Cystitis & FLUTD

Cystitis and Feline Lower Urinary Tract Disease (FLUTD)

What is cystitis?
Cystitis means inflammation of the urinary bladder. In cats, diseases of the lower urinary tract (the bladder and urethra) are grouped under the term ‘feline lower urinary tract disease’ (FLUTD) as it can be difficult sometimes to distinguish between diseases of the bladder and urethra, and many diseases will affect both structures.

What are the signs of FLUTD?
Typical signs in cats with FLUTD are those of inflammation and irritation, commonly-

	Increased frequency and urgency of urination.
	Difficulty in urinating (spending a long time straining on the litter tray while passing only small quantities of urine).
	The presence of blood in the urine or blood spots in the litter tray.
	Occasionally complete obstruction to the passage of urine (straining persistently without producing any urine).
	With the latter sign particularly (straining without the passage of any urine), it is important to seek urgent veterinary attention as complete blockage to the flow of urine can be a life-threatening complication if left untreated.

What causes FLUTD?

	Idiopathic (no known cause) but possibly caused by unidentified viruses or bacteria
	Urinary calculi (‘bladder stones’)
	Bacterial infections
	Neoplasia (tumour)
	Anatomical abnormalities
	Urethral plugs (blockage of urethra with a mixture of crystals or small calculi/stones, mucus and inflammatory material)

How is FLUTD diagnosed?
The initial diagnosis of FLUTD is based on the identification of signs of lower urinary tract inflammation. The clinical signs displayed by the cat are often characteristic but where there is doubt, analysis of a urine sample will confirm the presence of inflammation or blood. Initially, a cat with uncomplicated FLUTD may be treated symptomatically with a short course of tablets. However, if the signs do not respond to this treatment, or if there is recurrence of the clinical signs further investigation may be required to identify the underlying cause of the FLUTD.

What further investigations are required to diagnose the cause of FLUTD?

Where clinical signs are persistent or recurrent further investigations will be required -

	Laboratory analysis of a urine sample
	Bacterial culture of a urine sample
	Blood samples to look for other evidence of urinary tract disease or other systemic disease
	Radiographs (x-rays) and/or ultrasound examination of the bladder and urethra

The information from these investigations should help to identify a specific treatable underlying cause if one is present.

What is the treatment for FLUTD?
This depends on the underlying cause. For example:

	Cases of idiopathic disease may respond to treatment with anti-inflammatory or analgesic drugs. It is crucial that you only use drugs specifically prescribed by your veterinary surgeon, as may human products are extremely dangerous to use in cats.
	Bacterial infections of the lower urinary tract usually respond well to antibiotic therapy.
	If a cat develops a blocked urethra (this almost exclusively occurs in males), emergency treatment is required to remove the blockage, which may require flushing of the urethra while the cat is given a short anaesthetic.
	If bladder stones (calculi) are present they may have to be removed surgically or, depending on their type, they may be able to be dissolved by using a special diet, or dietary additive.

There is no universal treatment for FLUTD. Each case has to be investigated to determine the underlying cause, and then the treatment has to be tailored to the individual cat. Sometimes despite appropriate investigation and treatment clinical signs may still recur, requiring further therapy.

How can FLUTD be prevented?
It is impossible to completely prevent diseases of the lower urinary tract occurring. However, FLUTD is more common in cats that have a lower water consumption, and in cats that are inactive and obese. All these factors may relate, at least in part, to the frequency with which a cat urinates. Avoidance of obesity and encouraging exercise may be of some help in preventing FLUTD, and, as cats tend to drink very little, the feeding of at least some tinned food rather than exclusively a dry cat food product will help to maintain a higher water intake.

If a cat develops urinary calculi (stones), the feeding of special prescription diets (available from veterinary surgeons) may help to prevent recurrence of stone formation.