Feline Lower Urinary Tract Disease

FLUTD in cats

What is FLUTD?

Formerly known as FUS (Feline Urologic Syndrome), FLUTD (feline lower urinary tract disease) is a group of conditions affecting the cat’s lower urinary system and bladder, including urolithiasis (stones in the urinary tract), cystitis (inflammation of the bladder), urinary tract infection and urethral obstruction.

Approximately 1% of the cat population will experience FLUTD, it is more serious in males than females as they have a narrower urethra, making them more prone to becoming blocked.
Urethral obstruction is a medical emergency.

All cases of FLUTD have the same symptoms, but there are numerous causes, some of which are not fully understood yet.

What are the symptoms of FLUTD?

  • Straining to urinate or only passing a small amount of urine. This can sometimes lead the owner to believe that the cat is constipated.
  • Blood in urine (hematuria).
  • Frequent visits to the litter tray.
  • Excessive genital licking, way beyond normal self-cleaning.
  • Crying in the litter box. You may hear your cat crying near, around or in the litter box. This also involves the cat attempting to urinate and little or no urine is passed.
  • Urinating in places other than the litter box, such as the bath or floor.

How is FLUTD diagnosed?

Your veterinarian will be able to give a tentative diagnosis based on physical examination and signs, such as straining to go to the toilet, licking genitals. He will feel the bladder through the abdomen, the bladder may feel large, full and distended or it may feel small and thickened.

He may also investigate further by performing a
urinalysis, blood work, ultrasound or x-ray.

What are the causes of FLUTD?

There are several causes of FLUTD in cats:

  • Feline Idiopathic Cystitis (FIC) or unknown cause: This is the most common cause of FLUTD in cats, and is seen in 50 – 65% of cases. Cystitis means bladder inflammation. Even with extensive testing, much of the time a cause of the symptoms cannot be determined.
  • Urinary stones (uroliths):  Struvite or calcium oxalate are the most common form of urinary stones. Uroliths are seen in 15 – 20% of cases. Your veterinarian will be able to perform an ultrasound or x-ray to detect urinary stones in your cat. Depending on the type of stone, it is possible to prescribe a stone-dissolving diet. This appears to have worked well for struvite crystals, but not for calcium oxalate crystals. Diet is believed to play an important role in the formation of urinary stones and crystals.
  • Urethral obstruction: Urethral plugs are usually composed of large quantities of matrix (protein) mixed with minerals.  Some urethral plugs are predominantly composed of matrix, some may contain tissue fragments, blood cells, and cellular debris, and a few may be composed primarily of crystalline minerals.
  • Stress: FLUTD has been linked to stress in some cases. So reducing stress in the household may be of help. This includes providing enough litter trays in hour household. A general rule of thumb is one litter tray per cat, plus one extra. So, if you have two cats, three trays. Obviously, this isn’t always practical, and if you have fewer litter trays try scattering them around the house, and ensure they are cleaned frequently.
  • Cancer: This is seen in less than 1% of cases.
  • Trauma or anatomical defects of the urethra: This is seen in less than 1% of cases.
  • Bacterial infection: This is an uncommon cause of FLUTD and is seen in around 1 – 3% of cases.

How is FLUTD treated at home?

Treatment depends on the cause and severity of the condition. Treatment will also vary according to the type of crystals your cat has, should he/she have crystals.

  • As stone build up is caused by urine which is too concentrated   it is important to try and get more fluids into your cat, to reduce the concentration of the urine. It is also beneficial to aim for a pH below 6.5. pH in a cat’s urine usually ranges from 5.5 to 8.0, but diets which result in < 6.5 decreases the chances of struvite crystals forming.
  • Diet: Moisten dry food or change to canned/raw food. Dry food contains approximately 10% water, whereas canned or raw food contains approximately 70% water. Avoid fish flavoured food. Feed a diet which increases the acidity of urine. There are special diets which are created to increase thirst. When I was dealing with a cat with FLUTD several years ago it was fairly widespread that magnesium was quite possibly a contributing factor to the formation of struvite crystals, and therefore a low magnesium diet could help. However, it appears that this is believed to not be the case.*1
  • Increase water consumption: Encourage drinking by other means, such as providing a drinking fountain for your cat.
  • Urine pH: Try to feed a diet which keeps the urine pH below 6.5. Unfortunately, long term use of an acidifying does carry some risks, one of which is the increased chances of developing calcium oxalate urolithiasis.*2
  • Antibiotics: This form of treatment is used for mild cases of FLUTD. The decision to prescribe antibiotics to a cat who is affected by FLUTD depends on upon the severity of the case. Most cases of FLUTD resolve themselves within 5 days. However, since FLUTD has been known to cause severe pain and damage in many cats, it is better to be safe than sorry. Antibiotics can help in some cases.
  • Medications: Amitriptyline, which is an antidepressant and Analgesia (painkillers) are two examples of medications which may help a cat with FLUTD. 

How is FLUTD treated a the vet?

  • Urine: If your cat is completely blocked then your veterinarian may extract urine by placing a syringe through the abdomen and directly into the bladder and draw out the urine. This is a fast and effective way of emptying out the bladder in an emergency situation. Alternatively, he may choose to catheterise the cat immediately. See below for info on catheterisation.
  • Fluid Therapy: This form of therapy is often used before catheterisation is attempted. It involves the feeding of fluids to the cat in order to continue to flush out the cat’s urinary system (particularly the bladder).
  • Catheterization: This is the system by which a catheterization needle is inserted into what is called the Cephalic vein. This vein is located in one of the front legs of the cat. After the intravenous needle is placed in the front leg of the cat it is wrapped. A urinary catheter is also placed in the cat’s urethra. This helps re-hydrate the affected cat and also helps flush out the FLUTD crystals that have formed, as well as the excess potassium. Catheterisation on a cat takes place while the cat is under anaesthesia.
  • Surgery: A procedure is performed on male cats who experience repeated bouts of FLUTD. It is also performed on cats who’s systems were not fully flushed during the catheterization process. This surgery is known as a perineal urethrostomy and involves partial amputation of the penis to the point where the urethral opening is larger. This will help reduce the risks of blocking, although it is still possible a small number of  cats will become blocked even after the perineal urethrostomy.

References*: 1) Yahoo Pets, 2) Lower Urinary Tract Disorders of Cats.

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