Urinary Tract Disease in Cats

Urinary tract disease in cats far too common (more on why that may be the case later in this article) and encompasses a whole range of problems, ranging from infection to crystals and bladder stones to life threatening blockage. Some urinary tract diseases are treatable, while others are irreversible.

Anatomy of the urinary tract

The urinary tract consists of two kidneys, which produce urine, the ureters that transport urine from the kidneys to the bladder, the bladder, where  urine is stored, and the urethra, which carries urine from the bladder to the outside.

Urinary tract disease can affect any part of this system and can manifest as any of the following:

Urinary Tract Infection (UTI)

UTIs are one of the top reasons why cats visit the vet. They are painful for your cat, and often lead to messy cleanup and expensive vet bills for you. They are most prevalent in male cats, and may be caused by excess weight, lack of exercise and poor diet. However, the most common causes are dehydration and a high urinary pH. Crystals and struvite stones may form, which are extremely painful to pass. The urinary tract will be inflamed and uncomfortable, and may even become restricted or blocked. Urinary blockage in male cats is a potentially life threatening condition that requires immediate veterinary attention.

Urinary crystals and bladder stones

Urinary crystals and bladder stones are collections of minerals that form in the urinary tract. They can range in size from microscopically small to several millimeters in diameter. While crystals may not cause any symptoms, larger stones can cause irritation, inflammation, and even dangerous urinary blockages.

Urinary blockage

Feline urinary blockages are a true emergency. Cats who are unable to urinate, especially  male cats, require emergency veterinary care in order to save their life. A urinary blockage occurs when the urethra becomes obstructed with stones, crystals or sludge. This blockage can quickly become a life-threatening problem. Without immediate veterinary intervention to relieve the blockage, the affected cat will likely die.

Pandora Syndrome

Urinary tract issues used to be lumped together under the term FLUTD (Feline Lower Urinary Tract Disease) or FIC (Feline Idiopathic Cystitis, “idiopathic” meaning that the cause is not known.) In the 1990’s, veterinarians began to make a connection between feline urinary tract problems and interstitial cystitis in women, a chronic condition in which affected women experience increased urge to urinate and bladder pain.

Finally, in 2011, a study conducted at the Ohio State University on 32 cats over a three year period found that stress had a significant impact on lower urinary tract health. Dr. Tony Buffington​, a professor at Ohio State University’s College of Veterinary Medicine and leader of the study, coined the term Pandora Syndrome.

The vast majority of cats who present with Pandora Syndrome have concurrent problems ranging from behavior issues and stress to heart disease and vomiting. The condition may come and go, and may sometimes be triggered by a stressful event in the cat’s life, such as the addition of a new cat to the family, home remodeling or a move.

Kidney failure

Kidney failure can be acute or chronic. Healthy kidneys act like a filter to remove waste products from the body. They regulate electrolytes such as potassium and phosphorous, and they produce erythropoietin which stimulates red blood cell production. Kidneys also produce rennin, which contributes toward regulating blood pressure. They also play a major role in turning vitamin D into its active form, which controls calcium balance in the body.

Acute kidney failure is a sudden loss of kidney function. Causes range from toxins such as lilies and antifreeze to ureteral or urethral obstructions. Acute kidney failure can be reversed if treated immediately and aggressively.

Chronic kidney failure is a gradual loss of kidney function that is common in aging cats. Signs can be subtle at first. They include increased thirst and urination, vomiting or other signs of nausea, lethargy or depression, poor hair coat, loss of appetite, lingering over the water bowl, eating cat litter, constipation, a strong ammonia-like odor to the breath, and changes in vision and hearing. Chronic kidney failure is irreversible.

Cancer

Cancer of the urinary tract is rare in cats, but can occur at any age, most frequently within the bladder.

Symptoms of urinary tract disease

• More frequent urination
• Straining to urinate
• Only urinating very small amounts
• Straining without urinating (this is a medical emergency)
• Bloody or foul smelling urine
• Urinating outside the litter box
• Vomiting
• Lethargy
• Dehydration
• Loss of appetite
• Weight loss

Diagnosis and treatment

Your veterinarian will perform a complete physical exam and may also run blood tests and a urinalysis. Additional tests may include x-rays and/or ultrasound.

Treatment will depend on the cause and can range from a round of antibiotics, medications to relax the bladder, and pain control to administering fluids, and even surgery.

How to keep your cat’s urinary tract healthy

Hydration

Water is critical to keeping your cat healthy. Cats as a species don’t have a high thirst drive, and this can lead to chronic low-level dehydration if a cat is fed mostly dry food, which in turn, can lead to urinary tract and kidney problems. Proper hydration can help prevent urinary tract disease and promote healthy kidney function by flushing toxins.

“Many cats suffer each day because of the water-depleted diets (read: any dry kibble) that humans insist on feeding to them.” – Dr. Lisa Pierson, catinfo.org

I believe, as does Dr. Pierson, that there is a direct link between the prevalence of urinary tract disease in cats and the prevalence of cats on dry diets. More and more studies are substantiating that a species-appropriate diet high in meat and moisture with few or no carbohydrates is the right diet for our feline family members.

While cats who eat only dry food will generally drink more water, they still don’t get enough moisture to support all their bodily functions and essentially live in a constant state of low level dehydration, which then leads to bladder and kidney problems

“To be quite frank, if humans – including many of my veterinary colleagues – had a cork inserted into their urethra until they experienced the excruciating pain secondary to bladder distension and rupture, I have no doubt that they would start to take this issue much more seriously and STOP condoning the feeding of dry food to cats,” writes Dr. Pierson on her website.

Please read Dr. Pierson’s comprehensive article Cat Urinary Tract Diseases: Cystitis, Urethral Obstruction, Urinary Tract Infection for more information.

Maintain a healthy weight

Feline obesity has continued to increase over the past years. Statistics by the Association for Pet Obesity in 2017 show that a staggering 60% of America’s cats are considered obese. Pet insurance company Nationwide reports that nearly 20 percent of its members’ claims in 2017 were for conditions and diseases related to pet obesity, marking a 24 percent increase over the last eight years. Overweight cats are prone to the same diseases as overweight humans, and that includes urinary tract disease.

Diet

Cats with urinary tract disease should never eat a dry diet (nor should healthy cats, for that matter.) A species-appropriate diet of raw or canned food that mimics based on meant, not grains, and with sufficient moisture is the best choice for cats prone to urinary tract issues.

Many conventional veterinarians will recommend a so-called prescription diet. The majority of these diets are very high in carbohydrates and contain wheat, corn and soy – ingredients that have no logical place in the diet of an obligate carnivore like the cat. They also generally contain a high amount of by-products.

I do not recommend these diets. It’s not easy to contradict your veterinarian’s recommendation, especially when it’s a vet you trust on all other matters. I urge you to educate yourself about feline nutrition, and make an informed decision before agreeing to put your cat on one of these diets. A high-quality over-the-counter or a properly formulated homemade diet may be a better nutritional choice for your cat, and still address her specific health needs.

Special considerations may be necessary for cats with chronic kidney disease. Please read The Right Diet for Cats with Kidney Disease for more information.

Litter box issues

Peeing outside the litter box can occur for many reasons, ranging from where the litter box is located to litter preference to other behavioral problems, but it is also a common symptom for many forms of urinary tract disease. For this reason, a trip to the veterinarian to rule out medical issues should always be the first step in addressing the problem.

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