Domestication of cats started over 10,000 years ago. Our cat companions evolved from desert dwelling cats that were adapted to desert conditions with low water availability. They have maintained this ability to live with low water intake by being very effective at concentrating their urine. This ability creates concentrated urine and helps conserve water. Some feel that this contributes to feline lower urinary tract disease (FLUTD), a broad term for a group of disorders affecting the urinary bladder and urethra (lower urinary tract).

The problem can affect cats of any age but is seen more frequently in middle-aged, overweight cats that are relatively inactive and have limited outdoor access. Cats experiencing stress or that have other health issues like diabetes or kidney disease are predisposed. For some cats the type of food fed can also play a role.

Cats with FLUTD show a variety of signs resulting from irritation in the lower urinary tract and even blockage of the urethra. Typical signs include straining in the litter box or urinating outside the litter box, crying out when urinating, frequent passing of small amounts of urine sometimes with blood, and licking the genital area. Cats with a blockage of the urethra will become increasingly distressed because the bladder gets progressively more distended and the kidneys can start to fail.

Affected cats showing signs of FLUTD should be seen by a veterinarian and evaluated to determine the cause if possible. A complete physical exam and history including what foods are being fed, patterns of use of the litter box, presence of other cats in the household, any new or ongoing sources of stress, and access to outdoors are important to know. Basic tests include urine and blood. X-rays and ultrasound along with urine bacteria cultures may be indicated to help focus the treatment and support plan.       

The treatment and support plan depends on the reason for the individual cat’s FLUTD. Common causes of FLUTD include stones in the bladder (uroliths), urinary tract infections, urethral blockage, and idiopathic cystitis. Idiopathic cystitis (interstitial cystitis) is the most common (60-70%) and as the name implies, the cause is unknown. These cats are usually less than 10 years of age and have other health issues. Stress and chronic anxiety may play a big role. Episodes may be short-lasting with improvement within a week without treatment. Keep in mind when blockage occurs it is an emergency and immediate treatment is needed. Untreated cats with a complete blockage can have kidney failure in 24-48 hours.

Blockage can occur when soft material containing mucous-like material, cells, and minerals form a urethral plug or from urinary stones. Male cats are more likely to experience obstruction or blockage because the urethra is longer and smaller. Urinary stones can form in the bladder or urethra and may be struvite or calcium oxalate stones. Some types respond to use of specific prescription diets. 

Urinary tract infections (UTI) are thought to be relatively uncommon in cats, however, UTI is a common cause of FLUTD in older cats, especially females. Older cats are at risk because they often have other disease problems like kidney disease that can lead to changes in the urine that allows infection.

It is important to monitor cat behavior in the litter box when possible. Keep the litter box clean daily. Have multiple boxes available in a quiet place. Encourage water consumption by having a kitty fountain or adding water to the food. Help the cats to be active and at ideal weights. Maintain a stress free environment. Make sure there is no back pain as a cause of stress or complication. There are many integrative approaches like acupuncture, herbs, and manual therapies like osteopathy that can be of benefit.

If you have questions about your cat’s urinary health, contact your veterinarian.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs. Dr. Carsten is the 2022 Colorado Veterinary Medical Association Distinguished Service Award recipient.