Q: I have three male cats, and my 4 -year male cat, who is otherwise healthy and weighs 15 pounds, has difficulty urinating. I have chlorine water, so I have been using filtered water from the refrigerator, but he doesn’t like it, and I periodically find him in the bathroom sink or on a rug trying to piddle.
He has had this issue periodically since he grew into a big kitty, and although I haven’t seen him urinate recently, when he’s in the sink, it looks like he is struggling to get it out. It’s hard to tell, as I have two other cats, but the boxes are pretty full in the morning and evening.
I will get him to a veterinarian soon and try to watch him in the box, but is there anything else available that will help him that you can suggest?
A: Thanks for getting in touch, and I am very sorry to hear of your kitty’s urinary problem. Unfortunately, the issue you describe is not uncommon in cats, and in some cases these behaviors may be an indication of a potentially serious condition. While I cannot, of course, diagnose your cat from afar, your inquiry provides a great opportunity to briefly discuss feline lower urinary tract disease (FLUTD).
FLUTD comprises a range of disorders that affect the structure and/or function of the urinary bladder, which stores urine until it is voluntarily voided, and the urethra, a tubular structure that connects the urinary bladder to the external genitalia and provides a route through which urine can be voided from the urinary bladder.
There are several potential causes of FLUTD, including the formation of urinary stones (uroliths) and/or plugs composed of inflammatory and epithelial cells that can irritate and/or obstruct the lower urinary tract, infections of the urinary bladder and/or urethra, and a syndrome called feline idiopathic cystitis (FIC), which is characterized by inflammation of the urinary bladder due to as yet undetermined causes.
It is very important to stress that that any time you observe your cat experiencing difficulty upon and/or painful urination, prompt evaluation by a veterinarian is vital. Cats that show signs of difficult/painful urination, frequent licking of the genitalia, blood in the urine, increased urination frequency, and/or inappropriate urination (outside the litterbox) are at risk of experiencing obstruction of the lower urinary tract, which can become a potentially life-threatening emergency if not addressed promptly.
Ruling out urinary tract stones and bacterial infections of the lower urinary tract (urolithiasis) and assessing renal (kidney) status via physical examination, urinalysis, urine culture, abdominal radiography (X-rays), complete blood count, serum biochemistry, and sometimes abdominal ultrasound are important.
If uroliths are identified, it is important to determine their chemical composition, as some of these are dissolvable with appropriate diet, while others are not. In some cases, measures to remove these and/or lower urinary tract plugs from the urinary bladder and/or urethra (either via surgery or a technique called voiding urine hydropulsion) may be necessary.
Bacterial infections of the lower urinary tract are best treated with antibiotics, ideally guided by urine culture results.
Perhaps the most common cause of FLUTD is FIC, a condition for which we do not have any definitive diagnostic tests, but rather is diagnosed by ruling out all other causes of FLUTD. Evidence suggests that FIC does not only involve the urinary bladder, but also other body systems, most notably the sympathetic (i.e., “fight or flight”) arm of the nervous system, which can be activated during times of stress. We know that stress can increase the likelihood of FIC and that environmental modifications that decrease stress or a cat’s sense of being threatened can be beneficial for cats experiencing FIC. The fact that you have a multi-cat household makes me wonder whether inter-cat conflict may be increasing stress in this kitty, which may predispose him to FIC.
Finally, cats that are overweight are predisposed to FLUTD, so consideration for a weight-loss program may be reasonable if your cat falls into this category. Always discuss a weight-loss program with your veterinarian, because a cat who loses weight too quickly can develop hepatic lipidosis (fatty liver disease), which can be a serious and even life-threatening condition.
I hope this is helpful, and please discuss these topics with your veterinarian as soon as possible.
