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Feline Cystitis-Feline Lower Urinary Tract Disease



Overview
Clinical Signs
Causes/Transmission
Diagnosis
Therapy
Prognosis
Prevention

Overview
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 inflammation that can cause straining to urinate and bloody urine. The cat often urinates frequently, usually with the passage of only a few drops of urine. This can be confused with constipation.

Clinical Signs

Many cats with FLUTD 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. In this situation, inappropriate urination is a reflection of the cat's extreme discomfort and is not a behavior disorder.

Most cats with cystitis have discomfort while urinating. They may go in and out of the box with increased frequency. They may squat around the house producing small amounts of urine. The urine may look bloody.

This disease is different from bladder stones and urethral obstruction. Bladder stones can form causing irritation to the bladder. They must be treated either medically or surgically. Urethral obstruction occurs mostly in male cats due to the smaller size of their urethra. The obstruction can be physical, like a small stone, gritty debris, or a mucus plug, or it can be functional due to urethral inflammation. Urethral obstruction is a life-threatening condition because the can is unable to urinate.

Causes/Transmission

The cause of this problem has not yet been definitively determined. Bacterial infections are the most common cause of cystitis in dogs and humans, but almost all 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. Stress may be an important factor in initiating the episodes. A herpes virus has been incriminated and someday may be proven to be the cause. In some cases there also seems to be a seasonal component; we see more cystitis in the spring and fall. Despite extensive research, the true cause remains elusive.

Diagnosis

Diagnosis of FLUTD is relatively straightforward based on history, clinical signs, and evaluation of a urine sample. Radiographs may be done to rule out a bladder stone.

Therapy

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 supportive 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, if they are present, in the urine and hasten recovery.

Following initial treatment, you will likely be asked to return with the cat 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 be terminated prematurely and a relapse will probably occur.

Many cats have recurrence of cystitis. This is the reason that a proper diet with emphasis on increased water consumption should be fed in the future. It is equally important that these cats live in a stress free environment (as defined by the cat).

Prognosis

The prognosis is generally good if the cat is responsive to medical management (i.e., change in diet, increased water consumption, decreased stress)

Prevention

1) Prescription diets can help if crystals are present. The specific diet is chosen based on the type of crystals present in the urine.

The most common type of crystals present in the urine is called struvite or triple phosphate. These crystals will dissolve in acidic urine. Therefore, acidification of your cat's urine can be a significant means of prevention. However, if your cat's crystals are not struvite, they are probably calcium oxalate. Acidification may actually make recurrence more likely if calcium oxalate crystals are present. 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.

Be aware that diets sold in grocery stores are designed for preventing the type of lower urinary tract disease caused by struvite crystals. Since struvite disease is primarily a disease of young cats, if you have older cats in the home that do not have a problem with FLUTD, they should be fed separately from cats on a crystal prevention diet and offered their regular diet. For this reason, your veterinarian should be instrumental in helping you choose the food that is best for your cat.

2) Increase water in the diet. 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 exclusively. 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 increase fluid intake which leads to a more dilute (watery) urine. Additionally you can try to encourage water consumption in several ways: increasing the number of water bowls around the house; adding ice cubes, tuna juice, or soup cubes to the water, leaving a faucet dripping, or getting a "kitty drinking fountain" (available at pet supply stores and various internet websites).

3) Decrease stress. If specific causes of stress in the cat's life can be identified and eliminated, this may significantly decrease the incidence of cystitis episodes. Further information can be obtained at The Indoor Cat Initiative (www.indoorcat.org).

4) Glucosamine-chondroitin supplementation may also help. If there is a defect in the bladder lining, this supplement may help it heal.



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