CYSTITIS AND LOWER URINARY TRACT DISEASE (FLUTD)

What is Cystitis? What is FLUTD?
Cystitis is a general term referring to inflammation in the urinary bladder. The term cystitis does not imply a specific underlying cause. FLUTD is a group of diseases of the lower urinary tract (bladder and urethra) that are grouped under the term ‘feline lower urinary tract disease’ (FLUTD). This is due to the fact that it can be difficult to distinguish between diseases of the bladder and urethra, and many diseases will affect both structures in cats.

What Are the Symptoms of Cystitis/ FLUTD?
Typical signs in cats with FLUTD are those of inflammation and irritation of the lower urinary tract. The common signs are therefore:

• Bloody urine
• Increased frequency of urination
• Eliminating outside the litter box
• Difficulty in urinating (spending a long time straining in the litter
box while passing only small quantities of urine)
• Complete urinary tract obstruction resulting in the inability to urinate (straining persistently without producing any urine)
• Licking urinary opening due to pain

With urinary tract obstruction, it is important to seek immediate
veterinary care because blockage to the flow of urine can be a life-
threatening complication if untreated.

What Causes FLUTD?
The key to treatment is to find the underlying cause if possible and treat
the source of the problem. Different diseases are common in general age
groups of cats.

The average age of a cat with FLUTD is 4 years. Of all cats with FLUTD:

• 50 % will have an undetermined cause
• 20% will have bladder stones
• 20% will have an obstruction
• 1-5% will have an infection
• 1-5% will have urinary cancer
• 1-5% will have had a traumatic cause
• 1-5% will have an infection and bladder stones

If a cat is over 10 years the causes are different:

• 66% will have some stage of kidney disease
• 50% will have infections
• 17% will have an infection and bladder stones
• 10% will have bladder stones
• 7% will have an obstruction
• 5% will have an undetermined cause
• 3% will have urinary cancer

How is FLUTD Diagnosed?
Diagnosis is accomplished by looking for known causes of the symptoms:

Kidney disease
Kidney or bladder stones
Infections
Urethral obstructions
Urinary crystals
Anatomic abnormalities
Cancer
Neurological disorders
Trauma
Behavioral causes

Physical Exam: Palpation of your cat's abdomen for presence of
obstruction, pain in the urinary tract, and kidney size and shape.
Diagnostic tests include:
Analysis of a urine sample
Bacterial culture of a urine sample
Complete Blood Panel
X-rays/Ultrasound of the bladder

The information from these tests should help to identify a specific treatable
underlying cause if present.

What Are the Treatment Options?
No single treatment has been shown to be consistently effective in
treatment of FLUTD. Often we need to combine treatments depending on
the individual cat.

1. Increased water consumption. More water consumption will produce more dilute urine. This will dilute out irritants and help to decrease the possibility of crystal formation. Multiple bowls full of fresh water should be changed daily and should always be available in various locations. Water fountains can be an extremely effective way to promote drinking. Often times a moist diet will be prescribed to increase water content.
2. Stress reduction. It is believed that stress is a major component of FLUTD. Stress may precipitate FLUTD episodes. Stress can come from many sources including other cats (multi-cat household or cats outside), stressed owners, or the environment (household changes in pets, people, furniture, remodeling, etc.).
   
   Provide adequate litter boxes (one per cat plus one)
   Avoid changing litter type
   Clean litter boxes daily
   Place boxes in quiet, safe areas
   Avoid major changes in routine
   Provide toys
   Avoid obesity
   Provide play time, grooming time
   Provide environment enrichment
3. Environmental cleaning. Residual urine can be a strong attractant to cats. Thoroughly cleaning soiled areas with an enzymatic cleaner is very important. Brands to consider are X/O, Nature’s Miracle and Odoban (from Sam’s Club). Avoid ammonia-based cleaners. See www.escapetheplaneturine.com for other suggestions.
4. Analgesics. In order to provide some pain relief, pain medications may be prescribed.
5. Diet. Feeding a canned food is much better for these cats than feeding dry food as it increases their water intake. You can try to add water to dry food if your cat does not like canned food. Sometimes special prescription diets are recommended in an effort to control urine pH and mineral content. This is especially true if there is evidence of crystals and/or stones.

Medications

1. Analgesics. In order to provide some pain relief, pain medications may be prescribed
2. Polysulfated Glycoaminoglycans (Cosequin). This drug helps repair damage to the protective mucosal lining of the bladder wall.
3. Pheromones (Feliway). Pheromones are chemicals that animals use to communicate with each other. The absence of these chemicals in a cat’s environment can create anxiety. Pheromones can have a calming effect.
   

Summary

FLUTD is a distressing disease for both owner and cat and remains a diagnostic and treatment challenge for veterinarians. Management of acute recurrences is mostly palliative but it is mportant to see your veterinarian early to rule out any known causes that can be treated.