The Non-Obstructed Cat
Urinary Blockage
The Non- Obstructed Cat
Interstitial Cystitis

THE  NON-OBSTRUCTED CAT WITH FLUTD

Now that you know what the syndrome is and what its possible causes are, the next step is a treatment approach.  The following information is referable to the following groups of cats:blocked cat

GROUP ONE: Young cats, either male or female, without current urinary obstruction. We know statistically that at least half of these cats will not have a definable cause for this syndrome, thus testing is often held to a minimum, especially on the first episode of the syndrome.  For these cats, it is reasonable to proceed to treatment perhaps armed with only urinalysis results as a guide.  This informational web site is for them.

GROUP TWO: Cats of any age, either male or female, without current urinary obstruction who have had thorough medical  work-ups and yet no cause for the syndrome has been found. No bladder stones are evident on radiographs. No bacterial growth has been revealed when the urine has been cultured. No bladder structural abnormalities have been found with ultrasound, contrast radiography or any other special imaging technique. This informational web site is for them.

GROUP THREE: Cats recovering froma urinary blockage who need a protocol to prevent  future urinary blockages. This site is for them, too.

TREATMENT GOALS: PREVENTION OF FUTURE EPISODES OF THE FLUTD SYNDROME, RESOLUTION OF A CURRENT EPISODE OF THE SYNDROME, AND PREVENTION OF URINARY BLOCKAGE.

HOW DO WE ACCOMPLISH THIS WITHOUT KNOWING THE CAUSE OF THE SYNDROME?

IF YOUR CAT HAS CONFIRMED STRUVITE CRYSTALS:

We used to believe struvite crystals in the urinary bladder were the primary cause of this syndrome. We thought the crystals were irritatin and led to increased mucus production in the urinary lining and that clumps of crystal and mucus caused obstruction in male cats.  This belief led to mass reformulation of commercial cat foods in the 1980’s and 1990’s so that commercial cat foods no longer promote the alkaline urine associated with struvite formation. As a result, the incidence of FLUTD dropped dramatically.

But now that most cat foods have been reformulated, how should the finding of struvite crystals be interpreted?

  • We know that FLUTD cats have struvite crystals in their urine as often as normal cats do.
  • We know about half of cats with FLUTD have no crystals in their urine whatsoever.
  • We know that struvite crystals are a major portion of urethral plugs removed from obstructed cats.

SO: The current feeling is that steps should be taken to reduce or eliminate struvite crystals in an FLUTD cat’s urine, at least in the male cat. It appears that the resolution of the crystals in a cat with an FLUTD episode corresponds to the resolution of the episode, thus while the true significance of the crystals remains unclear, the general feeling is that steps should be taken to eliminate them. It is crucial to realize though that diet may not be a significant cause of these crystals in a cat eating a reputable brand of commercial cat food and other prevention methods should be employed.

TREATMENT PLANS COMMONLY USED

INCREASE WATER CONSUMPTION:  Research has shown that cats who eat primarily canned food have a reduced incidence of blocking.  Ironically, this recommendation is consistent with the old “feed low ash foods” recommendation of the late 1970’s. While the “ash” theory of FLUTD has been long abandoned, the increased water consumption that goes with eating canned food keeps crystals dissolved.  Water consumption may be further increased by periodically refilling the water bowl, thus calling the cat’s attention to the water bowl. Adding broth to the food may also help. Feeding in meals rather than leaving food out all the time, also helps maintain an acid pH as everytime food is ingested, an alkaline tide hits the bladder.  Sticking to one food rather than changing flavors or brands has also been found to be helpful.

REDUCE STRESS: Stress is felt to be a significant cause of this syndrome. Cats frequently break with this syndrome after a move, the addition of another cat or, in our area, after an earthquake. It has been documented that even the stress of transport to the vet’s office can influence urinary pH and thus potentially lead to the formation of struvite crystals that are normally not present. This information makes it difficult to interpret the finding of struvite crystals in a cat’s urine sample.  Still, a stressed cat will alter its respiratory pattern in such a way that will alter blood pH and thus urinary pH.  Anti-anxiety medication such as amitriptylline has been advocated and found successful for cats with recurrent FLUTD. It is hard to determine the how amitriptylline might be working since it also has anti-inflammatory properties but its use has helped many cases.

ANTI-SPASMODICS AND TRANQUILIZERS: During the recovery period after an episode of blockage these medications are commonly used. They help the painful urethral spasms that occur with the inflammation associated with the episode.  They also help the urethra dilate so that urine can pass.

ANTIBIOTICS: While true infection is not typically involved in FLUTD in younger cats, antibiotics are still commonly prescribed. There is controversy about antibiotic  use since research seems to indicate that antibiotics may not alter the course of a typical  FLUTD episode. In older cats, infection is a common cause of FLUTD if a urinary catheter has been placed. Antibiotics may help prevent new infections

URINE ACIDIFIERS: These are not used as  commonly as in the past since foods have been reformulated. The idea behind them is to assist in the dissolution of struvite crystals. They are still prescribed in some cases, but the approach is somewhat controversial given that most diets have been acidified already.

PREDNISONE/STEROID ANTI-INFLAMMATORIES:  These medications are anti-inflammatory and may help with the swelling and pain but they can also promote infections in catheterized patients. These medications are probably not best used in patients who have received urinary catheters.  Research suggests that they do  not alter the course of the episode; however,  many feel they help with the pain.

ELMIRON/ADEQUAN:   These medications increase mucous lubrication in the bladder At first developed to increase lubrication within arthritic joints,  one theory of this disease is that the mucus lining of the bladder becomes disrupted in some cats, leading to an inflammatory reaction within the bladder wall and the consequences are the FLUTD syndrome.  These medications may restore the mucus lining.

A diagnosis is not usually found for most cats with FLUTD. When a diagnosis is not found, veterinarians must use treatment plans that seem to have worked in the past or which seem to be consistent with current disease theory. This approach is called “Empirical Therapy” and does not always work. As newer information is revealed, treatment protocols will be revised. FLUTD is an especially dynamic area of research today and new information and fresh theory can certainly be expected in the next few years.