Feline Lower Urinary Tract Disease (FLUTD) in Cats


This article is written by Pet Circle veterinarian, Dr Belinda Stancombe

Urinary related issues are one of the most common reasons that cats will present at the veterinarian. In fact, in some cases urinary issues in cats can be a medical emergency!

Unwanted toileting behaviour such as urinating outside the litter box is one of the most common complaints of pet parents. While this can be a frustrating issue for owners, for cats it is often an indication of an underlying medical condition.

Feline Lower Urinary Tract Disease (FLUTD) is the main complex of issues that affects the urinary system in cats. Understanding the risk factors behind the development of FLUTD and ways to help prevent it, can reduce your cats risk of developing urinary issues and help prevent unwanted toileting behaviours.


What is Feline Lower Urinary Tract Disease (FLUTD)?

The urinary system consists of the kidneys, ureters, bladder and urethra.

The kidneys are responsible for cleaning the blood of toxins and removing excess waste and fluid in the form of urine. This urine travels down the ureters and is stored in the bladder where it is eventually excreted and passed through the urethra when the cat urinates.

Urinary disease refers to any medical condition that affects an area of the urinary system, from the kidneys to the urethra.

Feline Lower Urinary Tract Disease (FLUTD), as the name implies is a group of medical conditions that affect the lower areas of the urinary system, of the bladder and urethra. Feline Lower Urinary Tract Disease (FLUTD) is not a single issue, but rather a group of medical conditions.

Source: MSD Veterinary Manual

Signs of FLUTD in Cats

  • Urinating outside the litter box
  • Straining to urinate
  • Blood tinged urine
  • Frequent urination
  • Vocalising when urinating
  • Passing small amounts of urine
  • Licking genitals

Common Causes of FLUTD

  • Urinary Tract Infection (UTI)

    A urinary tract infection is an infection present in the urinary system due to the presence of bacteria. Although a regularly diagnosed condition in dogs and humans, a UTI in cats is uncommon and often only occurs secondary to another underlying condition such as a concurrent disease (eg hyperthyroidism, diabetes, kidney failure) or suppression of the immune system. UTI's are most commonly seen in the Persian breed, females and older aged cats.

  • Uroliths- Crystals and Stones

    Minerals are naturally present and excreted in the urine. These minerals can clump together causing struvite crystals or calcium oxalate stones to form in the bladder, leading to irritation of the bladder lining, bleeding, mucous formation or plugs.

  • Mucous Plug

    A mucous plug is a solid mass of mucous, crystals and cellular debris causes by chronic irritation, inflammation or infection of the bladder.

  • Urethral Obstruction

    A urethral obstruction or blockage occurs when the urethra becomes completely blocked by uroliths (crystals or stones) or a mucous plug (formed due to inflammation of the bladder wall), and the cat is unable to pass urine. Urinary blockages are more common in male cats due to their anatomy and the narrowing of the urethra. A urethral blockage is a medical emergency and requires immediate treatment.

  • Feline Idiopathic Cystitis (FIC)

    In cases where no underlying cause for FLUTD can be found, then a diagnosis of FIC may be made. FIC refers to generalised inflammation of the bladder due to an unknown cause.

    Although the exact mechanism is not well understood, stress is often a factor in cats that suffer from FIC. When some cats experience stress, the protective lining of the bladder wall is weakened, predisposing them to signs of cystitis which may progress to the secondary development of uroliths, UTIs and urethral obstruction.

    Risk Factors of FIC include:

    • Stress
    • Young to Middle Aged
    • Male
    • Desexed
    • Overweight
    • Indoor only
    • Multi-cat household
    • Dry food only diet
    • Low water intake
  • Other- Neoplasia, Anatomical abnormalities

    In older cats, tumours can develop in the bladder, leading to secondary FLUTD signs. In young cats, persistent urinary issues can be present when a congenital abnormality has occurred and the cat has been born with an abnormal urinary system.

How is FLUTD Diagnosed?

For cats showing clinical signs of FLUTD, such as urinating inappropriately, a check up with a veterinarian is recommended. The veterinarian will ask questions to gather an accurate history and perform a thorough clinical examination. Further tests such as a urinalysis, urine culture, blood test, xray or ultrasound may be required to identify an underlying cause. Once the cause has been found then a treatment plan can be formulated.

What is the Treatment for FLUTD?

The treatment for FLUTD is dependent on the diagnosed underlying cause. If a urethral obstruction is identified, then emergency surgery is required to unblock the urethra and establish urination before the cat suffers permanent and irreversible damage. Complications of urethral obstruction can include bladder rupture, kidney failure and even death!

If uroliths are identified then a Veterinary Prescription Diet may be recommended to dissolve them or in some cases surgical removal may be required. In most cases, it is recommended that if uroliths have been found that they continue on a Veterinary Prescription Diet for life to prevent reoccurence.

If a UTI or Cystitis is diagnosed then antibiotics and/ or anti-inflammatories may be prescribed.

In the case of cats diagnosed with FIC, minimising stress is an important part of treatment through the use of calming supplements, pheromones, therapeutic diets or prescription medication.

Prevention of FLUTD in Cats

Once the underlying conditions have been diagnosed and treated then the focus can shift to preventing recurrence of FLUTD. Studies have shown that if no changes are made then 40-50% of cats that have suffered from FLUTD will have a recurrence within 1 year of diagnosis.

1. Reduce Stress

Some common causes of stress in cats include moving house, new visitors, introducing a new pet, a trip to the vet or groomer, coping with the loss of family member or pet, new furniture or even just rearranging your furniture.

If there is a pet or family member (such as a child) that a cat doesn't like, providing them with adequate hiding areas, can help them feel that they have somewhere safe to escape to. Things like cat trees, hidey-hole beds, and high shelf beds such as window hammocks and beds can all help cat's feel safe.

Natural anti anxiety products such as pheromones, supplements and therapeutic diets can help reduce daily anxiety in cats, and can also be introduced in the lead up to a stressful event.

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2. Provide Enough Litter Trays

It is important that enough litter trays are provided throughout the house, especially in a multi-cat households. The general rule is to provide the same number of litter trays as cats, plus one. For example in a 2 cat household, 3 litter trays would be recommended.

Cats can be incredibly fussy about all aspects of toileting including the type of litter tray, litter brand, cleanliness of litter tray and litter tray locations. Any variation in these may lead to them avoiding using the litter tray, which can increase the risk of FLUTD.

Ensure that the litter tray is kept clean, placed in a quiet place and that multiple location options are available to cater to all cat preferences. Investing in a self cleaning litter tray can be a great way to always keep the toileting area clean and fresh! Ensure that an enzyme-based cleaner is used to clean any accidents, to decrease the chance of inappropriate toileting again in the same area in the future.

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Hematuria Detection is a litter additive which can be used by cat owners at home for monitoring and early detection of urinary issues.

Simply sprinkle the white litter granules on your cat's regular litter and if blood is detected in the urine, the granules will turn from white to blue in colour. If blood is detected than a consultation with your veterinarian is recommended.

Early detection can help improve treatment, and avoid costly and life-threatening complications of urinary issues in cats.

    Key Benefits:

  • Non-invasive method of testing your cat's urine in the comfort of your own home
  • Can be added to regular litter
  • Provides reassurance to pet parents
  • Detects urinary issues early and may help avoid complications like urinary blockage
  • Approved by Veterinarians
  • Easy to use

3. Feed a Premium Diet

For cats that have not suffered from urinary issues before, feeding a premium diet can help prevent issues from developing. Premium brand cat food such as Hill's Science Diet, Royal Canin or Advance have ideal levels of magnesium, phosphorus, protein and calcium to help avoid the formation of crystals or stones in the urine. There are even a range of Premium Urinary Care Diets available that have been specially formulated to maintain urinary health in adult cats.

Cats that have suffered from FLUTD in the past, may require a Veterinary Prescription Urinary Diet for life. These diets are designed with the right balance of nutrients to promote a healthy bladder and contain ingredients to control urine pH, minerals and protein to decrease, and in some cases, even dissolve urolith formation. It is for this reason that these diets are recommended to be fed as sole diets as combining with different formulations can throw out this balance and reduce their efficacy. This also includes combining different brands of Veterinary Prescription Urinary Diets together.

4. Increase Water Intake

It can be hard to encourage your cat to drink more water. Many cats prefer fresh running water so providing your cat with a water fountain can be a great way to encourage them to drink. Wet food is high in water, so feeding your cat a diet with the addition of wet food or a broth or cat meal topper is a great way to boost their daily water intake.

Pro Plan Hydra Care Supplement is a tasty liquid enriched with important nutrients, formulated to increase water intake to keep your cat hydrated and help increase urine dilution. Pro Plan Hydra Care Supplement makes a tasty addition to your cats regular meal and is a great way to entice fussy cats.

5. Weight Management

Overweight cats are at a greater risk of developing urinary issues. As with humans, the best way to manage weight in cats is through diet and exercise.

Cats that are overweight may benefit from a veterinary prescription weight loss diet which is specially formulated to help manage calories and promote weight loss. Hills Science Diet even have a diet available that combines urinary and weight care with the addition of stress management in the one formulation, Hills Prescription Metabolic Plus Urinary Stress Dry Food and Hills Prescription Metabolic Plus Urinary Stress Wet Food.

Play is one of the best ways to get a cat moving and encourage weight loss. Many people assume that an overweight cat is too lazy to play. Often they just need more interactive toys to peak their interest, or a particular type of toy such as one with feathers or a laser. Changing toys regularly can help keep things interesting and encourage play.

Further Reading

Keep Your Cat Happy When You Are Away From Home

Your Guide To Using Feliway

How To Reduce Anxiety In Cats

Dental Care For Cats

Flea, Tick and Worming Guide For Cats

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