Cleaning up cat pee off your carpets… or new couch… or clean basket of laundry is NO FUN! Having a sick kitty is even less fun. If your cat has started urinating more frequently yet only producing small volumes of urine at a time, if you observe blood in your cat’s urine, or if you notice your cat straining or crying in the litterbox, your kitty may have Feline Lower Urinary Tract Disease, abbreviated FLUTD. The Meowing Vet explains the signs, causes, and treatment of this urinary disease as well as why FLUTD can sometimes progress to a serious emergency if not promptly detected and treated. Read on and share with those fellow crazy cat ladies and gents in your life!
What is FLUTD?
Feline Lower Urinary Tract Disease, or FLUTD (pronounced “floo-tid“), is an umbrella term for various diseases involving the bladder and urethra of cats. FLUTD typically affects young to middle-age cats (especially those that have been neutered). Previously called “Feline Urologic Syndrome,” FLUTD comprises several urinary disorders:
- Idiopathic cystitis
- Uroliths (urinary tract stones) and urethral plugs
- Urinary tract infections (UTIs)
- Injury to the bladder or urethra
- Urinary neoplasia (cancer)
- Rare neurologic disorders
These various diseases will be discussed in more detail further down, but all of these problems cause some or all of the same clinical signs in cats that characterize FLUTD, including:
- Bloody urine (hematuria)
- Pain or discomfort when urinating (stranguria)
- Multiple attempts to urinate or urinating several small volumes instead of a normal stream (pollakiuria)
- Urinating in inappropriate locations, i.e. outside the litterbox (periuria)
- Obstruction of the urethra (meaning urine cannot exit through the urethra – the tube connecting the bladder to the outside world) – This can pose a life-threatening medical emergency!
If your cat has FLUTD, you will observe him or her frequently going to the litterbox and posturing in a “squat” position for a longer than normal period of time in an attempt to urinate. However, your kitty may only produce a small amount of urine at a time, often just a few drops, which may be blood-tinged, have blood clots, or feel “gritty”. Because FLUTD is uncomfortable (the bladder is inflamed, and the urethra may have painful muscle spasms), your cat may start to associate the discomfort of urinating with its litterbox and start to urinate elsewhere, often on carpet, fabric, or furniture. (So don’t fuss at your kitty for peeing outside its litterbox! Instead, schedule a vet appointment if the problem persists.) You may also observe your cat scratching furiously at the litter in its box out of frustration of being unable to adequately urinate. Your cat may also be seen licking or biting its genital area, and you may notice that the area around the urethra or penis is red, purple, or swollen. Alternatively, some cats may seek a hiding spot, so if your kitty suddenly goes missing in the house and is found hiding with the monster under your bed, it’s probably time to see the vet.
Having difficulty removing cat urine stains and odors from your house? Try my personal favorite cleaner, Nature’s Miracle™ Just for Cats Urine Destroyer.
How is FLUTD diagnosed?
FLUTD must first be distinguished from constipation, which can look similar if your cat is observed straining in its litterbox. Secondly, FLUTD must be differentiated from behavioral disorders. For instance, if your cat is spraying urine on vertical surfaces in order to mark its territory, your cat most likely does not have FLUTD and instead is displaying a behavioral issue. Consult your veterinarian about how to change this unpleasant behavior or ask his or her advice concerning pet behaviorists in your area. Thirdly, FLUTD must also be distinguished from polyuria and polydipsia (or PU/PD), meaning an excessive volume of urine production with increased thirst and water consumption by your cat. In cases of FLUTD, your cat has an increased urge to urinate more frequently, but he or she usually only produces small volumes of urine at a time; a change in water consumption is usually not associated with FLUTD. PU/PD on the other hand is typically attributed to disorders like diabetes mellitus, hyperthyroidism, chronic kidney disease (CKD), or liver disease rather than lower urinary tract diseases (i.e. those involving the bladder and urethra).
If your cat is displaying the clinical signs listed in the previous section (hematuria, stranguria, pollakiuria, periuria, or appearing unable to urinate), FLUTD is likely, and your cat should have a physical examination and urinalysis performed by your veterinarian. Your vet will obtain a urine sample from your cat to analyze it for evidence of inflammation, infection, urinary stones or crystals, and kidney dysfunction. With FLUTD your cat’s urine will be well concentrated (meaning a normal or high USG) yet show signs of blood (hematuria), white blood cells (pyuria) secondary to inflammation or infection, bacteria (if your cat has a UTI), or crystals (often secondary to stone development).
If your vet is suspicious of urinary stones or if your cat has a urethral obstruction, your vet will also wish to obtain abdominal radiographs (x-rays) and/or ultrasound (sonogram).
Why is FLUTD so important to diagnose and treat? How is a urethral obstruction treated?
In early stages of FLUTD, your cat’s bloodwork should also be fairly normal (vs. with diseases causing PU/PD as described above), and your vet may not initially suggest running bloodwork. However, if your cat has developed a urethral obstruction, your vet will be interested in monitoring your cat’s biochemistry values, primarily BUN and creatinine as well as potassium and TCO2 (or bicarbonate). Male cats are at increased risk of developing urethral obstructions.
If your cat cannot pass urine out of the body as with a urethral blockage, urine can back up into the kidneys, resulting in kidney damage that increases toxic build-up of BUN and creatinine in the blood. The kidneys normally keep the body’s potassium levels in check by dumping excess potassium into urine. If urine (and therefore excess potassium) cannot exit the body, high levels of potassium (termed hyperkalemia) can cause life-threatening heart abnormalities, resulting in dangerously low heart rate (bradycardia) and an irregular electrocardiogram (ECG or EKG). Additionally, urethral blockages can also cause your cat to have acidosis in which the pH of the bloodstream is too low for normal cellular function. Furthermore, if the bladder cannot empty due to an obstruction, it can become severely damaged and rupture internally, necessitating emergency surgery to repair it.
Therefore, a “blocked” cat is an emergency requiring prompt diagnosis and treatment. So if your cat appears to be straining to urinate or is crying during its attempts, take your cat to your local veterinarian or veterinary emergency center immediately! THIS SHOULD NOT WAIT UNTIL THE NEXT MORNING! Your vet will promptly obtain blood for bloodwork analysis and begin stabilizing your cat by relieving pressure on your cat’s full, hard, painful bladder via a cystocentesis (in which a sterile needle is placed directly into the bladder through the skin to remove urine) or via urinary catheterization. (Your cat may require anesthesia for its catheterization, but your vet may wish to wait until your cat’s bloodwork results indicate that your cat is stable enough to undergo anesthesia.) Your cat will likely require hospitalization for several days with the urinary catheter still in place to give the urethra time to heal before the catheter is removed. While in the hospital, your cat will also receive IV fluids to “flush out” toxins from the kidneys and bloodstream, to rehydrate your likely dehydrated kitty, and to dilute urine to minimize crystal and blood clot aggregation which can re-block your cat. Your cat may also need antibiotics as well as medications to correct electrolyte abnormalities (i.e. potassium and TCO2) and may require a prescription dietary change if abnormal crystals or urinary stones were observed in your pet’s urine. Typical veterinary diets include Hill’s® c/d, Purina® UR, and Royal Canin® SO. If your veterinarian prescribes such a diet, this should be the sole food source that your cat ingests to ensure that the food’s beneficial action will aid your cat. (This means no other cat foods, no treats, no human food, etc. Otherwise, the prescription diet is wasted, as is your money.)
Once your cat is discharged from the hospital, your vet will advise you on at-home changes necessary to reduce your cat’s chances of re-developing signs of FLUTD. (Read below…) Your vet may also prescribe buprenorphine for pain management and to alleviate urethral spasms, a non-steroidal anti-inflammatory drug (NSAID) specially formulated for cats (such as Onsior®), and medications to relax the urethra to minimize the risk of re-obstructing (such as prazosin or phenoxybenzamine). Cats with frequently recurrent cases of FLUTD may be prescribed amitryptiline, an antidepressant that may also aid in stress management and urinary health. And though not proven, some veterinarians feel that glycosaminoglycan supplements (GAGs) such as Cosequin® for Cats, traditionally intended as a joint supplement, may reduce bladder inflammation in cats with FLUTD. (Ask your vet for more advice on the use of GAGs in your cat.)
In uncommon instances, your cat may develop bladder atony following a severe urethral blockage. Bladder atony occurs when a very full urinary bladder is stretched so much (think of a water balloon nearly ready to burst) that its nerve supply is damaged and it loses muscle tone. This condition prevents the bladder from emptying normally, and your cat will require intensive lifelong management should this occur.
Read more about how to interpret your pet’s urinalysis and why a urine sample can be valuable to your vet in monitoring your pet’s health. Click here. Interested in deciphering your pet’s bloodwork? Click here!
What causes FLUTD?
As explained, Feline Lower Urinary Tract Disease can be subdivided into several different conditions: idiopathic cystitis, urinary tract stones and urethral plugs, UTIs, bladder or urethral injury, urinary cancer, or neurologic disorders. Feline idiopathic cystitis (FIC, also called interstitial cystitis) is the most common cause of FLUTD. It obtains its name from “cyst” = bladder, “itis” = inflammation, and “idiopathic” = the cause is not known. As its name implies, this condition causes inflammation of the bladder (and urethra) though the inciting cause of this disorder is not fully understood. However, stress is thought to induce lower urinary tract inflammation in these affected cats. These affected kitties tend to have smaller than normal adrenal glands (the organs involved in the body’s fight-or-flight response to stressful situations) and produce less amounts of cortisol (the hormone released to aid the body in managing stress). Uncomplicated cases of idiopathic cystitis may last for up to 7-10 days before resolving, yet some may progress to urethral blockages or secondary bladder infections, persist longer than 10 days, or reoccur. Because the recurrence rate is so high at 30-70% and since finding a long-term cure can be difficult, learning proper ways of managing your cat’s stress at home is extremely important at treating this disease. (Keep reading for suggested stress management tips.) Other proposed explanations of idiopathic cystitis include unknown viral infections or nutritional deficiency of glycosaminoglycans (GAGs).
Stones of the urinary tract (uroliths) and urethral plugs are the second most common causes of FLUTD, both of which have the capacity to form a urethral obstruction. Idiopathic cystitis can progress to urethral plugs (commonly consisting of mucus, blood clots, and gritty debris). Additionally, urolith formation may be metabolic or dietary in nature, requiring a specially formulated prescription veterinary diet to dissolve existing stones or prevent the development of new stones. If your vet has diagnosed uroliths via urinalysis and x-rays, he or she will advise you about a prescription diet if indicated.
The other causes of FLUTD are quite uncommon. Urinary tract infections (UTIs) on their own are not very common in felines and usually have a more complicated underlying basis; however, idiopathic cystitis or bladder stones can cause a secondary UTI to develop. Injury to the lower urinary tract is also uncommon. Moreover, cancer of the bladder and urethra are very rare in cats, only occurring in less than 0.3% of FLUTD cases. Also extremely rare are neurologic disorders causing FLUTD (though urethral obstructions secondary to FLUTD can cause bladder atony, a neurologic impairment of the bladder, as previously described).
How can I reduce my cat’s chances of developing FLUTD?
Since the majority of FLUTD cases are caused by idiopathic cystitis, which is thought to be related to stress, taking action to properly reduce stress in your cat’s environment is imperative in managing this disease. For instance, the introduction of a new baby or pet, loud construction in the household, or moving to a new home are all potentially stressful situations for your cat. Additional risk factors for FLUTD development include obesity, a dry food-only diet, a multi-cat household, and being solely indoors. Though males and females may be affected equally, male cats are typically the only sex to develop urethral obstruction.
Stress reduction techniques are termed Multimodal Environmental Modification (or MEMO). Recommended changes include:
Proper litterbox care: How stressed would you be if your toilet was always yucky? Your cat enjoys a nice clean litterbox too, so make sure it is cleaned daily. You may also need to try a variety of boxes and litter types before your kitty settles on one he or she really likes. Additionally, use the “1+1 rule” with litterboxes: for every cat in your house, that cat should have its own litterbox plus one additional one for the group. (For example, if you have 3 cats, you should have 3 + 1 litterboxes, or 4 total in the household.) Keep litterboxes in a variety of locations around the house too instead of clustered together side-by-side. Your kitty may need some privacy!
Increasing water intake: Cats’ evolutionary ancestors were desert animals, meaning that they concentrated what little water intake they had, producing very concentrated rather than dilute urine; because cat pee contains so many toxins, salts, etc. dissolved in a comparatively small amount of water, these solutes can precipitate out and form crystals, which can cause urethral blockages. Therefore, we want to entice our kitties to drink more water in order to make their urine more dilute, minimizing crystal formation and improving bladder health. For starters, consider switching your cat from a dry food-only diet to a canned food, which has a higher moisture content. Furthermore, the “1+1 rule” applies to water bowls, too: for every cat in your home, he or she should have a primary water bowl plus one more for the group. Keep the bowls in multiple locations as well, and ensure that they stay clean. If your cat prefers drinking running water (such as out of a dripping faucet), consider a pet-friendly water fountain such as the Drinkwell Platinum Pet Fountain by PetSafe.- Weight management: As discussed, obesity increases your cat’s odds of developing idiopathic cystitis. Therefore, increase your cat’s physical activity and gradually decrease food consumption or ask your vet about a special weight loss diet to encourage your cat to slowly shed some pounds.
Play time: Persuading your feline companions to play will keep them mentally and physically active, minimizing stress and trimming their waistlines. Try a variety of different cat-safe toys to find ones that are purr-fect for your cat.- Human interaction: Although many cats are notoriously aloof, our cats need some attention, so give them a few extra gentle strokes, join in their play time, or set up cat-friendly videos to keep them company for when you’re away at work.
Controlled access to the outdoors: Although indoor-only cats are less likely to contract communicable diseases from stray cats and sustain injuries, cats that stay solely indoors may become bored. Therefore, if you have a screened-in porch or patio or if your cat is leash-trained, cautiously consider introducing your cat to the outside world under your supervision.- Safe hiding and snoozing places: Cats need to feel safe to de-stress, so provide them with safe, secluded areas to chill out (such as a cat tree or a bedroom to which only they, and not your family’s playful dog, have access).
- Reduction of aggression between felines: Sometimes cats experience sibling rivalry too! Unlike dogs, cats are not pack animals and prefer solitude. If you have a multi-cat household, some squabbles among your cats may ensue, and this stress can induce FLUTD. Therefore, separate your cats if they are not getting along, ensure that they have their own safe areas in which to hide, and consider the relaxing cat pheromones of Feliway® sprays or room plug-in diffusers.
For additional tips on stress management in cats, visit “Feline Life Stressors” on the Indoor Pet Initiative section of The Ohio State University College of Veterinary Medicine‘s website.
Looking for something new and exciting?! Dr. Liz Bales, a veterinary graduate of The University of Pennsylvania School of Veterinary Medicine in the U.S., created the NoBowl Feeding System™ for cats, an interactive and activity-packed means of feeding cats by simulating how they would obtain food in the wild. As shown in the video below, the innovative design of the NoBowl Feeding System™ mimics the predatory nature of cats to keep them mentally and physically stimulated when eating, reducing boredom and overall stress.
The NoBowl Feeding System™ may help reduce your cat’s risk for developing FLUTD as well as promoting weight loss if your cat is overweight. Since obesity is a risk factor for FLUTD, ensuring that your cat maintains a healthy weight is also key to managing FLUTD.
Ask your veterinarian whether the NoBowl Feeding System™ is right for your cat, and order your kit today!
Wondering how else to encourage your cat to lose weight? Read our articles on dog and cat obesity and weight loss:
Life Hack: Pet Edition #2: Weight Loss Tricks
When Your Pet Has a Muffin Top: Fighting Obesity in Dogs and Cats
What is the typical prognosis of FLUTD?
Cats susceptible to Feline Lower Urinary Tract Disease may have recurrence of their urinary signs throughout their lifetime. Some cats are sadly euthanized due to FLUTD because of owner frustration over carpet and furniture soiling, due to the high frequency of FLUTD recurrence, or because of the potential difficulty in some cases of managing this disease. In order to give your cat the best chance possible for minimizing its risk of developing FLUTD, reducing the number of flare-ups if your cat has had past bouts of FLUTD, and increasing your cat’s happiness and longevity, follow the above stress management tips and consult your veterinarian if you are worried about your cat’s health.
To learn more about FLUTD, visit the Cornell Feline Health Center on Cornell University College of Veterinary Medicine‘s website.
Boo cat pee! Boo FLUTD! Boo Princess Buttercup! Booooo! Booooo! (‘Cause if you can’t make a reference about The Princess Bride when you’re discussing cat urine, when can you? Amiright?!) If your cat has the urinary signs described in this article by The Meowing Vet, book an appointment with your veterinarian today to determine if your cat has Feline Lower Urinary Tract Disease. And if your cat is straining and crying when attempting to urinate without producing any urine, seek emergency veterinary care at once!
Stay in the loop of our daily animal videos and shared news articles by following The Meowing Vet on Facebook and Instagram (@themeowingvet). And sign up for our blog mailing list in the right-hand sidebar of your desktop browser so you never miss out on our weekly informative articles. You can help us (and animals) immensely by sharing our site’s articles with your pet-loving friends and inviting them to like our Facebook page!
– Maranda Elswick, DVM
Source: This article was adapted in part from notes comprised by David C. Grant, DVM, MS, Diplomate ACVIM. Associate Professor. Internal Medicine. Department of Small Animal Clinical Sciences. Virginia-Maryland College of Veterinary Medicine (VMCVM).
