## Introduction
Urinary tract infections (UTIs) are a relatively uncommon condition in cats, affecting only 1-2% over their lifetime (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826873/). However, UTIs can cause discomfort, pain, and even life-threatening complications if left untreated. Some of the most common symptoms of a feline UTI include frequent urination, straining to urinate, blood in the urine (hematuria), and crying out while urinating. UTIs occur when bacteria, usually E. coli, enters the urinary tract and multiplies in the bladder. Identifying a UTI early is crucial, as quick treatment with antibiotics can clear up the infection and prevent it from advancing to the kidneys. Allowing a UTI to progress can lead to more stubborn infections, kidney damage, and even sepsis. That’s why it’s important for cat owners to monitor their pet’s litter box habits and watch for any signs of discomfort or pain during urination that could indicate a UTI.
What is a UTI?
A urinary tract infection (UTI) is an infection in any part of a cat’s urinary system, including the kidneys, ureters, bladder and urethra. It is caused by bacteria, most commonly E. coli from the intestinal tract, that enters and multiplies in the urinary tract (https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats).
UTIs can develop when bacteria gets into the bladder or kidneys and begins to multiply. Some common causes include:
- Bladder stones or crystals
- Tumors or polyps in the urinary tract
- Anatomical defects
- Bladder inflammation
Cats of any age and breed can get UTIs, but they tend to be more common in older cats. The infection can occur in the lower urinary tract (urethra and bladder) or upper urinary tract (ureters and kidneys). Symptoms vary depending on the location (https://www.webmd.com/pets/cats/cat-urinary-tract-problems).
Common Symptoms
Changes in urinary habits are the most common signs of a UTI in cats. A cat with a UTI will have an increased frequency of urination and only pass small amounts of urine each time (1). They may attempt to urinate more frequently but with little success. This straining and difficulty urinating is often accompanied by signs of discomfort or crying out (2). Blood in the urine, known as hematuria, can also indicate a UTI. Cats may excessively lick their genital area due to the discomfort and irritation associated with a UTI (3).
(1) https://www.webmd.com/pets/cats/cat-urinary-tract-problems
(2) https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats
(3) https://www.animergevets.com/site/blog/2021/05/30/cat-urinary-tract-infection
Less Common Symptoms
While increased urination and inappropriate urination are the most common symptoms of a UTI in cats, there are some less common symptoms to be aware of as well. These include:
Decreased appetite – A cat with a UTI may show a decreased interest in food and eat less than normal. The infection can cause discomfort, pain, or nausea which suppresses their appetite. Loss of appetite is seen in an estimated 15-30% of cats with UTIs according to one study (https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats).
Lethargy – The illness and discomfort of a UTI can result in lethargy or tiredness in some cats. They may sleep more than usual or seem generally low energy. According to VCA Hospitals (https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats), lethargy was observed in around 26% of cats diagnosed with UTIs in one study.
Vomiting – Nausea is another occasional side effect of a UTI, which can lead to vomiting. Vomiting was seen in about 21% of cats with UTIs in a study cited by VCA Hospitals (https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats).
While UTIs more often cause urinary symptoms, keep an eye out for changes in appetite, energy level, or vomiting as well. If your cat is displaying any combination of concerning symptoms, it’s worth having your vet examine them for a possible UTI.
When to See the Vet
If your cat is exhibiting any symptoms of a potential UTI for over 24 hours, it’s important to schedule an appointment with your veterinarian right away. Prolonged or recurring symptoms can indicate an infection or other underlying condition that requires medical attention.
In particular, if your cat is straining to urinate, crying out when trying to pee, or has stopped urinating altogether, this signals a potential urinary blockage which is a life-threatening emergency. A blockage prevents urine from passing out of the body, causing toxins to build up which can lead to kidney failure and death if not treated immediately. Do not wait – take your cat to an emergency vet clinic right away if a blockage is suspected.
While home remedies may provide some relief, they are not a substitute for medical treatment when it comes to diagnosing and properly treating a UTI or other underlying condition. Don’t hesitate to call your vet if any symptoms last more than a day, get progressively worse, or your cat is clearly in distress while urinating.
Diagnosis
Veterinarians will run several diagnostic tests to determine if a cat has a UTI.
The most common diagnostic test is a urinalysis. The vet will collect a urine sample, either by cystocentesis (inserting a needle directly into the bladder) or catching a midstream sample as the cat urinates. The sample is examined under a microscope to look for bacteria, white blood cells, crystals, and other abnormalities that may indicate an infection.
If the urinalysis is inconclusive, the vet may recommend a urine culture. This involves incubating the urine sample on a culture medium to allow any bacteria present to multiply. The type of bacteria can then be identified to select the most effective antibiotic for treatment. Urine cultures are considered the gold standard for diagnosing UTIs in cats (1).
The vet may also recommend bloodwork, including a complete blood count (CBC) and serum biochemistry panel. These tests can check for impacts on the kidneys, which may be compromised by a UTI. Bloodwork also assesses the cat’s overall health.
Medical imaging such as x-rays or ultrasound allow the vet to visualize the urinary tract and check for any anatomical abnormalities, stones, or masses that could be contributing to the infection (2).
With a combination of these diagnostic tests, vets can confirm or rule out a urinary tract infection in cats.
(1) https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats
(2) https://www.petmd.com/cat/conditions/urinary/utis-cats-urinary-tract-infections-cats
Treatment
Treatment for a UTI in cats often involves antibiotics prescribed by a veterinarian. Some common antibiotics used are amoxicillin, cephalexin, trimethoprim-sulfa1. These antibiotics fight the infection and provide relief to the cat. Pain medication like buprenorphine may also be prescribed to help with discomfort associated with a UTI2.
Increasing water intake is an important part of treatment. This helps flush bacteria from the urinary tract. Offering wet food, cat fountains, or adding water to dry food can encourage more drinking. Dietary changes like prescription urinary food may also be recommended, as these are formulated to promote urinary tract health.
Prevention
There are several things cat owners can do to help prevent UTIs in their cats according to experts. Making sure your cat stays hydrated by providing ample access to fresh, clean water is important. Consider getting a cat water fountain which may encourage some cats to drink more. You should also feed your cat a urinary health diet designed to promote urinary tract health.
Keeping the litter box extremely clean is another way to avoid UTIs. Scoop waste from the litter box at least once daily. Completely change out the litter every 1-2 weeks. Reducing stress is also important as stress can increase UTI risk. Make sure your cat has access to vertical spaces, hiding spots, toys, and playtime.
Prognosis
The prognosis for cats with UTIs is generally good if treatment is started promptly.[1] With appropriate antibiotic therapy, most UTIs will resolve within 7-10 days. However, some cats may experience recurrences, especially if an underlying condition like bladder stones is present.
Without treatment, UTIs can progress and lead to potentially serious complications. An untreated UTI may travel up to the kidneys, causing a kidney infection known as pyelonephritis. Kidney infections can permanently damage the kidneys and be life-threatening. Other possible complications include sepsis, a dangerous body-wide infection.
For these reasons, it is critical to have a cat displaying UTI symptoms evaluated promptly by a veterinarian. With quick diagnosis and treatment, most cats make a full recovery. However, recurrent UTIs or untreated infections may have a more guarded prognosis.
Cats that have frequent UTIs may need further testing like radiographs or ultrasound to check for predisposing problems like bladder stones. Addressing any underlying issues can help prevent recurrent infections in the future.
[1] https://vcahospitals.com/know-your-pet/urinary-tract-infections-utis-in-cats
When to Retest
After your cat finishes a course of antibiotics for a UTI, it’s important to take them back to the vet for retesting to ensure the infection has cleared. According to the VCA, most cats will need a urine culture 7-14 days after finishing antibiotics. If the culture is negative, the UTI has likely resolved.
You should also get your cat retested if symptoms of a UTI recur after treatment. Symptoms like straining to urinate, blood in the urine, and frequent urination could indicate the infection has returned or was not fully cured. Getting a urine sample tested can help determine if additional treatment is needed (Small Door Veterinary).
For cats prone to UTIs, your vet may recommend periodic urine testing to monitor for infections, even when no symptoms are present. Routine urine cultures every few months may help detect UTIs early before they progress. Catching recurrences quickly can allow for faster treatment and prevent complications (VCA).
