We will explore what feline lower urinary tract disease is, the symptoms, how and who gets these infections, the diagnosis, and treatment, as well as prognosis for recovery.

WHAT:

Notice that the title of this was NOT “lower urinary tract infection” in cats – because cats rarely get that uncomplicated lower urinary tract infection as discussed in dogs. This is a completely different story!

There are a few names for this SYNDROME in cats – “Feline Lower Urinary Disease Tract Syndrome (FLUTD),” “Feline Idiopathic Cystitis (FIC),” “Feline Urologic Syndrome (FUS).” We’ll refer to it here as FLUTD. Unlike dogs, where we discussed that bacterial infection in the bladder causes the urinary tract infection and symptoms, our feline friends are quite a bit more complicated and these symptoms are actually rarely caused by infection – it is estimated that only 1-5% of cats with lower urinary tract signs actually have an infection.* The term FLUTD includes any number of inflammatory conditions (infection, tumor, bladder stone, etc.) in the urinary bladder AND environmental/emotional conditions (stress, anxiety) that produce the same symptoms.

*The exception to the rare urinary tract infection rule is those chronic kidney disease patients who have a decreased urinary immune system. True bladder infections are common in these patients, often without any clinical signs.

SYMPTOMS:

  • bloody urine
  • straining to urinate (can easily be mistaken for straining to defecate)
  • urinating in unusual places
  • urinary blockage (almost exclusively a male cat problem and constitutes an emergency)
  • licking the urinary opening (usually due to pain)

HOW:

In a large-scale retrospective study of cats affected by FLUTD:

  • 20% have bladder stones
  • 20% have a urethral blockage
  • 1-10% have an infection, is trauma related, or cancer
  • 50% have no known medical cause determined by testing (idiopathic)

WHO:

FLUTD signs are most commonly seen in young to middle-aged cats (4-6 years of age), male or female, and may be in single or multiple cat households. Cats that get this syndrome have a unique imbalance in the way their brain controls hormones. In other words, these cats are unusually sensitive to environmental stress and, due to a complicated cascade of metabolic events, stress manifests in the urinary tract.

DIAGNOSTICS AND TREATMENT:

These cases are very important to pursue diagnostics to rule in or out medical causes for the symptoms.

  • Urinalysis: almost always done to rule out infection, and to look for urinary crystals.
  • Urine culture: performed if an infection is suspected. This is the most sensitive way to evaluate for an infection.
  • Imaging: Ultrasound and/or radiographs (X-rays) to look for stones, tumors, or other causes of urinary symptoms.
  • Blood screen: performed if a more systemic cause is suspected.

TREATMENT:

Treatment plans depend on the cause, medical only or environmental-behavioral.

  • Medical management as indicated – antibiotics for infection, surgery for bladder stone, etc.
  • In cases of true FLUTD, not related to infection, we will often treat with pain medication, medications to relax the urethra, fluid therapy, and tincture of time.
  • In repeated cases, we may change the diet, especially if crystals are seen in the urine.
  • Increased water consumption at home is strongly encouraged to “flush out the bladder” – tips include switching to a canned diet, adding water to food, and fresh water fountains.
  • Weight loss if overweight or obese.
  • One of the pillars of management is to evaluate the environment and diminish the cat’s triggers for stress and anxiety. This includes discussion of proper litter box hygiene and placement, ideas for enrichment activities, and potentially use of anxiolytic medications.

PROGNOSIS:

Excellent for acute episodes without urethral blockage, guarded for recurrent episodes. The prognosis greatly depends on the owner’s and cat’s ability to comply with medical and environmental therapy.

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