How do I prevent Urinary Tract Disease in my Cat?

Feline lower urinary tract disease (FLUTD) is an umbrella term used to describe a group of problems associated with the lower urinary tract (bladder and urethra) of cats. Unfortunately, urinary tract disease is very common in cats, and it can be cause by a number of factors.  

Although FLUTD can occur at any age, the associated problems are usually seen in middle-aged, overweight cats that get little exercise and have little or no outdoor access. Potential stressors, such as changes in routine, moving to a new home, or living in a multi-cat household, also may increase the risk of FLUTD. 

While the diagnosis, treatment, and management of urinary tract disease in cats is best done by your veterinary team, there are also some things that can be done to reduce the risk of urinary tract disease, especially in cats that are at a higher risk. 

At Boundary Bay, we see cats through our emergency department when they are having acute urinary tract issues, or as referrals to our board-certified internal medicine team from family veterinarians for diagnosis and chronic management of urinary issues. 

 What are the signs and symptoms of urinary disease in cats? 

Major signs of FLUTD include the following: 

  • Blood in the urine 
  • Urine with a strong odour 
  • Pain when urinating (crying or vocalizing) 
  • Straining to urinate, with or without urine production 
  • Frequent or small volume urination 
  • Excess licking around the penis or vulva 
  • Over-grooming the abdomen over the bladder 
  • Inappropriate urination outside the litter box (on the floor, in the tub, etc.) 
  • Fine crystal/powder material in the fur around the opening to the urinary tract 
  • Hiding 
  • Reduced appetite 


In late stages of disease, especially in males, obstruction may occur which may manifest as vomiting, weakness, collapse, and lethargy. Note that in some cats, obstruction is the first urinary sign that is noted. 

What are the types of urinary diseases in cats? 

  • Stones (uroliths) and crystals (crystalluria) may form in the urinary tract. These may cause obstruction, but if not large enough to block the urethra they may produce significant inflammation and irritation to the bladder (cystitis) and urethra (urethritis). Sometimes very small stones accumulate, which may be called “sand”. Stones and crystals cause: physical irritation from moving and rubbing against the lining; damage to the normal mucous layer of the bladder; and irritation from urine which is outside the normal acidity/alkalinity balance. Crystals and stones form when urine is concentrated (high specific gravity), too acidic or basic, or contains too high a concentration of minerals such as calcium, magnesium, ammonium, or phosphate. 
  • Feline Interstitial Cystitis (FIC), also termed “Feline Idiopathic Cystitis,” is a commonly seen inflammatory disease of the bladder resulting from stress, genetic factors, and other conditions that stimulate inflammation and damage to the bladder wall. Indoor cats with sedentary lifestyles, anxiety, or lack of stimulation are at highest risk. Risk factors also include obesity, concentrated urine, and poor diet. Urine from cats with FIC is sterile with no crystals or stones, however severe inflammation and pain is present. This is possibly the most common cause of lower urinary disease in modern housecats. 
  • Urinary Tract Infections (UTIs) are not common in cats, especially young or male animals. When they occur, they may be present alone, or more commonly along with one of the other described conditions as a complicating factor. 
  • Bladder cancer (usually Transitional Cell Carcinoma), though uncommon, can lead to irritated tissues around the growth, bleeding, or infection. 
  • Congenital diseases (birth defects) such as malformed urinary tracts, misplaced ureters, underlying kidney diseases, or others may also occur. 
  • Spraying” is not truly a urinary disease, but a normal behaviour of intact male cats or cats exposed to testosterone. This involves peeing a fine mist on vertical surfaces with the tail raised as a territorial marking tool. 

“Blocking” or Lower Urinary Tract Obstruction 

Blockage of the urinary tract of cats can be caused by any of the above conditions and may be preceded by any or none of the discussed signs. Male cats are overwhelmingly more likely to experience obstruction due to their long and thin urethras. A blockage may develop if the cat has stones/sand that move down from bladder or kidneys and lodge in the narrow urethra. It can also occur if a scar tissue ring forms, inflammation or infection causes the urethra to swell closed or spasm, or a mucus/blood clot plugs the urethra. 

Cats with lower urinary obstruction often strain repeatedly and express little to no urine. They experience a lot of pain and may vomit or go into hiding. Cats may collapse and show extreme weakness in the late stages of disease. Additional signs may include howling while straining, distressed attitude, loss of appetite, and progression to inability to move. Within 48 hours of obstruction untreated cats may die of kidney failure or electrolyte disturbances. Potassium levels generally rise, and in extreme conditions these high levels may lead to stoppage of the heart. Bladder rupture may also occur, which is often fatal if not rapidly addressed. 

This condition is extremely painful and life threatening — do not delay seeking veterinary care if you suspect this issue is occurring. This is a disease that requires emergent treatment—do not “wait until morning,” but bring the cat to emergency as soon as possible. 

If your pet is experiencing an emergency, Boundary Bay is open 24/7; we are  VECCS Level 1 certified, and are capable of handling even the most critical, life-threatening emergencies and trauma, with specialists on staff and on-call to handle any medical or surgical issue.  


How do I prevent urinary tract disease in my cat? 

Stress Reduction Reducing stress is very important as cats often develop urinary tract issues when they feel threatened, bored, or generally anxious. This may include increased playtime, removal of sources of anxiety, and stress diets or supplements. Increased enrichment is possibly the most important of these. Both FIC and behavioural issues are strongly tied to stress levels. 

Diet and Water Cats should always be fed a balanced feline specific diet. Moist (canned) food is preferred to kibble as it maintains hydration and minimizes mineral content. 

Ask your veterinarian about urinary tract diets that are available—many of these are prescription only. Some are only meant to be fed short-term, others are well suited to lifelong feeding as a preventive. Diets may help dissolve or prevent stones and crystals, minimize stress and anxiety, promote weight loss, restore normal mucous barriers, and balance pH. Different diets may be chosen for different conditions; your veterinarian has information on various prescription (or potentially over-the-counter) options. 

Fresh water should be made available at all times. Change it at least twice daily and encourage drinking. Some cats like water to be chilled, while others prefer it at room temperature. Large bowls and cat fountains may encourage drinking in some cats. Adding water to food is also a good option to increase intake. 

Obesity and Exercise Cats that are physically fit and receive sufficient exercise are less likely to develop urinary disease (and many other systemic issues). Restricting calories, regular exercise, and a careful nutrition plan can minimize risks of lower urinary disease or recurrence. 

Litter Boxes Clean litter boxes frequently and monitor closely for any unusual signs, particularly blood-tinged urine or a change in urine volume. Most cats prefer open boxes (though some may like a covered box), and as a general rule larger and shallow boxes are better. Avoid the use of strongly scented litter and ensure there are enough litter boxes. One litter box for each cat plus an additional box is a good starting point. Keep boxes physically separated and do not change locations frequently. Boxes should be in calm areas away from laundry machines, doors, and high traffic areas. 

Elimination Behaviour Observe your cat and pay particular attention to its elimination habits. Early signs of problems are similar to those associated with constipation (frequent straining). Peeing outside of the litter box, frequent trips to the box, and straining to pee are all causes for concern. If in doubt, contact your veterinarian. 


How does a veterinary internist identify urinary tract disease in cats?  

In cats with signs of FLUTD, especially where signs are persistent, severe or where more than one episode of disease occurs, it is important to try to identify the underlying cause.  

Our board-certified internal medicine specialists would employ several investigations, including:  

  • Urinalysis – collecting a urine sample to analyse (examine microscopically and perform bacterial culture to rule out bacterial infections) is an important step. Your vet may obtain a urine sample by placing a very fine needle directly into the bladder (a technique called ‘cystocentesis’). This is a good way of obtaining a urine sample because it should not be contaminated with bacteria from elsewhere. This is an easy procedure and most cats do not even notice when it is done. 
  • X-rays – Taking X-rays of the bladder and urethra can be particularly helpful in identifying a number of causes. Some bladder stones are easily identified on X-rays, but in some cases a procedure called ‘contrast radiography’ is also needed. Here, a contrast dye is injected into the bladder through a catheter placed in the urethra. This helps outline the urethra and the bladder and can help in the diagnosis of some types of bladder stones, urethral strictures and tumours. This is a straightforward procedure but is done under an anaesthetic to avoid any discomfort for the cat and so that the cat does not move when the X-rays are taken. 
  • Ultrasound – An ultrasound examination of the bladder can also be performed which may also help identify bladder stones, thickening of the bladder etc. 
  • Biopsies – sometimes, obtaining a biopsy (tissue sample) of the bladder wall may be needed, especially if an underlying tumour is suspected. This may be collected during a surgical operation, although if only small biopsies are needed this can sometimes be done through a catheter placed in the bladder through the urethra (so called ‘suction catheter biopsy’). 


How is urinary tract disease treated in cats? 

Depending on the situation, one or several of the below therapies may be most suitable. For any of the conditions named above, earlier intervention leads to an improved prognosis. 

  • Pain medications and anti-inflammatories (use may depend on kidney function). 
  • Antibiotics are used if a UTI is confirmed and are ideally based on culture and sensitivity results. 
  • Urinary diets are frequently used as an adjunct or as a preventive measure; canned food is preferred due to high moisture levels. 
  • Anti-spasmodic therapy may be added to relax the urethra, most often a drug called “prazosin”. 
  • Different nutraceuticals may be considered. These include l-theanine, glucosamine, fatty acids, and complex carbohydrates to help support the protective lining of the bladder. 
  • Environmental enrichment and stress reduction. This may include private areas that are quiet and free of inter-cat competition, playtime, pheromones, toys, extra dishes, clean litter boxes, perches, and scratching posts. Allowing cats an outside view can help entertain them (watching birds, weather, etc.) and helps alleviate boredom. 
  • Surgery (cystotomy) may be necessary if the cat has large or multiple stones, especially calcium-based. Dissolution with diet is often tried first depending on the results of tests. 
  • Unblocking is necessary if the urethra has obstructed. The goal of this procedure is to flush obstructing material out of the urethra and into the bladder. IV fluids are also given to normalize electrolytes and flush toxins from the bloodstream (urea, potassium, and creatinine primarily). This is a hospitalized procedure. Once the obstruction is removed and the bladder flushed thoroughly, a catheter is left in the urethra to allow the overstretched bladder to recover. Adequate pain medicine, anti-inflammatory therapy, and spasm reducing medications are essential. After unblocking, urine production is closely monitored, and the vitals checked regularly while in hospital. Hospitalization is continued until it is confirmed urinations are occurring in the day or so following removal of the urinary catheter. Risk of re-blocking is highest in the week following the blockage as swelling and spasms continue in the urinary tract. 
  • Drugs are available to help manage stress and anxiety and can be helpful during active illness to promote healing. 
  • In rare cases, a surgery called “perineal urethrostomy” may be needed to shorten and widen the male urethra through removal of the penis. This is a salvage procedure that is generally only used as a last resort or in intractable obstruction due to high long-term risks of complications. At Boundary Bay, our board-certified surgeons are specially trained and equipped to perform such surgeries on an as-needed basis. 

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