Cats can be very private about their toilet behaviour, so you may at first not notice your cat is struggling to urinate.

Feline Lower Urinary Tract Disease or FLUTD as it is known, has multiple causes like:

• Bacterial infections,
• Stones in the bladder,
• Cellular plugs clogging the urethra

FLUTD can be difficult to diagnose, but with a systematic approach a cause may be found.

You may notice your cat showing signs of straining, difficulty and pain when urinating, increased frequency of urination, urinating in strange places, over grooming of the tummy hair and maybe even blood in the urine.

FLUTD is most frequently seen in:

• Middle-aged cats,
• Cats that are overweight,
• Cats with restricted access to outside, and
• Frequently environmental stressors plays a role, e.g. visiting feral cats, adverse weather or changes in routine.

Your Vet will perform a full physical examination followed by a full urine analysis. If no immediate cause can be identified, further tests include blood tests, x-rays, ultrasound and urine culture.

Very Important:

If you cat has crystals, stones or cellular plugs, there exist a risk of a blocked urethra, which is considered a true medical emergency that requires immediate veterinary attention. If the bladder cannot be emptied, there is a build-up of toxic by-products normally excreted in urine, this can lead to kidney failure and ultimately death. Rapid response is required to drain the bladder, maintain a patent urethra and correct the electrolyte imbalances with intravenous fluids. Cats susceptible to repeated event of this disorder may require surgery in which the urethra is widened to prevent its blockage (urethrostomy).

Common causes:

Urolithiasis:

• this term describes stones in the bladder.
• The two most common types of stones are struvite (magnesium containing) and oxalate (calcium containing) stones.
• Struvite stones can be dissolved with a special diet in some cases, but if they don’t dissolve or oxalates are present, surgery to remove the stone has to be done.
• Sometimes little stones can be voided but can get stuck along the urethra causing a blockage.
• Special diets will then be used to prevent future stone formation.
• Urolithiasis generally accounts for +- 10-15% of FLUTD.

Bacterial infections:

• Bacterial cystitis (bacterial infection of the bladder) is relatively uncommon in cats.
• It tends to happen more often in older cats that don’t void their bladder often enough.
• It is treated with antibiotics after a culture and antibiogram of the urine has been done.
• Courses of treatment can be up to 4-6 weeks.
• It probably accounts for 5-15% of FLUTD.

Urethral plugs:

• Obstruction of the urethra, in especially male cats (because it is narrower) may occur by aggregates of proteins, cells, crystals and debris in the urine that combines to form a plug.
• The plugs area flushed out of back into the bladder and then the cause for the irritation/inflammation is treated to prevent them from reforming.

Anatomical defects:

• This is where a mechanical reason exist to prevent normal flow of urine.
• Most commonly due to strictures that form when the urethra got damaged by a plug or stone obstruction.
• During the healing process fibrous tissue makes the urethra narrower.

Neoplasia:

• Although uncommon, tumours/cancer especially in older animals must always be ruled out.
• If the tumour can’t be surgically removed, palliative anti-inflammatories are used.

Idiopathic Cystitis:

• Despite the well-recognised causes of FLUTD, in the majority of cats, probably around 60-70%, NO SPECIFIC underlying disease can be identified.
• These cats are classified as having “feline idiopathic cystitis”, a term that simply means inflammation of the bladder without a known cause.
• Management of FIC is complex as the underlying causes is not fully understood.
• It involves increasing water intake and reducing environmental stress as well symptomatic use of Glycosaminoglycan replacement (extrapolated from human medicine), painkillers and anti-depressants.