FLUTD (Feline Lower Urinary Tract Disease) and Your Cat

Does your cat spend ages in the litter box?

Straining and feeling the urge to constantly visit the litter tray are signs your feline friend may be suffering from FLUTD.

Feline lower urinary tract disease (FLUTD) is common, with your average vet practice seeing more cases of FLUTD (5% of their caseload) than kidney disease (4.2%). But if you think a sore bladder is all about infection or urinary crystals think again. The information you are about to read may come as a surprise.

What is FLUTD?

It’s easier to say what FLUTD isn’t!

FLUTD is NOT a single condition, but an umbrella term used as shorthand to describe several different problems that have similar symptoms. This is because when the bladder is damaged (for whatever reason) it has limited ways to respond, and the result is nearly always inflammation, leading to pain and discomfort passing urine.

These underlying causes include:

• Infection
• Crystals in the urine
• Bladder stones
• Bladder polyps
• Bladder cancer
• Sterile cystitis [also called Interstitial cystitis or feline idiopathic cystitis (FIC)]

What are the Signs of FLUTD?

A cat suffering from FLUTD has a sore bladder and is uncomfortable passing urine. The symptoms include:

• Straining to pass urine
• Blood in the urine
• Repeated attempts to urinate
• Breakdown in litter box training
• Crying out while urinating
• Excessive licking of the genital area
• Straining to pass urine but the tray remains dry

The last point is an important one because in some cases a plug forms in the urethra (the tube through which the cat pees). This is an emergency which needs immediate veterinary intervention. However, there is an overlap in symptoms with those of cystitis, and so if you see any sign of urinary discomfort you should contact the vet straight away.

What Causes FLUTD?

OK, now for the big surprise.

What is the commonest cause of FLUTD?

If your answer is “Infection” you wouldn’t be alone in thinking this. However, the actual answer is feline idiopathic cystitis (FIC). According to scientific studies, the actual breakdown of FLUTD cases looks like this:

• 55% are caused by FIC
• 42% ‘other causes’ e.g. crystals, stones, polyps, or cancer
• 3% are the result of infection.

OK, at the risk of getting too complicated, these figures may be slightly skewed away from infection because they are from cats referred to specialist centres. However, the fact remains between 55 – 70% of all cases of FLUTD are caused by FIC.

Wow! I hear you say. So, what is FIC and how is it treated?

Feline Idiopathic Cystitis (FIC)

There is no specific test for FIC and the diagnosis is made by eliminating all other possible causes of bladder discomfort, including infection, crystals, and stones. Unfortunately, vets only have a hazy grasp of the causes, although this is improving and the subject of much current research. At which point, this is probably a good time to reveal that “idiopathic” is a fancy way of saying “unidentified reasons”.

Just because the causes aren’t known, doesn’t make the condition any less real. Biopsies taken from the bladders of affected cats show changes in the cell structure. The cells have tiny gaps between them which shouldn’t be there (like bricks that need repointing in a rickety wall) and this allows urine to soak deep into the tissue of the bladder wall, causing inflammation and soreness. Extensive research has failed to reveal why this happens although some of the risk factors have been identified. These include:

• Being male
• Being overweight
• Eating dry food

Treatment for FIC

This is a very real and painful condition. Whilst many aspects are still poorly understood, there are ways to help cats suffering from FIC.

• Nutraceuticals: Products containing glucosamine (Cystaid) or Pentosan (Cartrophen injection) encourages the formation of a protective ‘bandage’ layer of mucus over the bladder wall.
• Wet Food: In one study, cats with FIC that switched from dry food onto a high quality wet food, had zero recurrence of symptoms ten months later.
• Feliway: Decreasing your feline friend’s stress levels with the use of synthetic pheromones such as Feliway can be hugely beneficial.
• Pain Relief: This condition is painful and giving NSAIDs, such as meloxicam, helps ease discomfort.
• Weight Control: Putting your overweight cat on a diet, removes one of the risk factors.
• Encourage Water Intake: The use of cat drinking fountains and lots of water bowls around the house encourages the cat to drink, which is of proven benefit.

It seems the secret to reducing FIC is to apply as many different strategies as possible, of which, feeding a good quality wet food is the most important.

Crystals and Stones

After FIC, the next most common cause of FLUTD are crystals in the urine and bladder stones. These form when minerals in food interact with the body chemistry to form crystals in the urine, which then stick together and form stones. The type of crystals depends on the food eaten, and the crystals are identified by examining a sample of urine under the microscope.

Treatment involves feeding a diet (as prescribed by your vet) low in the mineral from which the crystals are built. If a stone is present then surgery may be necessary to remove it, or in some cases dissolving the stone with a special prescription diet does the trick (this depends on the chemical composition of the stone.)

Infection and FLUTD

Infection is not as common as you might think, but it does happen and is more likely in older cats. This is because senior felines are less able to concentrate their urine, and so their urine loses some of its natural disinfectant properties.

Your vet may check for infection by sending a sample away for culture to find out what bugs are present. However, don’t be surprised if you cat is given antibiotics straight out because, rightly or wrongly (and it’s a complicated argument!), over two-thirds of FLUTD cases are.

Happily, bladder polyps and cancer are both rare.

From this whistle-stop tour of the ins and outs of FLUTD you will appreciate the complexity of the problem. Each section could take up pages of their own, but I hope this information has given you paws for thought.

If your cat has urinary issues, work with your veterinarian to test for those issues with a specific treatment (such as crystals, stones, and infection), and therefore identify if a FIC strategy is the best way forward for your furry friend.

Reference: Lecture by Andy Sparkes, BVetMed, PhD, DipECVIM, MANZCVS MRCVS, Veterinary Director International Cat Care. London Vet Show. November 20^th 2015.