Unfortunately, several of the conditions that cause cats to urinate outside of the box and experience other symptoms of lower urinary tract disease have a tendency to improve with treatment, but often return after therapy is stopped.

Feline idiopathic cystitis, urethral blockages in male cats, and bladder stones all fall into this category. Therefore, prevention of relapses and monitoring are vital to successfully managing feline urinary issues.

In general, the best way to prevent a relapse of lower urinary tract disease is to continue the forms of treatment that have little or no risk of side effects for the rest of your cat’s life. This sounds daunting, but if you remember, some of the most effective treatment options that we have talked about were really changes in husbandry, such as:

• Environmental enrichment and stress relief — play with your cat, rotate and purchase or make new toys, place perches near windows, have lots of scratching posts available, and reduce negative interactions between cats.

• Litter box management — keep litter boxes, preferably the large, uncovered variety, scrupulously clean and have one more box than the number of cats in your house.

• Encourage water consumption — feed canned food rather than dry and place several of your cat’s favorite types of water bowls filled with fresh, clean water around the house or keep a source of running water available if your cat prefers.

• Urinary diets — if your veterinarian has prescribed a food to promote bladder health and/or dissolve crystals or stones, consider continuing to feed it as a preventive measure. Ask your veterinarian if the diet that he or she recommended is appropriate for long term feeding.

If relapses continue despite all of your efforts, talk to your veterinarian about whether medications that relieve anxiety might be in your cat’s best interest. In some cases, cats can be slowly weaned off of these drugs when their condition improves, while other individuals do best with life-long treatment.

Monitoring your cat’s urinary health is as simple as knowing what is normal for him or her. How big are the clumps of urine in the box and how many do you usually scoop out in a day? Is your cat visiting the box more frequently or spending an inordinate amount of time inside? Is he or she listless, restless, not eating well, or licking excessively around the urinary opening? Some owners report that they know their cats are relapsing when they find the first "accident" outside the box after months of consistent litter box use.

Pay attention to what your instincts tell you. Cats are exceptionally good at hiding the fact that they don’t feel well, so even subtle changes can be signs of significant illness. If you think your cat could be relapsing or developing lower urinary tract disease for the first time, talk to your veterinarian. And be persistent. You know your cats better than anyone, and they are relying on you to be their advocate.

Dr. Jennifer Coates

Image: Color Cordinated by Radio Rover / via Flickr