An Overview of Feline Lower Urinary Tract Disease

“My cat is straining to pee and he keeps going in and out of the litter box”…. This is a very common call over the course of an emergency weekend, and my workday wouldn’t be complete without at least one urinary issue coming my way. It is not uncommon to see 2-3 cases of pee troubles in a shift, and I am often asked, “What causes this?”

This becomes a difficult question to answer because just about any inflammatory condition in the feline lower urinary tract will create the exact same presenting clinical signs. Translation: an infection, a bladder stone, inflammation, or a tumor will all paint the same clinical picture, and appropriate treatment requires knowing the source of those symptoms.

Feline Lower Urinary Tract Disease, or FLUTD, is a complex problem and I wanted to begin tackling the subject by starting with a broad overview of the common clinical signs, the possible causes, and how to begin to sort it all out.

What are the signs?

• bloody urine

• straining to urinate:  this can easily be mistaken for straining to defecate!

• urinating in unusual places: on the couch, on your bed… basically anywhere but the litter box

• no urination despite attempts, or only producing very small drops of urine: this can be a sign of a urinary blockage. It is important to note that this symptom in male cats
 can indicate a urinary blockage, which is a LIFE-THREATENING emergency!
 If you are not sure that your cat is able to urinate,
 assume it is a blockage and call your veterinarian’s office immediately!

• licking the urinary opening: this is usually due to pain or discomfort

What are the possible causes?

The age of the cat is tremendously relevant regarding which underlying causes are most likely. If we look at all cats with lower urinary tract symptoms, here is what we find:

• 50 percent will not have a cause that can be determined despite extensive testing.  This is a condition referred to as cystitis, which is inflammation in the bladder with no identifiable source. Cystitis becomes a diagnosis of exclusion, making testing extremely important so that other causes can be ruled out.

• 20 percent will have bladder stones, with female cats having a slightly higher incidence.

• 20 percent will have a urethral blockage.

• 1-5 percent will have a true urinary tract infection.

• 1-5 percent will have a urinary tract cancer.

• 1-5 percent will have had trauma to the urinary tract (have been hit by a car, etc.)

• 1-5 percent will have both a bladder stone and an infection.

• The average age for symptoms is four years.

Now, if we separate out the cats that are 10 years of age or older, and only look at their cases, a different statistical picture emerges:

• 50 percent will have true urinary tract infections.

• 10 percent will have bladder stones.

• 17 percent will have both infection and bladder stones.

• 7 percent will have urethral blockage.

• 3 percent will have urinary tract cancer.

• 5 percent will not have a cause that can be determined despite extensive testing.

• 66 percent will be in some stage of kidney failure.

• 5 percent will have urinary incontinence.

Sorting out the causes:

Diagnostics are performed to help get to the bottom of the clinical signs as well as to ensure that your pet is being properly treated. A urinalysis is commonly performed and is usually the first step in information gathering. With a 50% incidence of infection in older cats, the addition of a urine culture would be extremely important for a cat age 10 or more, but may not be as important for a younger cat. Radiographs to rule out bladder stones might be performed, especially if you are dealing with a recurrent problem. Blood work can also be performed to determine if kidney failure is contributing to the clinical signs.

I hope this serves as a good introduction to a syndrome that has many causes, as well as help you begin to understand the complex issue of FLUTD. Next week I'll begin to discuss the more common causes of this frustrating disease that include crystals in the urine, urinary "blockage", and cystitis (inflammation of unknown cause). Please feel free to post any questions or suggestions!