Feline Urological Syndrome (FUS, FLUTD)
FLUTD is also known as Feline Urological Syndrome or Feline Cystitis. FLUTD has many causes, including infection, trauma, bladder stones, crystals, urethral obstruction or cancer.
The most frequent cause of cystitis or blood in the urine in cats is unknown- officially, this is called Idiopathic FLUTD (see below).
FLUTD can be obstructive (commonly known as `blocked’), or non-obstructive. Obstructive cases happen in male cats when a plug forms and lodges in their naturally long, thin urethra. Obstruction in female cats is rare. Non-obstructive cases are more common, but obstructive cases are life threatening.
Obstructive cases can cause kidney failure
or death within 3-6 days of obstruction
Male and female cats prone to this are usually between 2-6 years of age. Clinical signs are usually pain on urinating, increased frequency of urinating, and blood in the urine. Urine is usually concentrated and acidic, and clinical signs usually subside in 5-7 days, unless signs lead to an obstruction. Recurrence is common, and episodes may decrease in severity and frequency over time.
A urine test is usually required to check for abnormalities, and sometimes, an additional test to see if bacteria is present in the urine is warranted. The vet will discuss what is required and what your options are. Treatment usually includes anti-inflammatories (for pain and inflammation), antibiotics (if an infection is suspected or proven by lab urinalysis) and prevention.
All cases need a thorough workup by a vet to determine the exact nature of the problem and the correct management plan to try and prevent re-occurrence.
- Urinating inappropriately (increased frequency, small numerous dribbles, or urinating in unusual places)
- Blood in the urine
- Straining or pain on urination- this can be seen when your cat spends more time crouched over the litter tray which is often mistaken for signs of constipation
- Increased licking of the bottom area
Affected cats feel the irritation in their urinary tract and have an urge to urinate (cystitis). Quite often, bacteria accompany the crystals increasing the level of discomfort. Cats suffering from FUS/FLUTD try to urinate more often than normal, often crying out whilst doing so. Owners may notice small drops of blood tinged urine in the litter tray.
The urethra in female cats is wider then in male cats. Unfortunately for male cats, their urethra is much narrower. Urinary crystals or "plugs" made of a mixture of inflammatory cells, thick mucous-like material (usually from inflammation of the bladder wall and/or crystals) can get stuck in a male cat urethra causing a blockage to the flow of urine. The male urethra is surrounded by small muscles, which sometimes spasm/cramp when there is a blockage or irritation in the urethra, thus compounding the initial blockage.
A “blocked” male cat is in a life threatening situation. The kidneys keep making urine despite the fact that the cat can not pass it. The bladder gets bigger and bigger, and the kidneys start to get a huge amount of back pressure of urine applied to them. There is a dramatic rise in the amount of potassium in the bloodstream as a result of this, which causes an irregular heartbeat. Death can occur within 24-36 hours of a complete blockage.
Although there is no single cause of FLUTD, various risk factors have been determined that predispose cats to the disease:
- Urine too alkaline or acid
- High urine concentration of magnesium
- Foods with excess protein
Factors that cause high urine levels of magnesium
- High magnesium content in the food
- Infrequent urination caused by a dirty litter tray
- Poor quality water
- Dry cat food
Factors that contribute to an alkaline urine pH
- Size and frequency of meals
- Type of food eaten
- Bacterial infections of the bladder
Female cats do not usually present with a blockage. Urine samples are examined to determine the exact nature of the crystals as not all cases are Struvite. The cat is placed on antibiotics (if bacteria are present), mid anti-inflammatories to lessen the irritation and special prescription diets e.g. Hills Feline S/D (struvite diet) or Royal Canin Urinary to dissolve the crystals by changing the urine pH. If the cat has Oxalate crystals, it usually goes onto Hills X/D diet.
Water intake has to be increased so tin foods are preferable to dry foods.
Blocked cats need surgery to relieve the pressure on the kidneys. If a cat is in serious trouble, a vet may place a large needle directly into the bladder to suction out as much urine as possible, thus removing the back pressure on the kidneys and “buying some time” prior to surgery. Once stabilised, the cat is anaesthetised and a smooth urinary catheter passed into the tip of the penis in an attempt to flush the blocked crystal backwards into the bladder and the bladder is emptied.
Some vets like to leave the catheter in place for 1-2 days to prevent a re-occurrence of the blockage. Other vets like to remove the catheter to try and minimise trauma to the sensitive ling of the urethra.
Occasionally, male cats can be so severely blocked that it is not possible to pass a catheter into the bladder. These cases need to have an operation to change the plumbing so they urinate through a much wider hole. This operation is called a perineal urethrostomy. This is a rare operation to perform these days with the advent of the special preventative diets from Hills.
- Stress reduction
- Weight control and exercise
Overweight cats and cats that are inactive tend to have a higher chance of developing FLUTD. Encourage exercise whenever possible.
Try to make sure your cat has a choice of litter material and litter location to encourage frequent emptying of the bladder. This is especially important in multi-cat households.
Keep the litter tray clean and fresh
Studies have shown that a consistent diet, and use of tinned food (compared with dry food) can help. This may have to do with higher water content in wet foods.
- Urinary pH
Acidifying the urine can help, if your cat’s urine tends to be alkaline. This can be helped by maintaining of a prescription diet (Hills c/d or s/d, Royal Canin Urinary), or by daily administration of a urinary acidifier (tablet).
- Avoid extras
e.g. extra treats, food scraps or vitamin supplements.
Provide plenty of fresh water at all times. Feeding can food can be helpful in increasing water intake.
- Periodic urine testing
Having the urine analysed every 4-8 weeks is important in the management of the disease.
Tips on Transitioning Food
Generally introduce a new food over a 7 day period for dogs and 4 weeks for cats. Mix the new food with the old food, gradually increasing its proportion until only the new food is fed.
If your pet is one of the few that doesn't readily accept a new food, try...
- Warming the canned food to body temperature
- Hand feeding for the first few days
- Mixing the dry food with warm water (wait 10 minutes before serving)
- Feed only the recommended food. Be patient but form with your pet
This is important because the success of treatment depends to a large degree on strict adherence to the new food.
The Risks of Excessive Salt Intake in Your Pet
Salt can be added to products to improve their taste or to try and encourage more drinking.
Too much salt in your cat's diet could put her at an increased risk of health problems such as heart diseases and higher blood pressure.
Excess salt can stimulate the progression of kidney disease, even before it can be detected, particularly in older cats who may be in the early stages of disease but their owners are not aware of it.