Cystitis and Lower Urinary Tract Disease in Cats

What are cystitis and lower urinary tract disease?

Cystitis means inflammation of the bladder. Several diseases and conditions can cause this inflammation. Cystitis can occur with or without an infection.

Feline lower urinary tract disease (FLUTD) is a general term for conditions that affect a cat’s bladder and urethra (the lower urinary tract). These conditions are often grouped together because their signs can be similar and difficult to distinguish.

Feline idiopathic cystitis (FIC) is one of the conditions included under FLUTD. Your veterinarian diagnoses FIC when tests rule out other causes of lower urinary tract signs. “Idiopathic” means the exact cause is unknown. 

Note that Pandora syndrome is often used synonymously with FIC, but FIC is only one component of Pandora syndrome.

What are the signs of FLUTD?

Signs of FLUTD may include:

• Blood in the urine
• Pain or discomfort
• Urinating more frequently
• Difficulty urinating (affected cats may strain in the litter box while passing only a small amount of urine; this can look like constipation)
• Urinating in unusual places
• Urine that is cloudy or smells foul
• Excessive grooming or licking of the genital area

If your cat repeatedly strains to urinate but passes little or no urine, seek immediate veterinary care. Your cat may have a urinary tract obstruction (blockage). This condition is painful and potentially life-threatening.

What causes FLUTD?

Several conditions can cause or contribute to FLUTD, including:  

• Feline idiopathic cystitis (FIC; the most common cause)
• Urinary or bladder stones
• Bacterial infections (uncommon in otherwise healthy adult cats, but more common in cats over 10 years of age)
• Tumors in the bladder or lower urinary tract (neoplasia)
• Abnormal anatomy, especially in younger cats with chronic or persistent urinary tract issues
• Urethral plugs (a buildup of crystals and inflammatory material that can block the urethra)
• Trauma

More than one condition can occur at the same time, such as bladder stones and a bacterial infection. 

How is FLUTD diagnosed?

The initial diagnosis of FLUTD is based on identifying signs of lower urinary tract disease. A urinalysis (analysis of a urine sample) can detect the presence of inflammation or infection, but it may not identify the cause.

Initially, your veterinarian may treat a cat with uncomplicated FLUTD to relieve its signs, using pain medication, dietary changes, or, if a bacterial infection is identified, antibiotics. However, if the signs do not improve with treatment, or if they return, your veterinarian may recommend additional tests to identify the underlying cause of the FLUTD.

What other tests might my cat need?

Your veterinarian may recommend additional tests if the initial tests do not identify the cause, the signs persist, or FLUTD keeps returning. These tests may include:

• Bacterial culture of a urine sample to identify bacteria in the urine
• Blood tests to look for other signs of illness or underlying conditions, such as kidney disease
• X-rays or an ultrasound examination to look for stones, masses, or other abnormalities in the bladder and urethra

How is FLUTD treated?

Treatment is based on the underlying cause. For example:

• Feline idiopathic cystitis: Your veterinarian may recommend pain medication, increased water intake, and changes to your cat’s environment to reduce stress. Dietary changes may also help some cats.
• Bacterial infections: Bacterial infections of the lower urinary tract usually respond well to antibiotics.
• Urethral obstruction: If a cat develops a blocked urethra, emergency treatment is required to remove the blockage. Usually, the cat will be given a short-acting general anesthetic, and the urethra will be flushed or catheterized. Urethral obstruction occurs almost exclusively in male cats. Other treatment options may be recommended based on your cat’s specific blockage.
• Bladder stones: Bladder stones or uroliths must be eliminated. Some stones can be dissolved with a special diet, while others require surgery. Urinalysis may suggest the type of stone present.

There is no universal treatment for FLUTD. Your veterinarian will investigate the underlying cause and tailor treatment to your cat. Sometimes, despite appropriate tests and treatment, signs may return and require further treatment and testing.

Treatment for FIC focuses on relieving pain, increasing water intake, and reducing stress. Your veterinarian may prescribe medication, recommend a diet change, and suggest ways to encourage drinking. A predictable routine, opportunities to play and rest, and easy access to clean litter boxes, food, and water can help reduce stress and future flare-ups.

How can FLUTD be prevented?

It is impossible to completely prevent diseases of the lower urinary tract from occurring. However, FLUTD is more common in cats that have low water consumption and in cats that are inactive and overweight. 

Helping your cat maintain a healthy weight, stay active, and drink more water may reduce the risk of FLUTD. Because FIC is linked to an abnormal response to stress, reducing stress in your cat’s environment may help prevent further episodes.

If urinary stones or crystals contribute to your cat’s signs, a therapeutic veterinary diet might be required, often long-term, to help prevent a recurrence. Ask your veterinarian which diet is appropriate for your cat.