If you have ever owned a cat, you are likely familiar with feline lower urinary tract disease (FLUTD). Cats are mysterious creatures, inside and out, and that includes how their urinary tract works. For numerous—at times unknown—reasons, cats’ urinary tracts become inflamed, irritated, or infected, which can lead your cat to eliminate inappropriately. To understand why your feline friend may suddenly shun their litter box in favor of the center of your freshly made bed, read our Just Cats Clinic team’s FLUTD guide.

What is feline lower urinary tract disease?

FLUTD is a complex, multi-condition medical issue that affects your cat’s bladder and urethra. Typically, FLUTD does not include kidney issues, as these organs are in the upper urinary tract. No matter your cat’s FLUTD-causing conditions, their signs are similar. 

Which cats are most susceptible to FLUTD?

While FLUTD can affect any cat of any age, middle-aged and overweight cats commonly develop the disease. Other factors that can increase you cat’s FLUTD risk include:

  • Little to no exercise
  • Limited outdoor access
  • Dry food diet
  • Indoor litter box use
  • Pre-existing kidney disease
  • Diabetes

FLUTD occurs equally in male and female cats; however, male cats have a greater risk of developing a urethral obstruction (i.e., urinary blockage) because of their urethra’s shape.

What causes cats to develop FLUTD?

Many causes contribute to FLUTD’s associated disease signs. Some of FLUTD’s most common causes include:

  • Urinary crystal or stone formation 
  • Urethral plug formation, consisting of mucous, crystals, and other debris
  • Urethra wall muscle spasms 
  • Bacterial and viral infections
  • Urinary tract structure abnormalities
  • Stress and behavioral problems
  • Bladder or urethral cancer
  • Disease affecting the bladder-control nerves 

While FLUTD’s potential causes are many, roughly 60% to 70% of FLUTD cases have no known cause (i.e., idiopathic FLUTD), which can make the condition frustrating to manage. 

What are FLUTD signs in cats?

No matter your cat’s FLUTD cause, all FLUTD signs are similar and can include:

  • Straining to pass urine
  • More frequent urination
  • Passing small amounts of urine
  • Avoiding the litter box
  • Bloody urine
  • Vocalizing when urinating
  • Decreased appetite
  • Lethargy
  • Behavior changes (e.g., hiding, aggression)

Some cats with FLUTD are completely unable to pass urine, and they can behave as though they are constipated, straining to eliminate in the litter box, but unable to do so. This urethral obstruction can be a life-threatening emergency that, if not treated immediately, can quickly prove fatal.

How is FLUTD diagnosed in cats?

FLUTD is most often an idiopathic condition that your veterinarian can find challenging to diagnose. However, your veterinarian must rule out all possible causes before diagnosing idiopathic FLUTD, and only by knowing the correct diagnosis can they ensure your cat will receive the most effective treatment. 

Our Just Cats Clinic veterinary team will begin by asking you to describe your cat’s signs. We will then complete a thorough physical exam to assess your cat’s bladder, other organs, and overall health. If your cat shows urinary tract disease signs, we will do blood work to evaluate their electrolyte levels and organ function, and a urinalysis to determine whether crystals, protein, red blood cells, white bloods, or bacteria are present. We may also perform a urine culture if indicated. In addition, a urinalysis provides information on how well your cat’s kidneys are concentrating urine, which helps us separate the issue from an upper urinary tract issue.

We will also perform additional diagnostic testing to determine the cause of your cat’s urinary issues. Abdominal X-rays and ultrasound can indicate stones, masses, or other abnormalities in the urinary tract, allowing our team to locate the problem’s exact site. At Just Cats Clinic we have found that doing a full diagnostic workup in the beginning saves time and money in the long run when looking to solve this problem.

How is FLUTD treated in cats?

FLUTD treatment varies based on the underlying cause. If your cat has been diagnosed with FLUTD, the condition may be treated by:

  • Prescribing pain medications Regardless of the cause of your cat’s FLUTD, they will be painful. The first step in alleviating the problem is multimodal pain management. We will often prescribe a combination of opiates and NSAIDs to help make your cat comfortable.
  • Prescribing antibiotics — Young cats rarely have a bacterial urinary tract infection. Older cats more often develop bacterial urinary tract infections. The urinalysis will help us determine if your cat needs antibiotics.
  • Dissolving or extracting stones — Urinary crystals or stones can develop as a result of improper urine pH, which can be remedied by changing your cat to a prescription urinary diet that oftentimes dissolves crystals and stones. However, some stones require surgical removal.
  • Increasing water intake — Maintaining hydration is important to help keep your cat’s urine dilute. More frequent urination also helps to regularly flush bacteria, crystals, and other irritants from the urinary tract.
  • Creating calm — One of the most challenging FLUTD issues to solve—stress-induced cystitis—requires environmental modification to reduce your cat’s stress. This may mean adding litter boxes, changing litter substrates, providing enrichment, diffusing calming pheromones, creating separate resource areas to reduce competition, or potentially rehoming a bullying cat. Occasionally, anti–anxiety medication can help ease your cat’s stress, as can a prescription diet.
  • Performing surgery — Urethral obstruction can lead to urine backing up in your cat’s kidneys and affecting their function. Your veterinarian must immediately remove the blockage. Your cat must undergo anesthesia during this procedure, and will be hospitalized several days so your veterinarian can correct your cat’s electrolyte imbalances, address their dehydration, and ensure their urethral blockage has been cleared.

Your cat’s urinary issues will not resolve on their own, and earlier intervention makes a cure more likely. Left untreated, a urinary problem can become life-threatening, so contact our Just Cats Clinic team for an appointment.