Telltale Symptom Foretells a Serious Problem, Don’t Delay Medical Help

Analysis by Dr. Karen Shaw Becker

feline lower urinary tract disease

Story at-a-glance -

  • Feline lower urinary tract disease (FLUTD), which includes any condition affecting the bladder or urethra, is a common health problem in cats
  • Indoor-only lifestyles, dry diets, obesity, lack of exercise and environmental stress are some of the risk factors for developing FLUTD
  • The primary symptom of FLUTD is urinating outside the litterbox
  • To help manage the condition, cats with FLUTD typically need nutritional intervention, increased water consumption and a relatively stress-free environment

Feline lower urinary tract disease (FLUTD) is a quite common problem in cats. FLUTD describes any disorder affecting the bladder or urethra. A few of the most common FLUTD conditions include:

  • Cystitis, which describes inflammation of the lining and wall of the bladder and can result in a collection of blood, mucus and cellular debris in the bladder.
  • Urethral blockages 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.
  • Bacterial infection, which can result from the blood, mucus and other debris associated with tissue inflammation.
  • Uremia, which is caused by an accumulation of toxic wastes in the bloodstream resulting from an untreated urethral blockage.

The most common type of FLUTD in kitties under the age of 10 is feline idiopathic cystitis (FIC), followed by uroliths and then urethral plugs. In cats older than 10, FLUTD most often takes the form of urinary tract infections, followed by uroliths.1,2

Risk Factors and Causes

FLUTD is seen equally in male and female cats, and approximately half the kitties who experience one episode of FLUTD will have a recurrence. 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, some of which were mentioned above, include:

Anatomic abnormalities

Uroliths (stones)

Behavioral abnormalities



Neurologic disorders

Urinary tract infection


Symptoms to Watch For

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 a problem in the lower urinary tract 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 your cat is having one or more of these symptoms, it's extremely important to make an appointment with your veterinarian. If your kitty isn't passing urine (a situation more commonly seen in males than females but can happen to either), it's 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.

Nutritional Strategies for Cats With 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 your cat's water intake. Since many kitties don't like to drink still water from a bowl, consider a pet water fountain, which may encourage more drinking.

Another important goal is to switch cats eating dry food to canned food, and then preferably to a fresh, balanced, raw diet rich in omega-3 fatty acids. 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, in particular 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. 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.

If Your Veterinarian Suspects a Bacterial Urinary Tract Infection

Although urinary tract infections can cause FLUTD, they're certainly not the only cause, yet I see far too many veterinarians prescribing (and re-prescribing) antibiotics to cats with chronic urinary tract issues.

This is bad medicine because often the root cause isn't a urinary tract infection (UTI) at all. If an infection is present, often no culture is performed, and cats end up with resistant infections from antibiotic overuse. Or they're given the wrong antibiotic 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.

Stress and FLUTD

It's extremely important to focus on reducing or eliminating potential stressors in the lives of kitties with FLUTD. 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.3

In addition to nutritional stress, discussed above, your cat can also be negatively impacted by environmental and immunologic stressors.

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 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, herbal and flower remedies available to decrease stress, 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 nonexistent, and unnecessary vaccines can put a tremendous amount of immunologic stress on your pet.

Enriching Your Cat's Environmental to Mitigate Stress

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 that stimulates 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. She needs her own resting place and a hiding place (sometimes these are the same spot) where she feels untouchable.

I have had good success calming stressed out kitties with Spirit Essences formulas, as well as well as EFT and TTouch for animals. Partnering with an integrative veterinarian who can offer acupuncture, homeopathy, herbs, beneficial nutraceuticals and other healing modalities is the best approach to ensuring your kitty is getting the best care for a condition that is often quite difficult to manage.