Urgent Cat Health Warning: Urinary Issues Explained!

 If your cat is experiencing urinary issues, it could be a sign of something serious. Learn about feline lower urinary tract disease in this urgent cat health warning video! Discover the common signs, causes, and treatments for cat urinary problems. Your cat's health is important, so don't delay in seeking veterinary care. Tune in for insights that can make a difference in your cat's health. 

What you will learn:

• The role of cat owners in managing feline urinary health
• Importance of addressing both medical and behavioral causes of urinary issues
• Types of urinary issues and treatment options
• Dietary dissolution for struvite stones
• Surgical intervention: cystotomy and its purpose
• Why antibiotics aren't always prescribed for FLUTD
• Emergency procedures for urethral obstructions
• Hospitalization vs. outpatient treatment for blocked cats
• Prevention and management strategies for recurrent urinary obstructions
• Overview of PU surgery and its implications

Transcript

Dr. Sugerman: 0:01

Think your cat is just being a rebel by not using the litter box? Think again. Welcome to Vetsplanation, where we're all about decoding your pet's health, one episode at a time. I'm Dr. Sugerman, and in today's session, we're going to uncover the truth behind your feline's puzzling behavior. It's not just mischief, it's actually a message. So join me as we delve into the hidden world of urinary issues in cats. Let's dive deep and find out what's really going on. Every night at work, at least one cat comes in with a urinary problem. Urinary problems in cats are known by many names. You may have heard the terms Pandora Syndrome, FLUTD, which means feline lower urinary tract disease, LUTS, which is Lower Urinary Tract Signs, FUS, Feline Urologic Syndrome, or FIC, which is Feline Idiopathic Cystitis or Feline Interstitial Cystitis. That's a lot of names, right? There's a lot of terms for this, but for simplicity's sake, I'm just going to refer to it as FLUTD or feline lower urinary tract disease. All of these are used to describe a disease in cats where the urinary bladder is really angry for some reason. I'm just going to do a quick anatomy so that people understand what I'm talking about when I'm talking about lower urinary tract disease. So lower urinary refers to the bladder, then you have the urethra, which goes from the bladder that goes out to where they're going to urinate. So these problems can lead to a life threatening condition that's called a urethral obstruction. This obstruction or blockage of urine typically occurs in male cats more often than female cats because the urethra in the penis is much smaller than the urethra in the females. Therefore, female cats can actually pass a lot bigger things that would cause an obstruction, things like stones and blood clots a lot of times. So let's talk about what the symptoms are of FLUTD. Some of the most common beginning signs that your cat is going to be that your cat is urinating outside of the litter box. We used to call it inappropriate urinary behavior, but now we describe it more as an undesirable urinary behavior. To give you an example of this, my wife's cat, Vashti, had peed in her luggage when she was packing for a trip one time. Literally right before we were leaving for the trip. Most people would think that Vashti was just angry with my wife because she was leaving. She's going on vacation, she's leaving me, she's super angry. But that was actually Vashti's way of telling us that there was something actually really wrong. Sometimes they'll urinate just outside of the litter box or maybe even on a pile of clothes. It tends to be brushed off as like just something that they're doing because they're upset or they're angry about something. They also may excessively lick at their genital area. They may not urinate on anything again for a little while until one day you notice them going in and out of the litter box multiple times. You might even see that the males are standing in a way that makes it look like they're trying to poop instead. And people think that they're actually constipated. That's one of the most common things that I hear people bring their male cats in for is they think that they're constipated. Next, it progresses to bloody urine or it just becomes really life threatening. These cats are usually found with piles of vomit next to them, meowing really loudly in pain, and sometimes lying on their side, unable to stand. The signs can progress really quickly as well. Therefore, if you see these signs, it is really important to bring them in right away before it's actually too late. To sum this portion up really quickly, urinary problems like peeing outside the litter box should be addressed immediately. There are urinary problems, but it isn't a urinary obstruction until they cannot pee. So then you see signs of them going in and out of the litter box, posturing as if they're trying to defecate, vocalizing, vomiting, maybe even lying on their side. These are signs that they have an obstruction, otherwise known as a urethral obstruction, because they cannot pee. And they need to be brought in immediately. Next we're going to talk about the causes of FLUTD and urethral obstruction. There are many elements that can cause a cat to become FLUTD. We're going to talk about them from the most common to the least common, identifying four main areas. The most common cause in cats are urinary crystals called struvite crystals. Struvite crystals are composed of the minerals ammonium, phosphate, and magnesium. These minerals are actually commonly found in the bladder together in all species, all the time. If they're found in high enough concentrations, though, they start to bind together to make crystals. If you're on YouTube, we're actually going to put a picture of these crystals up so you can see what these look like. These crystals are often harmless on their own, and can be found in many pets without having any urinary issues at all. It's when they team up together with mucus in the bladder they form a plug in the urethra and can cause a blockage. Imagine a snowball as the mucus that's like rolling down a hillside. It's going to pick up all these branches and leaves, plus more snow, and eventually become larger and pokier. Then that snowball has to try to pass through this tiny little tube. It's likely to become stuck and cause your cat pain with spiky crystals that are poking out of it. The urethra becomes inflamed and swollen, causing your cat to become completely obstructed. And they cannot urinate, which becomes a life threatening problem at that point. The next most common cause you're gonna have to bear with me a bit. So it is called FIC, which is feline idiopathic cystitis, or feline interstitial cystitis. Cystitis means inflammation of the bladder, and idiopathic really just means that we don't know the cause. So this is really complex and can be due to really anything. It can be due to stress, not having enough water, anxiety, a combination of all of those things. Or as I like to say, some star aligned with some moon just right and it just happened. We don't know why. We talked with Dr. Megan a while back about acupuncture and she actually mentioned that there's a phenomenon in eastern medicine that talks about why this may happen to cats during a certain season. It is true that we see it more in winter and fall but you can see it any time. Weirdly we attribute it to around the time when it's rainier. There's no studies that have been done on this to my knowledge to show that it happens more in the rainier months, but I do think it is because we stay inside more when it rains. And that stresses our cats out a bit because there's more noise, they're not used to just being there all the time during the day, and they're really not comfortable with that. All right, our third most common cause is urinary stones or also known as cystoliths or uroliths. These can be struvite stones like what we talked about with those struvite crystals. So what they do is they can ball up together and form a stone that becomes lodged in the urethra. Actually only 50 percent of the stones are struvite stones though. The other 50 percent are usually calcium oxalate stones. Quick interesting fact about bladder stones in cats is about 25 years ago, all cats had struvite bladder stones because of their diet. They were fed a diet that was more basic, and by basic I mean like acid versus neutral versus base of a pH. Or a high pH is basic and a low pH is acidic. Cat food companies had tried to rectify this by making diets that were more acidic. Now if the cat's urine is more acidic, it is likely to be calcium oxalate crystals, not struvite crystals. There's also two breeds that seem to be genetically predisposed to these stones. Those are the Burmese and the Himalayan cats. You might wonder why it matters what kind of stone the cat has. It matters actually for two reasons. It matters because it guides us on how to treat them now and in the future. We'll talk more about that when we talk about our treatments though. Lastly, we can see cats with urinary infections or what we call UTIs. This is definitely more common in female cats than male cats though. Also more common in our older cats like over 10 years old. This is typically due to bacteria but it can really be from like fungus, parasites, or even a virus that can cause that UTI. I can't imagine having a parasite that caused it but gross. This commonly happens with cats who have a weakened immune system, like when they have kidney disease or diabetes. It rarely occurs in younger cats, because the acidity of the urine is too high, and usually kills off all those other organisms. To sum that part up, so FLUTD and an obstruction are usually caused by one of four things in ranking order. Crystals, idiopathic, meaning we don't know, stones, and rarely a UTI. Alright, so now we're going to talk about treatment. First we're going to talk about the early detection and management, and then we'll talk later about when we have emergencies. So for struvite crystals and idiopathic, we essentially treat them the same way. We need to manage their pain, manage their stress, and decrease their inflammation. If they have an early diagnosis and they have not become obstructed, then your vet will likely suggest pain medications, multimodal environmental modification, which is what we call a MEMO, and a diet change. At our clinic, we try to handle pain with a few different medications. Typically, we give them a pain medication that lasts for about three to four days. So we know that we can get this pain under control immediately without having to try to give them a liquid or a pill and stress them out more. Next we try to decrease their stress and anxiety as well as help with the pain by using a medication called gabapentin. Some of us also use this medication called Cerenia. It's to help with the nausea associated with the pain, but it's also an anti inflammatory for the bladder. In some other clinics you might also see them using medications to try to help open up the urethra or basically make it relax. At home, we usually recommend feeding a prescription diet that is made to help prevent crystals from forming. These diets make it so that your cat's urine is exactly neutral, therefore it cannot make struvites in a basic environment, or calcium oxalate stones in an acidic environment. It's like making a teeter totter exactly balanced. So when it's empty, nobody can get on that teeter totter. But when we tip over to one side, now we start getting one of those different types of crystals or stones. So these diets are usually Royal Canin SO, Hill's C/D, and Purina UR. You might be wondering why we have all these letters in them. We discussed why that is when we talk to Dr. Delaney in next week's episode on diets. And the amazing website that you can use for homemade diets as well. So you should definitely check that one out. With these diets though they only work if that is the only thing your cat is eating. If you sneak a little tuna or they eat a little cat grass or treats. They change the pH of the urine and then they return to making more crystals again. Therefore, it is extremely important that they are on the urinary diet and the urinary diet only for the rest of their life. Some questions I get are usually about how your cat may be very picky and may not like the diet. There are three different types to try, and so far I've not had anyone who has said that their cat wouldn't eat at least one of them. You can also use wet and/or dry. Preferably both. Water really helps dissolve those crystals as well and there's lots of water in canned food. The second most common question I get is what should I do if I have multiple cats? If everyone in the house is healthy, the easiest way is to just feed them all the same urinary food. It will be more expensive, but you know that your cat with the urinary problem is not going to be eating the crumbs from the other cat's food. The other thing that you can do is get those feeders that recognize your cat's microchip, or they'll have a specific tag that you can put on a collar, so that you can put it for only that cat to eat that food. That way your cat who can only have this very specific urinary food cannot eat anybody else's food. The other question that I commonly get is, I've gone to this pet store and I saw that it had urinary food there on the shelf. It said urinary health. Can I use that one instead? Unfortunately, no. That is used more for things like urinary tract infections. It's not as good for when we have crystals, stones, or even these idiopathic cystitis. Because it doesn't change the pH of the urine. It only provides more nutrients inside that diet to try to help just with the bladder health in general, but it's not going to help fix those crystals. We also discussed MEMO. Remember the multimodal environmental modification. Dr. Cerná and I talked more about this in the cat behavior podcast that you're gonna hear in two weeks. But it means to provide the main things that your cat needs, a safe place, resources, play and predatory behavior, consistent social interactions with us, and to be aware of their heightened sense of smell. So listen to that episode with Dr. Cerná to hear more about how we can provide these things for our cats. Now, if your cat has stones, then it depends on what type of stone they have as to what we will do. So struvite stones can potentially be dissolved in the bladder with certain diets. We call this dietary dissolution. These diets make the urine pH neutral, just like we did with the crystals and can cause those little crystal snowman to dissolve or melt away and basically just fall apart. The most common protocol for this is to feed the diets solely, just like we did with the crystals. And then radiographs, or the other term for that is x rays, are taken every three to four weeks to see if those stones are actually dissolving. It can sometimes be as little as seven days that they dissolve in or up to six weeks. We check them at three to four weeks though because they may not actually be struvite stones. Remember that 50 percent of stones are struvites, which means that we only have a 50/50 chance of this working. We don't know which stones they are because we can't tell based off of our x rays, or of our radiographs, or aka x rays, or an ultrasound. Sometimes we can even have a mixture of stones as well, meaning like maybe the outside is struvite and the inside is calcium oxalate stone. And so only part of it dissolves and the rest does not. The only way we can know what kind of stones there are would be to remove the stones. This is a surgery called a cystotomy. Otomy means to make an incision into and then cyst refers to a bladder or something that holds something. The surgery involves going in through the abdomen, cutting into the bladder and then removing those stones. The bladder and the abdomen are closed up and then the stones are sent to the lab to tell us what kind of stones they are. So this is really important for prevention though because we want to feed the appropriate diet to avoid making those stones in the future. So if we have struvite stones then we know we have to feed a diet that's going to make their urine more neutral or acidic. And if we have calcium oxalate stones, then we know that we need to feed them a diet that's going to be more basic because they typically live in a more acidic environment. All right, lastly, we treat urinary tract infections usually by using antibiotics as long as it's an infection due to bacteria, which most of the time it is. I have not found anybody that has had a parasite that's caused it so far, but it's definitely possible. So the most common questions I get with this is why don't we just give antibiotics to all the FLUTD cats? So people assume that they have a UTI. Even after I've discussed this, they will always say it's a UTI. It's an infection. But most of the time it is not an infection. Like the majority of the time, most cats do not get a urinary tract infection. It's those older ones that we talked about and usually females that typically get the urinary tract infections. So we don't want to give antibiotics to all cats if they don't need them. We can cause that bacteria to become really resistant to antibiotics, which means that they become super bugs and limit the antibiotics that we can use. Because antibiotics don't just kill off bad bacteria, they also kill off good bacteria as well. Which your cat needs. So therefore we don't give antibiotics in most cases. Alright, now let's talk about when they get to me, unfortunately. Usually, I see cats when they have become blocked or have a urethral obstruction. Like I said, this is a life threatening emergency. If you have noticed that your cat is not able to urinate, or they are showing other signs we talked about, like vomiting, vocalizing, laying on their side. That is a dire emergency and they need to come in immediately. So we make urine by our kidneys filtering out the urine and waste from the bloodstream. The urine goes through the kidneys, and then through the ureters, into the bladder, where it is held. Your cat cannot pee due to the blockage in the urethra. Which means that all of the urine is backing up from the bladder through the ureters into the kidneys. And that waste cannot be filtered through the kidneys, and so it's just staying in the bloodstream. And that is not good. The kidney values rise. But most importantly, an electrolyte called potassium rises as well. This can cause the heart to beat incorrectly, which is what we call an arrhythmia, and eventually could even cause the heart to stop. So we have to bring down that potassium immediately and try to catch this before those arrhythmias and their heart stops. We do this by getting the urine out of the bladder. That may mean initially performing what's called a therapeutic cystocentesis, meaning that we stick a needle into the bladder and remove as much urine as possible to try to give your cat temporary relief while we talk about what those next steps are. The ideal treatment is going to be to hospitalize your cat for 48 hours. We sedate your cat to place a urinary catheter and flush out as many crystals and as much mucus as possible. Then we suture the urinary catheter in place for it to stay in for the next 48 hours. We then put your cat on IV fluids and flush all that waste product out of their bloodstream so their kidneys can filter it as well. And this also helps bring down those kidney values. These two things allow the urethra, or that tube that goes from the bladder and that allows them to pee. It helps that urethra to relax and bring down a lot of inflammation. Then they're put on medication, the same medication we talked about before that helped with pain and anxiety. Medication for pain. Medication like gabapentin to help with anxiety. Medication like Cerenia to help with the inflammation. After 48 hours, if their kidney values are normal, and we've removed the urinary catheter, and we've seen that they're able to urinate, then they're able to return home after that. So the most common question I get about this is this the only option is to hospitalize? So no, it is not. We can try to sedate your cat, place a urinary catheter, flush as much of that bladder out as possible, still give all the medications, and then remove the urinary catheter immediately and send your cat home with you. That's called outpatient treatment. This is not ideal because it does not give the urethra time to relax. And if the kidney levels are high, we cannot bring them down with fluids at home. Your cat just cannot drink enough water to do that, and we cannot give as much fluids under the skin as we can through the IV. So the next most common question is, if you hospitalize your cat, is this curative? It's never going to happen again? It's not curative, in fact. The first 10 days are usually when they reblock. The diet hasn't had time to work yet and so there's still lots of crystals and mucus in those folds. There's no way we can get all of those out just by flushing out their bladder. Even later, they can reblock if they produce more crystals and if they aren't fed the urinary diet exclusively for the rest of their lives. So if they're one of those cats that have FIC, or the idiopathic cystitis, where we don't know why they blocked. Even a stressful event can lead to them reblocking as well. So our goal is to stabilize them enough to be able to return home, and then after that, it's up to you to help manage them the best that you can at home. We provide all the tools, but this is why it is so important for you guys to be a part of your cat's health care team. You are a huge part of this equation. Lastly, we're going to talk about a special surgery that can be performed. It's called a PU surgery, or a perennial urethrostomy. This means that the tip of the penis is actually removed in order to make the urethra, or remember that tube that goes from the bladder to the penis, a wider opening. Sometimes this has to be done the first time they come in. If there are stones that are stuck, we can't get them out. Or sometimes this is performed when your cat has recurrent urinary obstructions. Our matching number that we usually use was when they've had three urinary obstructions. You might wonder why we don't just do this the first time and, why wait to the third time to be able to do the surgery? Every surgery and treatment, has complications. It could happen that your cat forms a ring of scar tissue where the opening is and can reobstruct again, even with this surgery.It is a small chance, but it's still a chance. Typically, this surgery is performed once the kidney values are normal and that potassium is normal as well. Then, as soon as they've had the surgery, they're released as soon as they're able to pee on their own. So that may mean that they don't actually have to stay for the 48 hours, just depending on what their blood work looks like. I do let pet parents know that you can expect some bloody urine sometimes after the surgery for a few days afterwards. Now, I always talk about how prevention is the key, right? And in this situation, that's actually really tough. Really the best thing to do is to get your cat in right away if you see these signs. The best prevention here is really just to make sure that your cat has all their needs satisfied. Which is what we're going to talk about with Dr. Cerná in the behavior episode in a couple weeks here, so please make sure to check that out. So I usually do a animal fact and I'm very sorry today I have a sinus infection and I'm not feeling great, but I still have to go to work. So I'm not going to be doing my animal fact today. But I will try to make sure I do one for you next time. So really understanding and addressing all these underlying issues causing FLUTD cannot only improve your cat's quality of life, but also prevent potentially fatal complications. It's reading the signs and seeking professional help and providing necessary care. Remember that your pet relies on you in order to interpret their signals and act accordingly. I also like to mention, that I talked about all of our experiences here at my hospital. Experiences at other hospitals will be different as well. Every doctor is going to be different in the way that they treat your pet. It's just the way that medicine is, there is no one exact way. So remember that these are all suggestions. This is not a diagnosis from us. If you have problems and you have questions, make sure you ask your veterinarian about them. We're talking about urinary obstructions right now. Sometimes cats can pee outside of the litter box for other reasons. Like I said, definitely check out Dr. Cerná's episode here in a couple of weeks because it could be because a behavioral issue as well. And it may be because they're not getting the five things that they need in their life in order to be able to stay comfortable and safe. So definitely check out that episode, especially if you've taken your cat to the vet and they found out that there was no medical reason for it, then it could be a behavioral thing and her episode could really help you with that. So I hope today's episode sheds some light on the importance of recognizing and addressing feline urinary issues. You're not alone in this journey. There are resources, professionals, and communities ready to help support you. So never hesitate to reach out to your veterinarian if you suspect that your cat might be suffering from FLUTD or any other health conditions. So thank you for tuning into Vetsplanation. We are committed to helping you understand your pet's health better with each episode at a time. I'm Dr. Sugerman, reminding you to listen closely to your pets. They're communicating more to you than you might realize. Stay curious. Stay informed. And join us next time as we continue to explore the fascinating world of pet health as we talk to Dr. Delaney about how you can safely make human grade pet food at home. I get lots of people who feed just chicken and rice, but that's not a balanced diet. So we want to make sure that we balance these foods as best as possible for our pets. So thank you to Shawn Hyberg for your exceptional editing skills and Kelly Dwyer for your amazing website skills. Remember to keep your pets happy, healthy, and safe. Take care and we'll see you in the next episode.