Feline Lower Urinary Tract Disease

General information

Feline lower urinary tract disease (FLUTD) is a term used to describe a number of conditions that affect the urinary bladder and urethra of cats. The symptoms for these conditions are all very similar meaning a diagnosis is impossible without diagnostic investigations. The most common cause of FLUTD is feline idiopathic cystitis (FIC) which is often a challenging and difficult condition to manage.

Major causes of FLUTD

The types of possible underlying causes of FLUTD in cats will largely depend on the cat’s age.

Young to middle aged cats (under 10 years of age)

  • Feline idiopathic cystitis (FIC)                   50-70%
  • Uroliths (bladder stones)                             20% (some of these have FIC)
  • Urethral plug                                                  20%(some of these have FIC)
  • Anatomical defects                                        5-10%
  • Behavioral                                                        1-6%
  • Neoplasia (cancer)                                          1-5%
  • Bacterial infection (UTI)                               1-5%

Older cats (over 10 years of age)

  • Bacterial infection (UTI)                                 50%
  • Uroliths and UTI                                              17%
  • Uroliths (bladder stones)                               10%
  • Urethral plug                                                     7%
  • Neoplasia (cancer)                                           3%
  • Idiopathic cystitis (FIC)                                 5%

Symptoms of FLUTD

FLUTD can be classified as either “non-obstructive” or “obstructive”. Cats with non-obstructive FLUTD have a patent urethra and therefore are able to void urine, although often only in small amounts.
With obstructive FLUTD, the cat’s urethra becomes obstructed with a stone or a mucus plug which then prevents urine flow. Males are at greater risk of obstructive FLUTD due to their narrower urethra. Unsuccessful attempts to urinate will progressively lead to distress, lethargy, inappetance and vomiting. Without prompt veterinary attention, the condition will progress to acute kidney failure and death.

Signs of FLUTD in cats can include one or more of the following symptoms:

  • Increased frequency of urination
  • Blood in the urine
  • Straining or difficulty urinating sometimes accompanied by distressed cries
  • Inappropriate urination in unusual sites (like the bath or sinks)
  • Loss of litter tray training
  • Increased grooming, especially in the area around the genitals
  • Behavioural changes including aggression

Risk factors

Often there are a number of factors involved and the exact cause is not known so addressing as many of these as possible will give the best outcome.

  • Male cats, neutered cats and overweight cats (increased risk for FIC)
  • Cats that eat a predominately dry food diet ((increased risk for FIC))
  • Cats that do little/no exercise, or have limited/no access outdoors (increased risk for FIC)
  • Cats that use litter trays (increased risk for FIC)
  • Cats in households with more than one cat (increased risk for FIC)
  • Cats in a stressful environment e.g. new baby or pet, moving house, change in household routines (increased risk for FIC)
  • Persians, Manx and Himalayan cats (increased risk of calcium oxalate crystals/stones)
  • Intercurrent disease such as liver disease or diabetes (increased risk of urinary tract infections)
  • Abnormal anatomy resulting in abnormal flow of urine (increased risk of urinary tract infections)

Diagnostic investigation of FLUTD

It is vital to identify the underlying cause of FLUTD, especially if your cat has severe, recurrent or persistent symptoms. After performing a thorough physical examination on your cat, our vet will recommend which tests to start with and then on the basis of the results, may recommend further testing.

For young to middle aged cats under 10 years of age the most likely cause of FLUTD will be feline idiopathic cystitis (FIC) however this condition can only be diagnosed by excluding all other causes. Idiopathic is a term used to describe a condition has no known cause identified. It is currently thought that FICis caused by multiple factors including genetics, environment and an altered and inappropriately nervous system response to stress.

To investigate FLUTD in younger cats, urinalysis is the first essential step. Depending on your cat’s age and symptoms, they may also require blood testing to assess a complete blood count, serum biochemistry and thyroid hormone levels.

For mature and senior cats older than 10 years of age:

The most common cause of FLUTD in older cats tends to be urinary tract infections and these generally develop secondary to an underlying disorder such as chronic kidney disease, diabetes or hyperthyroidism. These cats will require blood and urine testing including a complete blood count, serum biochemistry, thyroid hormone testing and a urinalysis with a culture and sensitivity. It is also prudent to measure blood pressure to screen for hypertension.

Further testing

Cats with recurrent symptoms or those who fail to respond to treatment will require further investigations. This will usually include abdominal x-rays and ultrasound, and sometimes also advanced contrast studies (pneumocystogram). For senior cats with FLUTD symptoms, an abdominal ultrasound can be a useful tool to screen for bladder cancer. If a suspicious looking mass is found, your vet may also recommend a biopsy.

Treatment of FLUTD

Treatment recommendations for FLUTD will depend on the underlying cause. We have a number of information pages available listed below on specific FLUTD diagnoses.

Disclaimer: Please note that the information provided on this page does not replace the advice of your veterinarian. If you are concerned about your cat’s health in any way, we strongly recommend you seek veterinary advice. 

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