Cystitis (my cat is peeing too much or not at all!)

Let’s first start off with if your cat cannot urinate at all then stop reading and bring him/her to a veterinarian immediately or they will not make it. There is nothing that you can do to help him/her at home! These fur kids also cannot wait until morning or after work, etc. This is a life or death situation.

What is feline cystitis?
The term “cystitis” literally means inflammation of the urinary bladder. Although this term is rather general, there is a common form of cystitis that occurs in male and female cats. This disease is also known as Feline Urologic Syndrome (FUS) or Feline Lower Urinary Tract Disease (FLUTD). It affects the bladder (not the kidneys), resulting in the production of tiny crystals and urine which is bloody. The cat often urinates much more frequently than normal, usually with the passage of only a few drops of urine. This is often confused with constipation. Many cats will urinate in places other than the litter box, and often on hard surfaces such as tile floors, counter tops, sinks, and bathtubs. They should not be punished for doing so.

What causes feline cystitis?
We are not completely sure of the cause of this problem. Bacterial infections are the most common cause of cystitis in dogs and humans, but most cats with cystitis do not have bacteria in their urine. Neutering of male cats and feeding of dry cat food have been proposed as potential causes, but these have been disproved as initiating factors. It is true, however, that many dry foods may aggravate the problem after it begins. A herpes virus has been incriminated and someday may be proven to be the cause. Despite extensive research, the cause remains elusive.

Are bloody urine and straining to urinate the main problems?
Most cats with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort is usually mild but can become much worse if it is not treated. Female cats may develop l/2 inch diameter stones in the bladder that must usually be surgically removed. Male cats may develop enough crystals in the urethra (the narrow tube carrying urine out of the body) to cause an obstruction. This is an emergency situation. This obstruction prevents elimination of urine from the bladder. If the obstruction is not relieved within several hours, most cats will die from kidney failure and the retention of toxins that were not removed by the kidneys. Because the urethra is relatively larger in the female cat, the emergency posed by complete obstruction is almost always found in male cats.

How is cystitis treated?
Each cat with cystitis is treated according to the changes in the urine (pH, crystals, blood, etc.), the type of crystals present, the presenting clinical signs (straining, increased frequency, etc.), and the presence or absence of a bladder stone or urethral obstruction.

If neither a bladder stone nor urethral obstruction is present, proper medication will generally relieve the discomfort. A urinalysis is necessary to determine the proper medication. A special diet, explained below, will help to dissolve crystals in the urine and hasten recovery.

If the cat has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting anesthetic. The catheter is frequently left in place for about 24 hours. The cat is discharged from the hospital when it appears unlikely that obstruction will reoccur, usually 1-2 days later. If he is experiencing kidney failure and toxemia, intravenous fluids and additional hospitalization are needed.

How long is treatment continued?
Following initial treatment, you will be asked to return the cat in 7-10 days for a recheck of the urine. This is very important because some cats will appear to feel much better, but the urine is still bloody or contains crystals. If medication is stopped based on how the cat appears to feel, treatment may terminated prematurely and a relapse will probably occur.

Can cystitis occur again?
Many cats have recurrence of cystitis. This is one reason that a virus is suspected as the cause. It is also the reason that a proper diet should be fed in the future.

Are there ways to prevent recurrence?
Two things should be done to help prevent recurrence.

• The most common type of crystals present in the urine are called struvite. These are dissolvable in acidic urine. Therefore, acidification of your cat’s urine can be a significant means of prevention. Several special foods are available for this purpose. However, if your cat’s crystals are not struvite, acidification may actually make recurrence more likely. Therefore, if at all possible, the crystals in the urine should be analyzed for their composition. This is the most important step in preventing future problems.
• Restrict the cat’s intake of dry cat food. Though dry foods do not cause cystitis, several studies have shown that the cat’s total fluid intake is decreased when dry diets are fed. When the fluid intake is decreased, the urine is more concentrated with minerals and other materials that can cause future episodes of cystitis. Canned foods can result in increased fluid intake and more dilute urine.

However, we know that many cats do not like canned food and that there are several distinct advantages to feeding dry food. Therefore, if there have been only a few infrequent episodes of cystitis, these other factors may be more important.

What complications may occur due to an obstructed urethra? The most common complication of a urethral obstruction is bladder atony. Atony means that the muscles of the bladder wall are unable to contract to push out urine. This occurs when they are stretched to an extreme degree. Not all cats with obstructions develop atony; in fact, most do not. However, if this occurs, longer hospitalization is necessary. The muscles will nearly always rebound and become functional again, but this may take several days to as long as a week.

Another complication that occurs occasionally is kidney damage. Although feline cystitis does not directly affect the kidneys, if the bladder becomes extremely enlarged, urine may backup into the kidneys and create enough pressure to temporarily or permanently damage them. If this occurs, prolonged hospitalization will be necessary to treat the kidney damage. However, with aggressive treatment, most cats will recover their normal kidney function.

It should be noted that both complications, bladder atony and kidney damage, are the direct result of the bladder becoming extremely enlarged. Both problems may be prevented by prompt recognition of the problem and prompt medical care.

My male cat has had several urethral obstructions. Can this be prevented?
Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the obstruction. Although this prevents future obstructions, some of these cats will still have an occasional recurrence of cystitis, though usually not as severe.

This surgical procedure is also performed if the urethral obstruction is so severe that normal urine flow cannot be reestablished or if there are permanent strictures that develop in the urethra.

Surgically changing the cat’s urethra makes him more prone to bacterial infections in the bladder and bladder stones. Therefore, this surgery is only recommended if other means of prevention or treatment are not successful. However, the complications associated with the surgery are not life-threatening like urethral obstructions, so the surgery generally offers a significant benefit for the cat that really needs it.