Cats cannot tell us when they feel unwell, but behavior changes often indicate something is wrong. Your cat’s litter box etiquette offers clues about their urinary tract health, and you should monitor this behavior to prevent conditions such as feline lower urinary tract disease (FLUTD). A cat who suddenly begins urinating outside their litter box or is urinating more frequently could be suffering from FLUTD. Our Oliver Animal Hospital team explains this common—but complex—condition, so you can take steps to reduce your cat’s risk. 

Conditions associated with feline lower urinary tract disease

FLUTD is not one condition. The term describes multiple disorders that affect a cat’s bladder and urethra. Some conditions associated with FLUTD include:

  • Feline idiopathic cystitis (FIC) — FIC causes bladder inflammation, and is the most common FLUTD cause. Stress appears to be FIC’s most common cause, but an abnormal bladder lining may also contribute to the condition. Veterinarians often diagnose cats with FIC when they cannot identify underlying disease causing the illness.
  • Urinary tract infections (UTI) — Bacteria that colonize in the urethra or bladder cause feline bacterial UTIs. Cats younger than 10 years of age do not usually develop this condition.
  • Bladder stones — Bladder stones (i.e., uroliths) are hard mineral formations that develop in response to  disease or bladder inflammation. Affected cats may have one large stone or many, which can range in size from a grain of sand to a piece of gravel. Common bladder stone signs include bloody urine and straining to urinate. Bladder stones can become lodged in the urethra and cause an obstruction. If an obstruction occurs, your cat cannot fully empty their bladder, and the organ can rupture if not drained. A complete obstruction is potentially life-threatening, and requires immediate emergency treatment.
  • Urethral plugs — Mucous plugs that form in the bladder and pass into the urethra—feline urethral plugs—commonly cause male cats to have a urethral obstruction. A male cat’s urethra is longer and narrower than a female’s, which increases their obstruction risk. As with bladder stones, urethral plugs are a potentially life-threatening emergency. Without prompt treatment, an obstructed urethra can cause kidney failure, toxin accumulation in the bloodstream, electrolyte imbalances, and potentially death.
  • Cancer — Bladder or urethra cancer is a rare but serious FLUTD-related condition. 

Feline lower urinary tract disease signs

Cats with FLUTD have bloody urine and discomfort while urinating. Other FLUTD signs include:

  • Urinating outside the litter box
  • Straining to urinate
  • Urinating small amounts
  • Frequent urination
  • Excessively licking the urinary opening 

Feline lower urinary tract diagnosis and treatment

Because FLUTD describes multiple conditions, to determine the appropriate treatment, your veterinarian must identify the underlying cause. Your veterinarian diagnoses FLUTD’s most common underlying causes by doing the following: 

  • Excluding other diseases — FIC is a diagnosis of exclusion, which your veterinarian determines only after ruling out all other potential conditions that might cause similar symptoms.
  • Performing urinalysis and culture and sensitivity testing — If your cat displays UTI signs, your veterinarian will perform a urinalysis. A urinalysis provides information about your cat’s urine concentration and pH levels, and identifies the presence of ketones, glucose, bilirubin, blood, and protein. In addition, your veterinarian may send your cat’s urine sample to a laboratory for a culture and sensitivity test, which identifies the specific bacteria causing the UTI. These results determine which antibiotic treatment your veterinarian prescribes for your cat. 
  • Imaging the urinary tract — Your veterinarian can feel some bladder stones by palpating your cat’s abdominal wall. However, to confirm a diagnosis usually requires bladder X-rays or ultrasound imaging.  Most bladder stones can be surgically removed, passed through a catheter, or dissolved with a special diet. 
  • Running diagnostic tests — For your veterinarian to diagnose whether your cat has a urethral plug, they may have to perform several tests, including a urinalysis, culture and sensitivity testing, blood work, and abdominal X-rays. Once a plug’s presence is confirmed, your veterinarian must relieve the obstruction and re-establish urine flow by inserting a urethral catheter. 
  • Detecting a tumor— If your veterinarian suspects your cat has a urinary tumor, they will perform an abdominal X-ray or ultrasound to determine the growth’s cause. A urinary tract tumor also requires additional blood work and urinalysis. Urinary tract cancer treatment depends on the tumor’s type, location, and degree of metastasis, and may include chemotherapy, radiation therapy, or surgery. 

Feline lower urinary tract prevention measures

You cannot prevent all your cat’s FLUTD conditions. However, you can reduce your cat’s FLUTD risk by taking the following measures:

  • Feed them small meals throughout the day.
  • Ensure they always have clean, fresh water.  
  • Keep their litter box clean.
  • Minimize major changes in routine.

If your cat is exhibiting FLUTD signs, such as urinating outside the litter box, contact our Oliver Animal Hospital team to schedule an appointment for testing and treatment. Remember, urethral obstructions require emergency care, so if your cat is not urinating at all, contact us immediately.