By Dr. Becker
Feline lower urinary tract disease (FLUTD) is unfortunately a quite common problem in cats. FLUTD is used to describe a group of conditions affecting the bladder or urethra. A few of the most common include:
• Cystitis, which describes inflammation of the lining and wall of the bladder and can result in a collection of blood, mucous, and cellular debris in the bladder.
• Bacterial infection, which can result from the blood, mucous, and other debris associated with tissue inflammation.
• Urethral blockage or plug/urolithiasis resulting from the crystallization of minerals and irritation of the lining of the bladder and urethra, which causes the formation of clay-like material that creates a blockage.
Blockages are considered life-threatening when they cut off the flow of urine out of the urinary tract. Male cats are more likely to acquire urethral plugs than females.
• Uremia, which is caused by an accumulation of toxic wastes in the bloodstream resulting from an untreated urethral blockage.
Risk Factors and Causes of Feline Lower Urinary Tract Disease
FLUTD is seen equally in male and female cats typically between the ages of 2 and 6, and about half the cats that experience one episode of FLUTD will have a recurrence. In about two-thirds of kitties with FLUTD, it takes the form of feline idiopathic cystitis (bladder inflammation).
Additional risk factors include:
- Use of an indoor litter box exclusively
- A dry food (kibble) diet
- Lack of exercise and overweight/obesity
- Environmental stress
Causes of FLUTD include:
✓ Anatomic abnormalities
✓ Uroliths (stones)
✓ Behavioral abnormalities
✓ Neurologic disorders
✓ Urinary tract infection
Signs Your Cat May Be Dealing With FLUTD
The primary symptom of FLUTD is urinating outside the litterbox. That's why I always recommend a veterinary appointment when a cat's litterbox habits suddenly change.
Other signs your kitty may have lower urinary tract disease include:
- Frequent or prolonged attempts to urinate
- Straining to urinate
- Crying out while urinating
- Blood in the urine
- Excessive licking of the genital area
If you think your cat might have a problem in the lower urinary tract, it's important to make an appointment with your veterinarian to determine what's really going on and what's causing it.
If your pet isn't passing urine (a situation more commonly seen in males than females but can happen to either sex), this is a life-threatening medical emergency and you should seek immediate care.
Once a cat's urethra is completely blocked, the kidneys can no longer do their job. This can lead to uremia, a ruptured bladder, organ failure, and death within just a day or two.
Management and Prevention of FLUTD
Cats with feline lower urinary tract disease need to drink more water, urinate more, and eat a moisture-rich diet.
The first goal is to increase kitty's water intake. Many cats don't like to drink still water from a bowl, so if yours is one of them, consider a pet water fountain. Kitties are attracted to moving or flowing water, so a fountain should encourage more drinking.
Another important goal in managing FLUTD is to switch cats eating dry food to canned food, and then preferably to a fresh, balanced, and raw diet. Feeding your cat only dry processed food can make her chronically dehydrated.
Another step in managing this disease is to reduce inflammation in the body by eliminating pro-inflammatory (high carbohydrate) foods — particularly corn, wheat, rice, and millet. A high carb diet creates inflammatory byproducts in your cat's body that can ultimately inflame the bladder.
It's also important to identify potential sources of food allergies in cats with FLUTD. This often means eliminating both chicken and seafood from your cat's diet. Most cats with inflammatory conditions need a break from eating just one or two protein sources (typically chicken or seafood) for months or even years on end.
The goal is a minimum three-month break from chicken, seafood or whatever protein the cat has been eating regularly. In about half the FLUTD patients I've treated, we see a reduction in the amount of inflammation in their bladder just by making the switch away from food that is allergenic and pro-inflammatory.
Although urinary tract infections may be an underlying root cause of FLUTD, it's most certainly not the only cause of the condition. I see far too many conventional veterinarians address this chronic problem with poor medicine: simply prescribing (and re-prescribing) antibiotics to cats with chronic urinary issues.
This is terrible medicine for two main reasons. Number one, often the root cause isn't a urinary tract infection (UTI) at all. Number two, cats are taking antibiotics unnecessarily, while the root cause goes unaddressed.
If an infection is present, often no culture is performed, and cats end up with resistant infections from antibiotic abuse. Or they are given the wrong antibiotic altogether because the veterinarian didn't identify what medicine the cat needed to clear the infection.
If your vet suggests antibiotics because he or she found bacteria in a sterile urine sample, insist on a bacterial culture to identify the correct treatment. If your vet tries to offer antibiotics without a UA and culture, I recommend you decline them, and instead seek out a vet who is more cautious and selective in the use of antibiotics.
The Role of Stress in Feline Lower Urinary Tract Disease
It's extremely important to focus on reducing or eliminating potential stressors in your cat's life. Cats with feline idiopathic cystitis (FIC), in particular, benefit from a program of stress reduction and environmental enrichment.
According to one study, cats with the disorder showed 75 to 80 percent improvement in symptoms when they were fed at the same time each day, their litter boxes stayed in the same location, and regular playtime was encouraged.1 Stress typically has three different sources: environmental, immunologic, and nutritional.
• Environmental stress can be anything from a move to a new home, new living room furniture, the birth of a baby, a divorce, a child leaving home for college, or the addition of a new pet. All these things can create emotional stress in your cat.
You may see no outward signs because cats tend to internalize their stress, but it's there and it can exacerbate an inflammatory condition. Depending on the environmental stressor, I might recommend a product like Feliway, a calming pheromone spray for cats.
There are also very effective homeopathic remedies available to decrease stress. My favorite is aconitum. There's also Rescue Remedy, which I use with great success in helping to balance emotional disturbances in cats.
• Immunologic stress is primarily a result of unnecessary vaccinations. If you have an indoor-only kitty, the risk of exposure to infectious diseases is almost non-existent, and unnecessary vaccines can put a tremendous amount of immunologic stress on your pet.
• Nutritional stress is the result of poor quality, grain-based, and rendered diets that contain additives, potentially toxic preservatives, and unnecessary fats, salts and sugar.
Transitioning your cat to a species-appropriate, grain-free diet will reduce nutritional stress. The best choice is a balanced raw diet; second best is human-grade canned food.
Additional Stress Reduction and Environmental Enrichment Tips
Litterbox cleanliness is a key component in managing feline stress. Litter boxes should be cleaned frequently (scooped at least once daily and fully sanitized weekly or every other week). They should be located away from noisy areas, and should give cats easy access to and from them so there's no feeling of being trapped or unable to escape.
It's also important to have the right number of boxes (one for each cat in the household, plus one extra), as well as the size and shape your cat prefers. In a multi-cat household, especially, access to more than one source of fresh water and food may help reduce stress, avoid inter-cat aggression, and increase water intake.
It's also important that food and water bowls are in safe, secure locations. In the wild, cats not only hunt prey, they are prey for other animals. They feel most vulnerable while eating, drinking or eliminating. This vulnerability creates stress when a cat's food dish or litterbox is in a noisy or high traffic area.
Increased interaction between you and your cat may also reduce her stress. Petting, grooming, and play activities that stimulate hunting behavior may help. Discover what type of toy (prey) she responds to and engage her in play. Increasing your cat's access to private areas may also be beneficial, especially if there are other pets in the home. Your cat needs her own resting place and a hiding place (sometimes these are the same spot) where she feels untouchable.
It's important to remember that conventional veterinarians were not provided with non-toxic alternatives in veterinary school that can be beneficial in treating this frustrating medical condition. Often they don't have the knowledge necessary to offer your cat alternative natural healing options (and there are many).
Working with a holistic practitioner who can offer acupuncture, homeopathy, herbs and beneficial nutraceuticals will insure your cat is being treated as a whole animal, rather than a list of symptoms. This will hopefully lead to resolution of a condition that is often quite difficult to manage.