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Feline Lower Urinary Tract Disease (FLUTD)

overview

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What is Feline Lower Urinary Tract Disease?

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Feline lower urinary tract disease (FLUTD) is most commonly due to feline idiopathic cystitis (FIC), which is inflammation of the bladder with no known cause. Other less common causes are ideally ruled out, such as bladder stones, urethral plugs, bacterial infections, anatomical defects or cancer. It is important to note, that although bacterial cystitis is common in humans (more often referred to as a urinary tract infection, or UTI) it is very uncommon in cats, affecting <2% of cats with urinary symptoms.

FIC is most common in young to middle aged cats. It has been linked to stress and can be triggered by chronic stress (such as conflict with other pets) or short-term stress (such as moving house). Affected cats often have abnormalities of the nerves in their bladder and an atypical neurological response to stress, suggesting they may be predisposed, however FIC is also seen more often in cats who live indoors only, are overweight or lead sedentary lifestyles, live with other cats, and/or have a low water intake.

symptoms

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What are the symptoms of Feline Lower Urinary Tract Disease?

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Symptoms of urinary tract disease include:

• Dysuria – pain/discomfort on urination
• Pollakiuria – frequent urination
• Haematuria – blood in the urine
• Stranguria – straining to urinate but only passing small volumes
• Periuria – urinating in unusual places

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Often cats will be seen to be “in and out” of the litter tray, may sit posturing for a long time, and may groom their genital area excessively. Symptoms can be very similar to those seen with constipation and are easy to mistake.

In male cats, FLUTD can lead to obstruction of the urethra (the tube which urine leaves the bladder through). This prevents the bladder emptying and is a life-threatening emergency. A male cat that is straining to urinate and not producing urine should be examined as a matter of urgency.

diagnosis

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What tests are used to diagnose Feline Lower Urinary Tract Disease?

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Cats with FLUTD present with similar symptoms, regardless of underlying cause. FIC is the most common cause (especially in young to middle aged cats) but is a diagnosis of exclusion. This means that we need to rule out everything else to confirm the diagnosis. Less common causes of FLUTD include bladder stones, urethral plugs, bacterial infections, anatomical defects and cancer. On first presentation, your vet may treat on a presumed diagnosis of FIC, however, if there are recurrent episodes, or your cat does not fit the typical presentation, investigation may be advised. This usually includes:

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Urinalysis

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Assessment of a urine sample to look for signs of inflammation, blood, bacteria and crystals. If bacterial infection is suspected, sending a sample to an external lab allows confirmation of the presence and type of infection. This is ideally removed straight from the bladder using a needle and syringe (known as cystocentesis) to prevent contamination. If this is not possible, non-absorbent litter can be used to obtain a sample.

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Blood tests

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Conditions causing increased thirst can lead to increased urination; blood tests to check organ function may be recommended.

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Imaging

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An ultrasound scan allows accurate visualisation of the bladder and kidneys. Ultrasound can help identify bladder stones, tumours and changes in the bladder wall. Some stones (particularly kidney stones) are easier to assess by x-ray, so this may be advised as well. Occasionally, contrast is passed up a catheter into the bladder to show more detail.

treatment

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How is Feline Lower Urinary Tract Disease treated?

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If an underlying condition, such as bladder stones is found, this will need specific treatment. Many cats with FIC need a multi-pronged approach to successfully manage them, including the following:

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Increase Water Intake

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Increased water intake leads to dilute urine, reducing bladder inflammation and significantly reducing likelihood of FIC recurring. This may be achieved by gradually moving to a wet diet, increasing water availability, and offering alternative sources such as a water fountain. Make sure fresh water is available, in a quiet location away from any litter trays. Different cats prefer different drinking vessels; a shallow, wide brimmed ceramic bowl is most widely accepted but some prefer to have several options available or will prefer to drink from water left standing in the sink or bath. Try to work out what your cat prefers, and consider flavouring water with tuna, chicken or salt-free stock to encourage intake.

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Dietary Modification

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Moving from dry biscuits to wet (canned or pouched) food can significantly increase water intake. Prescription urinary diets are also available and may be recommended by your vet. Cats can be very resistant to changes in their food, and switching slowly increases the likelihood of the new diet being accepted long-term. Start by mixing a very small amount of the new diet into the existing food, and gradually increase the ratio of new:old over days or even weeks. Warming food to body temperature may help increase palatability if your cat isn’t keen.

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Stress Management

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Often stress is the trigger for FIC. Sometimes this is obvious, such as a new baby coming home or building works in the household. Other times it is more challenging to identify (e.g. a new cat in the neighbourhood) and careful consideration must be given to the cat’s daily life.

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Common causes of stress include:

• tension with other cats in the household
• competition over resources
• undesirable litter tray placement
• lack of outdoor access

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Giving your cat places to hide and feel safe, and sufficient mental stimulation (such as scratching posts or play sessions) can help. It is also important to offer suitable toileting facilities, especially for cats kept indoors. Ideally have one more litter tray than the number of cats, located in different areas of the house, and clean them regularly. Some cats prefer specific substrates (such as paper, wood chip or pellets), and like an open or covered tray design. Offering their preferred choice helps encourage regular toileting; this helps the bladder and reduces stress. Even if they aren’t using all of the trays don’t be tempted to remove them as having choice reduces stress.

Pheromone diffusers can provide a calming effect and your vet or nurse can discuss changes at home that may help. For severely affected cats, referral to a veterinary behaviourist may be advisable.

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Medication

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Drugs can help control FIC but are not an alternative to the measures above. The benefits of medication must be off set against any additional stress caused by administration. The primary recommendation is pain relief, often also anti-inflammatory, as FLUTD is painful. Supplements containing glycosaminoglycan (GAG) may be beneficial to help repair the bladder but there is little evidence to confirm this.

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Weight loss

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Cats who are overweight are more likely to suffer from FIC, so reducing food intake and encouraging movement will help reduce the risk of relapse.

outlook

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What is the outlook for cats with Feline Lower Urinary Tract Disease?

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A large proportion of cases of FLUTD are simple and resolve in 3-7 days. A small number of cats experience recurrent, or chronic, urinary tract disease. In these cases, investigation to look for an underlying cause is recommended, and stress management strategies should be employed. The prognosis for long-term management is still good, but significant changes may be needed at home to achieve successful long-term control.