Feline lower urinary tract disease (FLUTD) is a broad term often used to describe a range of clinical signs related to abnormal urination in cats. FLUTD is very common in cats and can be caused by a number of conditions that affect the lower urinary tract (the urinary bladder and urethra).
When no cause can be found, the condition is referred to as feline idiopathic cystitis (FIC), which appears to be similar to interstitial cystitis, a chronic pelvic pain syndrome, in humans. The condition has also been called Pandora syndrome because—much like the multitude of problems released from the mythological Pandora’s box—the underlying causes of lower urinary tract disease in cats may be related to problems in many different organ systems, including the nervous system. FLUTD or FIC may also get worse in response to environmental or emotional stress.
Lower urinary tract disease is very common in cats, but the condition often doesn’t have an identifiable cause.
Cats Affected by FLUTD
FLUTD can affect cats of any age or breed, but the condition is especially common in:
- Young to middle-aged cats
- Overweight or inactive cats
- Cats who live with other cats (in a multicat household)
- Those who have previously had bladder or urination issues
- Cats who tend to display anxious or nervous behaviour
Up to 3% of cats may be affected by FLUTD annually,* and FIC may account for about two-thirds of all FLUTD cases.**
Signs of FLUTD
Clinical signs of lower urinary tract disease in cats include:
- Frequent urination
- Painful urination
- Straining to urinate
- Passing a small volume of urine frequently
- Urinating outside the litterbox or in unusual locations
- Discolored or bloody urine
- Overgrooming (because of irritation and pain in the urethra and/or bladder)
- Changes in behaviour, including aggression
- Inability to urinate/urinary blockage (more common in male cats)
Inability to urinate is an emergency. Call us immediately if your cat can’t urinate!
If your cat can’t pee (even once), don’t wait to see if anything changes. Contact us right away, or if it’s after hours, take your cat to an emergency veterinarian.
Causes of FLUTD
Lower urinary tract disease in cats can be caused by or related to one or more of the following:
- Bladder infections or inflammation
- Bladder stones/crystals
- Urethral plugs
- Certain neurologic disorders
- Anatomic abnormalities, such as a deficient bladder lining or damaged urethra
- Benign tumours or cancer of the urinary tract (uncommon)
- Diabetes
- Hyperthyroidism
- Injury to the urinary tract or spinal cord
- Early exposure to trauma or environmental instability
- Stress
If the common causes of FLUTD have been ruled out, the condition is called feline idiopathic cystitis (FIC), as mentioned above. “Idiopathic” means there isn’t an obvious cause, and “cystitis” refers to inflammation of the bladder.
The Role of Stress in FLUTD and FIC
Stress may play an important role in lower urinary tract disease in cats. Not only can stress trigger an episode of FLUTD or FIC, but some cats who have these conditions may have an abnormal stress response. This may make them more likely to respond to stress in a way that increases their chances of getting lower urinary tract symptoms (easily stressed and taking longer to recover from a stressful event).
Fearful or anxious cats may be more likely to suffer from FLUTD.
Diagnosis of FLUTD
Your Beach Avenue veterinarian will investigate the potential causes of feline lower urinary tract disease by asking questions about your cat’s medical history and performing a physical examination. Some of the things your veterinarian may ask you about include:
- Changes in your cat’s routine or environment
- Feeding practices
- Other pets or new pets in the household
- Other possible stressors
In addition, they may recommend testing, such as:
- Urinalysis
- Urine culture
- Blood tests
- X-rays (radiographs) of the bladder and urethra; a contrast dye may need to be injected into the bladder to help your veterinarian see areas of interest more clearly
- Ultrasound of the bladder
- Video examination of the urethra and bladder
- Biopsies of the bladder wall
Treatment of FLUTD
Feline lower urinary tract disease is treated based on the underlying cause or, without a known cause, by managing the stressors that may have triggered your cat’s clinical signs. FIC or FLUTD treatment often involves a multimodal approach (incorporating several types of treatments), including:
- Prescribing anxiety-reducing medications
- Adding pain medications as recommended to alleviate discomfort during flare-ups
- Switching to a urinary diet, such as Royal Canin Urinary SO or Royal Canin Calm, or increasing canned food consumption
Fluid therapy may also be incorporated, and antibiotics are used for infections. In some cases (such as certain bladder stones), surgery or another medical procedure may be needed.
Reducing or eliminating stressors may involve:
- Keeping a regular daily schedule for feeding, rest/sleep, and play/affection
- Making any necessary changes in routine slowly
- Being consistent with “rules” for your cat
- Scooping litterboxes regularly to keep them clean (at least once or twice a day) and changing clumping litter completely every couple weeks (at least once or twice a week for clay litter)
- Keeping strange cats from wandering through your yard so your cat can’t see or sense them
- Reducing competition in a multicat household by ensuring your cats have enough litterboxes (at least one more litterbox than the number of cats), as well as easy access to food and water
- Ensuring that your cat has enough safe resting spaces (places to retreat to or hide in)
- Adding toys, scratching posts, and cat trees/condos as needed to keep your cat physically and mentally stimulated
- Incorporating feline pheromones at home or during travel
Prevention of FLUTD
Unfortunately, once a cat has shown signs of FLUTD or FIC, the condition often recurs, which can be extremely stressful for both the cat and owner. The above treatments and management approaches can be helpful for reducing the frequency of feline lower urinary tract disease. In particular, you’ll want to focus on reducing your cat’s stress, addressing behavioural issues, and making dietary changes that your veterinarian recommends.
If your cat is showing signs of urinary tract disease, schedule an appointment with your Beach Avenue Animal Hospital veterinarian. We’ll start working to determine a possible cause and help get your cat relief.
If your cat tends to be anxious, ask us about the CHILL Protocol. This protocol can calm down stressed patients and help them have a more relaxed hospital visit and examination.
References
*International Cat Care. Feline lower urinary tract disease (FLUTD). Published August 20, 2018. Accessed September 15, 2021. icatcare.org/advice/feline-lower-urinary-tract-disease-flutd
**International Cat Care. Feline idiopathic cystitis. Published August 20, 2018. Accessed September 15, 2021. icatcare.org/advice/feline-idiopathic-cystitis-fic
