Urine Trouble

By: Dr. Megan Mackalonis, VMD, Emergency Clinician, mmackalonis@vsecvet.com, Veterinary Specialty & Emergency Center, www.VSECVET.com

Have you ever gotten upset with your beloved kitty for urinating on your favorite rug? Nothing is more frustrating than finding an accident outside of the litter pan. There are times that these truly are “accidents” or (or what I like to call “on purposes”), but these accidents can also be a sign of a medical condition and can even lead to life-threatening health concerns in our feline friends.

If your kitty is urinating outside of the box, he may be suffering from a widespread condition of young/middle-aged male cats known as Feline Lower Urinary Tract Disease (FLUTD) or Feline Idiopathic Cystitis (FIC).

Both are acceptable terms for a syndrome affecting male cats, that, for reasons not entirely understood, leads to inflammation and spasm of the urinary tract which leads to difficulty urinating. Cats affected by this syndrome tend to begin to show signs as young adults. Your little buddy who would typically never do such a thing is suddenly rushing in and out of the litter pan, straining to urinate and squatting all over the house. He’s leaving small puddles of urine everywhere and it’s very frustrating to keep up with the clean up! He has not suddenly forsaken his litter habits. Rather, he could be having a flare up of Feline Lower Urinary Tract Disease.

In addition to frequent attempts at urination and straining to urinate, a flare-up of FLUTD can also be characterized by excessive licking/grooming of the hind end, excessive vocalizing and blood may be noticed in the urine. If your cat seems to be showing such strange behavior, he should be evaluated by a veterinarian immediately. Sometimes, a flare-up can lead to a complete obstruction of the urinary tract, which is very life-threatening.

Why is this happening?

 Feline Lower Urinary Tract Disease is still not 100% understood, but it is characterized by excessive grit, mucus, and inflammation of the urinary tract that leads to the signs above. In some cases, certain individuals may have underlying urinary crystals, making them more predisposed to such signs developing.

This is something that your veterinarian can test for and, if present, can prescribe a special diet that changes the urine pH to help prevent crystal formation.

Others may even have bladder stones. These can be tested for via x-ray/ultrasound and, if present, removed surgically to help relieve current signs and a prescription diet provided to help prevent re-formation of future stones. Rarely, some individuals may have an abnormal shape to their urinary tract (ie stricture, or narrowing, of the urethra) that predisposes to urinary tract signs. Contrary to what may seem intuitive, it is actually VERY RARE for male cats to have a urinary tract infection as a cause for urinary tract signs, so antibiotics are generally not helpful unless a UTI is actually documented with urine testing.

We do know that two things seem to play a significant role in this syndrome: stress and water intake. It’s hard to imagine that your cat could possibly experience any stress, right? You provide everything for him and all he needs to do is meander over to the food bowl when he feels like it. However, they experience more stress than we realize—the new baby in the house, the visitors that just came from out of town, the new puppy, or even the stray cat who keeps taunting him from outside. Any of these things in a cat already predisposed to FLUTD can lead to a flare-up. Additionally, cats simply do not drink as much as they should. The more we can get them drinking (and, thus, urinating), the better.

What can be done?

 It is best to get on top of a flare up as soon as possible. Your veterinarian can help to provide medication for pain and for spasm of the urinary tract and also check to be sure that your cat is not fully obstructed. If testing has shown that your cat has crystals in his urine, a special diet should be fed to help keep crystals from forming and reduce the incidence of flare ups.

Increasing water intake to the greatest extent possible will go a very long way toward helping to reduce flare ups as well. This can be done by feeding a canned food diet, mixing water with dry food, and by making your cat’s drinking water more enticing. Some tricks include providing numerous water bowls throughout the house, as well as trying feline water fountains—these are especially effective for cats who like to drink from faucets. For bowl-drinkers, you can try mixing a hint of flavor (such as tuna juice) with their water so that it smells more interesting.

Reducing both general and litter box stressors will also be helpful. The household should ideally have one more litter pan than the number of cats and should be spread throughout the home. Cats generally prefer uncovered litter pans without liners and the pans should be as large as possible. It is difficult to avoid general life stressors, but some things that can help include providing tall hiding places (such as cat trees) and plug-in diffusers of a product called Feliway (feline calming hormones) throughout the home.

It is important to know that, unfortunately, despite medical intervention, close monitoring and preventative measures, there is no fool proof way to prevent urinary obstruction. For this reason, if you ever fear that your cat is straining to urinate and CANNOT PASS URINE, another emergency trip to the veterinarian is warranted. This is when FLUTD becomes life-threatening.

My cat is blocked. Now what?

 Sometimes, a FLUTD flare can result in complete obstruction of the urinary tract—we refer to these guys in the hospital as “blocked cats.” This is life-threatening because these cats cannot excrete urine and, therefore, cannot excrete the toxins that they normally would also be excreting.

One of the most dangerous elements that builds up during these times is an electrolyte called potassium. Potassium, in excess, can actually cause abnormal heart rhythms and, when very high, can stop the heart. If your veterinarian finds your cat to be “blocked” (to have a urethral obstruction), emergency intervention will be recommended. The gold standard of treatment includes “unblocking” the patient, performing bloodwork to see how the kidneys and electrolytes have been affected by the obstructive event, performing urine testing to look for underlying crystals, performing an X-ray and/or ultrasound to evaluate for underlying bladder stones, and hospitalization for generally 24-36h with a urinary catheter in place. Sometimes, kitties with this problem come to the hospital very sick and, in those situations, can require more intensive care and monitoring, which can require a longer stay.

During hospitalization, IV fluids are administered along with pain management and medication to help relieve spasm of the urethra and the amount of urine being produced is monitored. If kidney values/electrolytes were abnormal at the time of presentation, medication to help treat the electrolyte abnormality may be warranted and the bloodwork will be monitored. The goals for discharge will be to see normal blood values, normal-appearing urine in adequate amounts and, ultimately, to see your cat urinate well on his own after the urinary catheter is removed. The catheter is kept in place for so long because we need to give the urethra some time to become less inflamed.

Wait, so my cat needs surgery?

 Nope, no surgery. Well, probably not…Your cat needs to be placed under deep sedation, but there is no surgery performed. A catheter is simply inserted through his urethra (the tube from the world to the bladder) into his bladder in order to relieve his obstruction and allow urine to flow. He is under sedation because it would be too uncomfortable to place the catheter with him awake. He then wakes up and is able to function perfectly normally with both a urinary catheter and IV catheter in place—although he will wear a cone in the hospital to keep him from removing these things and having the procedure repeated.  

I said “probably not” earlier for two reasons:

1) Should your cat happen to have bladder stones, surgery to remove them would be recommended as the risk for re-obstruction after unblocking would be very high without doing so.

2) In some cases, certain cats become “frequent flyers” for becoming blocked. We generally give them three strikes…after three strikes, a perineal urethrostomy (or PU) surgery is recommended. This surgery would shorten the penis and widen the hole through which your cat urinates. Although his FLUTD syndrome and occasional feelings of inflammation/irritation of the urinary tract cannot be cured, it would be very rare for him to be able to become obstructed again. This is not a first step option, however, as it is more invasive and not entirely benign.

This sounds awfully expensive! What if I can’t afford this?

It’s true—even an initial trip to the veterinarian for just a FLUTD flare-up without an obstruction is not super cheap. However, if medical medication followed by changes at home can help to prevent an obstruction and even minimize future flare-ups, it will definitely lead to savings in the long run. A urethral obstruction when treated in the way described can certainly add up.

Should surgery end up being required at some time, this could entail a few thousand dollar investment. For a variety of reasons, we cannot always do what is ideal and gold standard and need to consider a silver or bronze option. The options available vary depending upon the situation at hand, but your veterinarian can discuss with you all that is reasonably possible for you and your pet. Something to highly consider before any urinary signs begin is to obtain pet insurance to help defray the cost of such surprise expenses. More and more reputable pet insurance companies are gaining popularity and your veterinarian can help to provide you with information regarding these services.

Finally, be informed! Know that any change in urinary behavior for your male kitty is worthy of a check-up. Know that your family veterinarian and/or local ER such as the VSEC emergency service is here for you if concerns arise.

Dr. Megan Mackalonis is an Emergency Clinician at the Veterinary Specialty & Emergency Center. The Veterinary Specialty & Emergency Center operates state-of-the-art emergency and specialty veterinary hospitals that are open 24/7/365 in both Levittown PA and Philadelphia PA. For more information about our world-class emergency and specialty care, please visit VSEC on the web at www.VSECVET.com.