Feline Lower Urinary Tract Disease (FLUTD)

Your cat’s lower urinary tract disease (UTD) can cause them significant pain and discomfort. 

If it causes obstruction, it can even be life-threatening. Here, we’ll cover what FLUTD is, its symptoms, how the vet diagnoses it, and treatments for a FLUTD cat. 

What Is Feline Lower Urinary Tract Disease?

Feline lower urinary tract disease (FLUTD) is a term that refers to several conditions affecting a cat’s lower urinary tract, including the bladder and the urethra (a thin tube that carries urine from the body to the external genitals).  

Feline lower urinary tract disease can be frustrating for both pet parents and veterinarians because the underlying cause can be difficult to identify, and the illness can range in severity. 

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Most cases of feline lower urinary tract disease can be managed with a combination of medications, diet, and environmental changes. 

Feline lower urinary tract disease can occur in cats at any age, depending on the underlying cause.  

It’s most often seen in young to middle-aged adult cats. However, it has been diagnosed in kittens and even senior cats who have never shown urinary symptoms. 

Types of Feline Lower Urinary Tract Disease

Currently, feline lower urinary tract disease is used as an umbrella term to describe the clinical signs of a few syndromes that can occur on their own or in combination. 

Some of the conditions that can cause FLUTD include: 

• Urinary tract infection (UTI) 

• Bladder stones 

• Feline idiopathic cystitis (FIC) 

• Urethral obstruction 

Most causes of FLUTD will be caused by the conditions listed above. Less commonly, FLUTD can occur due to cancer (bladder or urethra), structural abnormalities in the urinary tract, injuries, or neurologic issues. 

Symptoms of Feline Lower Urinary Tract Disease

The most common symptom of FLUTD is your cat urinating outside the litter box.  

Inappropriate urination often occurs on clothes, bedding, and rugs. Some cats may choose one location, but others may urinate throughout the home. 

Your cat may also make very frequent trips to the litter box but only pee small amounts at a time. Other symptoms include vocalizing while urinating and/or the presence of blood in the urine. 

If you see your cat trying to use the litter box and producing no urine at all, or just a few small drops, bring them to the vet immediately.  

This may be a sign of the most severe FLUTD syndrome—urethral obstruction. This occurs more commonly in male cats but can occur in females as well. 

Causes of Feline Lower Urinary Tract Disease

Because FLUTD is an umbrella term for lower urinary tract diseases in cats, anything that can cause any of the potential “types” of FLUTD is a potential cause. 

• Urinary tract infections 

• Bladder stones 

• Urethral obstruction: urethral plugs, stones, tumors 

• Feline idiopathic cystitis (underlying cause not definitively known but chronic anxiety thought to play a major role) 

• Tumors in the urinary tract 

• Anatomical abnormalities 

• Injuries/trauma 

• Spinal cord injuries causing neurologic conditions 

How Vets Diagnose FLUTD

Diagnosis of FLUTD can be tricky and often relies on a combination of a physical exam, test results, and patient history.  

Your vet will perform a urinalysis to rule out a UTI. Some cases may require a urine culture if the infection is hard to find or does not respond to initial antibiotics. 

You vet may also perform blood work to look for systemic (whole body) infection, diabetes, and kidney disease.  

These conditions may have similar symptoms to FLUTD.  

Stones in the bladder or urethra can usually be found on X-rays, though ultrasounds may be preferred when looking for kidney changes or bladder abnormalities that wouldn’t show up on X-rays.  

Successful diagnosis and treatment of FLUTD often requires a lot of information about how a cat interacts with their environment at home.  

Recent behavior changes in your cat are an important part of the diagnosis. You may be asked to complete a detailed questionnaire about how and where your cat eats, sleeps, plays, and interacts with family members, as well as any recent changes to your cat’s environment. 

These questionnaires can be just as helpful as regular lab tests because they can help identify stressors in your cat’s environment. 

Treatment for FLUTD

Treatment of FLUTD is very individual and based on the specific syndrome. Some common treatments include increasing water consumption (feeding wet food or offering a water fountain), giving your cat more litter box options, and weight loss in overweight cats.  

Some cats require a combination of therapies or a “multimodal” approach. 

Here are some more specific treatments your vet may use based on the underlying cause: 

• Antibiotics for UTIs (most common first choice is amoxicillin) 

• Surgery or veterinary diets for bladder stones 

• Pain medications, veterinary diets, anti-spasmodic medications, and stress management for FIC.  

  • Short-term medications like buprenorphine (opioid) and prazosin (anti-spasmodic) may be used during the initial episode. 

• For stress management, you can use pheromone diffusers, food puzzles, cat trees, and water fountains to reduce stress and promote your cat’s happiness.

Extreme cases may require anti-anxiety medications, but these are often a last resort. 

Recovery and Management of FLUTD

Though improvement of symptoms can occur within days, it’s common for FLUTD to come back, so active management will be a lifelong commitment for a pet parent.  

Anti-anxiety medications like fluoxetine or sertraline may only be used long-term in severe cases.  

These medications can take over a month to take effect. In the interim, your cat may take short-acting anti-anxiety medications like gabapentin, Cats that respond well to veterinary diets should stay on them indefinitely. You will work with your veterinarian to adjust treatment accordingly. 

Sudden changes in your cat’s environment make it much more likely for symptoms to return. You will need to try to anticipate stressful situations for your cat, such as moving or adding new pets or family members to the household. 

While many cats with FLUTD can live a long and happy life, it’s not uncommon for treatment to fail. For male cats with recurrent obstruction, a surgery to create a new urethral opening in the perineum (perineal urethrostomy) may be recommended. 

Unfortunately, humane euthanasia may be considered for cats with pain that can’t be controlled.