Reviewed and updated for accuracy on June 1, 2018 by Dr. Hanie Elfenbein, DVM, PhD
Feline Idiopathic Lower Urinary Tract Disease in Cats
Idiopathic Feline Lower Urinary Tract Disease (IFLUTD) is a general term for disorders characterized by blood in the urine; difficult or painful urination; abnormal, frequent passage of urine; and urinating in inappropriate locations.
A subset of FLUTD is idiopathic and is known variably as Feline Idiopathic Cystitis (FIC), Feline Urologic Syndrome (FUS), or Interstitial Cystitis. These conditions develop when the bladder and/or urethra (the lower urinary tract) become inflamed without any physical cause.
To diagnose FLUTD, your veterinarian will first want to check for a urinary tract infection and urinary stones or crystals. The vast majority of FLUTD (64 percent) is idiopathic—that is, no identifiable physical cause.
Only 2 percent of cats with urinary signs have infections, while up to 14 percent may have urinary crystals or stones. In elderly cats, these percentages change as cats become more likely to develop infection and symptoms related to chronic kidney disease.
FLUTD occurs in both male and female cats. The incidence of blood in the urine, difficult or painful urination, and/or blockage of the urethra in domestic cats in the U.S. and the U.K. has been reported at approximately 0.5 percent to 1 percent per year.
While it can occur at any age, it is found most commonly in cats between the ages of one and four years old. The idiopathic variety is uncommon in cats less than one year of age and in cats greater than 10 years of age.
Symptoms and Types
- Difficult or painful urination (vocalizing while urinating)
- Blood in the urine, outside the litter box
- Abnormal, frequent passage of urine
- Urinating in inappropriate locations
- Blockage of urine flow through the urethra to outside the body
- Thickened, firm, contracted bladder wall, felt by the veterinarian during physical examination
By definition, this is a disease that arises without a known physical cause. Often, FLUTD is caused by an event or change in the cat’s environment.
This may be something identifiable like construction going on inside or near the home, having houseguests over, or the addition of a new pet. Sometimes the cause of your cat’s stress is invisible to humans. Nevertheless, your cat feels ill and needs treatment.
When cats do have a physical cause for their painful bladder, your veterinarian will readily identify the cause and recommend a specific course of treatment.
Your veterinarian will rule out a range of disorders in arriving at a diagnosis. Some possibilities are metabolic disorders, including various types of kidney stones and obstructions.
A urinalysis will be ordered to determine whether there is a physical cause such as infection or urinary crystals. A detailed physical examination will determine whether physical trauma, disorders of the nervous system, anatomical abnormalities, or something as simple as constipation, could be the factors behind the symptoms.
Your veterinarian may recommend bladder X-rays or an ultrasound. X-rays are useful in locating kidney or bladder stones if they are suspected, and an ultrasound is useful at visualizing the tissue of the urinary bladder and the bladder contents.
If your cat does not have blockage of the urethra, it will probably be managed on an outpatient basis, although diagnostic evaluation may require brief hospitalization. If your cat does have blockage of the urethra, it will most likely be hospitalized for diagnosis and management.
Most cats with FLUTD recover with a few days of pain medication and some environmental changes. Environmental changes include reducing exposure to stressors at home. This may be as simple as purchasing a plug-in Feliway diffuser, providing more opportunities for interactive play, or providing a quiet place for your cat to hide. If your cat has recurrent FLUTD, your veterinarian may recommend additional changes.
For cats with the persistent presence of crystals in the urine associated with plugs in the urethra that are causing blockage of the urethra, appropriate dietary management will be recommended.
Prescription cat food reduce the likelihood of recurrence of urinary signs. The goal is to promote flushing of the bladder and urethra by increasing urine volume. This dilutes the concentrations of toxins, chemical irritants, and substances that can add to the components that produce urinary tract stones, and that lead to inflammation of the bladder and urinary tract. Whether prescription pet urinary tract medications are used will depend upon the diagnosis.
Living and Management
Your veterinarian will want to continue to monitor blood in the urine by urinalysis, and will recommend a diet that will help with healing and prevent recurrence. It is wise to keep stress as low as possible for your cat, and you will need to be diligent in giving medications on the schedule prescribed by your veterinarian.
Signs of FLUTD generally subside within four to seven days of starting treatment. If they do not subside, you will need to return to your veterinarian for further treatment.
The means of preventing recurrence will depend upon diagnosis. If there is something in your pet's environment that is found to have brought the condition on, you will, of course, be advised to make changes.
Your veterinarian is dependent on you to help determine what that might be. If nothing can be specified, your veterinarian will discuss general changes you can make to keep your cat healthy and happy.