	Cat Breeds
	Cat Names
	Mating and Pregnancy
	Raising A Kitten
	Cat Food and Nutrition
	Cat Health
	Cat Care
	Cat Humor
	Cat Gallery
	Cat Horoscopes
	History and Famous Cats
	Cat Links

Feline lower urinary tract disease

The term feline urologic syndrome (FUS) is an older term which is still sometimes used for this condition. The terms plugged-penis syndrome and blocked cat syndrome also refer to this disorder. It is a common disease in adult cats. It may present as any of a variety of urinary tract problems, and can lead to a complete blockage of the urinary system, which if left untreated is fatal. FLUTD is not a specific diagnosis in and of itself, rather, it represents an array of problems within one body system.

FLUTD affects cats of both sexes, but tends to be more dangerous in males because they are more susceptible to blockages due to their longer, narrower urethrae. Urinary tract disorders have a high rate of recurrence, and some cats seem to be more prone to urinary problems than others.

"Feline lower urinary tract disorders" (commonly referred to as FLUTD, LUTD, or FUS--feline urologic syndrome) come in at least three distinct varieties. All of them put together affect less than 3% of cats, but for those who are affected, it can be a major problem. Bladder diseases occur in both male and female cats, although males have a higher risk of life-threatening blockage of the urethra. It is usually first seen in cats between 2 and 7 years of age (though some very young and very old cats may develop signs). Episodes of LUTD are usually triggered by stress, such as home remodelling, severe weather, or loss or addition of a family member.

Symptoms

Symptoms of the disease include prolonged squatting and straining during attempts to urinate, frequent trips to the litterbox or a reluctance to leave the area, small amounts of urine voided in each attempt, blood in the urine, howling, crying, or other vocalizations. Male cats may suffer complete blockage of the urethra, leading to painful bladder distension as the organ fills with urine. Kidney failure and uremia will follow within hours. A male cat may protrude its penis. The cat may seek seclusion, stop eating and drinking, begin to vomit, and become lethargic and eventually comatose as toxins accumulate in the bloodstream. This is a veterinary emergency which will lead to death if not treated.

The clinical signs of all the LUTDs are very similar. Cats may go to the litterbox frequently, strain to urinate, pass very small amounts at a time, lick their genitals more frequently or more intensely than usual, or have blood in the urine. The cat may associate the burning sensation of cystitis (bladder inflammation) with the litter box itself, and look for another place to go where it won't hurt. This leads to squatting in corners, in sinks or tubs, on rugs, laundry piles, or beds.
Most cats brought to the vet for LUTD do not yet have blockages. However, it's important to act quickly when you see any of these signs, because if a blockage does occur, the backup of urine toxins and pressure can lead to kidney failure and death in as little as 24 hours.

About 2/3 of LUTDs are classified as "idiopathic cystitis", meaning "bladder inflammation of unknown cause." It is rare for bacteria to be involved--most are "sterile" inflammations. Less common causes of these signs include behavior disorders, kidney stones, anatomical defects in the bladder wall, other systemic diseases, and bladder cancer.

Causes

Any condition which causes inflammation of the urinary bladder or constriction of the urethra can cause this problem. These conditions include but are not limited to:

trauma

congenital malformation of the urinary tract

struvite crystals (magnesium ammonium phosphate precipitates) - the most common substance causing mechanical

blockage of the urethra

kidney or bladder stones of struvite or other minerals

plugs of mucus or blood cells

neurological problems

dehydration

obesity

bacterial infection

tumor

intentional urinary retention - a common behavior seen in cats not given a suitable place to void (e.g. no litterbox or dirty litterbox)

The disorder may be caused by a combination of these factors. For example, a diet of dry food which is high in magnesium or other minerals and high in pH, combined with inadequate intake of water may lead to favorable conditions for precipitate buildup in the lower urinary tract. However, these factors affect individual cats differently. Most cats tolerate normal dry diets with no urinary problems.

A recent study suggested that lower urinary tract signs afflict approximately 1.5% of cats presented to private veterinary practices engaged in companion animal medicine. However, FUS and FLUTD do not contain any diagnostic specificity for the many (~30) causes of lower urinary tract signs. Results of university-based studies during the last four decades suggest that most (55% to 69%) cats presented for evaluation of nonobstructive lower urinary tract disorders have idiopathic cystitis, approximately 20% have a urolith (struvite or calcium oxalate), and the rest have a variety of less common problems.

Diet is a component of LUTD, though usually not the sole cause. Dry cat foods, particularly high-fiber "light" or "senior" foods, contribute to overall dehydration and high urine concentration. Cats with LUTD should not be fed any dry food at all if possible. Canned or homemade foods help keep the urine dilute, minimizing irritation and the risk of crystal or stone formation. Feed in timed meals rather than leaving food available.

Holistic veterinarians believe that LUTD is a sign of underlying chronic disease. Homeopathy, acupuncture, Chinese herbs, western herbs, and other holistic therapies may be valuable in rectifying the hidden "causes" of LUTD and bringing your cat's health into balance and well-being.

There are lots of diets and treatments out there. An individually tailored treatment program is needed for each patient. But, if I had only one rule I could make for all of them, it would be "no dry food."

Treatment

A blocked urethra requires immediate veterinary attention. The plug must be removed from the penis and the bladder drained. Gentle mechanical manipulation of the penis may dislodge the blockage, or a catheter might be used to drain the bladder. Intravenous fluids are given to treat uremia. Antibiotics and a special diet may be prescribed. Diets low in magnesium and urine acidifiers may be helpful. Cats prone to repeated attacks of this disorder may require surgery, such as the removal of the penis to prevent its blockage.

Antibiotics are often used to treat feline LUTDs and are a standard first-line of conventional treatment. Even though bacteria are rare, some antibiotics have anti-inflammatory or analgesic (pain relieving) effects. Other anti-inflammatory drugs, such as steroids, are occasionally used when there is severe inflammation. Urinary acidifiers are sometimes given if the urine pH is very high. Steroids and acidifiers should not be used long-term. The anti-depressant amitriptyline is commonly used as a long-term treatment, but its effectiveness and safety are being questioned. For male cats who block repeatedly, there is a surgery to widen the urethra. This is a last-ditch option, and some males will still block even after this surgery.

Many herbal and nutritional treatments have been tried with varying success. Certainly, antioxidant vitamins such as C and E, which are also helpful in times of stress, are indicated (Vitamin C as sodium ascorbate or Ester C, and Vitamin E). Other antioxidants such as BioSuperfood may also be helpful, because of their anti-inflammatory action. Herbs such as slippery elm, horsetail, and couch grass have helped some cats. Many cats have done well with Co-Enzyme Q10, which prevents inflammation at the cellular level.