Cystitis in Cats
By Graham Peck and Dave Nicol
Overview
Cystitis or Feline lower urinary tract disease (FLUTD) is used to describe a debilitating condition that affects the bladder and urethra of cats. Several causes of this condition are known that produce symptoms either alone or in combination. A significant percentage of cases (65%) however lack an identifiable cause and are therefore described as idiopathic cystitis.
Up to 1% of the cat population in the UK are affected by this condition. It can affect cats of all ages and of either sex. However it is most frequently seen in middle-aged, over-weight, inactive, neutered male cats. In particular those with restricted out door access, using mainly an indoor litter tray, often eating a dry food diet. These cats are frequently from a multi-cat household where a degree of in fighting may be the norm.
Signs to Watch For
- Increased frequency of urination
- Blood in the urine
- Straining to urinate sometimes accompanied by distressed cries
- Increased grooming of the area around the genitals
- Inappropriate urination in unusual sites (like the bath or sinks)
- Behavioural changes, occasionally the distress causes aggression
- Loss of litter tray training
Most cases of FLUTD are self-limiting with signs resolving over one to two weeks. Many cats will have recurrent episodes with variable frequency and severity of signs.
The most serious consequence is where obstruction occurs either with a stone or plug of material in the urethra. Without prompt veterinary attention a life-threatening emergency rapidly develops. Typically seen in male cats, unsuccessful attempts to urinate are followed by increasing distress, lethargy, inappetence and vomiting; culminating in acute kidney failure and death.
Causes of FLUTD
1. Idiopathic Cystitis
The majority of FLUTD cases have no identifiable cause and the diagnosis by exclusion is idiopathic cystitis. Stress, it has been speculated, may play an important part in precipitating episodes. Causes of stress can include:
- Dirty litter tray
- Change of litter type
- Change of diet
- Alteration of normal routine
- Bullying or fighting with other cats
- 'Home-alone' syndrome
2. Bladder Stones
The most frequent stones in cats are 'struvite' and 'calcium oxalate'. Over recent years emphasis was placed on using diets that restrict magnesium content and acidify the urine to promote dissolution and prevent formation of struvite crystals. While these diets have resulted in a decrease in struvite stones they have inadvertently produced an increase in the incidence of calcium oxalate crystals.
Recent research by Danielle Gunn-Moore of Edinburgh University Vet School has shown that the water intake is a key factor as many cats that form stones are fed dry diets. This results in an increased concentration of potential stone forming minerals in cats' urine.
It also contributes to reduced urine production and decreased frequency of urination allowing mineral saturated urine to remain for longer periods in the bladder, increasing the formation of crystals and stones.
3. Urethral Plugs
Chronic inflammation can result in the formation of a mucus-based sludge within the bladder, which may or may not contain crystals. The mucoid paste is believed to originate ('leak') from the bladder wall and plugs of it can be shed into the urine.
Where this sludge becomes very thick these plugs can cause urethral obstruction.
4. Infections
Bacterial infections rarely cause FLUTD and where found are usually secondary to other problems.
5. Cancer
Cancer of the bladder, urethra and prostate in males can give signs of FLUTD but is rare. 'Transitional cell carcinoma' an aggressive tumour of the bladder wall can occur secondary to chronic inflammation.
Combinations of the above causes are seen and can influence the appearance and severity of the signs associated with FLUTD.
Treatment
Non obstructive FLUTD while usually self-limiting is usually treated to alleviate the pain, distress and urethral spasms that accompany the signs.
Where obstruction with stone or plugs occurs then emergency veterinary attention is required to restore patency.
Prevention of FLUTD
FLUTD is a debilitating and potentially life threatening disease of cats and there is little owners can do once acute signs appear other than seek veterinary attention for their cat.
With a cat having a history of this problem proactive long term management changes are the key to reducing the frequency of attacks and minimising both the severity and duration of clinical signs when the problem occurs. The following are suggested management changes that owners can easily implement to help susceptible cats.
1. Make your cat produce more dilute urine
Increased water intake is now considered the cornerstone of management of FLUTD. A cat that drinks a lot of water will produce more dilute urine, helping the cat to void any problem material contained within the bladder.
Avoid feeding dry foods in cats suffering from this problem. Moist or caned foods are preferred with free access to fresh clean water. The use of a water fountain can be an extremely effective way to promote drinking.
(It should be noted that dry foods are still recommended for cats that do not suffer from idiopathic cystitis.)
2. Stress Reduction
Stressors described above can be important trigger factors in recurrence of clinical signs. Implement the following to reduce stressors:
- Provide an adequate number of litter trays - one per cat
- Avoid changing litter types
- Clean litter trays as soon as they become soiled - cats don't like using dirty trays!
- Site the litter trays in quiet, safe areas
- In multi-cat households avoid overcrowding and watch for bullying, provide escape routes and hiding places
- Minimise or avoid major changes in routine
- Provide toys and scratching posts
- Regular health checks and avoid obesity
- Use a ' Feliway®' diffuser in your home. This is a synthetic facial pheromone that reduces anxiety in cats
- Give your cat regular attention and tender loving care
3. Glycosaminoglycan (GAG) Supplementation
Glycosaminoglycan (GAG) supplements help protect the bladder wall, they may also have some pain-killing and anti-inflammatory effects. 'Cystease' and 'Cystaid' are two commonly used veterinary preparations that contain a precursor for GAG.
Summary
FLUTD is a distressing disease for both owner and cat and remains a diagnostic challenge for your veterinary surgeon to fully understand its underlying cause. Management of the acute recurrences is largely palliative but it is important to involve your vet early on as there is always the worry of a life threatening obstruction developing.
The approach to long-term management has shifted away from severe dietary restriction to more a fundamental, almost holistic, approach. It includes stress reduction, adequate water intake and appropriate supplementation.
If your cat has a problem with recurrent cystitis and you would like to discuss any of the above management measures with a veterinary surgeon call us and arrange an appointment today at your nearest branch of Parkvets.
