FLUTD or Feline Lower Urinary Tract Disease is an umbrella term used to describe a variety of disorders of the bladder and urethra (lower urinary tract) in cats. There are a range of disorders all causing pain and inflammation of the lower urinary tract in pets, yet they present very similar behaviour changes and clinical signs in affected cats. This is an incredibly frustrating disease for all involved, not least of all your pet if affected. The underlying causes of this disease do not necessarily originate within the urinary system, making them difficult to diagnose1.
What signs should I look out for?
Causes of this disease range from urinary tract infections, uroliths (urinary stones), or cancer, but sometimes the cause is never fully uncovered2. For this reason, it is imperative that you contact your veterinarian, who will explain the details of your pet's specific diagnosis. Cats of any age can develop this disease, but if your pet is an older, neutered male who are less active may be at an increased risk. Also, feeding your pet a dry diet is excellent for their dental health, however it can aid in the development of FLUTD, particularly if there is more than one cat in the home.
Signs to watch out for include crying out while urinating, your pet frequently attempting to use the litter tray without much urine produced, or even spots of blood in the tray. Your cat may suddenly become exceptionally preoccupied with grooming their genital area and you may discover ‘accidents’ on cool, smooth surfaces in your home. Some causes of FLUTD are very similar to the human form of the condition, and your kitty’s environment can play a large part in the onset of episodes in your pet. You may find that changes in your pet's routine precede a flare-up of FLUTD.
If you are concerned that your pet may be experiencing any discomfort urinating, or you've noticed behaviour changes it's advisable to book an appointment with your veterinarian. Your veterinarian will perform a physical examination and analyse your pet's urine for evidence of bacterial infection, blood or crystals. Crystals are accumulations of minerals that coalesce to form urinary stones and can block the urethra causing serious illness. Further testing may be required including blood tests, x-rays and behavioural consultation to ascertain the cause of your pet's discomfort.
A guide to treatment
There are such a range of diagnoses causing FLUTD symptoms in cats that treatment will depend on the cause3. In some cases if there is no blockage, the symptoms will resolve with anti-inflammatory medication. Veterinary treatment of FLUTD is primarily focussed on pain relief and preventing future episodes from occurring.
If your cat has been diagnosed with urolithiasis this means there are stone-like collections of mineral crystals accumulated in your pet's bladder4. Some types of crystal can be dissolved with dietary modification to increase the acid content of your pet's urine, or attempts may be made to flush your pet's bladder with sterile fluids. In the majority of cases, surgical intervention is required to remove the stones. The surgery is called a cystotomy, where a cut is made through the belly and the bladder is lifted up into view and opened to remove the stones. This is a perfectly safe procedure which will not cause your cat any significant pain.
Acute episodes and obstruction
When your pet suffers an acute episode of FLUTD often the first treatment is urinary catheterisation to relieve any pressure on the bladder, thus reducing discomfort. A narrow bore tube is passed up the urethra and your pet's bladder is then gently expressed. This usually requires sedation or general anaesthesia. Further treatment will depend on your pet's condition: antibiotics may be given if infection is the cause and intravenous fluids will be administered if your pet is dehydrated. Sometimes medication to help restore bladder function is given with the duration of hospitalisation, depending on your pet's response to therapy and the severity of their flare-up.
Acute obstruction occurs when your pet's urethra becomes partly or totally blocked, a serious, potentially life-threatening condition. This can be caused by stones, soft mucus plugs, or a spasm of your pet's urethra. Blockage is more common in toms than queens because of their long, narrower urethra. When the urethra is completely blocked, your pet's kidneys are no longer able to remove toxins from the blood nor maintain proper fluid and electrolyte balance in the body. In some cases, if left untreated episodes such as this can be fatal, but need not be if you ensure your cat receives treatment swiftly.
If medical therapy fails to relieve a persistent urethral obstruction, surgery may be required. The procedure is a perineal urethrostomy where most of the penis (in male cats) and a portion of the urethra is amputated to leave a wider opening for urination. Complications include post-operative bleeding for up to 10 days, narrowing at the surgery site or urinary incontinence, however these are only temporary side effects. Soon enough your kitty will be back to good health again.
Caring for your cat at home
Stress appears to play a large factor in the episodic nature of this disease. Stressors for your cat can include changes in environment, diet schedule, or any other pets you may have at home. Management of your cat will depend on its condition and history of previous attacks5. There are a number of steps you can take to reduce the frequency of episodes.
Dietary consistency is important: feed them small, frequent meals on schedule where possible6. If your pet has had urinary stones and requires an acidifying diet to prevent reformation, look out for commercial foods which specify they contain formulations for urinary health. Avoid feeding extra acidifying supplements, as these supplements can cause metabolic problems for your cat including compromising kidney function, potentially exacerbating any FLUTD symptoms. Clean, fresh water should also be available at all times.
Litter boxes should be kept scrupulously clean and placed in quiet and safe areas of the house. It's essential that an adequate number of litter trays are available, ideally you should provide at least one more tray than the number of cats in the house. In multi-cat households, it's important to avoid bullying and overcrowding, so make provisions of escape routes and hiding places to help reduce any antagonism7. Climbing posts and elevated shelves or walkways will allow your pets to pass each other without conflict, while toys that your cat can catch will help him express his natural predatory instincts. If your pet is closely bonded to you, some one-on-one time together will reassure him and help to minimise his anxiety.
Being in tune with your cat’s behaviour, and providing them with a clean and stress free environment are key to the reduction of your cat contracting FLUTD. Remember though, even if your cat is diagnosed with FLUTD, the disease is easily remedied with the appropriate care, so there is nothing to be worried about.
1 Buffington, CA Tony (2011) Idiopathic cystitis in domestic cats-beyond the lower urinary tract In: Journal of Veterinary Internal Medicine 25.4, pp. 784-796. 2 Gunn-Moore, D et al. (2003) Feline lower urinary tract disease In: Journal of Feline Medicine & Surgery 5.2, pp. 133-138 3 Kruger, John M, Carl A Osborne, and Jody P Lulich (2009). Changing paradigms of feline idiopathic cystitis In: Veterinary Clinics of North America: Small Animal Practice 39.1, pp. 15-40.