Feline Lower Urinary Tract Disease (F.L.U.T.D.)

Feline lower urinary tract disease refers to various disease conditons that all can cause similar lower urinary tract (bladder and urethra) signs in cats.  Signs of this problem, regardless of cause, include difficult, painful urination, blood in the urine, increased frequency, urinating outside of the litter box, and excessive licking of the genital area.  Owners often notice that cats with this syndrome go in and out of the litter box frequently and may or may not vocalize while attempting to urinate.  Potential causes of FLUTD include urinary tract infection, urethral obstruction, idiopathic cystitis, bladder stones, and bladder cancer.  Therefore, it may be necessary for your veterinarian to perform various diagnostic tests in order to accurately diagnose the specific cause of your cat's condition.  After a through pysical examination, it may be necessary to perform a urinalysis, blood work, take x-rays and/or perform an abdominal ultrasound, and possibly take a sterile urine sample for culture.

Feline Idiopathic Cystitis (F.I.C.)

Feline idiopathic cyctitis is probably the most common cause of FLUTD.  Although it is possible for any cat to develop FIC, overweight, male, indoor cats eating dry foods are most likely to develop this disease.  FIC is a sterile cystitis.  This means that the bladder becomes inflammed without the presence of bacteria or other pathogenic organisms.  The condition is thought to be related to a similar disorder that has been described in humans called interstitial cystitis.  There is no specific test to determine whether or not your cat has FIC so it may be necessary to perform multiple tests to rule out all of the other possible causes of FLUTD.
Signs of FIC include hematuria (blood in the urine), straining to urinate, urinating small amounts frequently (due to even slight stretching of an irritated, inflammed bladder wall).  This disease can be either non-obstructive or obstructive in nature.  The latter is far more serious and potentially life threatening and will be discussed later..  Non-obstructive FIC may spontaneously resolve over the course of 1-2 weeks regardless of treatment.  Therefore, prevention of recurrence is usually the main focus of treatment for this disease.  Studies have shown that there is a stong association between the type of diet fed to your cat and the environmantal conditions in which he/she lives and the development of FIC.  Cats being fed canned or "wet" foods have a lower incidence of FIC.  Additionally, environmental factors have also been implicated.  Conditions that contribute to stress may increase the likelihood of developing FIC.  Multicat hoseholds, the addition of new animals or people to a household, stressful interaction with owners, lack of sufficient litter area or type of substrate, and litter box placement (i.e. noisy or high traffic areas) are all factors that can contribute to developing FIC.  Owners are encouraged to use multiple litter boxes (one more than the total number of cats in the household), and to place them in quiet, low traffic locations.  Positive interaction with your cat is important also.  Playing with toys that encourage natural predatory type behavior (chasing objects) on a regular basis may be beneficial in lowering stress levels.
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Urolithiasis (urinary stones)

Urinary stones form when certain minerals precipitate out of the urine over time and form stones.  The two most common types of stones are struvite and calcium oxalate stones and are usually found in the urinary bladder.  Your veterinarian may find these stones with x-rays or ultrasound.  Struvite stones can sometimes be dissolved using special diets but most often bladder stones end up requiring surgical removal.  Calcium oxalate stones will not dissolve with diet change.  After dissolution or removal, a special diet may be prescribed to help prevent reformation of the uroliths.
Urethral Obstruction

Urethral obstruction is the most serious sequela of FLUTD.  This very serious and potentially life-threatening condition is most often the result of FIC.  It occurs when a mixture of mucus, crystals, and cells forms a tenacious material that can pass into the urethral and plug the opening causing either complete or partial obstruction of urinary flow.  Alternatively and less frequently, a bladder stone or stones can pass into the urethra and cause obstruction.  Urethral obstruction is almost exclusively a male cat issue.  Males have a longer, narrower urethra which makes it far more prone to becoming plugged up with debris.
Obstructed cats exhibit many of the same signs as non-obstructed cats with FLUTD only the signs tend to be more severe and there may be very little to no urine flow at all.  "Blocked" cats will go in and out of the litter box, strain to urinate, and very often will vocalize loudly due to the pain associated with bladder contraction and stretch without relief and urinary flow.  This situation is a medical emergency that needs to be addressed IMMEDIATELY!  Failure to relieve the obstruction can lead to death within 24-48 hrs.  Urination normally allows the removal of waste and the maintenence of normal electrolyte and water balance in the body.  Obstruction prevents the outflow of waste and causes the build-up of certain electrolytes that can lead to cardiac arrest and death.  If not treated early, urethral obstruction can lead to bladder rupture or perminant bladder and kidney damage.  Early treatment is essential.
Obstructed cats usually need to be anesthetized (unless already comatose... this would carry a poor prognosis) and the obstruction needs to be relieved by flushing the urethra with fluid and passing a urinary catheter into the bladder.  Cats are then usually provided intravenous or subcutaneous fluids, and varous medications based on the veterinarian's judgement of the particular case.  Most cats require hospitalization ranging from 3 days to over a week depending on the severity and whether or not the cat re-blocks after the catheter is removed.
In rare cases, some male cats will continue to re-obstruct despite all treatment and preventative measures.  These cats may need to undergo a surgical procedure called a perineal urethrostomy.  This procedure essentially removes the distal (most narrow) part of the penis, thereby making obstruction far less likely.  Potential complications of this surgery include narrowing of the urethral after surgery (stenosis), increased susceptibility to lower urinary tract infection, and urinary incontinence.  It is usuallly considered a last resort when managing FLUTD.
** Remember, if your cat exhibits any of the signs of FLUTD especially if he is passing very little or no urine or appears to be in pain, CALL YOUR VETERINARIAN IMMEDIATELY!  Do not wait or it may be too late!**
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