Download Feline Lower Urinary Tract Disease

CARLISLE HOUSE, TOWNHEAD ROAD, DALSTON, CARLISLE, CUMBRIA, CA5 7JF
TEL: (01228) 710208
FAX: (01228) 711960
Feline Lower Urinary Tract Disease – FLUTD
What is Feline Lower Urinary Tract Disease?
Feline lower urinary tract disease (FLUTD) describes a collection of conditions
in cats that can affect the bladder and/or urethra (the passage from the bladder to
the external opening). These conditions often show similar signs and other tests
may need to be performed to find out the cause however, the vast majority of
cases are idiopathic (which means that we cannot find the cause).
Clinical signs of FLUTD
Cats with FLUTD usually present with signs of difficulty and pain when
urinating, urinating more often, blood in the urine, urination outside the litter-box
and in inappropriate places or even complete obstruction to urine outflow
(blocked cats). Blocked cats are usually very painful and will often howl in pain
whilst trying unproductively to urinate. These cases are emergencies and can
quickly progress to kidney failure with signs such as vomiting, being unsteady on
their feet and even coma and death.
It is thought that the annual incidence of FLUTD in British cats is around 1%. It
is most commonly seen in middle-aged, over-weight cats, which take little
exercise, use an indoor litter-box, have restricted access outside and eat a dry
diet. Neutered cats are most susceptible to FLUTD and obstruction of the urinary
tract is most likely in males.
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CALDEW VETERINARY CENTRE, Townhead Road, Dalston, Carlisle, Cumbria, CA5 7JF (registered office)
TOWNHEAD VETERINARY CENTRE, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGON VETERINARY SURGERY, 87 London Road, Carlisle, Cumbria, CA1 2LG
PARAGON ADVANCED BREEDING, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGONVET LIMITED - www.paragonvet.com - Registered in England 4464469 - VAT Registration Number 755 8859 65
CARLISLE HOUSE, TOWNHEAD ROAD, DALSTON, CARLISLE, CUMBRIA, CA5 7JF
TEL: (01228) 710208
FAX: (01228) 711960
Causes of FLUTD
Below are two charts showing the causes of obstructive (blocked) and non-obstructive FLUTD.
Idiopathic = no cause can be found.
Urethral plugs = a combination of materials that block the urethra such as protein and cells
that leak from the bladder wall and crystal material.
Bladder stones = crystal structures that form in the bladder.
Causes of obstructive FLUTD
Idiopathic cystitis
Urethral plug
Bladder stones
Bladder stones + bacterial
infection
Causes of non-obstructive FLUTD
Idiopathic cystitis
Bladder Stones
Anatomical defects/cancer
Behavioural problems
Bacterial infection
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CALDEW VETERINARY CENTRE, Townhead Road, Dalston, Carlisle, Cumbria, CA5 7JF (registered office)
TOWNHEAD VETERINARY CENTRE, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGON VETERINARY SURGERY, 87 London Road, Carlisle, Cumbria, CA1 2LG
PARAGON ADVANCED BREEDING, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGONVET LIMITED - www.paragonvet.com - Registered in England 4464469 - VAT Registration Number 755 8859 65
CARLISLE HOUSE, TOWNHEAD ROAD, DALSTON, CARLISLE, CUMBRIA, CA5 7JF
TEL: (01228) 710208
FAX: (01228) 711960
1. Feline idiopathic cystitis.
In the majority of cases of FLUTD no underlying cause can be found. However research has
shown that changes between the bladder nerves, the protective layer that lines the bladder and
the urine may be to blame.
Bladder nerves can be stimulated either by the brain (due to stress) or by problems within the
bladder (eg, inflammation, bladder stones, concentrated urine, infection, etc.). These nerves
then cause pain and inflammation. When the brain causes the inflammation it is called
neurogenic inflammation. One of the major triggers of idiopathic cystitis is stress.
The thin layer of protective mucus that lines the bladder helps prevent bacteria and crystals
sticking to the bladder wall. Defects in this may leave the bladder vulnerable and prone to
inflammation.
2. Bladder stones.
There are a few different types of bladder stones (uroliths) some types can be dissolved by
using a specially designed diet but others have to be surgically removed.
3. Urethral plugs.
Urethral plugs are important because they can cause urethral obstruction (blocked cats). They
are made of a combination of protein (from the cells of the bladder and blood) and crystals.
Plugs form in response to inflammation caused by any of the other causes of cystitis.
4. Infectious causes.
Bacterial infection of the bladder is rare in cats and is usually secondary to other causes such as
placing a urinary catheter, bladder stones or cancer.
5. Cancer
Various cancers and growths can cause inflammation and so can lead to urethral plugs, bladder
infections and stone growth. This can cause obstructive or non-obstructive FLUTD.
The different causes of FLUTD may occur alone, or together. Obstruction usually results from
urethral plugs, but may also be caused by small bladder stones, or from spasm of the urinary
tract due to pain.
__________________________________________________________________________________________________________________
CALDEW VETERINARY CENTRE, Townhead Road, Dalston, Carlisle, Cumbria, CA5 7JF (registered office)
TOWNHEAD VETERINARY CENTRE, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGON VETERINARY SURGERY, 87 London Road, Carlisle, Cumbria, CA1 2LG
PARAGON ADVANCED BREEDING, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGONVET LIMITED - www.paragonvet.com - Registered in England 4464469 - VAT Registration Number 755 8859 65
CARLISLE HOUSE, TOWNHEAD ROAD, DALSTON, CARLISLE, CUMBRIA, CA5 7JF
TEL: (01228) 710208
FAX: (01228) 711960
Diagnosis
Idiopathic cystitis is diagnosed by excluding all other causes of FLUTD. This can mean blood
samples (to rule out systemic disease), urine samples, x-rays and ultrasound scans. In the case
of obstructive FLUTD (blocked cats) the initial diagnosis is usually straight forward as the
bladder is so large when it is palpated during abdominal examination.
Management of FLUTD
Obstructive FLUTD (blocked cat) is a medical emergency and is treated differently to nonobstructive FLUTD initially, though the long-term management is the same. When a cat’s
urethra becomes blocked whether by inflammation, spasm or stones the urine builds up in the
bladder until it becomes full, this then creates a back pressure on the kidneys and can severely
damage the kidneys causing kidney failure, coma and death. If a cat is suspected to be blocked
veterinary attention should be sought immediately. The treatment may vary depending on how
long the cat has been blocked and how severely ill it is but will usually involve blood tests to
determine any damage to the kidneys and fluids to restore and support kidney function. The
cat will then need to be anaesthetised so that a urinary catheter can be passed through the
urethra past the blockage and into the bladder. In most cases the catheter will be left in place
for 1-3 days until the blockage settles and so the patient will be hospitalised during this period.
Unfortunately, whilst they have a urinary catheter, cats will not be able to control their
urination and so they often end up with some urine staining on their coat.
If a specific cause is found such as bladder stones then this will need to be addressed however,
if no cause is found and a diagnosis of idiopathic cystitis is made then this will have to be
managed.
__________________________________________________________________________________________________________________
CALDEW VETERINARY CENTRE, Townhead Road, Dalston, Carlisle, Cumbria, CA5 7JF (registered office)
TOWNHEAD VETERINARY CENTRE, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGON VETERINARY SURGERY, 87 London Road, Carlisle, Cumbria, CA1 2LG
PARAGON ADVANCED BREEDING, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGONVET LIMITED - www.paragonvet.com - Registered in England 4464469 - VAT Registration Number 755 8859 65
CARLISLE HOUSE, TOWNHEAD ROAD, DALSTON, CARLISLE, CUMBRIA, CA5 7JF
TEL: (01228) 710208
FAX: (01228) 711960
The list of treatments that have been used for FLUTD is long but the current most successful
approach to the management of FLUTD is described below.
First line treatment:
1. Reduce stress.
Stress is a major factor in FLUTD. Identified stressors include, abrupt changes in diet,
environment, weather, overcrowding or addition of new pets or people to the household. Stress
associated with urination can be particularly significant, e.g. an unsuitable position or content
of the litter-box, competition for the litter-box, aggressive behaviour by other cats while the cat
is trying to use the litter-box or when urinating outside.
It is essential to reduce the level of stress to which a cat may be exposed. Providing a safe,
clean area in which the cat can urinate, reducing overcrowding or bullying and reassuring the
cat as much as possible may achieve this. Remember cats are not generally social creatures
and living in a multi-cat house increases their chance of developing FLUTD. The majority of
cats would generally prefer to live alone and it is only in forced situations where they will live
together such as in our houses. Competition over resources can be stressful for cats. There
should be more than one feeding station, watering station and litter tray per cat in the
house. These should be placed in different areas through the house.
As well as changing the cat’s environment, there are certain products that will help reduce
stress such as Feliway a synthetic feline pheromone and Zylkene, which mimics a substance
found in milk. In some cases referral to a behaviourist may be needed.
2. Alter the content of the urine:
The easiest way to alter the content of urine is to alter the diet. The single most important
thing is to increase the cat’s water intake, which dilutes any noxious components in the urine.
The best way to do this is to feed a 100% wet diet, though some dry diets will also help if your
cat will not eat wet food. Other ways to encourage water intake can be to use water fountains,
which supply constant running water and have several fresh water containers available.
3. Repair the protective bladder lining layer:
Some cats benefits from medications that supplement this layer. Supplements can be given by
mouth or by injection.
__________________________________________________________________________________________________________________
CALDEW VETERINARY CENTRE, Townhead Road, Dalston, Carlisle, Cumbria, CA5 7JF (registered office)
TOWNHEAD VETERINARY CENTRE, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGON VETERINARY SURGERY, 87 London Road, Carlisle, Cumbria, CA1 2LG
PARAGON ADVANCED BREEDING, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGONVET LIMITED - www.paragonvet.com - Registered in England 4464469 - VAT Registration Number 755 8859 65
CARLISLE HOUSE, TOWNHEAD ROAD, DALSTON, CARLISLE, CUMBRIA, CA5 7JF
TEL: (01228) 710208
FAX: (01228) 711960
Second line treatment:
1. Relief of urethral spasm:
Certain drugs such as hypovase can help relax the muscles within the urethra.
2. Tricyclic antidepressants
Tricyclic antidepressants (e.g. amitryptyline) can be used in very severe or chronic cases of
FLUTD. These act as anti-depressants and also have direct effects on the bladder including
anti-inflammatory and pain killing properties.
3. Pain killers
Pain killers will help reduce the pain and should help reduce the signs of FLUTD.
Treatment summary
It is important to note that all current
treatments for FLUTD are merely palliative.
The best results are gained by instigating a
number of changes, i.e., reducing stress,
feeding a wet diet, replacing the lining layer
and if necessary reducing urethral spasm or
giving tricyclic antidepressants. In the
majority of cases this, when tailored to the
individual cat, will reduce or prevent further
clinical signs. However, cat that have
FLUTD once are likely to have repeat
problems.
__________________________________________________________________________________________________________________
CALDEW VETERINARY CENTRE, Townhead Road, Dalston, Carlisle, Cumbria, CA5 7JF (registered office)
TOWNHEAD VETERINARY CENTRE, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGON VETERINARY SURGERY, 87 London Road, Carlisle, Cumbria, CA1 2LG
PARAGON ADVANCED BREEDING, Townhead Farm, Newbiggin, Penrith, Cumbria, CA11 0HT
PARAGONVET LIMITED - www.paragonvet.com - Registered in England 4464469 - VAT Registration Number 755 8859 65