Feline Lower Urinary Tract Disease (FLUTD)

Feline lower urinary tract disease (FLUTD) is the term used to describe a range of diseases with similar symptoms that affect the lower urinary tract of male and female cats.

FLUTD is one of the most common health implications affecting cats, estimated to affect over 1% of the total cat population. Fortunately, with treatment, the prognosis for FLUTD is good even when the underlying cause is unknown. However, recurrence rates are high, which is why it is important to understand the potential environmental issues that could be contributing to the disease and how to manage them.

The prevalence of FLUTD is increasing, which is in part thought to be a result of the increase in indoor cats and multi-cat households. Both of these are thought to be risk factors in the development of FLUTD.

Spotting the Signs of Feline Lower Urinary Tract Disease

Although there are various underlying causes of FLUTD, they all share similar symptoms that indicate a lower urinary tract disease. The most commonly seen symptom, which is also easiest to identify, is urination in inappropriate places (periuria), other symptoms are listed below:

  • Periuria – Urination in inappropriate place i.e. not outside or in the litterbox.
  • Dysuria – Painful urination.
  • Stranguria – Strained urination due to blockage or restriction of the urethra.
  • Haematuria – Blood present in the urine.
  • Pollakiuria – Increased frequency of urination.

If a cat develops unusual behaviours and is unable to urinate, this may indicate a blocked urethra, which is a severe medical condition. If not treated, toxins in the urine can accumulate in the bloodstream, which can be fatal.

Underlying Causes of Feline Lower Urinary Tract Disease

In most cases of FLUTD, veterinarians are unable to find an underlying cause of the disease, despite rigorous diagnostic tests. This occurs in over half of all FLUTD patients and is given the term feline idiopathic cystitis (FIC), which means unknown bladder inflammation. Other causes of FLUTD include:

  • Feline idiopathic cystitis (FIC) – Cats are diagnosed with FIC when diagnostic tests have been exhausted, but an underlying cause has still not been found. Surprisingly, this is the most common outcome for cats with FLUTD. It is thought a degradation of a protective layer (GAG layer) in the bladder allows acidic urine to irritate sensory nerves resulting in pain.
  • Urolithiasis – The formation of stones in the bladder from minerals in the urine. This can be a particular problem for male cats as their urethra (through which urine is excreted from the bladder) is much narrower, meaning even smaller stones (uroliths) can be a problem.
  • Urethral Plugs – Undetermined blockage of the urethra, which is again more of a problem in male cats. These ‘plugs’ are thought to be caused by the collection of proteins, cells, crystals and an alteration in urine pH. They often arise alongside inflammation or bacterial infection and require immediate veterinary attention.
  • Bacterial Infections (UTIs) – A bacterial infection of the urinary tract. Most common in older cats (10+) and those with a concurrent disease such as diabetes of liver failure.
  • Neoplasia – Neoplasia is the formation of tumours. FLUTD symptoms can occur if the tumours develop within the lower urinary tract.
  • Anatomical Defects – Genetic or developmental defects that affect the structure of the lower urinary tract can cause complications when urinating.
  • Neurological Disorders – Certain neurological and behavioural issues can cause symptoms of FLUTD. For example sphincter dysynergia is the loss of control of bladder sphincter muscles, which leads to inappropriate urination.

FLUTD may also be classified as either obstructive (urolithiasis, urethral plugs) or non-obstructive (other causes listed above) depending on whether the urethra is obstructed or not. Obstructive FLUTD occurs with the highest frequency in castrated male cats, although the age of castration does not affect the likelihood of the disease developing. Non-obstructive FLUTD occurs with equal frequency in both male and female cats.

This article identifies the percentage of each underlying cause that is responsible for FLUTD.

Risk Factors Associated with FLUTD

The typical age of onset for FLUTD is 2-6 years and is uncommon in cats younger than one year and older than 10. Cats over the age of 10 however, are more commonly diagnosed with UTIs than younger cats.

Bodyweight, diet and stress are all risk factors for development of FLUTD. A higher incidence of the disease has been found in lazy, obese cats as well as overfed cats or cats fed exclusively on dry food.

As mentioned earlier, indoor cats and cats from multi-cat households are also at higher risk of developing FLUTD. These conditions can increase stress levels and stress can contribute to the development of FLUTD. Other causes of stress include; confinement, moving home, competition for litter boxes/food dishes/water dishes and changes in routine (personal, work or feeding regime).

Try our feline stress calculator to find out if stress is affecting your cat.

If symptoms of FLUTD persist or recur repeatedly within a short period, it might be necessary to address any environmental or behavioural issues that are contributing to the disease.

Treatment of Feline Lower Urinary Tract Disease

Treatment of FLUTD can be split between veterinary intervention and home care, examples of both are listed below:

Veterinary Treatment

  • Antibiotic therapy – Cats with a UTI will be given appropriate antibiotics to eliminate the infection.
  • Surgery – The removal of large or undissolvable bladder stones, the removal of urethral plugs, the correction of anatomical defects or the removal of a tumour.
  • Dissolution – Feeding a veterinary diet to dissolve existing bladder stones and prevent recurrence.
  • NSAIDs (Anti-inflammatories) – To reduce inflammation following surgery and aid recovery.
  • Pain Relievers – May be used alongside NSAIDs to hasten recovery and relieve pain.
  • GAG Supplements – GAG (glycosaminogylcan) supplements, typically given to maintain joint health, may be recommended. It is thought the GAGs in the supplement will help restore the protective GAG layer in the bladder, preventing urine from irritating sensory nerves.

Home Care

The management of your cat’s environment at home is key to reducing stress and ensuring a healthy lifestyle. It is particularly important in cases of FIC where the underlying cause of the lower urinary tract disease is unknown and so therefore cannot be treated, only managed.

Dietary Modification

  • Encourage wet food consumption by offering wet food alongside normal food. Aim to slowly remove dry food altogether.
  • Encourage intake of water to promote healthy urination.
  • Ensure you cat only eats as much as they need to reduce obesity – see how many calories your cat needs here.
  • Feed small but frequent meals to mimic natural hunting patterns.
  • If recommended by your vet, feed a veterinary diet to promote acidic urine that will dissolve stones

New for 2014, Hill’s Pet Nutrition have announced ‘Hill’s Prescription Diet c/d‘ a first for dietary management of FLUTD. The veterinary diet contains ingredients designed for dissolution of bladder stones as well as L-Tryptophan and milk proteins to reduce stress and anxiety. See more about the release here.

Environmental Enrichment and Modification

  • Clean litter boxes frequently and ensure they are in a low traffic area free from other pets, children or noise.
  • In multi-cat households, ensure there are enough litter boxes, food dishes and water dishes for all cats. A general rule is to provide one more than the total number of cats, to reduce competition.
  • If inappropriate urination occurs, clean the area up quickly to avoid a repeat urination in the same spot.
  • Enrich your cat’s environment with places to climb, scratch, hide, play and rest.
  • Stimulate your cat’s natural hunting instinct through play.
  • Provide cats that are tolerant of humans with affection if they enjoy it.
  • Avoid changes in your own personal routine as this can cause stress in particularly sensitive cats, it might be worth using our feline stress calculator, to see if your cat is stressed.
  • Allow indoor cats outside (but don’t force them if they’d rather stay indoors) to provide stimulation.
  • Consider a synthetic facial pheromone (Feliway) that may help reduce stress and anxiety in some cats.

Hostutler, Roger A., Dennis J. Chew, and Stephen P. Dibartola. “Recent Concepts in Feline Lower Urinary Tract Disease.” Veterinary Clinics of North America: Small Animal Practice 35.1 (2005): 147-70. Web.

Image Credit – Kevin Dooley

About James Watts

BSc Bioveterinary Science. Editor of PetSci. When I'm not writing, learning, discussing, or reading about animals, you know it's the weekend! Currently developing PetSci HealthTrak, the fast and easy way to monitor your pet's weight and calorie intake. HealthTrak offers a simple way to track your pet's progress, helping them achieve a healthy weight and a long, happy life.

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