How Can I Treat My Cat’s Cystitis (or FUS, or FLUTD)?
The term “cystitis” literally means irritation of the urinary bladder. Prevention and treatment with diet is of utmost importance.
Although this term is rather general, there is a common form of cystitis that occurs in male and female cats. This disease is also known as Feline Urologic Syndrome (FUS) or Feline Lower Urinary Tract Disease (FLUTD). It affects the bladder (not the kidneys), resulting in the production of tiny crystals and bloody urine. The cat often urinates much more frequently than normal, usually with the passage of only a few drops of urine. This can be confused with constipation. Many cats will urinate in places other than the litter box due to the irritation of the bladder wall, Hard cool surfaces such as tile floors, counter tops, sinks, and bathtubs are often used. They should not be punished for doing so.
We are not completely sure of the cause of this problem. Bacterial infections are the most common cause of cystitis in dogs and humans, but most cats with cystitis do not have bacteria in their urine. Neutering of male cats has been proposed as a potential cause, but this has been disproved as an initiating factor. Dry foods may initiate and will aggravate the problem after it begins. This is because of the lower water content and higher mineral content (ash) of dry foods. Many episodes seem to be related to stress. Even a herpes virus has also been incriminated. Despite extensive research, the cause remains elusive.
Many, but not all, cats with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort often seems to be mild but some cats appear to be in acute distress. Every cat is an individual, and nees to be treated as such. Some cats may develop stones in the bladder which can be surgically removed, or dissolved with diet modification combined with homeopathic tratment. When indicated, supportive nutritional supplements ay be used.
Male cats may develop enough crystals in the urethra (the narrow tube carrying urine out of the body) to cause an obstruction. This obstruction prevents elimination of urine from the bladder. If the obstruction is not relieved within 48 hours, most cats will die from kidney failure and the retention of toxins that were not removed by the kidneys. Because the urethra is relatively larger in the female cat, the emergency posed by complete obstruction is almost always found in male cats
Each pet with cystitis is treated according to the changes in the urine (pH, crystals, bacteria, blood, etc.), the type of crystals present, the presenting clinical signs (straining, increased frequency, etc.), and the presence or absence of a bladder stone or urethral obstruction. The first line of treatment is always to increase water consumption, decrease minerals in the diet and decrease stress.
This is accomplished by eliminating dry food, and mixing water in with the canned food (which is preferably meat-base as it promotes an acidic urine pH) If neither a bladder stone nor urethral obstruction is present, proper medication will generally relieve the discomfort. A urinalysis is necessary for proper diagnosis. A special diet will often help to dissolve crystals in the urine and hasten recovery. If the cat has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting anesthetic. The catheter is frequently left in place for about 24 hours. The cat is discharged from the hospital when it appears unlikely that obstruction will reoccur, usually 1-2 days later. If he is experiencing kidney failure and toxemia, intravenous fluids and additional hospitalization are needed.
Following initial treatment, you will be asked to return the cat in 7-10 days for a recheck of the urine. This is very important because some cats will appear to feel much better, but the urine is still bloody or contains crystals. If medication is stopped based on how the cat appears to feel, treatment may terminated prematurely and a relapse will probably occur.
After one episode of cystitis, a cat is predisposed to recurrence. This is due to both systemic and environmental factors. In my experience, the susceptibility to cystitis can be reduced by balancing the internal state homeopathically. Regardless of treatment during the acute symptoms, it is critical that an appropriate diet should be fed in the future.
Two things should be done to help prevent recurrence. 1. The most common type of crystals present in the urine are called struvite. These are dissolvable in acidic urine. Therefore, acidification of your cat’s urine can be a significant means of prevention. It has been shown that environmental stress can produce the opposite of acidic (alkaline) urine. This is one reason why cases of feline cystitis are associated with stress, e.g. travel, new pets, new people etc.
Proper diet will acidify the urine. However, if your cat’s crystals are not struvite, acidification may actually make recurrence more likely. Therefore, if at all possible, the crystals in the urine should be analyzed for their composition. This is the most important step in preventing future problems.
2. Stop (or severely restrict) dry cat food. Though dry foods do not cause cystitis, several studies have shown that the cat’s total fluid intake is decreased when dry diets are fed. When the fluid intake is decreased, the urine is more concentrated with minerals and other materials that can cause future episodes of cystitis. Canned foods can result in increased fluid intake and more dilute urine. Please read the article about transitioning cats to wet food if your cat is a dry food “junky”.
The most common complication of a urethral obstruction is bladder atony. Atony means that the muscles of the bladder wall are unable to contract to push out urine. This occurs when they are stretched to an extreme degree. Not all cats with obstructions develop atony. If this occurs, longer hospitalization is necessary. The muscles will nearly always rebound and become functional again, but this may take several days to over a week. Another complication that occurs occasionally is kidney damage. Although feline cystitis does not directly affect the kidneys, if the bladder becomes extremely enlarged, urine may backup into the kidneys and create enough pressure to temporarily or permanently damage them. If this occurs, prolonged hospitalization will be necessary to treat the kidney damage. However, with aggressive treatment, most cats will recover their normal kidney function. It should be noted that both complications, bladder atony and kidney damage, are the direct result of the bladder becoming extremely enlarged. Both problems may be prevented by prompt recognition of the problem and prompt medical care.
Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the obstruction. Although this prevents future obstructions, some of these cats will still have an occasional recurrence of cystitis, though usually not as severe. This surgical procedure is also performed if the urethral obstruction is so severe that normal urine flow cannot be reestablished or if there are permanent strictures that develop in the urethra. Surgically changing the cat’s urethra makes him more prone to bacterial infections in the bladder and bladder stones. Therefore, this surgery is only recommended if other means of prevention or treatment are not successful. However, the complications associated with the surgery are not life-threatening like urethral obstructions, so the surgery generally offers a significant benefit for the cat that really needs it.
Please note: The information provided here is intended to supplement the recommendations of your veterinarian. Do not disregard veterinary advice or delay treatment based on information on this site. Nothing can replace a complete history and physical examination performed by your veterinarian. -Dr. Jeff
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