FLUTD And Urinary Tract Infections in Cats | Causes & Treatments

Why does stress cause cystitis?

Stress causes the release of certain steroids, which in the short term can be beneficial, but when released chronically can suppress the immune system and negatively affect a number of body systems. Cats with stress may have other signs, like occasional gastrointestinal upsets (e.g. vomiting and diarrhoea). They may also have hair loss from overgrooming. Overgrooming may be a displacement behaviour to try to reduce stress, but can also be a sign of pain in the abdomen, either from cystitis in the bladder or from intestinal pain. Many stressed cats have bald patches on their bellies and between their hind legs.

Stress causes the protective layer of the bladder to become weak and damaged, allowing urine to come into contact with the sensitive tissues of the bladder wall. As we said, cats tend to have very concentrated urine that is highly irritating to the bladder, so this can cause inflammation. Inflammatory cells in the bladder can form sludge or plugs and block the outflow of urine. This is a medical emergency because cats can go into renal failure or rupture their bladders if they become blocked. Both of these events can be rapidly fatal. This is much more common in male cats due to their very narrow urethra.

Being stressed also changes the pH of the urine and. As this increases, some cats will develop struvite crystals in their bladder, which can clump together to make bladder stones, another risk for blockage. Their very concentrated urine exacerbates this clumping because the minerals that make the crystals are in close contact.

Other causes of FLUTD

Although stress cystitis is the major cause of FLUTD in cats, there are other things that can cause it. Some of these are:

• Kidney stones and urinary crystals and stones. Calcium oxalate crystals, for example, may form if your cat has high blood calcium concentrations or kidney disease. High levels of urate may be the result of liver disease and can also cause bladder stones.
• Cancer in the urinary tract may cause signs of cystitis.
• Urinary tract infection (UTI). As we said at the start, UTIs in cats are pretty rare. Their super-concentrated urine makes it virtually impossible for bacteria to grow. However, it can happen and is much more common in older cats. This is because their urine tends to become more dilute as their renal function reduces, and this can allow bacteria to take hold.

Signs and symptoms of FLUTD

You should seek veterinary attention if you see any of the following signs:

• Blood in the urine or a pink tinge to urine.

• Straining to urinate but not producing a normal stream. If your cat is passing no urine, this is a medical emergency.

• Vocalising/yowling while urinating, which can be a sign of severe discomfort.

• Loss of house training or inappropriate urinating in the house.

• Increased frequency of urination.

• Gritty deposits around the rear end.

• Overgrooming of the belly.

Treatment of FLUTD

Obviously some of this will depend on the exact cause. Your vet will want to get a urine sample and blood tests and may want to do an x-ray or an ultrasound scan of the bladder. If a UTI is present, antibiotics will be prescribed. Treatment and prevention of recurrence may include:

1. Increased water intake. This is absolutely crucial in all cats with bladder issues. Diluting the urine makes it less irritating to the bladder and will make crystals much less likely to form. Using wet food with added water or soaking kibbles can help if your cat doesn’t drink much. Water fountains and multiple water stations also help.
2. Nutrition. Your vet may recommend a therapeutic diet. These can help dissolve stones and crystals, depending on the type, and have altered protein and mineral content to reduce the building blocks for crystals. They also have high levels of omega oils from fish to reduce inflammation and antioxidants to slow cell damage.
3. Weight loss and exercise. Obese cats are much more prone to FLUTD, so your vet may recommend a combination diet to address their weight and their FLUTD. Being sedentary may contribute to weight issues and allows urine to sit in the bladder for long periods. Encouraging exercise and play can really help.
4. Surgery. Your vet may need to sedate your cat in order to surgically unblock their urinary tract or remove calcium oxalate stones. This would usually be followed by a special food to prevent recurrence.
5. Repeat urine sampling. Your vet will need to monitor your cat to make sure the cystitis has resolved and any stones have been dissolved. This will involve repeated urine samples and possibly imaging.
6. Addressing stress in the environment. The fancy phrase for this is Multi-Modal Environmental Modification (MMEM), but it just means reducing stress at home. You can do this by:

   • Giving your cat access to the outdoors if at all possible.

   • Placing multiple food and water stations in quiet, separate places around the house so there is never conflict over food or water. You need one more of each than the number of cats you have.

   • Placing multiple litter trays in other quiet locations. Again, place one more than the number of cats. Offer trays even if you have a cat flap.

   • Placing furniture and shelves in corridors where your cats may have to pass each other. This lets them move freely at different levels without conflict.

   • Use pheromone plugins to make your cats feel more relaxed.

FLUTD is a complex condition, but with fast intervention and good teamwork, your cat can have a great outcome and hopefully never experience it again. As with all things, prevention is better than cure. Think twice about having multiple cats and if you do, talk to your vet or follow the tips above to keep the house as harmonious and stress-free as possible from the outset. Avoiding stress for your cat will make your life much more stress-free too!

Reviewed by Dr. Hein Meyer, DVM, PhD, Dipl-ECVIM-CA and Dr. Emma Milne BVSc FRCVS