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) 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 FLUTD?
Typical signs in cats with FLUTD 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 is life-threatening if left untreated.
What causes FLUTD?
There are a vast number of potential causes of FLUTD, but in many cats there may be severe inflammation of the bladder and/or urethra without an identifiable underlying cause (so called ‘idiopathic' FLUTD). These idiopathic cases have to be differentiated from other potential causes of the clinical signs, however, so that appropriate treatment can be given. Some of the potential causes of FLUTD are listed below:
• Idiopathic (inflammation with no known cause) but possibly caused by stress
• Bacterial infections
• Urinary calculi (‘bladder stones’)
• Neoplasia (cancer)
• Anatomical abnormalities
• Urethral plugs (blockage of urethra with a mixture of crystals or small calculi/stones, mucus and inflammatory material)
How is FLUTD diagnosed?
The initial diagnosis of FLUTD is based on the identification of signs of lower urinary tract inflammation. The clinical signs displayed by the cat are often characteristic of FLUTD, but where there is doubt, analysis of a urine sample will confirm the presence of inflammation or blood.
Initially, a cat with uncomplicated FLUTD may be treated symptomatically. 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 FLUTD.
What further investigations are required to diagnose the cause of FLUTD?
Where clinical signs are persistent or recurrent, a number of investigations may be required to differentiate idiopathic FLUTD 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 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 FLUTD?
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. Dietary therapy and anti-depressant medications may also be very effective.
• 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. Most cats will need to stay in hospital for several days.
• 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 FLUTD. 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 FLUTD be prevented?
It is impossible to completely prevent diseases of the lower urinary tract occurring. However, several therapies may be beneficial in reducing the number of attacks of idiopathic FLUTD. These include special acidifying diets (only available at vet clinics), adding water to food or feeding canned food, anti-depressant medications and anti-inflammatory medications. Minimising stressful events is very important in some cases.
A perineal urethrostomy is recommended for cats that have recurrent blockages of their urethra. This involves surgically removing the penis and approximately 3cm of urethra leaving a large opening for urine to be excreted from.