Feline Lower Urinary Tract Disease (FLUTD)

Feline Lower Urinary Tract Disease (FLUTD)

By Dr. Stephanie Brittin


  • Bloody urine
  • Straining to urinate
  • Urinating in unusual places
  • Urinary blockage
  • Licking the urinary opening


If we look at all cats with lower urinary tract symptoms, here is what we find:

  • 57% will not have a cause that can be determined despite extensive testing.
  • 22% will have bladder stones (females have a slightly higher incidence).
  • 10% will have a urethral plug.
  • 11% will have some other cause for the symptoms, such as:
    • A true urinary tract infection
    • Urinary tract cancer
    • Trauma to the urinary tract (hit by car, etc.)

Sorting out Causes

Testing is used to help sort through the many possible causes for urinary symptoms in an individual cat.  A urinalysis is commonly performed to look for evidence of infection, crystals, or other issues.  A urine culture may also be needed to confirm infection.  Radiographs (X-rays) to rule out bladder stones might also be performed.   In cases where a tumor is suspected, an abdominal ultrasound may also be beneficial.

There is a large percentage of cats for whom no clear underlying cause is found.   These cats are generally considered to have Feline Idiopathic Cystitis (FIC).

Feline Idiopathic Cystitis (FIC)

FIC is a chronic, sterile (meaning non-infectious), inflammatory condition of the urinary bladder resulting in symptoms related to the lower urinary tract as outlined above.  The term idiopathic means that we do not fully understand the underlying cause of FIC.  Although FIC is considered idiopathic, research has shown that the underlying cause is likely multifactorial resulting from complex interactions between the urinary bladder and urethra, nervous system, adrenal glands, and environmental stressors.

We know that cats that get this syndrome have a unique imbalance in the way their brain controls hormones.  In other words, these cats are unusually sensitive to environmental stress and, due to a complicated cascade of metabolic events, stress manifests in the urinary tract.   The urinary bladder loses its protective mucus layer and becomes inflamed and painful.  The nerves of the bladder wall become more sensitive, and a sense of urinary urgency results.  Straining and bleeding follow, and the classical urinary signs result.  In most (85%) cats, the episode is short (about a week) and resolves. Our goal is to keep the patient comfortable during the episode, prevent future episodes, and, if the cat is male, watch for progression to an actual urinary blockage.

FIC is typically episodic in nature and cats may present to the vet with an acute self-limiting episode or frequent recurrent episodes.   However, there is also a more persistent form where the clinical signs never resolve and in the worst cases can result in urethral obstruction which is a medical emergency.

For more information on FIC to to https://icatcare.org/advice/cat-health/feline-idiopathic-cystitis-fic


While medications are often used for acute episodes, more success has been achieved in preventing future episodes.   The goal of preventing future episodes is multimodal environmental modifications to alter the patient’s environment in a positive way in order to reduce stress and decrease the severity and frequency of FIC episodes.  Environmental enrichment, a stress management urinary diet, maintaining a healthy weight, and pheromones can all be part of successful management of FIC.

Environmental enrichment can include access to climbing structures, viewing and resting perches, elimination of punishment by owners, increased positive interaction with owner, scratching posts, and appropriate litterbox management.  Food-dispensing puzzle and toys can promote feline activity, which can help combat stress and obesity.   The Ohio State University Indoor Cat Initiative (https://indoorpet.osu.edu/cats) is a valuable resource that provides owners suggestions on environmental modification.

Dietary therapy can also be beneficial.  A diet high in antioxidants and omega 3 fatty acids, such as Hill’s C/D, is recommended to assist in breaking the inflammatory cycle.   Studies have shown an 89% reduction in FIC flare-ups in cats fed a diet of Hill’s C/D.   Hill’s C/D Urinary Stress takes this one step further by with the addition of L-tryptophan and hydrolyzed casein, which have been scientifically shown to reduce anxiety and stress in cats.  And for those overweight FIC kitties, Hill’s Metabolic + Urinary Stress is the ideal nutrition to help with weight loss and management of FIC.  You may also consider changing from a dry food to a canned food to help increase water consumption.  Adding extra water to dry food or adding extra water bowls or fountains can also encourage increased water consumption which will dilute the urine and make it less harmful to the damaged bladder wall.

Pheromones can also be used to help create a calming environment for cats.  Feliway (http://www.feliway.com/us/) is a synthetic pheromone that helps reduce stress-related behaviors by mimicking the calming feline facial pheromone cats produce naturally.

Recurrent urinary disease is painful, but can be significantly helped by feeding special diets and minimizing your cat’s stress.

Don’t Wait

Feline urinary issues are painful and in some cases with male cats, can be deadly.  Do not wait to be seen by a professional. Call us now.



Stephanie Brittin, DVM



Posted on

March 19, 2017

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