FLUTD/FUS

Author: Vick

Copyright © 1999-2005

Disclaimer: the information provided below is not intended to replace or override the advice of your veterinarian. Both the author and the site owner assume that this information will be used to work with your vet in planning the best treatment plan for your cat

What are the symptoms?
What is FLUTD?
What should I expect at the vet?
Does my cat need a special diet?
Is there anything I can do that will help prevent later attacks?

What are the symptoms?
urinating outside the litter box
frequent trips to the litter box with little or no urine passed
blood in the urine
crying in the litter box
frequent licking in the genital area
anorexia (not eating)
vomiting
hiding

Note: not all of the symptoms need be present for your cat to be in trouble. If you notice any of these symptoms or are concerned your cat may be having difficulty urinating call your vet immediately! If he or she has a urinary blockage, they can die within hours.

What is FLUTD?
The term Feline Lower Urinary Tract Disease is used to describe a host of problems associated with a cat's lower urinary tract: inflammation of the bladder and/or urethra; the formation of crystals and tiny stones in the urine; and the partial or total obstruction of the urethra. FLUTD may also be called Feline Urologic Syndrome (FUS), Lower Urinary Tract Disease (LUTD) or Cystitis.

Cystitis is specifically an inflammation of the bladder. This may be a result of a bacterial infection or from crystals irritating the bladder wall. As in humans, cystitis generally results in frequent, scanty urination and blood in the urine. Left untreated, a bacterial infection could progress to the kidneys. Your allopathic vet will probably prescribe antibiotics. However, according to the veterinary text The Cat: Diseases and Clinical Management, most unobstructed cases will resolve themselves within 5 days regardless of the treatment used. I usually take the antibiotics but don't use them unless a few days of cranberry pills (which prevent bacteria from adhering to the bladder wall) fail to provide my cat some relief.

Urolithiasis is the formation of stones in the bladder. Uroliths are hardened solids composed of many crystals. The two major types of crystals are:
struvite crystals which form in a urine that is too basic
calcium oxalate crystals which form when the urine is too acidic

The Merck Veterinary Manual says crystals "are not produced unless:
1) sufficiently high urine concentrations of (crystal) -forming constituents exist,
2) prolonged crystal transit time w/in the urinary tract occurs and
3) favorable pH (for formation) exists.

These criteria can be affected by UTI, diet, intestinal absorption, urine volume, frequency of urination and genetics." Urethral obstruction occurs when the crystals in the bladder combine with an organic matrix to form a paste-like plug that blocks the urethra. At this point, your vet will need to insert a catheter to clear the obstruction and allow the urine to pass. Do not delay medical treatment if you suspect your cat is in trouble.

What should I expect at the vet?
If they suspect a blockage, they will likely take your cat from the exam room to a back area where they can work better. This is really easier on the cat and them, so let them take him. Once in back, the vet will palpate your cat's bladder and try to manually express it - basically, she'll squeeze it gently to see if urine can pass through the urethra. If your cat is blocked and urine cannot pass through, they will sedate your cat in order to pass a catheter up his urethra into the bladder to clear the blockage.

A blockage generally means an overnight stay. They will use a couple stitches to keep the catheter in place, attach a bag to collect the urine and keep the cat under observation. At the clinic I worked at, we usually gave subcutaneous or IV fluids too. After the cat has had the catheter in for at least a day, the vet removes it and the cat is watched for a while longer to be sure he can urinate on his own. Your vet will test your cat's urine to determine what crystals led to the blockage, and then will select a diet appropriate for the type of crystals your cat has.
If the cat is not blocked, your vet will do a urinalysis. Some vets feel comfortable using a needle and syringe to collect the urine directly from the bladder (this technique is called cystocentesis), while others prefer to hold your cat for the day and wait for him to use an empty litter box. Either way, they really need the sample to help you help your cat. The urinalysis will tell them the pH, if there is any blood or bacteria present and how concentrated the urine is. In addition, they will examine any sediment in the urine to determine what type of crystals (if any) are present. Again, the vet will make diet recommendations based on the crystal type.

If your cat merely has a bladder inflammation, some vets will prescribe antibiotics to kill the bacteria that are causing the inflammation. Sometimes a vet will prescribe antibiotics even if no bacteria are found but they think the crystals will scratch the bladder and lead to infection. Still other vets will prescribe the antibiotics even if they can find nothing wrong. This has happened to my cat Sam several times. The vets have told me that even though they can't find the cause, the antibiotics always seem to help. I believe this occurs because of the phenomenon I mentioned earlier: unobstructed cases tend to resolve within 5 days regardless of the treatment used. So now I tell them I have antibiotics at home and save myself $20 if they can't find anything wrong with him :)

Does my cat need a special diet?
That depends.

If your cat had a bladder infection, diet probably isn't to blame. But if he had crystals or a blockage, look long and hard at what you're feeding. In either of the latter two cases, your vet probably sent you home with either a prescription food or recipes for a special diet anyways.
If you are free-feeding your cat a dry food, sometimes simply switching to feeding 1 or 2 meals a day of at least a high quality canned food will eliminate the problem. Better still, a switch to a raw diet cures many chronic crystal producers. But not all of 'em. Of course, my Sam is one of the exceptions (he exists to torture me:). I've tweaked his diet with the help of a holistic vet and tried herbs, homeopathy and vitamins to get his problem resolved, and none have afforded us a permanent solution. I recently purchased a urinary acidifier in the hope that will do the trick. We'll see.

The more water you get into the cat, the better, as it will help dilute the urine and decrease the concentration of crystal components in the urine. Add a little filtered water (not tap water) to your cat's canned, cooked or raw food. Your cat's bladder is about the size of a walnut when empty, so just getting a couple extra tablespoons of water in your cat will help. If your cat is amenable to it, you can use a syringe to administer extra water. I give Sam 5 cc's (5 mL or one teaspoon) at a time, several times a day. I also add extra water to his food, and sometimes do sneaky things like strain the liquid from tuna in spring water and add lots more spring water to spread it out, then pour a tablespoon or so on his food. Or add lots of extra water to a meat baby food and use that as 'gravy'.

I think the most helpful diet related thing you can do is stop leaving out food all day and stop feeding dry food. Feed your cat two meals a day, and clean up all traces of food after 1/2 hour of serving him. When cats smell food all day, their bodies react by becoming more alkaline, and their urine is affected as well. By leaving food available, you may actually be helping create the crystals that are causing you (and him) so much distress.

If you'd really like to make your own food, and don't have a holistic vet to work with, check the various food and supplement recommendations below, then look through our Kitty Kitchen to decide which appeal to you and talk to the people on the Holisticat mailing list to see what's working for them. It's weird, but from what I've seen, one thing that works for one cat may not work for another, so ya gotta talk to people and see what's been tried.

Is there anything I can do that will help prevent later attacks?
Vitamins A, C and E are very helpful. Pitcairn recommends the following for one month after an episode:
250 mg of Vit C twice daily.
Vitamin E -- add an extra 25 to 50 IU daily to your cat's food.
Vitamin A -- 4 drops of cod liver oil to the food once a day or 10,000 IU A once a week.

For sub acute cases where the cat is uncomfortable but not obstructed:

Pulsatilla 30C: This remedy is useful for the cat that does not like heat in any form. Here is how you can tell. Put out a hot water bottle or heating pad wrapped with a towel. If your cat is not interested in huddling next to it and prefers to lie on something cool like cement, tile, linoleum or even the bathtub or sink, then you will know it prefers coolness to heat. Usually the urine is passed in small amounts and contains blood.

Rhus tox 30C: This remedy is indicated for the cat who likes to sit around on cold cement, stones or steps when it is well. But then it may get chilled and have an attack of cystitis. So the problem often crops up after cold, wet, rainy weather. When sick, this cat will prefer to be warm, will like a hot water bottle and wants to be touched or rubbed. However, a cat with this problem does not rest quietly, but constantly changes position or stretches its limbs. Its urine will be dark and scanty and may contain blood. Urination is difficult and painful.

Sepia 30C: This medicine is indicated for the cat that has recurrent attacks associated with an attitude of "touch me or not". These cats are often unfriendly fellows, with a tendency to be aggressive to other cats and to be difficult to handle or medicate. Getting pills down them is almost impossible. There are also appetite problems -- rejecting many foods and being very finicky. Many of the cats needing this remedy will continue to produce a lot of crystals that are found in the urine.

Mercurius vivus (or solubilis) 30C: The cat needing this remedy will act very annoyed with his rear end, doing a lot of licking after urinating, thrashing the tail around and straining to produce small quantities of urine. Sometimes the straining is associated with passing stool. If the cat also has become unusually thirsty before the attack, this is probably the remedy to use.
** Give every 4 hours for a total of 3 treatments, then wait for 24 hours. If there is no improvement, reassess the situation. **

For chronic cases try shave grass, (a.k.a. horsetail) for two to three weeks. Bring one cup of water to a boil. Pour it over one rounded teaspoon of dried herb or one tablespoon of fresh herb. Cover and steep for 15 minutes. Strain. Give this twice a day

Anitra Frazier looks more to vitamin and nutritional support. She recommends that at the first sign of a urinary problem, withhold all solid food and give your cat 500 mgs of Vitamin C, 100 IU Vitamin E and a teaspoon of chicken broth. For the rest of the acute phase and during convalescence, she bolsters her veterinarian's treatment plan with the following:
A High Calcium Chicken Broth fast. Give 3 - 4 times a day for two days, and mix 1/16 tsp (250 mgs) ascorbic acid crystals into each serving of broth

If your cat is on antibiotics, add 1/2 tsp of liquid acidophilous suspended in water to food throughout treatment and continue for 2 weeks after antibiotics are finished.
Eliminate all stress in the cat's environment and provide it a warm, safe place to convalesce
Feed a high quality diet with as much raw food as possible. Use chicken as the protein source; carrots, green beans or zucchini as the vegetable; high calcium chicken broth as the liquid.
Eliminate yeast from the Vita Mineral Mix.... instead give around 10 mg of a low potency B complex pill twice daily and 1 teaspoon of the yeast free MIx twice daily with the cat's meal.
Eliminate all organ meats (liver, kidney and the like) from the diet.

Add instead 1 raw, organic egg yolk each day; 100 units Vit E each day for a month, then 400 units a week; 1/4 tsp cod liver oil to each meal or a capsule containing 10,000 units Vit A and 400 units Vit D once a week

Once the cat has recovered:
Never again feed dry food or fish
only give organ meats occasionally
go back to the original Vita Mineral mix a month after the episode is over
feed only two meals a day, and clean up all crumbs and dishes after a half hour
continue to add organic egg yolk 3 times a week; 400 units Vit E a week; 1/4 tsp cod liver oil to each meal or a capsule containing 10,000 units Vit A and 400 units Vit D once a week; 1/16 tsp or 250 mgs Vit C to each meal
continue to keep the litter box very clean

Dr William Winter suggests increasing water intake (of distilled, spring or mineral water) by adding high water content foods, adding water to food and regular fasting on water, broth, bouillon or juice. He also suggests adding Sea Salt to the diet to encourage water consumption.
In addition, he recommends you try to acidify the urine by offering tomato or cranberry juice; giving 1,000 mgs of Vit C 1 - 2 times a day; offering a few drops of apple cider vinegar; or by use of a commercial acidifier. You also want to make it as easy and pleasant as possible for your cat to urinate. This can be accomplished by having multiple litter boxes that you clean fastidiously. Also be sure the litter is one your cat likes and you do not feed him anywhere near the box.

For cystitis, Dr. Winter suggests the following
Homeopathic Therapy:
Urtica Urens -- for straining
Rhus tox -- if caught very early
Apis -- for frequent, involuntary urination; scanty and highly colored
Cantharis -- for intolerable urging, constant desire to urinate or great pain, urine may be bloody and w/ matter
Nux Vomica -- if Cantharis does not afford relief
Aconitum -- every 2-3 hours for feverish symptoms, frequent ineffectual and painful attempts to urinate, pain from pressure in region of bladder, scanty urine, turbid and bloody urine
Thalapsi Bursa -- every half hour for blocked urethra
Herbs:
Couch Grass Root -- steep 2 oz in 3/4 pint of boiling water. Add 1 tablespoon to food twice daily
Bladder infection formula -- Nettles, Goldenseal, 2 part Buchu and Flax seed. Mix and give 1/3 teaspoon twice daily.
Birch leaves -- make a tea and add 1 teaspoon to food twice daily
Nettles -- specific for urinary bleeding (also as a tea)
Supplements
Vitamin C (500- 1,000 mgs a day)
Sea Salt (1/8 tsp a day)
V-5 enzymes (Ness V-5) -- high dosage for 1 month, then a maintenance dose of Prozyme for life (the V-5 he has dosed at 1/2 tsp a day for all dogs and cats, so I'm not sure what he means by "high". For Prozyme, he lists 1/4 teaspoon per cup of food)
Some totally resistant cases may require systemic antibiotics

Feline Asthma

by Susan Little DVM, Diplomate ABVP (Feline)
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Feline asthma has been called by many other names, including chronic bronchitis, bronchial asthma, and allergic bronchitis. Regardless of the name, it is a common feline ailment. Inhaled allergens cause sudden contraction of the smooth muscles around airways, leading to typical clinical symptoms. It is usually impossible to determine which allergens cause asthma in individual cats, but common ones include grass and tree pollens, cigarette or fireplace smoke, various sprays (hair sprays, deodorants, flea sprays, deodorizers), and dust from cat litter.

Feline asthma is found in all areas of the world and in cats of all ages. The prevalence in the general adult cat population is about 1%. The most common symptoms in cats with asthma are wheezing and coughing. The coughing has been described as a dry, hacking cough that could be confused with gagging or retching. Many cats are misdiagnosed as having hairballs! Paroxysms of coughing occur frequently. In mildly affected cats, coughing and wheezing may occur only occasionally. A few cats with asthma are asymptomatic in between acute and severe bouts of airway constriction. The most severely affected cats have daily coughing and wheezing and many bouts of airway constriction, leading to open-mouth breathing and panting that can be life threatening.

The symptoms of asthma can mimic other diseases, such as heartworm, pneumonia and congestive heart failure. A diagnosis is reached by using chest x-rays, a complete blood count, a feline heartworm test, and a techniques to sample cells from the lower airways (transtracheal wash, bronchial wash, or bronchoalveolar lavage). Chest x-rays may be normal in some cats with asthma, while others will have signs of bronchial inflammation, collapse of the right middle lung lobe, and over inflation of the lungs.

Unfortunately, feline asthma is a chronic progressive disease that cannot be fully cured. Medications can reduce the symptoms of asthma a great deal, but may not be able to eliminate coughing fully. In recent years, veterinarians have found that the most effective therapy for feline asthma may be to use inhalers such as human asthmatics use. A mask and spacer system, called AeroKat®, has been invented to enable cats to use inhalers or puffers. This system is similar to the mask and spacer system used to treat babies and small children.

The most important type of drug for treating feline asthma is a corticosteroid to reduce the chronic inflammation. The most commonly prescribed corticosteroid inhaler is Flovent®. Some feline patients also benefit from another type of medication called a bronchodilator. Bronchodilators help open the airway at times of severe coughing or wheezing. One common bronchodilator inhaler used for humans and cats is Apo-Salvent®.

Some feline asthmatics may be given oral medication. This may be necessary if the patient does not respond well to inhaler therapy alone, but the amount of oral medication given is usually less than if the cat was not on inhaler therapy at all. Many patients that started asthma therapy a few years or more ago will be only on oral therapy, usually a corticosteroid such as prednisone. While oral therapy may be less expensive than inhaler therapy, it is suspected that inhaler therapy can do a better job and is associated with fewer long-term side effects. Regardless of the type of medication used, it is important to notify your veterinarian if there is any change in your cat's condition while on asthma medication.

Some actions can be taken in the home to reduce the symptoms of feline asthma. Avoiding smoke from fireplaces and cigarettes is very important. This type of smoke tends to settle near the floor in a room at the cat's breathing level. Reducing the use of air fresheners and other household sprays can also be effective. Use human grooming products that are in spray form, such as hair sprays or deodorants, well away from the affected cat. Change to a low-dust clay cat litter or one that is made of an alternate material. Air purifiers may also be helpful. Any activity that is associated with symptoms of asthma in the individual cat, such as going outside in cold weather, should be avoided. Finally, obese cats will benefit from weight reduction.

Bladder Stones in Cats

Bladder disease in the cat is a frequently recognized problem. It can occur in both male and females, but can be more serious of a problem in the male cat. Causes of bladder disease include simple bacterial infection, bladder stones and or crystals (minerals which merge to form bladder stones), infection within the bladder wall, and cancer or tumors in the bladder itself.

In the majority of cases, infection by itself, or accompanied by bladder crystals is seen. If crystals are present, they usually cause irritation and infection in the bladder before merging into forming bladder stones.

Common symptoms include straining to urinate, frequent attempts to urinate, spending a long time in the litter pan, producing small amounts of urine at a time, urinating outside of the litter pan, and blood in the urine.

Because male cats have a narrower urethra (tube leading from the bladder to outside the body) than female cats, bladder crystals in the male cat can often times obstruct the flow of urine by clogging or blocking the urethra . Blockage of urine flow is considered a medical emergency.

If allowed to continue, this blockage of urine flow backs up toxins in the cat's blood stream normally cleared by the urine. This accumulation of toxins can lead to a lack of appetite, vomiting, severe weakness, abnormalities with the heart rhythm, and ultimately death.

Treatment in the case of urine blockage, is aimed at restoring the flow of urine. A catheter inserted in the urethra acts to "break through" the blockade of crystals, thus allowing for evacuation of the urine. Most cats affected with crystals or stones usually have accompanying infection requiring antibiotics.

Not all cats develop crystals in the bladder. Affected cats may have a genetic cause behind the crystal development. These cats require special diets and or medications to eliminate their bladder crystals, and prevent them from recurring.

In some cases of urinary blockage in the male cat, surgery is required to allow them to urinate freely again. The surgery acts to widen the urethra, allowing for crystals to pass rather than to clog the urethra. Usually the cats requiring surgery, have not responded to the urinary catheter treatment, and continue to re-blocked after removal of the catheter. Surgery is aimed at reducing the chance of urine blockage but does not alter the development of bladder crystals. These cats will still require appropriate diets and medications to prevent crystal formation.


Female cats rarely block, unless stone formation has occurred. In which case, the stones are wide enough to clog the urethra, blocking the flow of urine. Surgical removal of the stones is usually required.

Persistent infection in which there are no crystals or stones, may have bacteria lodged within the bladder wall. This is called interstitial cystitis, and can be difficult to cure. Antibiotics often times are unable to penetrate the bladder wall to get at the bacteria. Medical and surgical procedures are performed to reduce the amount of tissue along the wall of the bladder that the bacteria have to "hide" in. This then allows the antibiotics a chance to affect the bacteria and cure the condition.

More info can be found at www.vet4petz.com