The term “feline lower urinary tract disease” describes a set of conditions affecting the urinary bladder and the urethra. These are very common and painful illnesses, and life-threatening complications may develop quickly. Speak to a vet as soon as possible if your cat is straining to pee or distressed.

The most common cause of feline lower urinary tract disease is Feline Idiopathic Cystitis, which is thought to be caused mostly by stress and lifestyle factors. Other common causes are crystals in the urine and infections. Many cats experience repeated episodes throughout their lives. If these conditions significantly reduce or halt urine flow, it is extremely painful and can quickly cause kidney damage and life-threatening complications. Emergency care is essential for these cases.

What is feline lower urinary tract disease?

The lower urinary tract includes the bladder, where urine is stored, and the urethra, the tube that connects the bladder to the outside. Problems affecting these areas are common in cats, and different conditions may cause similar symptoms.

• Feline Idiopathic Cystitis is caused by a combination of factors and can be difficult to manage in the long term, but treating the symptoms during flare-ups prevents serious complications

• Bladder stones and urine crystals are due to minerals in the urine coming together to form a small stone or a sand-like sludge. This can be due to imbalances in the food or water, and sometimes happens spontaneously. The crystals or stones can damage the bladder and urethra, and sometimes cause a blockage.

• Urinary tract infections are uncommon in cats. When they happen, they are often associated with one of the conditions above. Bacteria may be able to travel up the urethra. If the urinary tract defences are damaged, this leads to an infection.

• Any of these conditions can lead to spasming of the urethral muscles or formation of a plug, which can cause a urinary tract blockage.

If your cat is straining to pee and has a painful tummy, see a vet immediately.

Symptoms of feline lower urinary tract disease

• Straining to pee

• Vocalising or crying when passing urine

• Blood in the urine

• Peeing small amounts but very frequently

• Urinating outside of the litter tray or in abnormal places, like the shower

• Being in a rush to pee

• Being unable to pass any urine

• Tummy pain

• Frequent licking around the genital area

• Reduced appetite and becoming withdrawn

Cats at a higher risk of lower urinary tract disease

Urinary tract disease can affect any cat, but it’s more common in cats that are:

• Middle-aged

• Male

• Overweight

• Indoor only

• Housed with other cats

Different types of urinary crystals and stones are more common in specific breeds:

• Oxalate stones are more common in Burmese, Persian and Himalayan

• Urate and xanthine stones are more common in Siamese, Birman and Egyptian Mau

Diagnosis of lower urinary tract disease in cats

The first goal in treating lower urinary tract disease is to manage or prevent life-threatening complications. The next step is to identify all factors contributing to the problem so they can be addressed. This may include:

• Urine analysis, including culture to check for infections

• X-rays and/or ultrasound scans to check for masses, stones and crystals

• Blood tests: to assess for systemic illness

• Nutritional assessment to check for imbalances

• Thorough behavioural assessment to check for signs of stress

Chronic pain can be a significant cause of stress, and further investigations may be needed to rule this out, especially in older cats or those with other health problems.

Vet treatment of lower urinary tract disease in cats

• Urinary blockages are life-threatening emergencies and must be treated immediately. This involves passing a urinary catheter under anaesthesia to restore the flow of urine. If this is not possible, the bladder may need to be emptied through a needle, and surgery to remove or bypass the blockage may be required.

• Lower urinary tract disease can be extremely painful, adding stress and potentially leading to further changes in the bladder and urethra. Managing pain and inflammation is a vital part of treatment.

• If an infection is present, a course of antibiotics may be required.

• Large bladder stones and stones made of oxalate (the most common type, and are non-dissolvable) are removed via surgery.

• Small stones and crystals that are made of struvite (the second most common type, and are typically dissolvable) may sometimes be dissolved with specific diets.

• In cases of idiopathic cystitis that are not improving, medication to reduce anxiety or antidepressants may be used for a time to help manage stress and introduce a long-term management plan.

• Other medications, such as smooth muscle relaxants, may also be recommended in specific situations.

Home treatment of feline lower urinary tract disease

• The most important part of treating feline idiopathic cystitis is reducing stress and anxiety levels, both recent and long-term. This is the only way for the brain and bladder to fully heal. This involves adjustments in their environment, but should be done gradually. Any changes should be made alongside what was previously available, until it becomes clear what an individual cat prefers. This can be a complex process, and it is best to seek guidance from a vet, nurse or licensed behaviourist. Common strategies that help many cats:

  • Try to identify and manage possible causes of stress, such as competition with other cats, frustration, boredom, lack of socialisation, lack of control or lack of a feeling of safety.

  • Use pheromone products to help create a feeling of safety and control.

  • Always provide at least one more litter box than the number of cats in your home. Offer different types, litters, and locations. The litter boxes should be scooped at least once per day.

  • Environmental enrichment activities, such as puzzle feeding, hunting-like play, and opportunities to climb and explore, can be particularly helpful for indoor cats

• Specific diets can treat struvite stones and crystals, and help manage the symptoms of other types of stones as well.

• Increasing water intake and urine production often helps reduce symptoms and prevent complications. This can be achieved by ensuring they have their preferred drinking methods available, such as a water fountain. Many urinary diets are designed to encourage greater water intake. Offering more wet food may also help, but if your cat prefers dry, other approaches are better.

• Supplements may be helpful, although there isn’t much scientific evidence to confirm this at this stage. Products containing the following are frequently recommended:

  • Glycosaminoglycans, which are building blocks for the protective layer that lines the inside of the bladder and seem to be deficient in cats with this disease. These are available in capsules and are also added to many urinary diets.

  • Amino acids that are used to produce relaxing neurotransmitters in the brain, like tryptophan.

  • Casein is a protein that is believed to help reduce short-term stress in cats and is available as a supplement as well.

Stress and diet management in cats is often complex and very specific to each cat. Please don’t hesitate to ask your vet for further advice. The Joii vets are always available to discuss any concerns and provide further information.

Can feline lower urinary tract disease be prevented?

• The stress reduction strategies discussed above for home treatment can also be effective in preventing the development of feline idiopathic cystitis.

• A good quality, appropriately balanced diet, with the right quantities and proportions of minerals and amino acids, may prevent bladder stones and crystals

• Being overweight is a significant risk factor for all these conditions. Maintaining a healthy weight may help prevent them.

Is feline lower urinary tract disease contagious? Can people catch it from cats?

None of the common causes of feline lower urinary tract disease is contagious, and they cannot be passed to other cats or people.

When to worry about feline lower urinary tract disease

Visit a vet as soon as possible if your cat:

• Is constantly straining to pee

• Hasn’t passed any urine in 12-24 hours

• Is hiding and refusing to move

• Has no energy or appetite

• Has a painful tummy

Speak to a vet for advice if you notice:

• Your cat is urinating outside of his tray or in unusual places

• A change in your cat’s routines or interactions with other animals or people

• A change in the volume or appearance of your cat’s urine

The Joii vets are always available to give you advice and answer any questions.