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A gray cat with golden eyes, lying on a pillow. He looks sad.

A cat having trouble peeing is not something that should be ignored. Photo by Matheus Queiroz on Unsplash

This week, two of my friends had emergencies around their cat having trouble peeing. This made me think it’s a great time to share some information about urinary tract problems: the symptoms to look out for, how they’re diagnosed and treated, and what you can do to prevent a repeat of your cat’s unpleasant peeing problem.

A diagram of the urinary tracts of male cats and female cats. Image courtesy Merck Veterinary Manual

Your cat’s urinary tract starts with the kidneys and ends with pee leaving the body through the urethra. Images courtesy of Merck Veterinary Manual.

Let’s start out with a look at the urinary tract itself. As you can see above, the cat urinary tract starts with the kidneys. The job of the kidneys is to remove waste products from the blood. The toxins are carried out of the kidneys in liquid we call urine (or pee, if you’re not bougie). This liquid goes from the kidneys to the bladder through tubes called ureters. The bladder stores your cat’s pee until it is full, at which time your cat’s bladder tells his brain to go pee. When he does, the pee leaves his bladder through a tube called the urethra.

What causes cats to have trouble peeing?

When a cat has trouble peeing, the condition is called feline lower urinary tract disorder (FLUTD). There are three primary causes of FLUTD: urinary tract infection (UTI), stones or crystals in the bladder, and feline interstitial cystitis (FIC). According to the American Veterinary Medical Association, FLUTD occurs most often in middle-age, overweight cats. Stress, either due to household dynamics, intruder cats, changes in routine or moving house, or lack of stimulation in their lives can also cause or contribute to FLUTD.

According to VCA Animal Hospitals, urinary stones or crystals account for about 20 percent of FLUTD cases in cats under 10 years of age. Sometimes infections cause stones or crystals to develop, but PetMD tells us they can also be caused by diet or genetics.

An infection can also cause FLUTD. When bacteria, fungi, parasites, or viruses invade the bladder and urethra, they begin to multiply until they cause pain, irritation, and a burning sensation with urination.While UTIs are not generally common in cats, they are a common cause of FLUTD, especially for female cats over the age of 10. Usually, the urine is strong enough to kill these invaders, but as cats age and they develop issues like kidney disease, their urine becomes more dilute, which means it’s more watery and not as good at killing germs.

A white, female-presenting human with turquoise hair and glasses strokes a black cat. Photo by JaneA Kelley

When Siouxsie (that’s her in the picture!) turned 18, she started having regular urinary tract infections. Her kidney disease was a contributing factor. Photo by JaneA Kelley

Finally, feline idiopathic cystitis can make your cat have trouble peeing. This is probably the most frustrating of the urinary issues because the cause is unknown–that’s what “idiopathic” means. The most recent research has shown that stress is often behind episodes of FIC. Cats are creatures of routine, and they can get stressed by relationships with other cats, people in the home arguing or fighting, big changes like moving house or people moving into or out of your home, feral cats or other neighborhood cats wandering around outside, construction noise, and more. While FIC doesn’t appear to be caused by disease, it still can cause urethral obstruction just as much as an infection or stones.

Common symptoms of FLUTD

Regardless of the cause, FLUTD symptoms are pretty much the same.

The first thing you might notice is that your cat starts peeing where she shouldn’t. Sometimes people think this has to do with their cat being angry or resentful, but current research does not indicate that cats experience complex emotions like jealousy or resentment. Cats pee outside the litter box because they’re looking for comfort. Just as in humans with UTIs, it really does hurt them to pee! If your cat starts peeing where she shouldn’t, the first thing you need to do is get your cat to the vet and rule out FLUTD.

Some other symptoms that occur with FLUTD are:

  • Straining in the litter box
  • Running back and forth to the litter box trying to pee while producing little to no urine
  • Blood in the urine
  • Crying out while peeing
  • Frequently licking at the genitals, especially after attempting to use the litter box (this isn’t just a casual clean-up lick; it can go on for quite some time and sometimes seems almost obsessive)

A cat having trouble peeing could be a life-and-death emergency

If your cat’s urethra gets plugged by urinary stones or crystals, music, or even stress-induced muscle spasms, that means the pee (with all the waste filtered out of your cat’s blood) can’t leave the body. This can allow toxins to build up and make your cat miserable. This condition is called urethral obstruction.

But that’s not the worst of it: if you don’t get your cat to a vet right away and get him unblocked, he could die within hours. And it’s a really horrible death: the pain grows and grows until your cat may even cry out, the bladder gets bigger and bigger until it ruptures and dumps pee into your cat’s abdomen. The bladder rupture could also rupture blood vessels, so your cat could bleed to death.

I don’t know about you, but I wouldn’t wish this fate on my worst enemy, and certainly not on a cat I love with all my heart! So I’ll say it once again: If your cat is having trouble peeing, the first thing you need to do is take them to the vet to rule out disease or urethral obstruction.

Male cats are at higher risk of urethral obstruction because their urethras are longer and narrower than those of female cats.

A black cat sitting on a sisal rug, basking in a sun puddle.

Sinéad developed feline interstitial cystitis while we were living on the farm way back when. It was a very stressful time for all of us. Photo by JaneA Kelley

Tests your vet will run if your cat is having trouble peeing

So, you bring your cat to the vet because you saw her running back and forth to the litter box all morning and only a tiny bit of pee came out, and she’s been licking herself like crazy. Aside from a physical examination, what will your vet need to do in order to determine the cause of your cat’s FLUTD symptoms?

  • Urinalysis: Your vet will stick a tiny needle into your cat’s bladder and pull out some urine. They’ll test its pH (acidity or alkalinity) and look at it under a microscope to check for bacteria, stones, or crystals. I know a lot of us are on a budget–myself included–and sometimes we can’t afford to do every single test, but you absolutely must consent to a urinalysis. There is no way your vet will be able to determine why your cat has FLUTD without doing this test.
  • Blood work: Your vet might take a blood sample and analyze the levels of various chemicals and enzymes in your cat’s blood, and how healthy your cat’s levels of various blood cells are. This information would help your vet see if your cat has a systemic infection, and it would also rule out conditions like diabetes and kidney disease.
  • X-rays: If your cat’s urinalysis reveals stones or crystals, your vet might take an X-ray to see if there are stones in your cat’s bladder. If there are, those stones need to be removed in order to prevent chronic pain and recurrent infections.
  • Abdominal ultrasound: This is another tool for your vet to be able to see inside your cat and look for stones, inflammation, lumps, or other issues.
  • Urine culture & sensitivity: To perform this test, your vet will send a sample of your cat’s urine to a lab, where they will take the bacteria out and find out which antibiotics will kill them. A culture & sensitivity is typically done for cats with UTIs whose infections don’t improve with standard antibiotics, and sometimes in older cats whose urine is very dilute.

Treatments for FLUTD

The treatment for FLUTD depends on what is causing the condition.

For bacterial infections, the standard treatment is antibiotic therapy. Fortunately, cat antibiotics are pretty cheap, so you’re not going to go broke buying them.

For stones or crystals, the treatment is surgery to remove the stones and sediment from the bladder. After that nasty muck is removed, your vet may place your cat on a special diet to prevent crystals. Opinions about prescription diets are many and varied, but I recommend you talk to your vet about your specific cat’s needs rather than consulting Doctor Google on what your cat should eat. The reason I never make specific recommendations about diets is that I will never know your cat as well as you and your vet do…. and frankly, I’m not qualified to tell you what specific food your cat should eat.

For FIC, the treatment generally involves pain relievers, muscle relaxers, reducing environmental stress, and sometimes a prescription diet. Pheromone diffusers, strategically located cat trees, puzzle toys, and free-flowing water, for example, can help reduce stress. If all else fails, your vet may prescribe an anti-anxiety medication (for your cat, not you).

If your cat has a urethral obstruction, treatment will begin with inserting a catheter in your cat’s urethra to clear the blockage. Again, this treatment is not optional. Cats don’t unblock on their own. Surgery to remove stones and crystals will also be required.

Tips on preventing FLUTD

A small packet of Churu chicken cat treats

Bella and Tara go crazy for Churu treats, and they’re great for hydration! There are many other brands of “treats in a tube,” of course, so take your pick.

There’s no magic bullet that will keep your cat’s urinary tract troubles from ever happening again, but there are many things you can do to dramatically reduce the risk of recurrence.

  • Keep your cat at a healthy weight: As I mentioned at the beginning of this post, obesity is a risk factor for FLUTD, so make sure your cat stays fit and trim.
  • Keep your cat active: Daily exercise will not only help your cat keep her weight under control, but the activity will release feel-good hormones that will reduce your cat’s stress level.
  • Get your litter box situation sorted out: You should have at least one litter box per cat, and most cat experts recommend one box per cat plus one extra. If your home has more than one floor, there should be a box on each floor. Old cats should have litter boxes near their favorite resting places. Make sure your litter boxes are kept clean and that they’re located in safe, quiet places.
  • Keep your cat hydrated: Dehydration is a major risk factor for FLUTD. Cats have a very low “thirst drive”–that is, the signal that tells them they need to drink water doesn’t happen until they’re pretty dehydrated. Some ways to do this are to switch your cat from kibble to canned food (or at least increase the proportion of canned food to kibble), have pet drinking fountains strategically placed in your home, give “treats in a tube” like Churus on a regular basis.
  • Maybe skip the tuna: Back when Sinéad had FIC, my vet told me that I should stop feeding her tuna–well, seafood in general, but tuna in particular. I haven’t been able to find any research showing how and why tuna is specifically connected to FLUTD, so this is a conversation to have with your vet. Also, tuna, being at the top of the food chain, has high levels of mercury, so both humans and cats should avoid it!

The last word

Feline lower urinary tract disease is the most common reason cats have trouble peeing. Knowing the cause of your cat’s FLUTD symptoms–stones, infection, feline interstitial cystitis, or (very rarely) cancer–is critical for treatment and prevention. Treatment, especially for an emergency like a urethral obstruction, can be very expensive, so it’s better avoided. Your vet wants your cat to be well as much as you do, so if you’re on a budget when you take your cat in, please let your vet know. It’s nothing to be ashamed of.

Since my unemployment began last July, I’ve had to have the conversation with my vet about “this is my budget, and I can’t afford to do all of the things. But I want to do right by my cat, so if what’s needed to make my cat well or make sure she’s OK is more than I have, let me know and I’ll figure it out.” So yeah, I don’t have my shit all together, either!