July 2022

In this VETgirl online veterinary continuing education blog sponsored by Royal Canin, Dr. Kelly St. Denis, MSc, DVM, DABVP (feline practice) will review solutions for feline urinary disease. How can we take a more proactive role in feline urinary health?

Please note the opinions in this blog are the expressed opinion of the author and not directly endorsed by VETgirl.

Solutions for Feline Urinary Disease

By Dr. Kelly St. Denis, MSc, DVM, DABVP (feline practice)

When it comes to cats, there is no question that Feline Lower Urinary Tract Disease (FLUTD) is one of the most common presenting problems at veterinary clinics. Presentation of FLUTD can range from a history of house soiling to complete, life-threatening urinary outflow obstruction. The most common cause of FLUTD is feline idiopathic cystitis (FIC).[1] Uroliths, urethral plugs, crystalluria, and urinary tract infection (UTI) represent less common causes of FLUTD. UTI is an uncommon cause of FLUTD, especially in young adult cats[2], yet antibiotics are frequently prescribed without evidence of bacteriuria, pyuria, or a positive urine culture.

FIC is a diagnosis of exclusion, with the expectation that other causes have been ruled out. The disease tends to present as an acute problem with waxing and waning characteristics. FIC tends to present as non-obstructive disease, but some FIC cats may present with urinary tract obstruction.[3] A strong link between emotional wellbeing and FIC has been proposed and evaluated. Cats at increased risk of FIC are those living in stressful environments, and in particular those cats that may not have the full capacity to deal with normal day to day stressors. This stress may manifest through the urinary tract but affected cats may also exhibit other sickness behaviors such as gastrointestinal upset, dermatologic changes, or immune dysfunction. Stress reduction is a key part of therapy. Indeed, multimodal environmental modification (MEMO), institution of changes in the home targeted at reducing feline stress, is a successful treatment strategy for FIC. More on that shortly…

Cats with FLUTD present with a variety of signs and symptoms including hematuria, stranguria, vocalization, pollakiuria, dysuria, periuria, and/or hair loss on abdomen. Cats affected with FLUTD may also defecate out of the litterbox. FLUTD is a painful disease, and some of these clinical signs and symptoms reflect this. These and other symptoms of pain may go unnoticed at home due to the subtlety of feline pain. After all, cats are masters at hiding illness. Unfortunately, this often means that cats do not receive medical assessment and care well into the disease process, and sometimes not at all. In a 2016 telephone survey, 26% of cats were reported to have urinated or defecated outside of the box at some point in their lives, yet only 31.7% of those cats were evaluated by a veterinarian![4]

A lack of medical care for cats with FLUTD-related symptoms means a missed diagnosis, failure to treat pain, a lost opportunity to appropriately treat and resolve the problem and to prevent future episodes. There are many barriers for caregivers that may prevent them from seeking veterinary assessment in cases of FLUTD. We are living in a DIY-era, and it is always tempting to trouble shoot a cat’s symptoms through “Dr. Google” or the help of a neighbor. Caregivers may attribute the issues to some other cause. They may be reluctant to seek veterinary assistance if they or their cat have had bad experiences during veterinary visits in the past, or if they have cost concerns. Delays of any kind can be dangerous to the cat and often result in increased expense to the caregiver.

As we continue to educate our clients on the urgency that exists when any symptoms of LUT occur, we will continue to improve outcomes. This education will also assist in the implementation of preventive measures, which must center around good animal husbandry and appropriate diets. Discussions about FLUTD should start early, during kitten visits, as we educate about healthy, stress-free environments and high quality nutrition.

Cats require special consideration based on their history of domestication, their status as predator AND prey, and their nutritional needs as obligate carnivores. Unlike their canine counterparts, cats have been domesticated for only a fraction of the time. This makes them a somewhat wilder bunch, keeping their private business to themselves, like Kipling’s cat that walks by himself. To add to this, while we often remember that cats are master hunters, we also need to consider that as small-ish mammals, they are also prey. The potential risk of being hunted down as part of another animal’s meal plays a big role in the cat’s behaviors, including hiding illness from their caregiver. The cat is an obligate carnivore, making their dietary needs unique and requiring that they work as master predators all the while not succumbing to the predation of others.

Five Pillars of an Appropriate Environment, 2021 AAFP Feline Senior Care Guidelines, Journal of Feline Medicine and Surgery (2021) 23, 613-638. <Catvets.com/guidelines> Permission granted from the AAFP.

What does all of this mean in the home, and how is it relevant to FLUTD? If we do not meet the cat’s needs as a recently domesticated, obligate carnivore, that is both predator and prey, we leave the cat open to stress and anxiety which results in an increased risk of sickness behaviors, including FIC. The 5 essential pillars of a healthy feline environment can help us guide the caregiver. Ensuring each of these pillars is honored within the home and putting in place the necessary MEMO when they are not, is essential to reducing stress. The home needs to be a safe place for cats to have reduced stress. Safety should include an assessment of what makes the cat FEEL safe, not just a check list based on our interpretation. Cats require multiples of each resource (water bowls, litter boxes, beds etc.), distributed throughout the household. Cats needs opportunities to play and engage in predatory behaviors. They need predictable cat-human and cat-animal (other pet) interactions. In a multi-cat household, this requires additional attention as cats generally do not like to share with other cats. The perceived friendliness between two cohabitating cats is often just a draw to avoid physical battle. Caregivers can learn more about this by watching this video. Lastly, the cat’s intense sensitivity to olfactory stimuli needs to be respected, and not overwhelmed by perfumes, scented cat litters, smoke, or other strong odors. If the cat cannot use its sense of smell to detect prey, stress will likely ensue.

Cats diagnosed with FLUTD will commonly require a therapeutic diet targeted to their specific condition. Increased water consumption in the form of canned food, with the goal of increasing urine volume is often recommended. With FIC, dietary management means ensuring urinary tract health while addressing stress. Supplemental ingredients such as omega 3 fatty acids, anti-oxidants, milk protein hydrolysate, and/or L-tryptophan are included in some urinary therapeutic diets, with the goal of reducing stress. These supplements can also be found in nutraceutical products.

By incorporating conversations about FLUTD, the role of stress in sickness behaviors, and the 5 essential pillars of a healthy feline environment throughout the cat’s lifetime, we will continue to educate caregivers on prevention and early disease intervention.

Dr. Kelly St. Denis is a practicing veterinarian, author and presenter certified in the specialty of feline practice with the American Board of Veterinary Practitioners.

1. Gerber B, Eichenberger S, Reusch CE. Guarded long-term prognosis in male cats with urethral obstruction. Journal of Feline Medicine & Surgery [Internet]. 2008;10(1):16–23.
2. Weese JS, Blondeau J, Boothe D, Guardabassi LG, Gumley N, Papich M, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. The Veterinary Journal [Internet]. 2019;247:8–25.
3. Defauw PAM, Maele IV de, Duchateau L, Polis IE, Saunders JH, Daminet S. Risk factors and clinical presentation of cats with feline idiopathic cystitis. Journal of Feline Medicine & Surgery [Internet]. 2011;13(12):967–75.
4. Gerard AF, Larson M, Baldwin CJ, Petersen C. Telephone survey to investigate relationships between onychectomy or onychectomy technique and house soiling in cats. Journal of the American Veterinary Medical Association [Internet]. 2016;249(6):638–43.

Today’s VETgirl blog is sponsored by Royal Canin. Recommend multifunction Royal Canin Urinary SO® + Calm complete and balanced adult cat food to help support a healthy urinary tract while providing calming nutrients for cats facing stress. Learn more at my.royalcanin.com.

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