Pet Problems: Dealing with Urinary Blockage in Male Cats

My cat can't pee! Learn how to recognize this life-threatening condition that occurs in male cats.

Urinary blockage, or urethral obstruction as it is officially known, is a common emergency that see over the course of a weekend... I literally had another 3 cats being treated for this once again on Saturday and Sunday. Three little kitties with three little catheters...  

What is it?

Urinary blockage is almost exclusively a problem reserved for male cats, and occurs when the urethra becomes obstructed. The urethra is the “tube” that drains urine from the bladder out of the penis, and in males, it is very long and narrow. I usually describe to owners the difference between male and female urethras by using the example of McDonald’s straws… the female urethra is like a milkshake straw, while the male urethra is like a coffee stirrer. It gives the mental visual of just how much smaller of an opening male cats have, predisposing them to obstruction.

Obstructions are often the result of plugs of inflammatory material (such as white blood cells and mucus), as well as crystals or small bladder stones. All of this bladder “schmutz” conglomerates into a plug, lodges itself into the urethra, and blocks the exit for urine. When the urethra is completely blocked, and the cat has filled his bladder to capacity, his kidneys stop making urine as there is nowhere for it to go. With kidney “shut down” the body is no longer able to remove toxins from the blood or maintain a proper balance of fluids and electrolytes in the body, resulting in kidney failure and eventually death.

What are the clinical signs that an obstruction is occurring?

Most affected cats are 1 to 10 years of age. Initially cats may show signs of urinary tract inflammation, such as straining to urinate, frequent urination, blood in the urine, painful urination, or inappropriate urination (urinating somewhere other than the litter box). Once the cat becomes obstructed (“blocked”), they may attempt to urinate in the litter box but will produce only drops of urine or no urine at all. They may cry, move restlessly, or hide because of discomfort. Eventually they will lose their appetites, generally begin to vomit, and become lethargic. Complete obstruction can cause kidney failure in as little as 24 hours, and potentially death in as little as 48 hours. This is an easy diagnosis for your veterinarian to make because a cat with a urethral obstruction will have a very large, firm, and painful bladder that is easily felt in the back half of the belly on physical exam.

What tests are indicated?

Blood work is evaluated to check kidney function and to determine if there is any evidence of other systemic imbalances. The urinary toxins that build up can commonly cause life-threatening heart rhythm disturbances and an ECG may be needed. A urine sample is evaluated for crystals and may be sent in for culture. Radiographs of the belly are taken to see if calculi (stones) or other material are present in the kidneys or bladder.

What is the treatment?

Cats that have urinary obstruction require immediate emergency treatment and stabilization. Your veterinarian will need to anesthetize your cat to allow for placement of a urinary catheter into the urethra to flush out the plug or force the stone into the bladder. The bladder is then flushed through the catheter to remove as much urine sediment (“schmutz”) as possible. The urinary catheter is sewn in, with a urine collection system attached, and generally left in place for 48 hours to allow for inflammation in the urethra to settle down. After 48 hours, it is then removed, and the cat is monitored for an additional 24 hours to make sure that he doesn’t “re-block,” which is possible. During this 72-hour time frame, your kitty is placed on intravenous fluids so that it will urinate frequently, essentially helping to “flush out” the bladder and "clear the toxins." Medications to address pain, urethral spasms, and possible infection are generally used.

Once urine flow returns, the kidneys quickly begin to correct the metabolic disasters that have been taking place ("Ahhhhhh"). Often an extremely sick blocked cat can be snatched literally from the jaws of death by having proper fluid support and by re-establishing urine production. It is amazing how efficient the working kidneys can be in restoring the body’s balance!

Once the cat is no longer obstructed, management is the same as for any other cat with feline idiopathic cystitis that is not obstructed.

What is the prognosis?

Prognosis for recovery is often excellent if treated appropriately and in time. If sudden kidney failure does develop as a result of the obstruction, it is generally reversible and will get “back in check” with IV fluid therapy support. The biggest concern, however, is the potential to re-obstruct. For cats that have 2 or 3 recurrences of obstruction, your veterinarian will recommend a surgical correction of the problem with a PU (perineal urethrostomy) surgery. This procedure can be likened to a “sex change” in your male cat, and it involves the surgical widening of the urethra to make it more the size of a female urethra.

It is crucial to realize that the cat is at risk for re-blocking for a good week or two from the time of discharge. This is because the irritation syndrome that led to blocking in the first place is still continuing, and as long as the episode continues, blocking is a possibility.

Urethral obstruction is a true medical emergency, and any cat suspected of suffering from this condition needs to receive immediate veterinary evaluation and care.  

Questions? Comments? Topic ideas? Let me know!  

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Steve L. Patterson April 20, 2014 at 12:07 AM
Sometimes the blockage can reoccur within days after he is unblocked. You have to keep a careful eye on him and monitor his behavior. Feel his lower right abdomen and check for a hard mass in that area. His bladder will be swollen if he has blocked again. Be sure to change his diet to predominately wet food once he recovers.
Isa Ayumu May 18, 2014 at 01:06 AM
So my cat Mr. Fluff has had an infection twice. The first luckily cleared up on its own before anything especially alarming happened. The second time he was refusing to eat or drink and was extremely sensitive to the touch. We took him to the vet and it was cleared up without an issue and we now buy him special dry food to help keep his urethra from blocking again. He's extremely picky and dry food is the only thing he'll eat daily with no complaint. In the past few months however he's been having accidents. They're always on my bed where he spends a lot of time sleeping. The first few times were quite alarming but I passed it off. He has these accidents where he urinates on my bed randomly and after roughly a month without one it happened again! Now I see that it could be a warning sign? The thing is he eats regularly and none of his patterns have changed. I even noticed that he seemed to be having an easier time in the litter box. So I'm not sure what to do. He recently turned five and it's so tough to see him suffer. I just don't want to wait until he's really suffering to go to the vet. My family's tight on money so vet visits are out of the question. I was wondering if someone could give me suggestions? He's been by my side as a source of comfort during difficult times for years and I can't handle seeing him depressed or hurting. I'm really scared.
Steve L. Patterson May 18, 2014 at 01:24 PM
Isa, you really need to see if you can convert him to wet food only. Any wet food is better than the dry formula even if the dry food says it is for urinary tract health. As far as suggestions, I don't have anything to say other than he really needs to see a vet. When he starts urinating outside his litter box it is a clear indication that he is suffering from a UTI. I wasn't sure what was happening to my cat until the second occurrence when he became very lethargic. I know it took a while but I was able to get my cat to start eating wet food for his own sake.
Barbara Wilhite May 18, 2014 at 10:17 PM
I agree with Steve. Wet food is the only thing a cat should eat other than maybe an occasional dry treat. Stress is also an issue so make sure his environment is as stress free as possible, If he is inside only make sure he has cat trees and cant see outside cats from windows. Play with him etc...


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