By Jean Hofve, DVM
Few conditions strike greater fear into the heart of a cat guardian than “urinary tract problems.” Myths and misinformation abound, and many people know at least one other person who has a cat with this problem–or who has lost a cat because of it.
“Feline lower urinary tract disorders” (commonly referred to as FLUTD, LUTD, or FUS–feline urologic syndrome) come in at least three distinct varieties. All of them put together affect less than 3% of cats, but for those who are affected, it can be a major problem. Bladder diseases occur in both male and female cats, although males have a higher risk of life-threatening blockage of the urethra. It is usually first seen in cats between 2 and 7 years of age (though some very young and very old cats may develop signs). Episodes of FLUTD are usually triggered by stress, such as home remodeling, parties, severe weather, or loss or addition of a family member. These problems are also more common in the spring and fall and after major holidays.
Signs of FLUTD
The clinical signs of all the FLUTDs are very similar. Cats may go to the litterbox frequently, strain to urinate, pass very small amounts at a time, lick their genitals more frequently or more intensely than usual, or have blood in the urine. The cat may associate the burning sensation of cystitis (bladder inflammation) with the litterbox itself, and look for another place to go where it won’t hurt. This leads to squatting in corners, in sinks or tubs, on rugs, laundry piles, or beds.
Most cats brought to the vet for FLUTD do not yet have blockages. However, it’s important to act quickly when you see any of these signs, because if a blockage does occur, the backup of urine toxins and pressure can lead to kidney failure and death in as little as 24 hours.
Causes of FLUTD
About 2/3 of FLUTDs are classified as “idiopathic cystitis”, meaning “bladder inflammation of unknown cause.” It is rare for bacteria to be involved–most are “sterile” inflammations. Less common causes of these signs include behavior disorders, kidney stones, anatomical defects in the bladder wall, other systemic diseases, and bladder cancer.
Only about 20% of FLUTD cases involve bladder stones–about half of these are struvite, and half are calcium oxalate stones. Crystals are not the same as stones. Male cats who block usually do so with crystals held together in a gel-like matrix with mucus from the irritated bladder. This “plug” can get stuck at the narrow end of the urethra. Crystals may be present by themselves or at the same time as a stone. Occasionally, multiple types of crystals may be present at the same time.
Struvite, or “triple-phosphate” stones, are made from normal components of urine that clump together under certain conditions. Calcium oxalate crystals and stones, which were rare in cats 10 years ago, have become much more common due to increased feeding of highly acidified struvite-treatment diets. Struvite stones can be dissolved by diet, though it can take a long time; other types of stones cannot be dissolved, although diet can help prevent recurrence.
Treatment of FLUTD
Any stone can be surgically removed, and sometimes this is the most expedient solution. Stones are usually diagnosed either by radiographs (x-rays) or, ideally, ultrasound (which can “see” stones that x-rays might not reveal, and provides valuable information on condition of the bladder and kidneys). Cats with LUTD signs lasting more than a week in spite of treatment, or if the problem recurs after treatment is discontinued, should be evaluated for stones or other anatomic abnormalities.
There are many medical diets made to dissolve struvite stones and to prevent recurrence of struvite and calcium oxalate stones. These include Hill’s s/d, c/d(s) and c/d(o), Purina CNM-UR, Waltham’s Control pHormula, and others. These are only available through veterinarians since they create specific acid-base conditions in the cat’s body that should be monitored by your vet. Canned versions of these foods are vastly preferable to dry, although none of them contain the high quality ingredients we recommend and consist mainly of by-products and grains.
In one study, 60% of cats on a single dry food were symptom-free for a year, compared to 90% of cats eating one canned food. Homemade, organic, natural diets are always on the top of the “good” list for treating this and other chronic disease conditions, but only if they can be fed consistently. Diet changes must always be made gradually to minimize stress on the cat.
Diet is a component of LUTD, though usually not the sole cause. Dry cat foods, particularly high-fiber “light” or “senior” foods, contribute to overall dehydration and high urine concentration. Cats with LUTD should not be fed any dry food at all if possible. Canned or homemade foods help keep the urine dilute, minimizing irritation and the risk of crystal or stone formation. Feed in timed meals rather than leaving food available.
Antibiotics are often used to treat feline LUTDs and are a standard first-line of conventional treatment. Even though bacteria are rare, some antibiotics (particularly amoxicillin and Clavamox) have anti-inflammatory or analgesic (pain relieving) effects. Other anti-inflammatory drugs, such as steroids, are occasionally used when there is severe inflammation. Urinary acidifiers are sometimes given if the urine pH is very high. Steroids and acidifiers should not be used long-term. The anti-depressant amitriptylline is commonly used as a long-term treatment, but its effectiveness and safety are in doubt; some research shows that it actually increases recurrence. For male cats who block repeatedly, there is a surgery to widen the urethra. This is a last-ditch option, and some males will still block even after this surgery.
Holistic Treatment Options
Many herbal and nutritional treatments have been tried with varying success. Certainly, antioxidant vitamins such as C and E, which are also helpful in times of stress, are indicated (Vitamin C as sodium ascorbate or Ester C, and Vitamin E). Other antioxidants such as BioSuperfood may also be helpful, because of their anti-inflammatory action. Herbs such as slippery elm, horsetail, and couch grass have helped some cats. Many cats have done well with Co-Enzyme Q10, which prevents inflammation at the cellular level.
Cranberry extract is beneficial for many animals, especially dogs, who tend to have actual infections of the bladder. Cranberry is thought to prevent the attachment of the E. coli bacteria to the bladder wall. Because bacteria are not present in most cases FLUTD, it may be less beneficial for cats. However, cranberry has still been helpful in many cases, even those without any evidence of bacteria. Cranberry capsules are available at the health food store (typically in 250 mg strength which is a good once-a-day dose for cats), and are very safe to give long-term.
Essences are often very helpful for FLUTD. Because the problem is so highly stress-related, addressing any underlying emotional imbalances and susceptibilities can be critical for long-term resolution. The Spirit Essences formula “UR-Fine” is specifically designed to reduce stress and keep the urinary tract supported and balanced.
Holistic veterinarians believe that FLUTD is a sign of underlying chronic disease. Homeopathy, acupuncture, Chinese herbs, western herbs, and other holistic therapies may be valuable in rectifying the hidden “causes” of FLUTD and bringing your cat’s health into balance and well-being.
There are lots of diets and treatments out there. An individually tailored treatment program is needed for each patient. But, if I had only one rule I could make for all of them, it would be “no dry food.”