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The Granby Animal Clinic, Inc. FELINE CYSTITIS
The term "cystitis" literally means inflammation of the urinary bladder. Cystitis is very common in cats and is associated with significant pain and discomfort and in cases causing urinary obstruction it can be life-threatening. Unfortunately clinical signs alone are not enough to distinguish the different causes of cystitis.
The causes of cystitis vary not only from cat to cat, but can also from one occurrence to another. Although bacterial infections are the most common cause of cystitis in dogs and humans, most cats with cystitis do not have a bacteria infection. Stress plays an important role in many cases of feline cystitis. In addition to hematuria (blood in the urine) some cats will also have crystals or stones. Other cats may have polyps and occasionally tumors.
Most cats with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort can range from mild to severe. As a result of the discomfort, cats will urinate more frequently and often will urinate outside of their litter boxes. Cats with cystitis will often urinate on hard surfaces such as tile floors, countertops, sinks, and bathtubs. They should not be punished for doing so. Monitoring the litter box for smaller and more numerous urine balls can help you identify an early case of cystitis.
If mucus, crystals or stones are present, the urethra (the narrow tube carrying urine out of the body) can become obstructed. Urethral obstruction occurs more commonly in male cats due to their narrow urethra. If the obstruction is not relieved within 24-48 hours, most cats will die from kidney failure and the retention of toxins that were not removed by the kidneys. Signs of urethral obstruction are straining to urinate with little or no urine output. Many cats will vocalize when attempting to urinate due to pain. In more advance cases, the cat will be extremely lethargic.
Treatment of the cystitis depends on what underlying causes are found. A urinalysis can identify crystals, bacteria or abnormal cells. In addition, x-rays and ultrasound can identify stones, polyps and tumors. Cultures identify bacterial infections and contrast studies help identify congenital abnormalities. If there is a stone, mass or congenital defect, surgery is often required to treat the problem. However, most cases of cystitis will respond to medical treatment. In cases where an underlying cause is not known, treatment is aimed at relieving discomfort and decreasing stress. Increasing the cat’s water intake by feeding a canned diet will also dilute out inflammatory compounds and make it harder for crystals to form.
In older cats or cats with diseases that put them at increased risk of a bacterial infection like kidney disease or diabetes or cats with recurrent cystitis, a urine culture should be performed and if positive, the cat should be treated with an appropriate antibiotic.
If the cat has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting anesthetic. The catheter is frequently left in place for about 24 hours. The cat is discharged from the hospital when it appears unlikely that obstruction will reoccur, usually one to two days later. If the cat is experiencing kidney failure and toxemia, intravenous fluids and additional hospitalization are often needed.
Most cats will show improvement in one to three days. Following initial treatment, it may be necessary for you to return your cat in 7-10 days for a recheck of its urine. This is very important because some cats will appear to feel much better, but the urine is still bloody or contains crystals. If medication is stopped based on how the cat appears to feel, treatment may be terminated prematurely and a relapse will probably occur.
Many cats have a recurrence of cystitis. Reducing stress and using a special diet can often decrease recurrences.
Although we do not believe that any type of commercial cat food causes cystitis, we know that certain things can be done to the diet to minimize a recurrence. However, dietary prevention depends upon what type of cystitis is present. Canned diets can benefit almost all cats with cystitis by helping to dilute the urine. If struvite crystals are present, they can be dissolved in acidic urine. Therefore, diets that cause urinary acidification are recommended for these cats. However, if your cat's crystals are not struvite, especially if they have calcium oxalate stones, acidification may actually make the problem worse. Therefore checking a urine to examine for crystals is very important. In some cases, a prescription diet is beneficial, especially if your cat will not eat a canned food.
The most common complication of urethral obstruction is bladder atony. Atony means that the muscles of the bladder wall are unable to contract to push out urine. This occurs when they are stretched to an extreme degree. Not all cats with obstructions develop atony; in fact, most do not. However, if this occurs, longer hospitalization is necessary. The muscles will nearly always rebound and become functional again, but this may take several days to as long as a week.
Another complication that occurs occasionally is kidney damage. Although feline cystitis does not directly affect the kidneys, if the bladder becomes extremely enlarged, urine may backup into the kidneys and create enough pressure to temporarily or permanently damage them. If this occurs, prolonged hospitalization will be necessary to treat the kidney damage. However, with aggressive treatment, most cats will have improved kidney function.
It should be noted that both complications, bladder atony and kidney damage, are the direct result of the bladder becoming extremely enlarged. Both problems may be prevented by prompt recognition of the problem and prompt medical care.
Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the obstruction. Although this prevents future obstructions, some of these cats will still need treatment for recurrent cystitis, but re-obstruction is unlikely. Perineal urethrostomies are only performed when medical management fails to prevent recurrent obstruction, if the urethral obstruction is so severe that normal urine flow cannot be reestablished or if there are permanent strictures that develop in the urethra secondary to repeat catherizations.
Surgically changing the cat's urethra makes him more prone to bacterial infections in the bladder and bladder stones. Periodic monitoring for urinary tract infections is recommended. The surgery generally offers a significant benefit for the cat that really needs it.
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