FLUTD relates to any disorder that affects the bladder and urethra in domestic cats. Disorders observed are blood in urine, difficult or painful urination, urinating in inappropriate locations, frequent urination and complete blockage of the urethra known as urethral obstruction.
These symptoms can occur separately or concurrently and are commonly diagnosed in a veterinary practice. The condition tends to be a recurrent problem that affects male and female cats although male cats tend to have more complication due to a long, narrow and inflexible urethra. FLUTD can cause death in cases where the cat is completely blocked for 24 to 48 hours. Feline lower urinary disease is often referred as idiopathic cystitis since in a great majority of cases the exact cause of the problem is not diagnosed but the diagnosis is achieved by ruling out other causes of cystitis.
Who gets it?
Male and female cats can both be affected. This is usually a problem in young to middle age cats although not exclusively. Indoor cats, obese cats, cats fed dry food only and multicat household cats are more commonly affected. While the exact cause in still unclear, Calici and some other viruses were suggested – although stress, nutrition, life style and infection could be contributing factors. At this stage we assume that FLUTD is a result of multifactorial causes.
What are the common causes of FLUTD?
There are two main causes; Feline Idiopathic Cystitis (FIC) and urethral obstruction. While FLUTD is a combination of different diseases/entities, FIC and urethral obstruction are separate entities.
Feline Idiopathic Cystitis
It occurs as a result of sudden inflammation of the bladder for no obvious reason. This is the most common reason for FLUTD. The affected cat has difficulties urinating, there is blood in the urine but there are no crystals or stones present and the difficulty urinating comes from the swelling of the urethra and the neck of the urinary bladder. FIC tends to resolve on its own and it needs supportive treatment only if at all. Environmental causes are blamed to have a major role (e.g. stress, introduction of new pet, intercat aggression). Management of FIC is usually conservative and sometimes involves medication such as pentosan polysulphate (Carthophen) that helps to re-establish a lining of the urinary bladder.
Antibiotics are not very often indicated. Behavioural modification and environmental changes are important. Make sure there are a lot of toys, scratching posts and cat litters with different types of litter since some cats can have a certain preference. Shy cats need their own privacy and providing an enclosed cat litter box can help.
Urinary blockage with crystals and stones
This problem usually results from chronic urinary problems that may or may not be previously noticed. When urinary obstruction strikes, this is a serious matter and in some cases can be lethal. As a result of obstruction your cat is unable to eliminate urine that apart from causing discomfort can cause kidney failure, poisoning of the body with urine waste products and severe electrolyte imbalance. After the initial pain the cat becomes lethargic, may develop vomiting and eventually coma and death. Most cats that suffer from urinary blockage have issues with struvite crystals. Crystals tend to stick together and form a toothpaste-like plug that is firmly lodged in the urethra. Other common crystals are oxalate crystals and the incidence of oxalates has been on the rise since most of diets today keep the urine pH acidic to counteract struvite formation. Struvite and oxalate crystals may stick firmly together and form stones which are harder to combat than the crystals. truvite crystals always form in alkaline (high pH) urine while oxalates in acidic (low pH). The most common reasons for struvites to develop are excessive amounts of magnesium and phosphorus in the food and feeding a dry diet that is very concentrated. Environmental and social factors (e.g. unable to go to toilet as often as wanted) can cause urine to become more concentrated and as a result crystals precipitate in the bladder. Oxalate crystals occur as a result of urinary diets that keep the pH low and some other conditions in the body e.g. an increased amount of calcium.
Management of urethral blockage
The treatment must be prompt to save your pet’s life. A blood sample is taken first to assess the condition of your cat and the severity of the problem. Intravenous fluids are used to improve the kidney function and remove toxins from the body. However the most mportant part is to relieve the blockage by passing a urinary catheter though the urethra into the bladder. Most of the time your cat has to be sedated or put under general anaesthetic since the procedure is uncomfortable. Once the catheter is passed, and a urine sample is collected, the bladder is flushed with sterile fluid and the catheter is stitched up in place for a 24-48 hour period to keep the bladder open.
Many cats will need medications such as antibiotics since catheterisation increases the likelihood of infection. Pain relief is also needed in the first 24-48 hours. Once the bladder is over distended for a long period of time it will get paralysed and medications to increase the tone of the bladder and keep the urethra open can also be given. Most cats recover in a couple of days. Sometimes if the blockage is recurrent or impossible to relieve with catheterisation, a surgical procedure is performed to open up the urethra and keep it this way. However this procedure is not without risks and complications are possible so it is done as a last resort only.
Bladder stones can be either removed surgically or dissolution with special diet may be attempted (works for struvite crystals only). Oxalate stones must be removed surgically since they can’t be dissolved.
What do I do to keep my pet healthy?
Preventative measures greatly depend on the cause of FLUTD. It is advisable to increase water intake to improve flushing of the urinary bladder and this will also keep the specific gravity of urine low and make it less likely for the crystals to form. Tuna brine or chicken stock can be added to drinking water to increase water intake. Address all environmental issues and make sure there is always fresh water available, always provide extra cat litters, keep litters clean, minimise stress and changes in routine. If your cat suffered from struvite crystals it is advisable to start in on special diets which re low in magnesium and phosphorus and usually have salt added to promote drinking. This should improve flushing of the bladder and keep urine diluted. Many diets contain urinary acidifiers which keep the pH of urine in low range and minimise the chance of struvite build up but may promote oxalate production. Carthophen injection (pentosan polysulphate) can also help to maintain the balance within the urinary bladder by supporting its superficial layer which seems to get damaged when FLUTD occurs. The injections are given weekly for 1 month. Oral supplements can also be beneficial in combating FLUTD.