Cats often have problematic urinary tract issues, and in some cases, they can cause life-threatening consequences. Understanding this condition is critical to identifying a potential problem in your cat before they experience significant health problems. Our Gentle Touch Animal Hospital team addresses frequently asked questions about feline lower urinary tract disease in case your cat is affected. 

Question: What is feline lower urinary tract disease in cats?

Answer: Feline lower urinary tract disease (FLUTD) is not a single disease entity, but rather a term used to encompass many conditions affecting a cat’s bladder and urethra. Specific causes include:

  • Urolithiasis — FLUTD can be caused by urinary stones in the bladder or urethra. The most common types are magnesium ammonium phosphate (aka struvite) and calcium oxalate.
  • Urinary tract infection (UTI) — Pathogens, such as bacteria, fungi, and parasites, can cause FLUTD signs in cats, but UTIs are uncommon. When present, UTIs in cats are usually secondary to another disease process such as diabetes or urolithiasis.
  • Urethral obstruction — The most serious condition that causes FLUTD signs in cats is a urethral obstruction. Male cats are at higher risk because their urethra is longer and narrower than that of female cats. This is considered an emergency situation because if the obstruction is not removed promptly, the cat may experience kidney failure, a potentially life-threatening condition.
  • Feline idiopathic cystitis (FIC) — FIC is the most common FLUTD cause, and is a diagnosis made by excluding other potential causes. The exact cause is unknown, but stress seems to play a significant role. Abnormalities that may contribute to the condition include:
  • Defective bladder lining — A glycosaminoglycan (GAG) mucous layer lines the bladder wall to protect the cells from the irritating substances in urine. FIC cats often have a defective GAG layer, causing ulceration and inflammation.
  • Inflammation — Local irritation or signals from the brain in response to stress stimulate nerves in the bladder wall, causing inflammation.
  • Stress — FIC frequently is triggered by a stressful event. Cats kept indoors with no environmental enrichment and those living in multi-cat households are at highest risk.
  • Abnormal cortisol response — Stress normally causes a release of cortisol and catecholamines. In FIC cats, catecholamine levels are high, but cortisol levels are below normal.
  • Cancer — Cancer affecting the urinary tract is not common in cats but should be considered, especially in senior cats. Transitional cell carcinoma is the most common bladder tumor identified in cats.

Q: What are feline lower urinary tract disease signs in cats?

A: Common FLUTD signs include:

  • Vocalization — FLUTD cats may vocalize when using the litter box.
  • Increased urination — The cat’s inflamed bladder and urethra cause irritation, making them feel the need to urinate more frequently.
  • Bloody urine — The amount of blood in the urine may be microscopic or enough to cause the urine to appear pink or red.
  • Straining — If a cat’s urethra is blocked, they will strain to urinate. If you notice your cat exhibiting this sign, they should receive immediate veterinary attention.
  • Inappropriate elimination — Many FLUTD cats start to urinate outside the litter box because they associate using the litter box with pain and irritation. 
  • Licking — In response to the pain and irritation in the cat’s urethra, they may lick their perineum excessively. 

Q: How is feline lower urinary tract disease diagnosed in cats?

A: Identifying the underlying cause is important when diagnosing FLUTD. Common diagnostic tests include:

  • Blood work — A complete blood count (CBC) and biochemistry profile typically are performed to provide an overall picture of your cat’s health.
  • Urinalysis — A urine sample is usually collected by cystocentesis (i.e., a procedure involving collecting urine through a needle directly from the bladder). Evaluation of your cat’s urine can detect urinary crystals, blood, and bacteria.
  • X-rays — Abdominal X-rays can detect issues such as urinary stones and tumors affecting the urinary tract. Contrast X-rays also can detect urethral strictures.
  • Ultrasound — Performing an ultrasound on the bladder can detect abnormalities such as bladder stones and bladder wall thickening.
  • Biopsies — A tissue sample of the bladder wall may be needed, especially if a bladder tumor is suspected.

Q: How is feline lower urinary tract disease treated in cats?

A: FLUTD treatment depends on the underlying cause. Treatment for specific conditions includes:

  • Urolithiasis — A special diet designed to dissolve struvite stones can help manage them, but calcium oxalate stones must be removed surgically. Affected cats typically are fed a special diet for the remainder of their life to help prevent recurrence.
  • Urinary tract infection — A sample of the cat’s urine is cultured to determine the pathogen causing the problem, and an appropriate antimicrobial is used to treat the infection.
  • Urethral obstruction — Treatment involves dislodging the obstruction, usually by flushing a sterile solution through a urethral catheter under general anesthesia. Once the obstruction is removed, intravenous fluids may be needed to correct dehydration and electrolyte imbalances, and antibiotics may be recommended to prevent or treat infection.
  • Feline idiopathic cystitis — Many FIC cats are placed on a prescription diet to increase fluid intake and reduce urinary tract inflammation. Pain medications may be necessary to help alleviate signs, and environmental modifications also may be recommended to encourage fluid intake and decrease stress. 
  • Cancer — Bladder tumors are rare in cats, but when they occur, prognosis is usually poor. Chemotherapy may be helpful to reduce the size of the tumor, and pain medications can help alleviate signs.

FLUTD can significantly affect a cat’s quality of life, and determining the underlying cause is important to devise an appropriate treatment approach. If your cat is vocalizing when they urinate or urinating outside the litter box, contact our team at Gentle Touch Animal Hospital so we can investigate the problem and find an appropriate treatment.