Feline Lower Urinary Tract Disease (FLUTD)

Feline lower urinary tract disease (FLUTD) encompasses a number of problems that can affect the lower urinary tract, in cats not one specific disease. The lower urinary tract refers to the bladder and urethra. These problems may occur separately or in various combinations and will produce cystitis like signs. You may notice increased frequency of urination (pollakiuria), straining to urinate (stranguria) and blood passed with the urine (haematuria). In some cases, the urethra can become blocked completely so the cat cannot pass urine at all. This is a dangerous situation and would need to be seen by the vet as an emergency. Obstruction is far more common in male cats. FLUTD generally is more common in middle aged, overweight cats, often indoor cats or cats who lead a sedentary lifestyle. It is estimated that 1 in 100 cats in the UK are affected with Feline Lower Urinary Tract Disease (FLUTD).

Causes of Feline Lower Urinary Tract Disease (FLUTD)

Whereas in dogs, an infectious cause of cystitis is common, it is much less so in cats and only a small minority of cases of feline cystitis are caused by bacterial infection. Those that are, are often secondary to another problem such as bladder stones or kidney disease.

The majority of cases are “idiopathic” meaning that no underlying or inciting cause can be found. Stress however is an important factor in FLUTD. Some cats have an increased response to stress which may cause or worsen inflammation in the bladder, causing cystitis. As a result, managing stress with products such as Feliway pheromone diffusers is a large part of the treatment of FLUTD. This is discussed in more detail later on. Another factor that can lead to cystitis is abnormality of the bladder lining. There is a protective layer of mucus in the bladder containing compounds called Glycosaminoglycans (GAGs), the main one being Glucosamine. If there are reduced levels of these GAGs then inflammation may occur leading to cystitis. Supplementation of these compounds with products such as Cystease or Cystaid is another approach to treatment to be discussed later.

Bladder stones (uroliths) may also form and aggravate the lining of the bladder. These stones can be formed from several compounds but the two most common are called Struvite and Oxalate. Struvite can be dissolved with special prescription diets but oxalate cannot and needs to be removed surgically. Along with stones, microscopic crystals of struvite and oxalate can be seen in the urine, known as crystalluria. These crystals can irritate the bladder causing signs of cystitis but can also contribute to obstruction of the bladder.

Obstruction of the Bladder

Crystals can lodge in the urethra meaning urine cannot flow out of the bladder. These crystals are often incorporated into urethral plugs which are also capable of causing obstruction with or without the addition of crystals. These plugs are made of protein as a result of inflammation in the bladder. In some cases there is no physical obstruction and spasm of the urethra due to inflammation or pain is enough to cause an obstruction. This is a potentially fatal condition and if your cat cannot pass urine, you should have them checked by a vet as soon as possible.

Diagnosis of Feline Lower Urinary Tract Disease (FLUTD)

Diagnosis of the specific cause of Feline Lower Urinary Tract Disease (FLUTD) will be based on the history and clinical signs and further tests such as blood tests to check for underlying problems such as kidney disease and analysis of the urine. This will assess urine concentration, the presence of red and white blood cells and crystals. In some cases imaging of the urinary tract will be required in the form of ultrasound scans and x-rays.

Management of Feline Lower Urinary Tract Disease (FLUTD)

Feline lower urinary tract disease is usually a recurring problem and management ,not cure is often what is achieved. Many cases of idiopathic cystitis would be self resolving in a few days but early treatment is recommended to prevent pain for the cat and the possibility of a blocked bladder.

As mentioned, stress is a contributing factor to flare ups of Feline Lower Urinary Tract Disease (FLUTD). Management of a cat's lifestyle will help, ensuring easy access to a clean litter tray, minimising stressful events such as travel and weight loss where indicated will all be helpful. Some changes in routine are unavoidable, moving house or a new baby for instance and these will cause stress to cats. There are products available to reduce stress in predisposed animals. Feliway is a synthetic feline pheromone which will reduce anxiety in cats. Feliway comes as either a plug in diffuser for use in the home or as a spray which can be used on bedding; in cat carriers for instance. Long term use of Feliway is very useful in cats where stress is a recognised cause of their Feline Lower Urinary Tract Disease (FLUTD).

Supplementing the glycosaminoglycans that line the bladder can also help manage FLUTD. The most common GAG is glucosamine and this is found in supplements such as Cystease S Capsules 125mg, manufactured by CEVA Animal Health . Cystease capsules can be given at a high dose initially then tapered to a lower maintenance dose and long term use of Cytease would be recommended in cats with recurrent FLUTD. Cystease capsules are virtually tasteless so should be palatable for your cat and are useful to maintain the health of the bladder lining.

A very important aspect of the control of Feline Lower Urinary Tract Disease (FLUTD) is diet. If struvite crystals or stones are present in your cat then prescription diets such as Hills Feline s/d will dissolve these in an average of 3.5 months. They achieve this by acidifying the urine to a level where the struvite crystals cannot be sustained and they dissolve. Hills Feline s/d should only be fed for a few months and then changed to a diet such as Hills Feline c/d Multicare which would then be fed long term as a maintenance diet for cats with FLUTD. Royal Canin Feline Urinary SO diet can also be used to dissolve struvite crystals and is also safe to use as a long term diet for management of FLUTD. Maintenance diets such as Hills Feline c/d or Royal Canin Feline Urinary contain less of the compounds that form crystals, help to maintain a healthy bladder lining and also act to increase water consumption which is vital. Increased water intake will dilute and flush out the crystal forming agents in the urine. Hills Feline c/d and Royal Canin Feline Urinary come in dry and wet forms in a variety of flavours, the wet formulations further increasing water intake. Fresh water should always be available and products such as Drinkwell water fountains will stimulate cats to drink more.

A range of other medications such as anti-inflammatories, antibiotics or even anti-depressants when the Feline Lower Urinary Tract Disease (FLUTD) has a stress related or behavioural cause may be required but the exact needs of your cat will be decided by your veterinary surgeon.   

Caring for a cat with lower urinary tract disease has been written as the best information source and source of support for owners of cats who have been diagnosed with lower urinary tract disease. It is designed to explain what causes lower urinary tract disease, how this is diagnosed and treated, and how future relapses can be prevented. It can also be an excellent resource for student vets, veterinary nurses and technicians. The book deals with the emotional aspects of coping with a cat with lower urinary tract disease and there is practical advice on all aspects of cat care and welfare. The book contains a case report taking the reader through a case from initial signs and illustrating successful management and There is also a detailed glossary of terms which may be used by your vet.

'Dr Sarah Caney and Professor Danielle Gunn-Moore have written a book that could literally be life changing for cat owners there are many practical tips that make life with an affected cat much easier and it is worth having a book in every practice, cattery or rescue centre for this reason alone' Review in 'UK Vet: The Journal for the Veterinary Surgeon in General Practice' (Volume 14 No.4, May 2009)