Feline Urinary Tract Diseases: What You Need To Know

by Sarah Griffiths, DCH in Cats
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BY SARAH GRIFFITHS, DCH

A lot of kitty parents out there have, at one time or another, had to deal with feline lower urinary tract disease or FLUTD. There are different kinds of urinary diseases that cats can develop. It causes great discomfort and is stressful to watch your cat go through. In this article, we will differentiate the various urinary illnesses that cats can suffer from and what you can do nutritionally to help your cat. Diet can have a major impact on the development and resolution of all urinary tract issues. 

FLUTD is a broad term for all diseases related to the bladder and urethra. You’ll know something’s up with your kitty because they will let you know though physical and behavioural changes including increased frequency of drinking and urination (PU/PD), excessive licking of the genitals, blood in the urine, peeing outside the litter box, and crying while urinating. More serious symptoms can occur too. For example, if you see your cat trying to urinate but no urine comes out, you need to get them to the vet immediately. Consider this an emergency situation.Cats that can’t urinate could have a urinary blockage which can be fatal if not treated in a timely fashion. Alternatively, straining without producing urine can be a result of an empty bladder. FLUTD creates an urge to urinate caused by inflammation in the urethra but your vet needs to be involved either way in case of a blockage.

If your cat is diagnosed with FLUTD, you’ll want to get more specific about exactly what is causing the problem. There are 3 different issues that can develop so let’s differentiate them:

There Are 3 Types of FLUTD

  1. Infection– Bladder infections are less common in cats than one might think. They make up only 11.5% of FLUTD cases. (1) Infections can be caused by bacteria, fungus, parasites and even viruses. The most common infection is from bacteria but your veterinarian will confirm via urinalysis and urine culture. Underlying causes of infections include diet, microbiome imbalance, urinary crystals and stones, diabetes and auto-immune disease. 
  2. Urine crystals and stones (uroliths) – Uroliths make up approximately 30% of FLUTD cases. (1) Bladder crystals and stones can form for a number of reasons. Often times, it starts with inflammation of the bladder lining and/or an imbalance in the urine pH (with should be about 6.5). It can also be a result of improper diet or underlying disease. Crystals can sometimes form in the presence of a chronic urinary infection so it’s possible for your kitty to be dealing with both problems at the same time. Urinalysis and culture will show both. The most common reason for the formation of crystals is diet.
  3. Inflammation (cystitis)– Feline idiopathic cystitis (FIC) makes up to 60% of feline urinary disease cases. (1) It’s a commonly mismanaged issue in cats that involves bladder and/or urethral inflammation with unknown cause or “idiopathic.” Cystitis simply means inflammation of the urinary tract. The word idiopathic means “of unknown origin.” The unfortunate thing about FIC is that veterinarians often put these animals onto antibiotics as a preventative measure even though there is no bacterial infection. This can cause a microbiome imbalance leading to ongoing urinary and digestive issues. Inflammatory responses are caused by the immune system and this is cause to help support you cat’s immune function to help manage or prevent inappropriate inflammatory responses. Antibiotics can put unnecessary stress onto an already stressful situation. 

All 3 of these issues can present with similar behaviours so best to take a trip to the vet to investigate the nature of the problem. 

The Chicken or the Egg

Unfortunately, some cats are dealing with more than one of these issues at a time, and it can be hard to identify which one started first. Infections can be a result of immune-mediated disease (cystitis), stress or diet and uroliths themselves can increase the risk of infection. Alternatively, uroliths can form in the midst of urinary tract infection or an inflamed bladder lining so it’s important to look at the symptoms and the urinalysis to try and find the root cause. Idiopathic cystitis can also put your cat at risk for bladder infections and crystals so prevention is important for ensuring your cat never has to deal with any of these issues. 

6 Causes of FLUTD

  1. Spaying and Neutering Your Cat Too Early Can Cause Urinary Issues

Male cats make up the majority of FLUTD cases and one of the causes is preventable: neutering your cat too early. Neutering your male kitten before the age of 6 months dramatically increases their chances of chronic FLUTD. (1) The reason? The urethral canal fails to widen when the testicles are removed too soon. Lack of sex hormones = underdevelopment of the urinary canal. This can cause an increased risk for urinary infections and blockages. Female cats also have increased risk of urinary disease due to early spaying. (2)

  1. Obesity

Obesity is a lesser known risk factor of urinary tract disease. (3) (4) A shocking number of dogs and cats are obese (1 in 3 according to the Banfield State of Pet Health Report). Not only does it increase risk of FLUTD but puts your cat in danger of developing other diseases including diabetes, arthritis and heart disease. If you’re not sure how to tell whether your cat is overweight, ask ushow to check your pet’s body score. 

  1. Tap Water Vs. Filtered Water…Does It Matter?

In short, yes, it matters a LOT! Science shows that cats that drink tap water have an increased risk for FLUTD than cats that drink filtered water. (1) This is most likely to the toxic compounds found in tap water including chlorine and heavy metals which cause stress and inflammation. Filtering your tap water is extremely important if you’re on a city water system. 

  1. Dry Vs. Wet Diets

Cats that eat dry food are scientifically proven to be at higher risk for the formation of uroliths (4) (5) (6) Because cats don’t have a strong thirst drive, they tend not to drink enough water when fed solely on dry food. I believe this is one of the most common reasons that FLUTD develops in cats. The good news is that diet is something we can control. 

  1. Stress

As we know for us humans, stress is known as “the silent killer.” It’s also true for cats. Stress can increase risk of all manner of diseases, including FLUTD. (1) Cats with interstitial cystitis have been shown to have increased stress hormone levels. (7) (8) So what stresses cats out? Confinement (indoor-only living), lack of movement, overcrowding, unclean or inadequate number of litter boxes (you should have 1 per indoor cat) and boredom can all be sources of stress. Be sure to assess your cat’s stress levels if you’re having issues in the urinary department. 

  1. Microbiome Imbalance

Were you aware the urinary system has its own unique microbiome? It is a little-known factor of urinary disease and more study still needs to be done but it’s recognized in humans that the microbiome does play a significant role in the development of urinary disease. (9) Diet, stress and antibiotics can all affect the microbiome. 

Nutritional Solutions for FLUTD

  1. Diet First!– Diet is a foundation of health. Dry food diets are one of the major leading factors in the development FLUTD in cats. Studies show that moist diets reduce risk of FLUTD and that includes raw diets too. Turf the dry food and consider feeding a fresh food diet. Switching your cat to a balanced raw diet is an important step when it comes to addressing and preventing FLUTD. It will help your cat stay hydrated, maintain correct urinary pH and provide your cat with correct nutrition to keep their bladder lining healthy. It will also eliminate starchy fillers and chemicals from the diet which increase the risk for obesity, diabetes and stress.  If you’re searching for a good quality raw diet, make sure you choose one that is HACCP verified for food safety, theingredients are high quality, have a full nutrient analysis and they don’t contain a lot of vitamin/mineral premix. 

 

  1. Probiotics– Probiotics have been shown to help with recovery from urinary tract issues in humans (10) and vaginal health in dogs (11). No studies have been conducted on cats related to FLUTD but many veterinarians do recommend probiotics for it. Not only can it help restore a microbiome imbalance after antibiotic treatment but it may help you avoid using antibiotics by rebalancing the bladder flora so infection can resolve on its own. Our favorites: Olie Naturals New Beginningsand Adored Beast Love Bugs.

 

  1. Cranberry – cranberry contains proanthocyanidin (giving it it’s red color) which prevents pathogenic bacteria from adhering the bladder wall. (12) (13) (14) Cranberry is also an acidifying agent which can be useful in cases where urine pH is above 7. Normal feline urine pH should be between 6-6.5. Cranberry also contains vitamin C which is important for immune modulation and reducing cellular oxidation.  Our two favorite products:Cranimalsand Adored Beast Easy Peesy Protocol.

 

  1. N-Acetyl glucosamine (NAG) – NAG is a form of glucosamine that helps reduce smooth muscle inflammation which includes bladder and digestive linings. It can be helpful in reducing inflammation without the side effects of anti-inflammatory drugs. Adored Beast Easy Peesy also contains NAG or you can purchase it separately from a natural health food store- use 1/6 of a human dose. 

 

  1. D-Mannose – D-Mannose is a type of sugar that has been shown to have similar results to antibiotics in human cases of urinary infection and it has no known adverse side-effects. (13) No studies have been publish on d-mannose and cats but it is safe to use and clinical outcomes look promising. Purchase from a natural health pharmacy (1/6 of a human dose) or use the Adored Beast Easy Peesy. 

 

  1. Herbs- Marshmallow root, barberry, nettle leaf and dandelion are all safe for use in cats and have been shown to have benefits for the urinary system in humans. 

If your cat is suffering from chronic FLUTD, be sure to involve your veterinarian and the help of a professional animal nutrition specialist. See our consultation servicesfor more details on how we can help.

References:

1.    Scientific Reports: Prevalence and risk factors of feline lower urinary tract disease in Chiang Mai, Thailand, 2020

2.    Journal of the American Veterinary Medical Association: Epidemiologic study of risk factors for lower urinary tract diseases in cats, 2001

3.     American Journal of Veterinary Research: Feline urological syndrome: associations with some time, space, and individual patient factors, 1976

4.     Journal of Feline Medicine and Surgery: Risk factors and clinical presentation of cats with feline idiopathic cystitis, 2011

5.     Pusoonthornthum R, Pusoonthornthum P, Osborne CA. Risk Factors for Feline Lower Urinary Tract Diseases in Thailand. Thai J. Vet. Med. 2012

  1. Jones BR, Sanson RL, Morris RS. Elucidating the risk factors of feline lower urinary tract disease. N. Z. Vet. J. 1997%3B45/100–108. 

7.     Journal of Urology: Increased plasma norepinephrine concentration in cats with interstitial cystitis, 2001

8.     American Journal of Veterinary Research: Evaluation of the effects of stress in cats with idiopathic cystitis, 2006

9.    Annals of Translational Medicine: Questions and challenges associated with studying the microbiome of the urinary tract, 2017

10. Clinical Infectious Diseases: Randomized, Placebo-Controlled Phase 2 Trial of a Lactobacillus crispatus Probiotic Given Intravaginally for Prevention of Recurrent Urinary Tract Infection, 2011

11.  Journal of Internal Veterinary Medicine: The effect of an oral probiotic containing lactobacillus, bifidobacterium, and bacillus species on the vaginal microbiota of spayed female dogs, 2013

12. The Journal of Urology: Cranberry Products Inhibit Adherence of P-Fimbriated Escherichia Coli to Primary Cultured Bladder and Vaginal Epithelial Cells, 2007

13.  The American Journal of Obstetrics and Gynecology: D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis, 2020