Feline Lower Urinary Tract Disease (FLUTD) is a broad term used to describe a number of urinary tract conditions affecting the lower part of the urinary system (bladder and urethra). The most common include inflammation of the bladder (cystitis) and, in male cats, obstruction of the urethra (the tube from the bladder to the outside). The condition is unfortunately common and complex, involving medical and behavioural components and, in the vast majority of cases, a specific cause is not identified.

Causes

There are several different reasons for your cat to have problems with urination. These include:

• Idiopathic cystitis - this is a common condition involving inflammation of the bladder with no known cause. Concentrated urine (as cats tend to have), stress and damage to the lining of the bladder are thought to contribute to the problem. In male cats the inflammation in the bladder is very painful and this, in combination with the leak of proteins and blood into the urine, can block the urethra. This is a life-threatening complication meaning the cat cannot urinate. Male cats have a narrow and longer urethra than female cats so are more likely to suffer a blockage.
• Bladder stones - this is less common but will cause similar signs and can cause blockage of the urethra as above.
• Anatomical abnormalities - if your cat has been in an accident then damage to the bladder or urethra can cause lower urinary tract problems.
• Bacterial infection - this is very unusual in cats with no other health problems. Cats with conditions such as diabetes or kidney disease may be more prone to infection but infection is a very unusual cause of FLUTD.

We also know that FLUTD is most frequently seen in middle-aged, overweight cats using a litter tray and kept indoors with little exercise.

Signs of urinary problems

Signs include going in and out of the litter tray, straining to urinate, pain urinating (crying out in the litter tray), licking their genital area a lot, blood in the urine, producing little or no urine after straining and, in some cases, loss of litter training. As this can be a very serious and life-threatening condition, particularly in male cats, contact your vet immediately if you notice such signs.

Diagnosis

Your vet will need to do a few tests to rule out other causes and then may make a diagnosis of idiopathic cystitis. Blood tests should be performed to rule out underlying problems (e.g. with kidneys) and a urine sample tested for the presence of inflammatory cells, blood, crystals and to assess urine concentration. It may also be sent away to test for bacteria but, as mentioned above, bacterial urinary tract infections are very uncommon in cats. Further tests may involve x-rays and ultrasound to assess the bladder and urethra.

Treatment

If your cat is suffering a blockage to the urethra, then your vet will need to act quickly to remove the blockage and possibly place a catheter (tube) into the urethra to allow the passage of urine. Bladder stones may need to be surgically removed, with some types of stone requiring a diet change. In rare cases of bacterial infection, antibiotics may be required. Idiopathic cystitis is challenging to treat and involves the following approach:

• Pain relief - FLUTD of any cause is very painful and distressing for the cat. Pain also causes the urethra to narrow further, making blockage more likely.
• Drugs - to relax the urethra in male cats to try and prevent or treat blockages.
• Reduction of stress - stress has a role in idiopathic cystitis and so you and your vet need to discuss causes of stress in your cat’s life; consultation with a veterinary behaviourist may be required. Synthetic pheromone treatments may help anxiety and are available from your vet.
• Reduction in the concentration of the urine - by, for example, changing cats on dry food to wet food, adding a little water to wet food, or offering ‘soups’ of tuna or chicken in plenty of water (without salt).
• Encourage your cat to drink more water by providing multiple water sources, like cat water fountains and wide-brimmed ceramic bowls, in several locations inside and outside, and filling water bowls to the top so cats do not have to put their head into the bowl to drink.
• Medications, including drugs to improve the bladder-wall lining, may be recommended by your vet.
• Other medications may be discussed depending on each individual case.

FLUTD, and particularly idiopathic cystitis, is challenging to treat and requires patience and time. You may need to think about stress in your cat’s life and how to reduce it, and consult with a feline veterinary specialist or behaviourist. With veterinary help, many cats with urinary problems go on to have normal and happy lives.