Cat Urinary Tract Infections: Symptoms, Diagnosis, Prognosis and Treatment

Feline Lower Urinary Tract Disease (FLUTD) is one of the most frustrating syndromes in veterinary medicine. At the least, cats suffer from uncomfortable urination and frequent trips to the litter box. In the worst case, the urethra can become completely obstructed, which, left untreated, results in a painful death.

Although some cats present with urinary crystals, stones, or infection, the majority of cases do not have a readily identifiable cause. Stress is thought to be a trigger in many cases, causing a painful syndrome similar to interstitial cystitis that occurs in people. Regardless of the cause, prompt veterinary care is key to a positive outcome. All cat parents should be aware of the signs of urinary tract disease so they can be evaluated quickly if these symptoms occur.

Symptoms of Urinary Tract Problems in Cats

In its milder forms, cats make frequent trips to the litter box, usually passing small amounts of urine. Cat parents may notice blood in the urine. Some cats start to relive themselves in areas outside the litter box, particularly if they begin to associate the litter box with pain. (Learn more about litter box problems.)

In some cases, usually young adult male cats, the urethra may become plugged with crystals, stones or a plug of cells and mucous.  Once this happens, the cat cannot urinate at all, and may become increasingly agitated. Pet parents often misinterpret straining in the litter box for constipation and elect to monitor the situation, not realizing their pet is experiencing a life-threatening emergency. In its most severe stage, the cat may become depressed and unresponsive, or even die.

Diagnosis of Urinary Tract Problems in Cats

Examination by a veterinarian is needed to determine whether or not a cat is suffering from lower urinary tract disease. Your vet may recommend the following tests:

  • In cases where the urethra is blocked, a large, painful bladder may be palpated.
  • Urinalysis helps determine the presence of crystals, blood, or infectious agents. Many cat parents are surprised to discover that less than 5% of these cats actually present with an active urinary tract infection; most cases are sterile.
  • X-rays are indicated to evaluate the urinary tract for stones, which show up on the x-ray as white dots. Urinary stones are present in about 10-20% of cases, a condition known as urolithiasis.
  • In severely ill cats, especially those with full obstructions, bloodwork is necessary as the patient may have life-threatening electrolyte imbalances.

Prognosis for Urinary Tract Problems in Cats

For cats who do not present with obstruction, the prognosis is fair to good. Uncomplicated cases usually resolve in 5-7 days, although many cats experience a recurrence within one year. Appropriate environmental management can be very helpful in reducing or eliminating these events.

The long term prognosis of cats who present with obstruction depends on their health at the time of presentation. Severely ill cats may have heart arrhythmias due to high levels of potassium in the blood. Many cats are prone to recurrences, so cat parents need to be extra vigilant with felines who have a history of obstructions and bring them in at the first sign of straining.

Treatment for Urinary Tract Problems in Cats

  • For cats who present with no infection, stones or crystals in the urine, the emphasis is on alleviating the pain of the symptoms with appropriate pain medications and providing stress reduction to reduce the chance of recurrence. Environmental enrichment  that minimizes the stress in the household is a key component of management. In particularly anxious cats, anxiety medications may also be indicated.
  • Cats with crystals or stones often require long-term dietary modification to keep the urine pH at appropriate levels. Large stones may need to be removed surgically.
  • Felines with obstructions require immediate hospitalization. The bladder is decompressed, usually by performing a cystocentesis through the abdominal wall and removing urine with a needle. The veterinarian may need to place a urinary catheter in order to relieve the obstruction of the urethra, often under anesthesia. These cats may require several days’ hospitalization, depending on the severity of their symptoms.

If a cat suffers multiple recurrences of obstruction, the veterinarian may recommend a perineal urethrostomy. This surgery widens the urethra and prevents further obstruction, though the underlying causes of inflammation are still present.

FLUTD is stressful for both cats and cat parents. It can be disheartening for cat parents to learn that this is often a lifelong problem. The good news is, vigilant care, appropriate diet and stress management go a long way in preventing recurrence, so cat parents can take heart that their good care will pay off for their favorite feline.