Feline lower urinary tract disease (FLUTD) describes a collection of conditions that can affect the bladder and/or urethra of cats.  It includes the condition more commonly known as cystitis (inflammation of the bladder) and does not usually involve the kidneys. The signs shown by cats with FLUTD are often similar regardless of the cause.  This is why it is important that your cat is examined by a vet.  Also, if your cat is straining and not able to pass any urine, then there may be a blockage.  In these cases, emergency treatment to ‘unblock’ the bladder is needed or your cat may die.  While there are many conditions that can result in signs of FLUTD the vast majority of cases are idiopathic (ie we cannot find the cause).  This commonly occurs in cats with an exaggerated response to stress.

Clinical signs of FLUTD

Cats with FLUTD usually present with signs of difficulty and pain when urinating, increased frequency of urination, blood in the urine, urination outside the litter box, or even complete obstruction to urine outflow.  Some cats show only behavioural changes, loss of litterbox training and/or aggression.

Which cats are most susceptible to FLUTD?

While the condition can be seen in cats of any age, it is most frequently seen in middle-aged, overweight cats, which take little exercise, use an indoor litterbox and have restricted access to outside.  Persian cats appear to be predisposed.  FLUTD occurs equally in male and female cats but the risk of urinary tract obstruction is greatest in males.

What causes FLUTD?

There are many causes of FLUTD including:

• Urinary stones or crystals that form in the urine and irritate the lining of the bladder
• Urethral plugs that form in the male cat’s urethra, causing a physical obstruction
• Spasm of the muscle in the wall of the urethra
• Abnormalities in the structure of the urinary tract
• Stress and behavioural problems
• Cancer of the bladder or urethra
• Disease affecting the nerves controlling the bladder
• Bacterial or viral infections

However, in 60-70 per cent of cases, it is not possible to find an underlying cause – this is termed idiopathic FLUTD.

How is FLUTD treated?

Treatment of FLUTD should be directed to the underlying cause if one has been diagnosed, eg:

A bacterial infection will be treated with antibiotics – further urine samples may be required to show the infection is no longer present before stopping the antibiotics.

The presence of urinary crystals or stones may require a change in your cats food to a prescribed diet specifically designed to dissolve them.  Surgery may be needed to remove certain stones which do not dissolve.

Increasing water consumption to dilute the urine.  This may be achieved by: Changing your cats diet to tinned food or moistening dry food

Supplying free access to water and encouraging your cat to drink eg using water fountains; leaving a tap dripping; using ceramic bowls instead of plastic or metal as these may taint the water; supplying multiple bowls/glasses of water; using distilled or bottled water; or flavoured broths (check with your vet to ensure the flavouring is safe for short or long-term use)

Controlled weight loss and increasing exercise for long term control.

Reducing stress as this may be a ‘flare factor’.  Stressors include change in diet, environment, weather, overcrowding or bullying, owner stress, the addition of new new animals or people to the house, including babies and workmen.  Stress associated with urination is particularly significant, eg unsuitable position/content of litter tray or competition for the litter tray.  A pheromone diffuser (FELIWAY) from your vet may help.

A urethral obstruction will be dealt with as a medical emergency because it can be life threatening.  Complete blockage of the urethra can lead to urine backing up to the kidneys and affecting their function.  Your cat will need to be unblocked immediately, usually under a general anaesthetic.  He will probably remain hospitalised for a few days after the blockage has been cleared.

Medical therapy issued by the vet such as:

A supplement to repair the protective lining of the bladder.  Can be given as Furinaid (TRM) or Cystease (CEVA).

Anti-inflammatory drugs may help to relieve the pain in some cases

Relief of urethral spasm with drugs that relax the muscles

Anti-depressant drugs may be beneficial in some severe or chronic cases.
•FLUTD is very painful and distressing to the cat.
•Cats with FLUTD may self-traumatise their perineal region (the area below their tail).
•Cats with FLUTD may stop eating.
•Male cats with FLUTD are at risk of developing urethral obstruction, which can be fatal.
•Cats with FLUTD may develop behavioural changes, become aggressive to their owners or other cats within the household, or may lose their litterbox training.
•Having a cat with FLUTD is very distressing to the owner.