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 20th 2015.
Thanks for another really informative post Tracy! FIC is one reason I always included wet food in my cat’s diet.
Thanks for such a thorough and informative post. (I tried to Pin this but it says there are no pinnable images… hope to see it in the blogpaws group when you pin it)
My cat has never had FLUTD, but he has all the risk factors – he’s male, overweight and eats dry food. But it seems there no consensus about dry food. His vet only recommends dry food – according to him my cat should never eat wet food. From time to time I feed him wet food as a treat, but he mainly eats dry food. It’s seems every veterinarian has his own opinion and it’s quite confusing for us owners.
I, sadly, have experience with this (my first ever kitty as an adult had it, and a current senior rescue cat had it while in the shelter). When I was trying to manage it years ago in my first kitty, it was just awful and heartbreaking when he’d have relapses. Treatment (and foods) have come a long way since ten, thankfully.
Not sure whether you are aware, but I learned in a recent Purina Better With Pets summit that a doctor (Tony Buffington, DVM) has found a link between FLUTD and stress in cats. Of course, this does not surprise me at all (especially in shelter cats), but the great thing about that ink is that when we recognize what the stressor is, and get rid of it, cats can fully recover within 6 weeks. My Maddox fully recovered after he left the shelter. Yay!
Great article!
I’ve seen this in the clinic – very important to educate cat owners about this – great post.
This is great information. I’ve never noticed these problems with Galadriel, but it;s great to know for future reference. Thanks!
Christie from lifewithbeagle.com
Thank you for sharing this important information. I don’t think I really realized what FLUTD was.
I had a dog with chronic UTIs and I know this struggle is very real. Very well done with this post and I know where to refer folks with this issue.
It is scary how often I hear about cats with some form of FLUTD. I lost my poor Obi-Wan to a ruptured bladder, so FLUTD is a bit of a sensitive subject for me. I hope that there are a lot of cat owners finding this post and taking your advice. It is hard to watch a kitty go through this.
Great information! I didn’t realize that FLUTD was an umbrella term. Thank you for sharing – it is so important that we cat owners are proactive about preventing diseases like this!
My poor Nala got an infection in her last 6 months at 17 and a half and never really fully recovered. The vet thought it had gone to her kidneys. She had been on a wet diet for many years then went on a special diet to help. Thanks for sharing the information.
Fortunately, my cat doesn’t have this problem, but it sounds very painful. I feel like I should start feeding him wet cat food as a preventative.
Carmine was diagnosed with FLUTD when he was 4 years old. At that time, I still didn’t know a lot about cats and only gave wet food as a treat – which I am completely embarrassed by now!! He had struvite crystals. He’s been on a prescription kibble for the past 6.5 years, and yes, he gets wet food at least twice a day – usually more. Wet food is a big component in his treatment, and it helped me learn just how important wet food is for kitties in general. I also keep his stress level as low as possible and he has two fountains and two water bowls to drink from. He takes Cosequin for arthritis, but I know it also helps the urinary tract.
Thanks for writing a very informative and important post. Mom has known kitties that died from FLUTD in the past but now it does seem more treatable. Hopefully our overweight Rhette who loves his dry kibble will stay healthy! Love Dolly
Wonderful information! It’s a great reminder to pay close attention to changes in habit to catch this stuff early.
I haven’t heard of FLUTD. I had a cat that had FUS and it was horrible. Never only feed a cat dry kibble, they need moist foods too.
This is a great post! A lot of people don’t about this stuff. I had no idea that dry food could cause urinary issues until it did and I was at the vet with my cat. We are very careful now and only feed wet food and try to make sure they drink enough water!
Thanks for sharing all this great info!
I did not really know a whole lot about FLUTD before reading your post.
Wow so much information here. Great post. Thanks so much for sharing this, I have 3 cats and fortunately none of them have this issue, but it is good information to know what symptoms to watch for.
My one kitty, Winter, had a urinary block a few years ago. It was super scary, and at that point, I hadn’t realized how important it was to make sure the cats were drinking enough water!
This is good to know. My cat used to have blood in urine. It hurts
FLUTD can be such a frustrating problem, for cats, cat owners, and veterinarians!
Great informative post 🙂
Great job on this post. I have FLUTD caused by FIC. Fortunately my special combo of meds is working and I haven’t had an issue since May 13th.