May 21, 2024 • 24 mins
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
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Sugerman (00:01):
Think your cat is just being a rebel by not using
the litter box?
Think again.
Welcome to Vetsplanation, wherewe're all about decoding your
pet's health, one episode at atime.
I'm Dr.
Sugerman, and in today'ssession, we're going to uncover
the truth behind your feline'spuzzling behavior.
It's not just mischief, it'sactually a message.
So join me as we delve into thehidden world of urinary issues
(00:22):
in cats.
Let's dive deep and find outwhat's really going on.
Every night at work, at leastone cat comes in with a urinary
problem.
Urinary problems in cats areknown by many names.
You may have heard the termsPandora Syndrome, FLUTD, which
means feline lower urinary tractdisease, LUTS, which is Lower
Urinary Tract Signs, FUS, FelineUrologic Syndrome, or FIC, which
(00:48):
is Feline Idiopathic Cystitis orFeline 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 asFLUTD or feline lower urinary
tract disease.
All of these are used todescribe a disease in cats where
the urinary bladder is reallyangry for some reason.
I'm just going to do a quickanatomy so that people
(01:09):
understand what I'm talkingabout when I'm talking about
lower urinary tract disease.
So lower urinary refers to thebladder, then you have the
urethra, which goes from thebladder that goes out to where
they're going to urinate.
So these problems can lead to alife threatening condition
that's called a urethralobstruction.
This obstruction or blockage ofurine typically occurs in male
(01:31):
cats more often than female catsbecause the urethra in the penis
is much smaller than the urethrain the females.
Therefore, female cats canactually pass a lot bigger
things that would cause anobstruction, things like stones
and blood clots a lot of times.
So let's talk about what thesymptoms are of FLUTD.
Some of the most commonbeginning signs that your cat is
(01:52):
going to be that your cat isurinating outside of the litter
box.
We used to call it inappropriateurinary behavior, but now we
describe it more as anundesirable urinary behavior.
To give you an example of this,my wife's cat, Vashti, had peed
in her luggage when she waspacking for a trip one time.
Literally right before we wereleaving for the trip.
(02:12):
Most people would think thatVashti was just angry with my
wife because she was leaving.
She's going on vacation, she'sleaving me, she's super angry.
But that was actually Vashti'sway of telling us that there was
something actually really wrong.
Sometimes they'll urinate justoutside of the litter box or
maybe even on a pile of clothes.
It tends to be brushed off aslike just something that they're
(02:32):
doing because they're upset orthey're angry about something.
They also may excessively lickat their genital area.
They may not urinate on anythingagain for a little while until
one day you notice them going inand out of the litter box
multiple times.
You might even see that themales are standing in a way that
makes it look like they'retrying to poop instead.
And people think that they'reactually constipated.
(02:54):
That's one of the most commonthings that I hear people bring
their male cats in for is theythink that they're constipated.
Next, it progresses to bloodyurine or it just becomes really
life threatening.
These cats are usually foundwith piles of vomit next to
them, meowing really loudly inpain, and sometimes lying on
their side, unable to stand.
The signs can progress reallyquickly as well.
(03:16):
Therefore, if you see thesesigns, it is really important to
bring them in right away beforeit's actually too late.
To sum this portion up reallyquickly, urinary problems like
peeing outside the litter boxshould be addressed immediately.
There are urinary problems, butit isn't a urinary obstruction
until they cannot pee.
So then you see signs of themgoing in and out of the litter
box, posturing as if they'retrying to defecate, vocalizing,
(03:40):
vomiting, maybe even lying ontheir side.
These are signs that they havean obstruction, otherwise known
as a urethral obstruction,because they cannot pee.
And they need to be brought inimmediately.
Next we're going to talk aboutthe causes of FLUTD and urethral
obstruction.
There are many elements that cancause a cat to become FLUTD.
We're going to talk about themfrom the most common to the
(04:02):
least common, identifying fourmain areas.
The most common cause in catsare urinary crystals called
struvite crystals.
Struvite crystals are composedof the minerals ammonium,
phosphate, and magnesium.
These minerals are actuallycommonly found in the bladder
together in all species, all thetime.
If they're found in high enoughconcentrations, though, they
start to bind together to makecrystals.
(04:25):
If you're on YouTube, we'reactually going to put a picture
of these crystals up so you cansee what these look like.
These crystals are oftenharmless on their own, and can
be found in many pets withouthaving any urinary issues at
all.
It's when they team up togetherwith mucus in the bladder they
form a plug in the urethra andcan cause a blockage.
Imagine a snowball as the mucusthat's like rolling down a
(04:47):
hillside.
It's going to pick up all thesebranches and leaves, plus more
snow, and eventually becomelarger and pokier.
Then that snowball has to try topass through this tiny little
tube.
It's likely to become stuck andcause your cat pain with spiky
crystals that are poking out ofit.
The urethra becomes inflamed andswollen, causing your cat to
(05:08):
become completely obstructed.
And they cannot urinate, whichbecomes a life threatening
problem at that point.
The next most common causeyou're gonna have to bear with
me a bit.
So it is called FIC, which isfeline idiopathic cystitis, or
feline interstitial cystitis.
Cystitis means inflammation ofthe bladder, and idiopathic
(05:28):
really just means that we don'tknow the cause.
So this is really complex andcan be due to really anything.
It can be due to stress, nothaving enough water, anxiety, a
combination of all of thosethings.
Or as I like to say, some staraligned with some moon just
right and it just happened.
We don't know why.
We talked with Dr.
Megan a while back aboutacupuncture and she actually
(05:50):
mentioned that there's aphenomenon in eastern medicine
that talks about why this mayhappen to cats during a certain
season.
It is true that we see it morein winter and fall but you can
see it any time.
Weirdly we attribute it toaround the time when it's
rainier.
There's no studies that havebeen done on this to my
knowledge to show that ithappens more in the rainier
months, but I do think it isbecause we stay inside more when
(06:13):
it rains.
And that stresses our cats out abit because there's more noise,
they're not used to just beingthere all the time during the
day, and they're really notcomfortable with that.
All right, our third most commoncause is urinary stones or also
known as cystoliths or uroliths.
These can be struvite stoneslike what we talked about with
those struvite crystals.
(06:33):
So what they do is they can ballup together and form a stone
that becomes lodged in theurethra.
Actually only 50 percent of thestones are struvite stones
though.
The other 50 percent are usuallycalcium oxalate stones.
Quick interesting fact aboutbladder stones in cats is about
25 years ago, all cats hadstruvite bladder stones because
(06:54):
of their diet.
They were fed a diet that wasmore basic, and by basic I mean
like acid versus neutral versusbase of a pH.
Or a high pH is basic and a lowpH is acidic.
Cat food companies had tried torectify this by making diets
that were more acidic.
Now if the cat's urine is moreacidic, it is likely to be
(07:16):
calcium oxalate crystals, notstruvite crystals.
There's also two breeds thatseem to be genetically
predisposed to these stones.
Those are the Burmese and theHimalayan cats.
You might wonder why it matterswhat kind of stone the cat has.
It matters actually for tworeasons.
It matters because it guides uson how to treat them now and in
the future.
(07:37):
We'll talk more about that whenwe talk about our treatments
though.
Lastly, we can see cats withurinary infections or what we
call UTIs.
This is definitely more commonin female cats than male cats
though.
Also more common in our oldercats like over 10 years old.
This is typically due tobacteria but it can really be
from like fungus, parasites, oreven a virus that can cause that
(07:59):
UTI.
I can't imagine having aparasite that caused it but
gross.
This commonly happens with catswho have a weakened immune
system, like when they havekidney disease or diabetes.
It rarely occurs in youngercats, because the acidity of the
urine is too high, and usuallykills off all those other
organisms.
To sum that part up, so FLUTDand an obstruction are usually
(08:22):
caused by one of four things inranking order.
Crystals, idiopathic, meaning wedon't know, stones, and rarely a
UTI.
Alright, so now we're going totalk about treatment.
First we're going to talk aboutthe early detection and
management, and then we'll talklater about when we have
emergencies.
So for struvite crystals andidiopathic, we essentially treat
(08:44):
them the same way.
We need to manage their pain,manage their stress, and
decrease their inflammation.
If they have an early diagnosisand they have not become
obstructed, then your vet willlikely suggest pain medications,
multimodal environmentalmodification, which is what we
call a MEMO, and a diet change.
(09:05):
At our clinic, we try to handlepain with a few different
medications.
Typically, we give them a painmedication that lasts for about
three to four days.
So we know that we can get thispain under control immediately
without having to try to givethem a liquid or a pill and
stress them out more.
Next we try to decrease theirstress and anxiety as well as
help with the pain by using amedication called gabapentin.
(09:27):
Some of us also use thismedication called Cerenia.
It's to help with the nauseaassociated with the pain, but
it's also an anti inflammatoryfor the bladder.
In some other clinics you mightalso see them using medications
to try to help open up theurethra or basically make it
relax.
At home, we usually recommendfeeding a prescription diet that
(09:48):
is made to help prevent crystalsfrom forming.
These diets make it so that yourcat's urine is exactly neutral,
therefore it cannot makestruvites in a basic
environment, or calcium oxalatestones in an acidic environment.
It's like making a teeter totterexactly balanced.
So when it's empty, nobody canget on that teeter totter.
But when we tip over to oneside, now we start getting one
(10:10):
of those different types ofcrystals or stones.
So these diets are usually RoyalCanin SO, Hill's C/D, and Purina
UR.
You might be wondering why wehave all these letters in them.
We discussed why that is when wetalk to Dr.
Delaney in next week's episodeon diets.
And the amazing website that youcan use for homemade diets as
(10:31):
well.
So you should definitely checkthat one out.
With these diets though theyonly work if that is the only
thing your cat is eating.
If you sneak a little tuna orthey eat a little cat grass or
treats.
They change the pH of the urineand then they return to making
more crystals again.
Therefore, it is extremelyimportant that they are on the
(10:52):
urinary diet and the urinarydiet only for the rest of their
life.
Some questions I get are usuallyabout how your cat may be very
picky and may not like the diet.
There are three different typesto try, and so far I've not had
anyone who has said that theircat wouldn't eat at least one of
them.
You can also use wet and/or dry.
Preferably both.
Water really helps dissolvethose crystals as well and
(11:15):
there's lots of water in cannedfood.
The second most common questionI get is what should I do if I
have multiple cats?
If everyone in the house ishealthy, the easiest way is to
just feed them all the sameurinary food.
It will be more expensive, butyou know that your cat with the
urinary problem is not going tobe eating the crumbs from the
other cat's food.
(11:36):
The other thing that you can dois get those feeders that
recognize your cat's microchip,or they'll have a specific tag
that you can put on a collar, sothat you can put it for only
that cat to eat that food.
That way your cat who can onlyhave this very specific urinary
food cannot eat anybody else'sfood.
The other question that Icommonly get is, I've gone to
(11:58):
this pet store and I saw that ithad urinary food there on the
shelf.
It said urinary health.
Can I use that one instead?
Unfortunately, no.
That is used more for thingslike urinary tract infections.
It's not as good for when wehave crystals, stones, or even
these idiopathic cystitis.
Because it doesn't change the pHof the urine.
(12:18):
It only provides more nutrientsinside that diet to try to help
just with the bladder health ingeneral, but it's not going to
help fix those crystals.
We also discussed MEMO.
Remember the multimodalenvironmental modification.
Dr.
Cerná and I talked more aboutthis in the cat behavior podcast
that you're gonna hear in twoweeks.
But it means to provide the mainthings that your cat needs, a
(12:40):
safe place, resources, play andpredatory behavior, consistent
social interactions with us, andto be aware of their heightened
sense of smell.
So listen to that episode withDr.
Cerná to hear more about how wecan 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 wewill do.
(13:01):
So struvite stones canpotentially be dissolved in the
bladder with certain diets.
We call this dietarydissolution.
These diets make the urine pHneutral, just like we did with
the crystals and can cause thoselittle crystal snowman to
dissolve or melt away andbasically just fall apart.
The most common protocol forthis is to feed the diets
(13:23):
solely, just like we did withthe crystals.
And then radiographs, or theother term for that is x rays,
are taken every three to fourweeks to see if those stones are
actually dissolving.
It can sometimes be as little asseven days that they dissolve in
or up to six weeks.
We check them at three to fourweeks though because they may
not actually be struvite stones.
(13:44):
Remember that 50 percent ofstones are struvites, which
means that we only have a 50/50chance of this working.
We don't know which stones theyare because we can't tell based
off of our x rays, or of ourradiographs, or aka x rays, or
an ultrasound.
Sometimes we can even have amixture of stones as well,
meaning like maybe the outsideis struvite and the inside is
(14:07):
calcium oxalate stone.
And so only part of it dissolvesand the rest does not.
The only way we can know whatkind of stones there are would
be to remove the stones.
This is a surgery called acystotomy.
Otomy means to make an incisioninto and then cyst refers to a
bladder or something that holdssomething.
The surgery involves going inthrough the abdomen, cutting
(14:28):
into the bladder and thenremoving those stones.
The bladder and the abdomen areclosed up and then the stones
are sent to the lab to tell uswhat kind of stones they are.
So this is really important forprevention though because we
want to feed the appropriatediet to avoid making those
stones in the future.
So if we have struvite stonesthen we know we have to feed a
diet that's going to make theirurine more neutral or acidic.
(14:52):
And if we have calcium oxalatestones, then we know that we
need to feed them a diet that'sgoing to be more basic because
they typically live in a moreacidic environment.
All right, lastly, we treaturinary tract infections usually
by using antibiotics as long asit's an infection due to
bacteria, which most of the timeit is.
I have not found anybody thathas had a parasite that's caused
(15:13):
it so far, but it's definitelypossible.
So the most common questions Iget with this is why don't we
just give antibiotics to all theFLUTD cats?
So people assume that they havea 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 notan infection.
Like the majority of the time,most cats do not get a urinary
tract infection.
(15:34):
It's those older ones that wetalked about and usually females
that typically get the urinarytract infections.
So we don't want to giveantibiotics to all cats if they
don't need them.
We can cause that bacteria tobecome really resistant to
antibiotics, which means thatthey become super bugs and limit
the antibiotics that we can use.
Because antibiotics don't justkill off bad bacteria, they also
(15:56):
kill off good bacteria as well.
Which your cat needs.
So therefore we don't giveantibiotics in most cases.
Alright, now let's talk aboutwhen they get to me,
unfortunately.
Usually, I see cats when theyhave become blocked or have a
urethral obstruction.
Like I said, this is a lifethreatening emergency.
If you have noticed that yourcat is not able to urinate, or
(16:16):
they are showing other signs wetalked about, like vomiting,
vocalizing, laying on theirside.
That is a dire emergency andthey need to come in
immediately.
So we make urine by our kidneysfiltering out the urine and
waste from the bloodstream.
The urine goes through thekidneys, and then through the
ureters, into the bladder, whereit is held.
Your cat cannot pee due to theblockage in the urethra.
(16:40):
Which means that all of theurine is backing up from the
bladder through the ureters intothe kidneys.
And that waste cannot befiltered through the kidneys,
and so it's just staying in thebloodstream.
And that is not good.
The kidney values rise.
But most importantly, anelectrolyte called potassium
rises as well.
(17:01):
This can cause the heart to beatincorrectly, which is what we
call an arrhythmia, andeventually could even cause the
heart to stop.
So we have to bring down thatpotassium immediately and try to
catch this before thosearrhythmias and their heart
stops.
We do this by getting the urineout of the bladder.
That may mean initiallyperforming what's called a
(17:22):
therapeutic cystocentesis,meaning that we stick a needle
into the bladder and remove asmuch urine as possible to try to
give your cat temporary reliefwhile we talk about what those
next steps are.
The ideal treatment is going tobe to hospitalize your cat for
48 hours.
We sedate your cat to place aurinary catheter and flush out
as many crystals and as muchmucus as possible.
(17:45):
Then we suture the urinarycatheter in place for it to stay
in for the next 48 hours.
We then put your cat on IVfluids and flush all that waste
product out of their bloodstreamso their kidneys can filter it
as well.
And this also helps bring downthose kidney values.
These two things allow theurethra, or that tube that goes
from the bladder and that allowsthem to pee.
(18:06):
It helps that urethra to relaxand bring down a lot of
inflammation.
Then they're put on medication,the same medication we talked
about before that helped withpain and anxiety.
Medication for pain.
Medication like gabapentin tohelp with anxiety.
Medication like Cerenia to helpwith the inflammation.
After 48 hours, if their kidneyvalues are normal, and we've
(18:27):
removed the urinary catheter,and we've seen that they're able
to urinate, then they're able toreturn home after that.
So the most common question Iget 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 aspossible, still give all the
(18:47):
medications, and then remove theurinary catheter immediately and
send your cat home with you.
That's called outpatienttreatment.
This is not ideal because itdoes not give the urethra time
to relax.
And if the kidney levels arehigh, we cannot bring them down
with fluids at home.
Your cat just cannot drinkenough water to do that, and we
cannot give as much fluids underthe skin as we can through the
(19:11):
IV.
So the next most common questionis, if you hospitalize your cat,
is this curative?
It's never going to happenagain?
It's not curative, in fact.
The first 10 days are usuallywhen they reblock.
The diet hasn't had time to workyet and so there's still lots of
crystals and mucus in thosefolds.
There's no way we can get all ofthose out just by flushing out
(19:31):
their bladder.
Even later, they can reblock ifthey produce more crystals and
if they aren't fed the urinarydiet exclusively for the rest of
their lives.
So if they're one of those catsthat have FIC, or the idiopathic
cystitis, where we don't knowwhy they blocked.
Even a stressful event can leadto them reblocking as well.
So our goal is to stabilize themenough to be able to return
(19:55):
home, and then after that, it'sup to you to help manage them
the best that you can at home.
We provide all the tools, butthis is why it is so important
for you guys to be a part ofyour cat's health care team.
You are a huge part of thisequation.
Lastly, we're going to talkabout a special surgery that can
be performed.
It's called a PU surgery, or aperennial urethrostomy.
(20:16):
This means that the tip of thepenis is actually removed in
order to make the urethra, orremember that tube that goes
from the bladder to the penis, awider opening.
Sometimes this has to be donethe first time they come in.
If there are stones that arestuck, we can't get them out.
Or sometimes this is performedwhen your cat has recurrent
urinary obstructions.
(20:37):
Our matching number that weusually use was when they've had
three urinary obstructions.
You might wonder why we don'tjust do this the first time and,
why wait to the third time to beable to do the surgery?
Every surgery and treatment, hascomplications.
It could happen that your catforms a ring of scar tissue
where the opening is and canreobstruct again, even with this
(20:58):
surgery.It is a small chance,but it's still a chance.
Typically, this surgery isperformed once the kidney values
are normal and that potassium isnormal as well.
Then, as soon as they've had thesurgery, they're released as
soon as they're able to pee ontheir own.
So that may mean that they don'tactually have to stay for the 48
hours, just depending on whattheir blood work looks like.
(21:20):
I do let pet parents know thatyou can expect some bloody urine
sometimes after the surgery fora few days afterwards.
Now, I always talk about howprevention is the key, right?
And in this situation, that'sactually really tough.
Really the best thing to do isto get your cat in right away if
you see these signs.
The best prevention here isreally just to make sure that
(21:41):
your cat has all their needssatisfied.
Which is what we're going totalk about with Dr.
Cerná in the behavior episode ina couple weeks here, so please
make sure to check that out.
So I usually do a animal factand I'm very sorry today I have
a sinus infection and I'm notfeeling great, but I still have
to go to work.
So I'm not going to be doing myanimal fact today.
(22:01):
But I will try to make sure I doone for you next time.
So really understanding andaddressing all these underlying
issues causing FLUTD cannot onlyimprove your cat's quality of
life, but also preventpotentially fatal complications.
It's reading the signs andseeking professional help and
providing necessary care.
Remember that your pet relies onyou in order to interpret their
(22:24):
signals and act accordingly.
I also like to mention, that Italked about all of our
experiences here at my hospital.
Experiences at other hospitalswill be different as well.
Every doctor is going to bedifferent in the way that they
treat your pet.
It's just the way that medicineis, there is no one exact way.
So remember that these are allsuggestions.
(22:45):
This is not a diagnosis from us.
If you have problems and youhave questions, make sure you
ask your veterinarian aboutthem.
We're talking about urinaryobstructions right now.
Sometimes cats can pee outsideof the litter box for other
reasons.
Like I said, definitely checkout Dr.
Cerná's episode here in a coupleof weeks because it could be
because a behavioral issue aswell.
(23:06):
And it may be because they'renot getting the five things that
they need in their life in orderto be able to stay comfortable
and safe.
So definitely check out thatepisode, especially if you've
taken your cat to the vet andthey found out that there was no
medical reason for it, then itcould be a behavioral thing and
her episode could really helpyou with that.
So I hope today's episode shedssome light on the importance of
(23:29):
recognizing and addressingfeline urinary issues.
You're not alone in thisjourney.
There are resources,professionals, and communities
ready to help support you.
So never hesitate to reach outto your veterinarian if you
suspect that your cat might besuffering from FLUTD or any
other health conditions.
So thank you for tuning intoVetsplanation.
We are committed to helping youunderstand your pet's health
(23:51):
better with each episode at atime.
I'm Dr.
Sugerman, reminding you tolisten closely to your pets.
They're communicating more toyou than you might realize.
Stay curious.
Stay informed.
And join us next time as wecontinue to explore the
fascinating world of pet healthas we talk to Dr.
Delaney about how you can safelymake human grade pet food at
(24:12):
home.
I get lots of people who feedjust chicken and rice, but
that's not a balanced diet.
So we want to make sure that webalance these foods as best as
possible for our pets.
So thank you to Shawn Hyberg foryour exceptional editing skills
and Kelly Dwyer for your amazingwebsite skills.
Remember to keep your petshappy, healthy, and safe.
Take care and we'll see you inthe next episode.
Think your cat is just being a rebel by not using
the litter box?
Think again.
Welcome to Vetsplanation, wherewe're all about decoding your
pet's health, one episode at atime.
I'm Dr.
Sugerman, and in today'ssession, we're going to uncover
the truth behind your feline'spuzzling behavior.
It's not just mischief, it'sactually a message.
So join me as we delve into thehidden world of urinary issues
(00:22):
in cats.
Let's dive deep and find outwhat's really going on.
Every night at work, at leastone cat comes in with a urinary
problem.
Urinary problems in cats areknown by many names.
You may have heard the termsPandora Syndrome, FLUTD, which
means feline lower urinary tractdisease, LUTS, which is Lower
Urinary Tract Signs, FUS, FelineUrologic Syndrome, or FIC, which
(00:48):
is Feline Idiopathic Cystitis orFeline 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 asFLUTD or feline lower urinary
tract disease.
All of these are used todescribe a disease in cats where
the urinary bladder is reallyangry for some reason.
I'm just going to do a quickanatomy so that people
(01:09):
understand what I'm talkingabout when I'm talking about
lower urinary tract disease.
So lower urinary refers to thebladder, then you have the
urethra, which goes from thebladder that goes out to where
they're going to urinate.
So these problems can lead to alife threatening condition
that's called a urethralobstruction.
This obstruction or blockage ofurine typically occurs in male
(01:31):
cats more often than female catsbecause the urethra in the penis
is much smaller than the urethrain the females.
Therefore, female cats canactually pass a lot bigger
things that would cause anobstruction, things like stones
and blood clots a lot of times.
So let's talk about what thesymptoms are of FLUTD.
Some of the most commonbeginning signs that your cat is
(01:52):
going to be that your cat isurinating outside of the litter
box.
We used to call it inappropriateurinary behavior, but now we
describe it more as anundesirable urinary behavior.
To give you an example of this,my wife's cat, Vashti, had peed
in her luggage when she waspacking for a trip one time.
Literally right before we wereleaving for the trip.
(02:12):
Most people would think thatVashti was just angry with my
wife because she was leaving.
She's going on vacation, she'sleaving me, she's super angry.
But that was actually Vashti'sway of telling us that there was
something actually really wrong.
Sometimes they'll urinate justoutside of the litter box or
maybe even on a pile of clothes.
It tends to be brushed off aslike just something that they're
(02:32):
doing because they're upset orthey're angry about something.
They also may excessively lickat their genital area.
They may not urinate on anythingagain for a little while until
one day you notice them going inand out of the litter box
multiple times.
You might even see that themales are standing in a way that
makes it look like they'retrying to poop instead.
And people think that they'reactually constipated.
(02:54):
That's one of the most commonthings that I hear people bring
their male cats in for is theythink that they're constipated.
Next, it progresses to bloodyurine or it just becomes really
life threatening.
These cats are usually foundwith piles of vomit next to
them, meowing really loudly inpain, and sometimes lying on
their side, unable to stand.
The signs can progress reallyquickly as well.
(03:16):
Therefore, if you see thesesigns, it is really important to
bring them in right away beforeit's actually too late.
To sum this portion up reallyquickly, urinary problems like
peeing outside the litter boxshould be addressed immediately.
There are urinary problems, butit isn't a urinary obstruction
until they cannot pee.
So then you see signs of themgoing in and out of the litter
box, posturing as if they'retrying to defecate, vocalizing,
(03:40):
vomiting, maybe even lying ontheir side.
These are signs that they havean obstruction, otherwise known
as a urethral obstruction,because they cannot pee.
And they need to be brought inimmediately.
Next we're going to talk aboutthe causes of FLUTD and urethral
obstruction.
There are many elements that cancause a cat to become FLUTD.
We're going to talk about themfrom the most common to the
(04:02):
least common, identifying fourmain areas.
The most common cause in catsare urinary crystals called
struvite crystals.
Struvite crystals are composedof the minerals ammonium,
phosphate, and magnesium.
These minerals are actuallycommonly found in the bladder
together in all species, all thetime.
If they're found in high enoughconcentrations, though, they
start to bind together to makecrystals.
(04:25):
If you're on YouTube, we'reactually going to put a picture
of these crystals up so you cansee what these look like.
These crystals are oftenharmless on their own, and can
be found in many pets withouthaving any urinary issues at
all.
It's when they team up togetherwith mucus in the bladder they
form a plug in the urethra andcan cause a blockage.
Imagine a snowball as the mucusthat's like rolling down a
(04:47):
hillside.
It's going to pick up all thesebranches and leaves, plus more
snow, and eventually becomelarger and pokier.
Then that snowball has to try topass through this tiny little
tube.
It's likely to become stuck andcause your cat pain with spiky
crystals that are poking out ofit.
The urethra becomes inflamed andswollen, causing your cat to
(05:08):
become completely obstructed.
And they cannot urinate, whichbecomes a life threatening
problem at that point.
The next most common causeyou're gonna have to bear with
me a bit.
So it is called FIC, which isfeline idiopathic cystitis, or
feline interstitial cystitis.
Cystitis means inflammation ofthe bladder, and idiopathic
(05:28):
really just means that we don'tknow the cause.
So this is really complex andcan be due to really anything.
It can be due to stress, nothaving enough water, anxiety, a
combination of all of thosethings.
Or as I like to say, some staraligned with some moon just
right and it just happened.
We don't know why.
We talked with Dr.
Megan a while back aboutacupuncture and she actually
(05:50):
mentioned that there's aphenomenon in eastern medicine
that talks about why this mayhappen to cats during a certain
season.
It is true that we see it morein winter and fall but you can
see it any time.
Weirdly we attribute it toaround the time when it's
rainier.
There's no studies that havebeen done on this to my
knowledge to show that ithappens more in the rainier
months, but I do think it isbecause we stay inside more when
(06:13):
it rains.
And that stresses our cats out abit because there's more noise,
they're not used to just beingthere all the time during the
day, and they're really notcomfortable with that.
All right, our third most commoncause is urinary stones or also
known as cystoliths or uroliths.
These can be struvite stoneslike what we talked about with
those struvite crystals.
(06:33):
So what they do is they can ballup together and form a stone
that becomes lodged in theurethra.
Actually only 50 percent of thestones are struvite stones
though.
The other 50 percent are usuallycalcium oxalate stones.
Quick interesting fact aboutbladder stones in cats is about
25 years ago, all cats hadstruvite bladder stones because
(06:54):
of their diet.
They were fed a diet that wasmore basic, and by basic I mean
like acid versus neutral versusbase of a pH.
Or a high pH is basic and a lowpH is acidic.
Cat food companies had tried torectify this by making diets
that were more acidic.
Now if the cat's urine is moreacidic, it is likely to be
(07:16):
calcium oxalate crystals, notstruvite crystals.
There's also two breeds thatseem to be genetically
predisposed to these stones.
Those are the Burmese and theHimalayan cats.
You might wonder why it matterswhat kind of stone the cat has.
It matters actually for tworeasons.
It matters because it guides uson how to treat them now and in
the future.
(07:37):
We'll talk more about that whenwe talk about our treatments
though.
Lastly, we can see cats withurinary infections or what we
call UTIs.
This is definitely more commonin female cats than male cats
though.
Also more common in our oldercats like over 10 years old.
This is typically due tobacteria but it can really be
from like fungus, parasites, oreven a virus that can cause that
(07:59):
UTI.
I can't imagine having aparasite that caused it but
gross.
This commonly happens with catswho have a weakened immune
system, like when they havekidney disease or diabetes.
It rarely occurs in youngercats, because the acidity of the
urine is too high, and usuallykills off all those other
organisms.
To sum that part up, so FLUTDand an obstruction are usually
(08:22):
caused by one of four things inranking order.
Crystals, idiopathic, meaning wedon't know, stones, and rarely a
UTI.
Alright, so now we're going totalk about treatment.
First we're going to talk aboutthe early detection and
management, and then we'll talklater about when we have
emergencies.
So for struvite crystals andidiopathic, we essentially treat
(08:44):
them the same way.
We need to manage their pain,manage their stress, and
decrease their inflammation.
If they have an early diagnosisand they have not become
obstructed, then your vet willlikely suggest pain medications,
multimodal environmentalmodification, which is what we
call a MEMO, and a diet change.
(09:05):
At our clinic, we try to handlepain with a few different
medications.
Typically, we give them a painmedication that lasts for about
three to four days.
So we know that we can get thispain under control immediately
without having to try to givethem a liquid or a pill and
stress them out more.
Next we try to decrease theirstress and anxiety as well as
help with the pain by using amedication called gabapentin.
(09:27):
Some of us also use thismedication called Cerenia.
It's to help with the nauseaassociated with the pain, but
it's also an anti inflammatoryfor the bladder.
In some other clinics you mightalso see them using medications
to try to help open up theurethra or basically make it
relax.
At home, we usually recommendfeeding a prescription diet that
(09:48):
is made to help prevent crystalsfrom forming.
These diets make it so that yourcat's urine is exactly neutral,
therefore it cannot makestruvites in a basic
environment, or calcium oxalatestones in an acidic environment.
It's like making a teeter totterexactly balanced.
So when it's empty, nobody canget on that teeter totter.
But when we tip over to oneside, now we start getting one
(10:10):
of those different types ofcrystals or stones.
So these diets are usually RoyalCanin SO, Hill's C/D, and Purina
UR.
You might be wondering why wehave all these letters in them.
We discussed why that is when wetalk to Dr.
Delaney in next week's episodeon diets.
And the amazing website that youcan use for homemade diets as
(10:31):
well.
So you should definitely checkthat one out.
With these diets though theyonly work if that is the only
thing your cat is eating.
If you sneak a little tuna orthey eat a little cat grass or
treats.
They change the pH of the urineand then they return to making
more crystals again.
Therefore, it is extremelyimportant that they are on the
(10:52):
urinary diet and the urinarydiet only for the rest of their
life.
Some questions I get are usuallyabout how your cat may be very
picky and may not like the diet.
There are three different typesto try, and so far I've not had
anyone who has said that theircat wouldn't eat at least one of
them.
You can also use wet and/or dry.
Preferably both.
Water really helps dissolvethose crystals as well and
(11:15):
there's lots of water in cannedfood.
The second most common questionI get is what should I do if I
have multiple cats?
If everyone in the house ishealthy, the easiest way is to
just feed them all the sameurinary food.
It will be more expensive, butyou know that your cat with the
urinary problem is not going tobe eating the crumbs from the
other cat's food.
(11:36):
The other thing that you can dois get those feeders that
recognize your cat's microchip,or they'll have a specific tag
that you can put on a collar, sothat you can put it for only
that cat to eat that food.
That way your cat who can onlyhave this very specific urinary
food cannot eat anybody else'sfood.
The other question that Icommonly get is, I've gone to
(11:58):
this pet store and I saw that ithad urinary food there on the
shelf.
It said urinary health.
Can I use that one instead?
Unfortunately, no.
That is used more for thingslike urinary tract infections.
It's not as good for when wehave crystals, stones, or even
these idiopathic cystitis.
Because it doesn't change the pHof the urine.
(12:18):
It only provides more nutrientsinside that diet to try to help
just with the bladder health ingeneral, but it's not going to
help fix those crystals.
We also discussed MEMO.
Remember the multimodalenvironmental modification.
Dr.
Cerná and I talked more aboutthis in the cat behavior podcast
that you're gonna hear in twoweeks.
But it means to provide the mainthings that your cat needs, a
(12:40):
safe place, resources, play andpredatory behavior, consistent
social interactions with us, andto be aware of their heightened
sense of smell.
So listen to that episode withDr.
Cerná to hear more about how wecan 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 wewill do.
(13:01):
So struvite stones canpotentially be dissolved in the
bladder with certain diets.
We call this dietarydissolution.
These diets make the urine pHneutral, just like we did with
the crystals and can cause thoselittle crystal snowman to
dissolve or melt away andbasically just fall apart.
The most common protocol forthis is to feed the diets
(13:23):
solely, just like we did withthe crystals.
And then radiographs, or theother term for that is x rays,
are taken every three to fourweeks to see if those stones are
actually dissolving.
It can sometimes be as little asseven days that they dissolve in
or up to six weeks.
We check them at three to fourweeks though because they may
not actually be struvite stones.
(13:44):
Remember that 50 percent ofstones are struvites, which
means that we only have a 50/50chance of this working.
We don't know which stones theyare because we can't tell based
off of our x rays, or of ourradiographs, or aka x rays, or
an ultrasound.
Sometimes we can even have amixture of stones as well,
meaning like maybe the outsideis struvite and the inside is
(14:07):
calcium oxalate stone.
And so only part of it dissolvesand the rest does not.
The only way we can know whatkind of stones there are would
be to remove the stones.
This is a surgery called acystotomy.
Otomy means to make an incisioninto and then cyst refers to a
bladder or something that holdssomething.
The surgery involves going inthrough the abdomen, cutting
(14:28):
into the bladder and thenremoving those stones.
The bladder and the abdomen areclosed up and then the stones
are sent to the lab to tell uswhat kind of stones they are.
So this is really important forprevention though because we
want to feed the appropriatediet to avoid making those
stones in the future.
So if we have struvite stonesthen we know we have to feed a
diet that's going to make theirurine more neutral or acidic.
(14:52):
And if we have calcium oxalatestones, then we know that we
need to feed them a diet that'sgoing to be more basic because
they typically live in a moreacidic environment.
All right, lastly, we treaturinary tract infections usually
by using antibiotics as long asit's an infection due to
bacteria, which most of the timeit is.
I have not found anybody thathas had a parasite that's caused
(15:13):
it so far, but it's definitelypossible.
So the most common questions Iget with this is why don't we
just give antibiotics to all theFLUTD cats?
So people assume that they havea 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 notan infection.
Like the majority of the time,most cats do not get a urinary
tract infection.
(15:34):
It's those older ones that wetalked about and usually females
that typically get the urinarytract infections.
So we don't want to giveantibiotics to all cats if they
don't need them.
We can cause that bacteria tobecome really resistant to
antibiotics, which means thatthey become super bugs and limit
the antibiotics that we can use.
Because antibiotics don't justkill off bad bacteria, they also
(15:56):
kill off good bacteria as well.
Which your cat needs.
So therefore we don't giveantibiotics in most cases.
Alright, now let's talk aboutwhen they get to me,
unfortunately.
Usually, I see cats when theyhave become blocked or have a
urethral obstruction.
Like I said, this is a lifethreatening emergency.
If you have noticed that yourcat is not able to urinate, or
(16:16):
they are showing other signs wetalked about, like vomiting,
vocalizing, laying on theirside.
That is a dire emergency andthey need to come in
immediately.
So we make urine by our kidneysfiltering out the urine and
waste from the bloodstream.
The urine goes through thekidneys, and then through the
ureters, into the bladder, whereit is held.
Your cat cannot pee due to theblockage in the urethra.
(16:40):
Which means that all of theurine is backing up from the
bladder through the ureters intothe kidneys.
And that waste cannot befiltered through the kidneys,
and so it's just staying in thebloodstream.
And that is not good.
The kidney values rise.
But most importantly, anelectrolyte called potassium
rises as well.
(17:01):
This can cause the heart to beatincorrectly, which is what we
call an arrhythmia, andeventually could even cause the
heart to stop.
So we have to bring down thatpotassium immediately and try to
catch this before thosearrhythmias and their heart
stops.
We do this by getting the urineout of the bladder.
That may mean initiallyperforming what's called a
(17:22):
therapeutic cystocentesis,meaning that we stick a needle
into the bladder and remove asmuch urine as possible to try to
give your cat temporary reliefwhile we talk about what those
next steps are.
The ideal treatment is going tobe to hospitalize your cat for
48 hours.
We sedate your cat to place aurinary catheter and flush out
as many crystals and as muchmucus as possible.
(17:45):
Then we suture the urinarycatheter in place for it to stay
in for the next 48 hours.
We then put your cat on IVfluids and flush all that waste
product out of their bloodstreamso their kidneys can filter it
as well.
And this also helps bring downthose kidney values.
These two things allow theurethra, or that tube that goes
from the bladder and that allowsthem to pee.
(18:06):
It helps that urethra to relaxand bring down a lot of
inflammation.
Then they're put on medication,the same medication we talked
about before that helped withpain and anxiety.
Medication for pain.
Medication like gabapentin tohelp with anxiety.
Medication like Cerenia to helpwith the inflammation.
After 48 hours, if their kidneyvalues are normal, and we've
(18:27):
removed the urinary catheter,and we've seen that they're able
to urinate, then they're able toreturn home after that.
So the most common question Iget 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 aspossible, still give all the
(18:47):
medications, and then remove theurinary catheter immediately and
send your cat home with you.
That's called outpatienttreatment.
This is not ideal because itdoes not give the urethra time
to relax.
And if the kidney levels arehigh, we cannot bring them down
with fluids at home.
Your cat just cannot drinkenough water to do that, and we
cannot give as much fluids underthe skin as we can through the
(19:11):
IV.
So the next most common questionis, if you hospitalize your cat,
is this curative?
It's never going to happenagain?
It's not curative, in fact.
The first 10 days are usuallywhen they reblock.
The diet hasn't had time to workyet and so there's still lots of
crystals and mucus in thosefolds.
There's no way we can get all ofthose out just by flushing out
(19:31):
their bladder.
Even later, they can reblock ifthey produce more crystals and
if they aren't fed the urinarydiet exclusively for the rest of
their lives.
So if they're one of those catsthat have FIC, or the idiopathic
cystitis, where we don't knowwhy they blocked.
Even a stressful event can leadto them reblocking as well.
So our goal is to stabilize themenough to be able to return
(19:55):
home, and then after that, it'sup to you to help manage them
the best that you can at home.
We provide all the tools, butthis is why it is so important
for you guys to be a part ofyour cat's health care team.
You are a huge part of thisequation.
Lastly, we're going to talkabout a special surgery that can
be performed.
It's called a PU surgery, or aperennial urethrostomy.
(20:16):
This means that the tip of thepenis is actually removed in
order to make the urethra, orremember that tube that goes
from the bladder to the penis, awider opening.
Sometimes this has to be donethe first time they come in.
If there are stones that arestuck, we can't get them out.
Or sometimes this is performedwhen your cat has recurrent
urinary obstructions.
(20:37):
Our matching number that weusually use was when they've had
three urinary obstructions.
You might wonder why we don'tjust do this the first time and,
why wait to the third time to beable to do the surgery?
Every surgery and treatment, hascomplications.
It could happen that your catforms a ring of scar tissue
where the opening is and canreobstruct again, even with this
(20:58):
surgery.It is a small chance,but it's still a chance.
Typically, this surgery isperformed once the kidney values
are normal and that potassium isnormal as well.
Then, as soon as they've had thesurgery, they're released as
soon as they're able to pee ontheir own.
So that may mean that they don'tactually have to stay for the 48
hours, just depending on whattheir blood work looks like.
(21:20):
I do let pet parents know thatyou can expect some bloody urine
sometimes after the surgery fora few days afterwards.
Now, I always talk about howprevention is the key, right?
And in this situation, that'sactually really tough.
Really the best thing to do isto get your cat in right away if
you see these signs.
The best prevention here isreally just to make sure that
(21:41):
your cat has all their needssatisfied.
Which is what we're going totalk about with Dr.
Cerná in the behavior episode ina couple weeks here, so please
make sure to check that out.
So I usually do a animal factand I'm very sorry today I have
a sinus infection and I'm notfeeling great, but I still have
to go to work.
So I'm not going to be doing myanimal fact today.
(22:01):
But I will try to make sure I doone for you next time.
So really understanding andaddressing all these underlying
issues causing FLUTD cannot onlyimprove your cat's quality of
life, but also preventpotentially fatal complications.
It's reading the signs andseeking professional help and
providing necessary care.
Remember that your pet relies onyou in order to interpret their
(22:24):
signals and act accordingly.
I also like to mention, that Italked about all of our
experiences here at my hospital.
Experiences at other hospitalswill be different as well.
Every doctor is going to bedifferent in the way that they
treat your pet.
It's just the way that medicineis, there is no one exact way.
So remember that these are allsuggestions.
(22:45):
This is not a diagnosis from us.
If you have problems and youhave questions, make sure you
ask your veterinarian aboutthem.
We're talking about urinaryobstructions right now.
Sometimes cats can pee outsideof the litter box for other
reasons.
Like I said, definitely checkout Dr.
Cerná's episode here in a coupleof weeks because it could be
because a behavioral issue aswell.
(23:06):
And it may be because they'renot getting the five things that
they need in their life in orderto be able to stay comfortable
and safe.
So definitely check out thatepisode, especially if you've
taken your cat to the vet andthey found out that there was no
medical reason for it, then itcould be a behavioral thing and
her episode could really helpyou with that.
So I hope today's episode shedssome light on the importance of
(23:29):
recognizing and addressingfeline urinary issues.
You're not alone in thisjourney.
There are resources,professionals, and communities
ready to help support you.
So never hesitate to reach outto your veterinarian if you
suspect that your cat might besuffering from FLUTD or any
other health conditions.
So thank you for tuning intoVetsplanation.
We are committed to helping youunderstand your pet's health
(23:51):
better with each episode at atime.
I'm Dr.
Sugerman, reminding you tolisten closely to your pets.
They're communicating more toyou than you might realize.
Stay curious.
Stay informed.
And join us next time as wecontinue to explore the
fascinating world of pet healthas we talk to Dr.
Delaney about how you can safelymake human grade pet food at
(24:12):
home.
I get lots of people who feedjust chicken and rice, but
that's not a balanced diet.
So we want to make sure that webalance these foods as best as
possible for our pets.
So thank you to Shawn Hyberg foryour exceptional editing skills
and Kelly Dwyer for your amazingwebsite skills.
Remember to keep your petshappy, healthy, and safe.
Take care and we'll see you inthe next episode.
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