This month Dr. Jacqui writes about Lower Urinary Tract Disease

What is FLUTD? For purposes of description, the urinary system of the cat is divided into two portions: the upper portion which includes the kidneys and ureters and the lower half, which includes the bladder and urethra. Feline Lower Urinary Tract Disease (FLUTD) is a catch-all term for disorders that affect the lower urinary tract of cats. This could include infections, inflammation, bladder stones, bladder crystals, cancer and congenital disorders of the lower urinary tract.

How common is FLUTD? FLUTD is a very common problem in cats and is one of the primary reasons that cat owners seek veterinary help. The incidence of FLUTD occurrence varies between studies and study populations (general private practice vs. referral veterinary hospitals) but is estimated to be about 5-8% of cats receiving veterinary care.

What does FLUTD look like? Although there are many different underlying causes of FLUTD, the clinical signs of FLUTD are often the same, regardless of underlying cause and may include: straining to urinate, frequent urination, painful urination, blood in the urine and urinating in inappropriate locations. Some cats get a complete blockage of their urethra (tubular passage from bladder to the outside world) either via a small bladder stone getting lodged, a matrix of crystals getting stuck or a mass such a tumor and cannot urinate.

If a blocked cat does not receive veterinary care the cat will get very ill due to the toxins building up in the body from the retained urine, often becoming comatose prior to death.

What is the most common underlying cause of FLUTD? The most common causes of FLUTD in cats under 10 years of age are idiopathic cystitis (~60%), urolithiasis (~20%) and urethral plugs (~15%). In cats over 10 years of age, the incidence of bacterial infections and cancer increase.

• Idiopathic cystitis: Idiopathic means that we don't know what causes it and cystitis is an inflammation of the bladder wall. There is no simple test for this condition, so you have to rule out other causes of FLUTD to arrive at this diagnosis.
• Urolithiasis: Bladder stones. These can be identified with imaging (x-rays/ultrasound) techniques.
• Urethral plugs: These occur when urine crystals group together to form a matrix and that matrix gets stuck in the urethra. This is more likely to occur in male cats because their urethral diameter is smaller than in female cats and therefore can't be passed as easily. These can be identified with imaging (x-ray) techniques.
• Infections: While infections (e.g. bacterial) can be a cause of FLUTD, it is uncommon in young to middle-aged cats with less than 4% of cats under 10 years of age actually having an infectious process. Older cats (>10 years of age) have a much higher incidence of bacterial bladder infections (~50%).
• Cancer: Cancer of the lower urinary tract is relatively rare in cats with only 2-3% of cats showing FLUTD signs being due to cancer. Cancer is more likely to appear in older cats.

What tests need to be performed in my young to middle aged cat with signs of FLUTD? Tests may vary based on your cat's condition at time of the presentation. But basic tests will include a physical examination, a urinalysis and medical imaging (e.g. x-rays, ultrasound) of the lower urinary tract.

What does treatment usually involve? Treatment will vary based on your cat's condition and underlying cause of FLUTD. If your cat is not able to urinate (blocked), emergency treatment will be necessary to stabilize your cat and relieve the blockage. Long term treatment for the three most common forms of FLUTD (idiopathic cystitis, urolithiasis and urethral plugs) usually involves dietary therapy, increasing water consumption and stress reduction. Other specific treatments are tailored for each case.

Why does treatment involve increasing my cat's water consumption? Cat urine is usually very concentrated and this promotes the formation and growth of urinary crystals in the bladder. This concentrated urine is also an irritant to a compromised bladder wall, aggravating inflammation. By increasing a cat's water intake, the urine will be less concentrated, therefore providing an improved bladder environment.

How can I get my cat to drink more water? Getting a cat to drink more water sometimes is difficult to do! The most effective way to increase feline water consumption is to switch the cat from a dry food to a canned food. Canned cat food contains a lot of water (~75%), thus the cat is getting a good drink of water every time it eats!

Other ways to encourage your cat to drink more water is to offer multiple, different types of water sources. Consider the location, bowl shape, bowl material and still vs. flowing water as you are offering water sources around your home. Keep water bowls clean and fresh by changing water daily.

How can I reduce my cat's stress? Identifying specific sources of stress (e.g. noises, views of neighbor cats) and removing them from the environment may help. In multiple cat households, intercat tension may contribute to the overall stress level. Simply providing cat resources in multiple locations throughout the home may help relieve some of intercat tension. This may include multiple litterbox sites, multiple feeding/water stations and lots of vertical perches about the home.

Regular exercise and outlets for species typical behaviors such as predation using toys designed to mimic hunting behaviors (feathers on end of a pole) can help to reduce stress. Pheromone therapy using synthetic analogues of the facial pheromone via a diffuser may help reduce stress. For very severe cases, anxiolytic drug therapy may be considered. Please consult your veterinarian when considering the use of drug therapy for your cat.