Inappropriate urination, difficult urination and urethral obstruction are common problems in cats of all ages. Terminology used to describe these problems has changed over time: Feline urologic syndrome (FUS), Feline lower Urinary Tract Disease (FLUTD), Interstitial Cystitis (IC) and Idiopathic Cystitis (IC). Veterinary research has shed some light on these frustrating and sometime life-threatening and life-altering conditions. However, the disease processes that are responsible for urinary problems in cats are variable in their causes, prognosis, treatment(s) and response to treatment(s).

Critical signs include but may not be limited to inappropriate urination (urinating outside the litter box), difficult or painful urination (dysuria/stranguria). Vocalizing while urinating (associated with pain), visible blood in urine (hematuria), frequent, unproductive (little or no urine passed) trips to the litter box, lethargy, depression or anxiety and even death (associated with obstruction or rupture).

Complete urethral blockage results in the inability to expel urine. Within twenty-four hours (or less), unrecognized/untreated urethral obstruction (blockage) results in death from electrolyte abnormalities and cardiac arrhythmias secondary to uremia (toxic waste products in the blood).

Approximately 20 – 30% of cases are due to an identifiable cause. These include cystic calculi (stones), crystalluria (crystals such as triple phosphate or calcium oxalate) & bacterial infections (less than 2%). The majority are idiopathic (no known causes) in nature, may or may not be accompanied by bloody urine and, not unlike Interstitial Cystitis in human women, is chronic, intermittent (waxing and waning) and can seriously alter the quality of life in protracted cases. The diagnosis of Interstitial Cystitis must exclude stones, crystals, infection tumors, etc.

A consultation with a Board Certified Internist or Nephrologist is recommended. A variety of diagnostic procedures are helpful and will include, urinalysis with culture & sensitivity (more than just one or two would not be uncommon) from urine taken directly from the bladder, x-rays, ultrasound and cystoscopy. Cystoscopy is invasive, carries the risk of complication and is not often necessary or recommended.

Treatment For Stones or Crystals: This depends upon exactly which variety is identified. Struvite crystals (triple phosphate) can be dissolved by acidifying the urine. This is done with special veterinary diets like Waltham s/o Control. Oxalate crystals can be approached in the same manner but with a food like IVD select Care Control that would create an alkaline atmosphere in the urine. Careful and frequent monitoring of Ph at home along with frequent urinalysis is essential. It is possible that while on therapy for one kind of crystal or stone another can develop.

Treatment For Infection: Although most cats with any kind of urinary tract symptoms are prescribed antibiotics, less than 2% need or benefit from them. Only cats with true infection that has been proven by culture and sensitivity obtained through a sample of urine taken directly from the bladder should be treated with antibiotics. Multiple urinalyses with culture and sensitivity testing may be required to adequately treat true infection both before as well as after antibiotic therapy. The length of time of the antibiotic therapy should not be less than 30 days. Ultrasound examination is recommended for any cat with urinary infection, as well.

Urinary Blockage: This is a life-threatening medical emergency that occurs mainly in male cats but can be present in females. The urethra may be occluded (blocked) by crystals, stones or mucoid matrix (plug) or, in some cases, obstruction may be due to spasm of the urethra. The obstruction must be relieved with a urinary catheter and the cat hospitalized. Therapy includes intravenous fluid therapy and careful monitoring of blood and EKG. Cats who experience blockage are predisposed to recurrence.

Some cats have repetitive obstruction to the degree that surgical intervention is required. A perineal urethrostomy (a permanent opening) is created by removal of the penis in order to create a larger urethral diameter. This procedure decreases the chance of obstruction but doesn’t treat the underlying disease or the emotional/behavioral aspects (inappropriate urination/inability to use the litter box in a consistent, acceptable manner) of the condition.

Cats who experience any/all kinds of urinary tract disease may continue to urinate outside the litter box even when and long after the primary problem has been solved. A consultation with a seasoned animal behaviorist who is expert in this particular area is highly recommended. This consult can take place at any time during the period of diagnosis and treatment but most certainly should be undertaken as quickly as possible after treatment is complete and the inappropriate (outside the litter box) urination continues. Never scold, startle or attempt to “correct” a cat engaging in this behavior. It will make matters worse.

Cats are remarkable animals who live with many painful conditions in less than ideal or acceptable environments for long periods of time before they display any observable signs of distress. No cat fails to use the litter box because he or she is “stupid, spiteful, lazy or getting even”. A compassionate, well informed approach to the behavioral component in all disease and living conditions is as important a factor as diagnostics, surgery, drugs and nutrition. The best outcomes are those in which cats have had the benefit of a consultation with a good animal behaviorist.

Interstitial Cystitis: There is no known cure for this disease. Therapy is currently aimed at decreasing and relieving symptoms and episodes of this frustrating and painful condition. Multiple therapies are available both as single treatments or in combination with each other. A plan for each cat must be designed and monitored by the Veterinarian (preferably a Board Certified Internist or Nephrologist), the behaviorist and the family. Amitriptyline (Elavil) is a frequently prescribed medication for this condition and some cats get good relief with it. Many other medications are under investigation and the problem is one that the entire veterinary community is anxious to understand and solve. Flare-ups can occur on a regular basis despite medical therapy and it is important to remember that antibiotics are not the treatment for interstitial, idiopathic, sterile cystitis.

The idea that these conditions are caused by eating dry food or any particular brand of food is the result of myth and misinformation. It is simply not so !

This article is Copyright © Barbara Meyers, and printed with permission of the author.
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