CYSTITIS AND LOWER URINARY TRACT DISEASE

What is cystitis?

Cystitis is a general term referring to inflammation in the urinary bladder.  The term cystitis does not imply a specific underlying cause.

In cats, diseases of the lower urinary tract (the bladder and urethra) are grouped under the term 'feline lower urinary tract disease' (FLUTD) or FUS as it can be difficult sometimes to distinguish between diseases of the bladder and urethra, and many diseases will affect both structures.

What are the signs of FUS?

Typical signs in cats with FUS are those of inflammation and irritation of the lower urinary tract.  The common signs are therefore:-

*     Increased frequency and urgency of urination.

*   Difficulty in urinating (spending a long time straining on the litter tray while passing only small quantities of urine).

*   The presence of blood in the urine or blood spots in the litter tray.

*   Occasionally complete obstruction to the passage of urine (straining persistently without producing any urine).

With the latter sign particularly (straining without the passage of any urine), it is important to seek urgent veterinary attention as complete blockage to the flow of urine can be a life-threatening complication if left untreated.

What causes FUS?

There are a vast number of potential causes of FUS, but in many cats there may be severe inflammation of the bladder and/or urethra without an identifiable underlying cause (so called 'idiopathic' FUS).  These idiopathic cases have to be differentiated from other potential causes of the clinical signs though so that appropriate treatment can be given.  Some of the potential causes of FUS are listed below:

Idiopathic (inflammation for no known cause) - probably 95% of cases

Urinary calculi ('bladder stones')

Bacterial infections

Neoplasia (tumour)

Anatomical abnormalities

Idiopathic FUS should be considered to be a chemical burn of the bladder. To understand this you have to remember that cats are desert animals and conserve water by putting out very concentrated urine. If this urine sits in the bladder too long it irritates it and this causes inflammation which causes debris to come away from the lining of the bladder. This is really annoying for female cats because it hurts and they feel like they have to pee all the time. However, for male cats it is potentially fatal because this debris along will cells and small crystals will form a blockage in their much smaller urethra. Not being able to pee is fatal.

What are the risk factors?

           Rainfall in the last month

                  Obesity

                  Laziness  

                  Eating dry food  

                  Infrequent urination

                  Boring diet

How is it diagnosed? 

The initial diagnosis of FUS is based on the identification of signs of lower urinary tract inflammation.  The clinical signs displayed by the cat are often characteristic of FUS, but where there is doubt, analysis of a urine sample will confirm the presence of inflammation or blood.

Initially, a cat with uncomplicated FUS may be treated symptomatically by a veterinary surgeon (for example with a short course of tablets).  However, if the signs do not respond to this treatment, or if there is recurrence of the clinical signs further investigation may be required to identify the underlying cause of the FUS.

A blocked male cat presents as an emergency. They need immediate unblocking and catheterisation. Generally they stay in hospital on a drip for a number of days and recurrence is not uncommon. Occasionally we need to operate and do what is called a perineal urethrostomy.

What further investigations are required to diagnose the cause of FUS?

Where clinical signs are persistent or recurrent, a number of investigations may be required to differentiate idiopathic FUS from the other known causes of urinary tract inflammation.

These investigations may include:

Laboratory analysis of a urine sample

     Bacterial culture of a urine sample

   Blood samples to look for other evidence of urinary tract disease or other systemic disease

Radiographs (x-rays) and/or ultrasound examination of the bladder and urethra

The information from these investigations should help to identify a specific treatable underlying cause if one is present.

What is the treatment for FUS?

This depends on the underlying cause.  For example:

·    Cases of idiopathic disease may respond to treatment with anti-inflammatory or analgesic ('pain-relieving') drugs, but it is crucial that you only use drugs specifically prescribed by your veterinary surgeon, as many human products are extremely dangerous to use in cats.

·    Bacterial infections of the lower urinary tract, although uncommon in cats, will usually respond well to antibiotic therapy.

·    If a cat develops a blocked urethra (this almost exclusively occurs in males), emergency treatment is required to remove the blockage, which may require flushing of the urethra while the cat is given a short anaesthetic.

·    If bladder stones (calculi) are present they may have to be removed surgically or, depending on their type, they may be able to be dissolved by using a special diet, or dietary additive

There is no universal treatment for FUS.  Each case has to be investigated to determine the underlying cause, and then the treatment has to be tailored to the individual cat.  Sometimes despite appropriate investigation and treatment, clinical signs may still recur, requiring further therapy.

How can FUS be prevented?

It is impossible to completely prevent diseases of the lower urinary tract occurring.  However, FUS is more common in cats that have a lower water consumption, and in cats that are inactive and obese.  All these factors may relate, at least in part, to the frequency with which a cat urinates.  Avoidance of obesity and encouraging exercise may be of some help in preventing FUS, and as cats tend to drink very little, the feeding of at least some tinned food rather than exclusively a dry cat food product will help to maintain a higher water intake.  Some cats get FUS whenever they eat dry cat food.

If a cat develops urinary calculi (stones), the feeding of special diets (available from veterinary surgeons) may help to prevent recurrence of stone formation.