and stimulated.
Reducing stress is key. Identify and minimize any sources of stress for your cat, such as loud noises, changes in routine, or introducing new pets. Provide a consistent daily schedule and keep litter boxes clean. Consider using synthetic feline pheromones to promote a sense of calm.
Ensure your cat has easy access to litter boxes, preferably in quiet, low-traffic areas. Provide at least one more box than the number of cats in your home. Scoop daily and change litter regularly. Consider trying different unscented clumping litter to see if your cat has a preference. Keep boxes clean to encourage use.
When to Euthanize
Euthanasia may be considered when a cat’s quality of life is severely compromised by a condition that cannot be treated effectively. Some conditions that may warrant euthanasia include:
- Severe kidney failure – When kidney function declines to less than 15%, cats often experience significant clinical signs like vomiting, diarrhea, weight loss, and anorexia. At this stage of chronic kidney disease, the condition is typically not reversible or manageable long-term. Euthanasia may help relieve suffering.
- End-stage cancer – Feline cancers like lymphoma or mammary tumors can often be managed for a period of time. However, once tumors become non-resectable or resistant to treatment, euthanasia may be the most humane option to prevent further suffering from the cancer.
- Suffering refractory to treatment – Even with aggressive therapy, some cats have persistent clinical signs that significantly diminish their quality of life. If a cat is experiencing constant pain, distress, or discomfort that cannot be relieved through any interventions, euthanasia may be the most compassionate choice.
According to the AVMA Guidelines for the Euthanasia of Animals: 2020 Edition, euthanasia should be considered when “a medical condition results in uncontrollable and progressive pain or distress that cannot be managed by pain medications, sedatives, or other therapies” (see https://www.avma.org/sites/default/files/2020-02/Guidelines-on-Euthanasia-2020.pdf). The decision to euthanize is complex, so cat owners should thoughtfully weigh their pet’s condition and prognosis with a veterinarian.
