Cystitis and Feline Lower Urinary Tract Disease (FLUTD)
Veterinary & Aquatic Services Department, Drs. Foster & Smith

Cat using the litter boxFeline lower urinary tract disease (FLUTD) was formerly called 'feline urologic syndrome' or FUS, and is now more commonly called 'feline idiopathic cystitis' or 'FIC'. 'Cystitis' is the term commonly used to describe bladder inflammation. 'Idiopathic' means the cause is unknown. Idiopathic cystitis in cats is similar to interstitial cystitis in humans. FLUTD affects the cat's urinary bladder and sometimes the urethra (the tube-like structure that leads from the bladder to the outside of the body).

What are the symptoms of idiopathic cystitis or feline lower urinary tract disease?

Idiopathic cystitis in cats is a serious disease. Signs of idiopathic cystitis include:

  • Prolonged squatting or straining in or out of the litter box and not producing urine or only a small amount (some owners may confuse this with signs of constipation)
  • Frequent urination or straining
  • Pain while urinating (meowing or howling)
  • Urinating outside of the litter box
  • Blood in the urine
  • Frequent licking of the genital area

Many times these symptoms resolve on their own within a week, but they often recur.

Most cats with idiopathic cystitis are less than 10 years of age. In cats who are older than 10 years, the above signs are usually associated with other conditions including kidney disease, urinary tract infections, or bladder stones.

What causes the symptoms of idiopathic cystitis?

Normally the lining of the bladder protects the underlying bladder tissues from the urine. In idiopathic cystitis in cats, it is thought that the inside of the bladder changes and becomes more porous and a protective lining of the bladder is lost or decreased. The bladder becomes thicker, cells associated with inflammation accumulate and pinpoint hemorrhages can occur. The bladder becomes painful.

It is thought that stress may play a major role in the development of idiopathic cystitis. Stressors may include changes in the number of family members (both human and animal); changes in the litter box location, litter type, or cleanliness; changes in diet; and changes in the routine (e.g., no longer goes outside, owner no longer plays with cat).

How is idiopathic cystitis or FLUTD diagnosed?

A male cat with a blocked urethra is an emergency, as this is a fatal condition if not treated rapidly.

Idiopathic cystitis is cats is diagnosed by eliminating other diseases as causes of the symptoms, such as kidney disease, urinary tract infections, cancer, trauma to the bladder, bladder stones, or blockage of the urethra. Some cats can develop very small microscopic crystals in their urine. In the male cat, these crystals can block his urethra preventing him from urinating even though the bladder still fills. You may have heard of a male cat with this condition called a 'blocked tom.' A male cat with a blocked urethra is considered an emergency, as this is a fatal condition if not treated rapidly.

A veterinarian will perform a physical exam on the cat. The veterinarian may find the bladder either small and thickened or very large and distended. The veterinarian will press on the bladder (called 'expressing' the bladder) to see if the cat is able to urinate or if the urethra is blocked. The veterinarian may also be able to feel bladder stones.

A sample of urine will be collected to perform a 'urinalysis' that will indicate if there are crystals, bacteria, blood, or white blood cells in the urine; the urine pH and also how concentrated the urine is (called 'specific gravity'). A urine culture may be performed to identify any urinary tract infections. The veterinarian may also take radiographs (X-rays) to look for stones, tumors, or congenital abnormalities. Certain dyes are sometimes passed into the bladder to aid in seeing abnormalities.

Blood may also be taken and tested to rule out kidney disease or other disorders.

How is idiopathic cystitis or FLUTD treated?

The two main goals of treatment are to relieve stress and provide pain relief. It may also be helpful to decrease the concentration of the urine (specific gravity).

Reduce stress and enrich the environment

  • Keep to as normal a routine as possible.
  • If possible, do not change the diet. Feed in a quiet location.
  • Provide toys, window perches, scratching posts and other means to prevent boredom and encourage instinctual behavior such as stalking and pouncing.
  • Locate litter boxes in a quiet location. Use large litter boxes. Most cats prefer clumpable litter. It is recommended to have one more litter box than the number of cats in the household (eg., if you have two cats, have three litter boxes).
  • Increase the time you spend with your cat. Playing, grooming, or simply sitting with the cat on you lap may help the cat feel more secure and less anxious.
  • Reduce any conflict between other pets or humans and the cat. For conflict between cats, be sure to provide separate feeding locations, litter boxes, sleeping areas, etc. to reduce conflict over resources.
  • Provide sufficient space for the cat. The more room the better. Also think vertically - most cats like to be up high.
  • Consider using a cat pheromone product such as Feliway. Pheromones are chemicals which are used to communicate with other members of the same species. You may notice your cat rubs her face and chin on vertical surfaces. She is leaving a scent there which contains these pheromones. The pheromones from the face have a calming effect on other cats.

Provide pain relief

Your veterinarian may prescribe a pain reliever and also possibly a tranquilizer to help your cat be more comfortable. Cystitis is a very painful condition, and relieving the pain is an important way to reduce stress.

Cat drinking waterLower specific gravity

Cats with cystitis should be encouraged to drink more water. Increase the number of bowls of fresh water located around the house, consider a cat fountain, or add small amounts of unsalted broth or water from a tuna can to the drinking water. If your cat enjoys canned food, you may want to increase the amount of canned food fed while slowly decreasing the amount of dry food. This will also help to provide the cat with more moisture.

What is the prognosis for cats with idiopathic cystitis/FLUTD?

Symptoms will often resolve within a week, but the disease tends to recur. By keeping stress low, you may be able to decrease the risk of your cat having further episodes.

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