Guest Post by Brenda Eisenhauer, DVM
Everything You Need To Know About Feline Lower Urinary Tract Disease (FLUTD)!
Feline lower urinary tract disease is one of the most common medical issues affecting cats. Often abbreviated FLUTD (and pronounced as one word that sounds like “fluted”) this term describes an aggregate of diseases that can cause uncomfortable or painful urination when mild and in severe cases it can be fatal.
We see quite a few FLUTD cats in our clinic and it can be a stressful condition to manage. When we talk to cat owners about FLUTD we tend to get three main questions:
- What causes it and what are the signs to look for?
- How do veterinarians diagnose FLUTD?
- What treatment options are available?
What Causes FLUTD?
Because FLUTD is a broad term to describe a variety of different diseases talking about it can sometimes get a little confusing. These diseases are grouped together because they generally result in very similar symptoms (which we will get to soon). Here are a few of the most common causes of FLUTD:
- Idiopathic cystitis– Unfortunately, this is just a fancy way of saying we don’t know the cause but the bladder is inflamed. Idiopathic describes any condition that arises without a clear or known cause. Cystitis refers to an inflammation of the bladder. What’s even more frustrating is that this is the main cause of FLUTD by a long shot. In fact, around 60-70% of causes are attributed to idiopathic cystitis.
- Bladder stones– These account for another large slice of the FLUTD pie. Bladder stones occur when various minerals (usually calcium or magnesium) accumulate into a stone in the bladder. This can require surgical intervention if the stones are too big to pass through the urinary tract or if the stones don’t respond to changes in diet.
- Bacterial infections- Bacterial infections can occur for a variety reasons and can sometimes be intertwined with other causes. This can usually be treated with a round of antibiotics but may require advanced testing (like cultures and ultrasound) to rule out complicating factors.
There are a handful of other causes including congenital defects, cancer or urethral plugs but the conditions listed above are the cause of most FLUTD cases and the ones you want to be most familiar with.
What Are The Symptoms of FLUTD?
Despite the variety of causes for lower urinary tract disease in cats, we see the same symptoms in most cases. Here’s what you need to look for in your cat:
- Straining or more frequent urination– Any of the causes of FLUTD can result in your cat struggling to urinate. Inflammation of the urinary tract is a common effect of the disease and this makes it more difficult for your cat to easily pass urine. Pay attention to how long your cat stays in the litter box – cats with FLUTD will stay longer due to straining or vocalize while in the litter box due to pain/discomfort. Additionally, cats may also go to the litter box more frequently or keep going in and out of the litter box as if they can’t decide.
- Painful urination- Cats with moderate or severe FLUTD may yowl or let out a long low meow while urinating. Sadly, these cats are trying to urinate but the process is now painful for them.
- Bloody urine- Your veterinarian may refer to this as hematuria which simply means bloody urine. Since cats are generally good about using the litter box this one may be harder to spot.
- Urinating outside of the litter box- This is certainly one of the quickest ways for cats to get their owner’s attention! While there can be a variety of reasons for a cat to avoid the litter box a lower urinary tract disease is one of the most common. Cats can eventually associate the pain of urination with the litterbox and untreated urinary tract disease can lead to long term litter box aversion. Urinating outside the box can be a result of many different things but FLUTD should certainly be on the list of causes to consider.
Unfortunately, this isn’t what we mean by “outside the litterbox”!
If you see any of these behaviors in your cat it’s important that you get them to a veterinarian as soon as possible. While not all these symptoms indicate a threat to your cat’s life, if your cat is unable to excrete urine (and thus remove waste) it could quickly become life threatening. Male cats in particular are prone to becoming blocked as a result of their narrow anatomy.
How Do Veterinarians Diagnose FLUTD?
Because the symptoms of FLUTD could be the result of different diseases requiring different treatments – your veterinarian will need to run a series of diagnostics to identify exactly what is going on. Complicating things further is the fact that there isn’t always just one cause so veterinarians need to take a big picture approach.
At Colorado veterinary clinic, Parkside Animal Health Center, we always start with the cat’s history and any recent changes in the household. We know that idiopathic cystitis can be attributed to around 60% of FLUTD cases and there is often a connection between the sudden inflammation of the urinary tract and new stressors in the household. The most common ones are new pets, new people or a new home but it could be something more subtle like a change in routine that may seem minor for you but a big deal for your cat.
Again, because there may be more than one cause we will want to do some more objective diagnostics after a history is collected. The standard approach is to collect a urine sample and take radiographs of the bladder. A urine sample gives us a good idea of the overall health and function of the urinary system and also allows us to identify bacteria that may be causing an infection. Radiographs also allow us to see stones in the bladder. Generally, these stones can be pretty easy to see.
The bladder stones are right where you think they are!
The combination of history, x-rays and analysis of the urine usually provides enough information to figure out what is going on. Or as is more often the case in veterinary medicine, we get closer to obtaining a clear picture of what isn’t going on!
How Do Veterinarians Treat FLUTD?
Again, this will depend on the exact cause of the disease. Diet is almost always a part of the equation. Keeping cats well hydrated through wet food can help manage some causes of FLUTD. Special diets can help manage the development of crystals and mineralizations that can cause blockages or bladder stones.
Some of the other major treatment options include:
- Stress management- We wish this one was more cut and dry but in the case of idiopathic cystitis this is often our best option. Reducing stress can mean a lot of different things. It may mean letting things settle after a big change or creating more structure around your cat’s routine. Your veterinarian can either help talk you through stress reduction or refer you to a feline behaviorist who can help identify stressors for your cat.
- Surgical intervention- While some bladder stones can be dissolved with prescription diets, others require surgical intervention. Anesthesia always presents a risk and your veterinarian will evaluate your cat’s overall status as a surgical candidate.
- Antibiotics- In the case of a bacterial infection a course of antibiotics can be used to eliminate the bacteria. Your veterinarian will want to collect another urine sample after the completion of antibiotics to evaluate treatment success.
FLUTD cats can be managed and our clinic has a lot of success keeping cats with a history of urinary tract disease comfortable and happy. Your veterinarian will come up with an individual plan that fits your cat and your family. It will likely encompass all aspects of your cat’s lifestyle from diet, stress levels and monitoring urine and blood markers.
The long and short of it? FLUTD cats can still live full and happy lives! Which means happier cat owners too! Do you have a FLUTD cat? Tell us about it below!
Brenda Eisenhauer is a veterinarian and practice owner at Parkside Animal Health Center in Aurora, Colorado. When she isn’t spending time at her practice or with her husband and their fur family, Dr. Eisenhauer works with shelters and rescue groups around the Aurora area.