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Urinary Problems in Cats
Lower urinary tract inflammation in cats and its treatment
Bladder unable to empty
Odor problem and chronic bladder problems
Fluoroscein dye in urine to locate spraying cat
Bacterial cystitis
Cystitis in Kitty
Urinary problems
Strong urine odor
Urinary problems and Baytril
Improper urination - medical or behavioral
Urinary Problem
Periodic urinary problems
Urinary Problems- incontinence possible
Blood in urine after antibiotic therapy
Inappropriate urination and hair pulling
Urine odor treatment
Perineal urethrostomy
Lower urinary tract disorders
Recurrent urinary tract disease
Urinary tract and bowel problems
Urinary Acidification and FUS
Trickling urine, licking behind
Picky litterpan behavior
Cystitis is likely
Interstitial Cystitis
Urinary acidifiersalso see Litterbox Behavior
also see FLUDT/FUS
also see Kidney Disease
Lower urinary tract inflammation in cats and its treatment
Question: One of my cats ("Bart") has blood in his urine and is going in and out of
the litter box all day (since 2/1).
My vet has tried Baytril, Clavamox, Dibenzyline, and Prednisone - nothing is
working.
Now we are trying Orbax in combination with Amitriptyline (just started -
but I am not optimistic.)
I should also add that 2 years ago he had the same thing and Baytril worked.
He was flushed yesterday with a catheter and there was lots of blood in his
urine. It is being sent for a culture and sensitivity analysis - should have the results in a week.
An Xray did not show any stones and my vet said he is not "blocked" - his bladder was empty.
Other info: He is about 3 years old, neutered and a feral cat that I have been socializing -
so not easy to pill. We just moved to Florida (1/21) from New Jersey and the UTI started a two
weeks later. He's had 2 courses of Baytril (one pill a day) for 14 days each time - crushed in beef baby
food. It seemed to work for the first 10 days - then he started back into the litterbox.
Three questions:
1) Is Baytril as effective if it is crushed and added in food or does it
have to be "pilled"?
2) I read that Orbax may cause crystals in urine. Is this drug good for UTI?
3) Do you have any suggestions as to what else I can to to help "Bart"?
Thank you!
AudreyQuestion: Audrey-
1) Baytril comes in a chewable tablet form (as well as pill form) so it seems unlikely that there is any problem with crushing the tablet and mixing it with food.
2) If enrofloxacin (Baytril Rx) didn't work it is really unlikely that orbafloxacin ( Orbax Rx) will work because they are closely related medications. Once in a while there are situations in which one of these medications will work when the other one didn't but that is not usually the case. I am under the impression that all of the fluoroquinolone antibiotics can cause crystal formation in the urine but I am not certain that is correct -- the only reports I know of for certain concern ciprofloxacin (Cipro Rx), which has been reported to cause crystal formation in the urine in humans in some circumstances such as when the patient is dehydrated. Enrofloxacin is metabolized to ciprofloxacin in the body and so it seems reasonable to assume that this effect might occur in pets, as well.
Whether any of the fluoroquinolones (ciprofloxacin, orbifloxacin, enrofloxacin, marbofloxacin and others ) are helpful when there are signs of lower urinary tract inflammation in cats primarily depends on whether there is actually a bacterial infection. It is estimated that less than 5% of male cats with signs of urinary tract discomfort and inflammation have bacterial infections. The rest have other problems.
3) The veterinary communities understanding of lower urinary tract inflammation in cats is still evolving. We do not have many definite answers for people. At the present time the folks who study urinary tract inflammation in cats seem to agree on some basic things but there are also a lot of questions about what these things mean ultimately for treating affected cats.
There is a feeling now that these are the most important preventative measures for lessening the frequency and duration of attacks of urinary tract inflammation in cats?
a) Limit stress as much as possible. Unfortunately there are times when you have to do things like move and cats are very stressed by this. Keeping more than 2 cats seems to significantly increase the stress in households with cats, as well. Try to have more litter pans than you have cats and try to make sure the litter pans are located in quiet areas in which the cats can have some privacy while urinating or defecating.
b) Increase water intake as much as possible. Use canned food (if your cats accepts it readily) for its water content, encourage water drinking and when there are severe attacks consider supplementing oral fluid intake with subcutaneous fluids or IV fluids.
c) Feed foods that you cat eats readily and try to stick with a small number of foods rather than giving a large variety of foods. This seems to aid in limiting stress. The use of urinary tract acidifying diets should be reserved for cats who have a known problem with struvite stone or crystal blockages of the urinary tract or inflammation that seems very likely to be due to crystals. Remember that just seeing crystals in the urine is not enough to warrant the use of acidifying diets as this is a common finding in normal cats.
d) Ensure that there isn't a problem like bladder stones, consider a urine culture done on urine drawn directly from the bladder with a needle (cystocentesis) to find out if a bacterial infection is likely and consider more advanced testing if the problem persists. Checking for urinary tract infection from cats by taking urine from a catheter will give more false positive culture results than cystocentesis.
d) Wait out the attack. In most cases these will resolve within 3 to 10 days on their own whether you treat or not, as long as the cat doesn't develop a urinary tract blockage in the meantime. If a blockage does occur (very frequent trips to the litter pan, howling when attempting to urinate, straining without visible urination and rapidly becoming lethargic are all signs that a blockage might be present.
Unfortunately, these measures are not very satisfactory to cat owners who have a very uncomfortable cat and want some relief for it. Consequently there are a large number of things that people do that don't work very well in studies, including giving antibiotics, using pain relief medications, using amitryptilline or other medications to relax the bladder or for stress reduction effects, using corticosteroids and using polyglycosamines.
Even though there is little evidence that any of these therapies work in all cats or even most cats, there does seem to be some response in a few cats. Therefore, it is reasonable to try some of these therapies, especially the ones that aren't likely to be harmful. We have had the best success with amitriptyline, which may be due to pain relieving effects or to stress reduction effects. We have had some luck using glucosamines. We have tried Adequan (Rx) injection and Elmiron (Rx). They both seem to work in some cats, at least subjectively. Other vets seem to have better luck with other medications. We have recently noticed (again this is subjective until studied) that some of our patients we are treating with fluoxetine (Prozac Rx) for urinary marking behaviors seem to have less urinary tract disease when on this medication. With increasing evidence that urinary tract information in cats seems to be related to stress it is possible that this would explain a mechanism of action for fluoxetine.
I wish that I did know something that would reliably end these attacks in my patients but I don't. Hopefully as Bart gets more used to his new surroundings and relaxes a little it will help to alleviate this problem.
Mike Richards, DVM
3/10/2005
Question: I need some help to clear my mind. My cat Sammy who is about 3-4 years of age, ( adopted from a co-worker who had moved ) had a lot of blood in his urine. I took him to the vet, and he found that his bladder was VERY enlarged, ( had pushed all other organs up into his rib cage ). His little body couldn't release the urine, so his bladder kept on stretching. My vet said he couldn't find a reason since this is very rare. He called the vet school, and still couldn't find an answer. It was like he was living with an infection for some time, and kept getting worse ( we had him for only 2 months ) Poor thing. I ended up putting him down, which was very hard. Have you ever heard of a thing like this?
Melanie
Answer: Melanie-
Trauma is the most common cause of inability to empty the bladder in cats. This is most commonly associated with spinal cord injury, often due to a condition referred to as "tail jerk" in which the tail is pulled or held still while the cat continues to move (such as when it is caught under a rocking chair). If there is no chance of trauma then it is harder to figure out a cause for the this problem but an inapparent blockage of the urethra (the urine channel the runs from the bladder to the tip of the penis) or nerve damage for other reasons such as cancer of the spine or parasite infection affecting the nervous system (a rare problem) would be other possibilities. There are probably other possibilities that I am not able to recall at this time.
Mike Richards, DVM
10/12/2003
Odor problem and difficulty treating cat with chronic bladder problems
Question: Hi Dr. Mike,
Thanks for that comprehensive info on pH from last time.
Lacey, my 14.5 yr old, is really smelling horrifying again. I had a
basic urinalysis done and it showed a pH of 8 and enormous amount of
bacteria. It wasn't a "clean" sample but I know she's infected. Anyway, my vet
suggested 1000mg Vitamin C and 500mg amoxycillin split in 2 doses. But it is
impossible to get medication into her. If she suspects there is some
pill hidden in anything she spits it out and bites at me if I try to force
it. I am afraid she will die of an untreated infection that spreads. I have
taken to spraying her rear fur with Febreeze because of the strong stench.
And 3 out of 5 times I have put her into the tub against her will to wash
down her rear quarters she has defecated into the tub or on the floor. She has
also bitten me several times in the last few weeks when I go to clean her
up.My vet has no solution. I have tried hiding the pills in chopped liver,
tuna salad, egg salad, peanut butter, baby food, etc. but she is totally
recalcitrant. What are any other options for treating her? Every time I
miss a dose I feel that her system will build up an immunity to the
antibiotics and they will never work. In November she had 2 weeks of Orbax but that
clearly didn't fix anything. This has been going on again since the
start of December. I can't do liquid in her mouth because she will bite me
again.If I leave her somewhere for IV antibiotics would it help or would she
just die from heartbreak? She is rarely alone. I am at a loss.I would appreciate hearing your opinion.
Thanks, DEE
Answer: Dee-
The best approach to this problem would be to obtain a urine sample for
culture by withdrawing it directly from the bladder with a needle, to
try to identify the bacteria involved and to pick the best possible
antibiotic based on sensitivity testing, which can be done in conjunction with the
culture. Even with the signs you are seeing there is a small chance that
there isn't a bacterial infection but it does seem likely. If the urine
cultures were negative it would make the possibility that the problem is
due to other causes, such as chronic interstitial cystitis, more likely.
This is a hard condition to treat but there are medications that seem to
help some cats.As far as the antibiotics go, I think that you have several choices. The
first is to use an antibiotic that has been made into a flavored gel or
liquid by a compounding pharmacy. There are enough flavors that it is
usually possible to find one that a cat will eat when it is mixed with
their food. Many antibiotics can be mixed with flavorings without
altering their effectiveness. There is also the possibility of making the
antibiotic into a transdermal gel, which is applied to the skin and carries the
antibiotic into the body. This approach works well with some
antibiotics. I am willing to dispense injectable antibiotics that can be given
subcutaneously after showing my clients how to administer them, but a
lot of vets won't do this. The antibiotics do sting in most cases and it is
important to realize that and to be careful not to get bitten or
scratched when the cat gets tired of the injections and starts to retaliate for
them.
The last choice is to arrange for hospitalization long enough to
administer a complete course of antibiotics, or to bring her in daily for
injections (which usually means your vet has to come in on his or her days off to
give them unless the clinic is open 7 days a week). Most cats actually do
fine when they are hospitalized, even some that don't otherwise leave their
homes. However, it is more stressful.If this is a bacterial infection it would be a good idea to look for an
underlying cause of recurrent bladder infections, such as bladder
stones, pyelonephritis, diabetes, Cushing's disease (uncommon in cats), feline
leukemia virus, feline immunodeficiency virus and sometimes
hyperthyroidism. If none of these things is found and the problems
continue to recur it may be necessary to do urine cultures a week or two after
stopping antibiotics and continuing them again if the cultures show
bacterial growth, then repeating the process until the cultures are
negative may be necessary. This is a tough situation to be in with a cat
like Lacey who doesn't like to be medicated but if the flavored
medications or transdermal gels work for her, it wouldn't be too bad.I hope that this helps some. If your vet is unfamiliar with transdermal
gels a compounding pharmacist familiar with medications for cats should
be able to help in finding an appropriate medication.Mike Richards, DVM
12/14/2001
Fluoroscein dye for urine
Question: Hi, Dr. Richards...I'm a subscriber to VetInfo (and plan to re-subscribe, as I LOVE your
monthly newsletter!)I'm trying to find out about the product that you can give a cat to make
his urine show up differently (under black light?) than the other cats'
in the household -- for example, if you're trying to figure out who's
peeing in the corner.Do you know the name of the product?
Does it have to come from a vet, or can it be obtained OTC?
How does it make the urine distinctive?
Does normal cat urine show up under black light?
Does is "glow?"
How would you tell "marked" urine from normal urine?Thanks, and
Purrrrrrs... Wendy
Answer: Wendy-
The product you are looking for is fluoroscein dye. This is used to make
corneal (eye) ulcers show up better. It used to be possible to buy the dye
in little bottles of the liquid version but now I can only find it in test
strips. This might sound a little odd, but if you cut up several of the
test strips into small pieces (four to six of the size that contains 9mg of
fluoroscein per strip seems to be about the right number) and then stuff
the strips into a capsule and give it orally the same effect can be
obtained as with the liquid. You can buy empty gelatin capsules from your
vet or from your pharmacy.Urine from the cat who has been administered the dye will show up light
yellow-green even to the naked eye, if you have really good vision. It is
easier to find with a black light, though. The urine that contains the
dye will fluoresce well. Normal cat urine does not fluoresce. This testing
is usually done in multiple cat households when one or more cats are
spraying furniture but it is hard to determine who the culprit is. If you
use it for this purpose try to remember that there can be more than one
culprit, so it may be necessary to continue testing even after identifying
one cat who is urine marking.The urine will fluoresce in as short a time as a half-hour or so and will
continue to fluoresce for about 24 hours or so. This means that you have to
be prepared to do all your searching within the day after administration of
the fluoroscein dye. I am not aware of any serious complications from using
this dye in this manner but it is definitely not an officially approved use.Hope this helps some.
Mike Richards, DVM
5/9/2001
Question: In your reply to my question, you state that bacterial cystitis is pretty rare. But my vet tells me that he can see lots of bacteria in my cat's urine. If what he is seeing is not actually bacteria, what could it be and how do we identify it? Munchie is being treated on the basis of the visual condition of her urine, not on any clinical signs.
If she does not have bacterial cystitis, but she is a CRF and hyperT cat, how should we proceed? She is
currently taking another three weeks of antibiotics, Trimethoprim/Sulfa, which I know is not recommended for
CRF cats, but the vet is afraid that the bacteria(?) will go to her kidneys if it isn't knocked out. I am totally
confused now!
AnneAnswer: Anne-
Most of the internal medicine specialists who deal with cystitis problems in cats agree that bacterial
cystitis is rare in cats and that it usually occurs when there is a primary problem like bladder stones,
immune system suppression, diabetes or something like that.Bacteria are difficult to identify with certainty in urine (there are artifacts that look like bacteria in
urine at times) and many of the stains used to make urine easier to examine can harbor bacterial
growth --- so when the stain is mixed with the urine, so are bacteria.To prevent confusion over this issue, the best approach is to culture urine that has been withdrawn
from the bladder through a needle. It is usually pretty easy to obtain urine with a syringe and needle in
cats.I would be uncomfortable treating a patient repeatedly for cystitis based on seeing what I thought
were bacteria in the urine without clinical signs. If I was pretty sure that the bacteria were really there
I would want to do a urine culture to prove this to myself and also to get an idea of what antibiotics
might work based on sensitivity testing.Mike Richards, DVM
3/23/2001
Cystitis in Kitty and hyperthyroidism
Question: My vet has not actually seen my kitty (Fiona) but from description of
symptoms has diagnosed cystitis. It is a 5 year old female, for the past 4
days she has been scooting her behind along the carpet, licking that area
alot, and acting restless. Yesterday she's started squatting like she's
trying to pee outside the litterbox (on my clothes, etc) without any result.
She did do a few drops on white fabric and it was pinkish red as if blood
was present. The vet said to gradually switch her food to one designed to
prevent urinary problems, which we have started to do. She also prescribed
500mg vitamin C twice a day to acidify her urine.
Is this enough, or should we be doing something else? Is there a medication
(antibiotic) she should be taking? I guess I'm leary because no blood/urine
samples were taken, although on the other hand I can't really afford any
more high vet bills because my 17 yr old Topaz has been having health
problems lately too. I guess I'd just like you to confirm my vet's diagnosis
and treatment plan.
Answer: Andrea-
I think I'd be more comfortable about a patient with suspected cystitis if
an antibiotic was administered. I don't like to use the urine acidifying
diets until there is a clear indication that cystitis is going to recur on
a regular basis. These diets promote the formation of calcium oxalate
bladder stones and so they aren't risk free. I think they are a good idea
when cystitis is recurrent but hesitate to use them on the first incidence
of it. So for Fiona, I would probably take a different approach than your
vet took but your vet's actions aren't unjustified. Many times the symptoms
of cystitis in cats are from inflammation rather than bacterial infections.
When this is the case, antibiotics probably aren't helpful. It may be just
as reasonable to take your vet's approach as it is to take my approach.Good luck with Fiona's problems. I would recommend having her
examined by your vet, if that is possible for you to manage.Mike Richards, DVM
5/27/2000
Question: Dr. Richards,
I have a situation with my cat Jasper that has been going on since around mid-December. I have tried to
list all the relevant information below.
FYI: He eats IAMS dry for less active cats and IAMS or Science Diet Wet for feline
maintenance.On, 12/15/99, after two days of Jasper not using his litterbox (he was going to the bathroom everywhere
but the litterbox) I decided to take him to the vet. He also seemed to only be going to the bathroom once a
day. He was not acting abnormal except for the litterbox behavior. He was eating normally and was
energetic. When I took him into the vet they could not take a urine sample because his bladder was not
full. They decided to treat it as a urinary infection and prescribed Clavamox (1 1/2 droppers 1x a day). We
gave him the Clavamox until it ran out. He was extremely stressed whenever we did this (drooling, etc.).About a week later things were a little better, he was using his litter box and the carpet. He was always
going to the bathroom right outside the box at this point, if he didn't use the box. He seemed like he was
going to the bathroom more than once a day, but not all the time. I had plans to fly east on 12/23/99 so I
made a second appointment for him on 12/22/99. When I took him in his bladder was not full enough to
get a sample so they asked me to leave him there for a few hours to get a urine sample. They were finally
able to and they said there was no sign of infection, but a small amount of blood, which was probably due
to inflammation. I debated whether to board him because he is a strictly indoor cat and does not get
exposed to many people and has become VERY skittish. If anyone other than myself or my boyfriend
come in the door he bolts to go underneath the bed. I was trying to weigh whether it would be more
stressful for him to be at the vet or at home. I had a relative (who always watches him while I am away)
checking in and feeding him everyday. I asked the vet what she thought and she said that he would
probably be fine but I could sign a permission for treatment as a precautinary measure. She gave him a
steroid shot to reduct inflammation and prescribed Amitriptyline for me to start when I got back on 12/28.
When I got back on the evening of 12/28 Jasper came out of the bedroom to greet me but he was wheezing
and sneezing, his eyes were watery, his face was swollen and his ears were bright red. His food from that
morning (wet & dry) had not been touched. I took him to the emergency vet. I told them about the past
week's incidents. They were not sure what was going on and decided to do a blood test. Here are the
results:ALB 2.4 ALP 23 ALT 46 AMY 657 TBIL 0.7 BUN 12 CA++ 9.1 Chol 146 CRE 1.8
GLU 134 K+ 1.6 TP 6.7 GLOB 4.4WBC 4.0 HGB 13.0 RBC 9.76 HCT 46.8
His temp was 100.2.
They said that his white blood count was low, but he didn't have a fever. They also said that his creatine
was slightly high but nothing to be concerned with. They decided that is was probably a combination of
an allergic reaction and an upper respiratory infection. They gave him fluids for dehydration, Benadryl, B
Complex, Dexamethasone and Baytril shots. They also prescribed Baytril tablets and gave me 2 cans of
Science Diet A/D. When we took him home and gave him food he ate right away. He also went to the
bathroom (outside the litterbox).I took him to the regular vet the next day and they gave him another injection (Benadryl ?). My vet
thought that it was probably an allergic reaction to Clavamox and an upper respiratory infection that he
probably picked up while he was at the vet for them to get a urine sample. They gave me some more of the
prescription diet and told me that if the respiratory infection did not go away to bring him back in.Since then the Upper Respiratory Infection has gone completely away and his energy level is normal.
However, his litterbox habits have not dramatically improved. He is eating more wet and less dry food, his
weight is good (it hasn't dropped) and his energy level is good. He had been going to the bathroom
pretty much 2x a day right outside of the litterbox in the same areas every time at about the same time
everyday. We put a mat down, so its not as problematic for us to clean up. The urine is always very
strong smelling and sometimes dark. One time last week there was alot of mucus in his stool, but other
than that normal.On saturday, 1/29, he only went to the bathroom once and has done that up to today 2/1. Today he
urinated but a smaller than normal amount considering he hadn't gone in more than 24 hours. I am really
getting concernced and have no idea what to do. He has changed some of his behavior as far as areas he
is sleeping in, but seems normal other than the litterbox behavior.Do you have any idea what this could be?
Thank you in advance,
KimberlyAnswer: Kim-
There are a couple of things that I think would be a good idea at this time.
If the mat is waterproof and you can get a small urine sample by sucking the urine up in a
syringe, eye dropper or pipette it might help to get your vet to examine it. Sometimes, having
several urine samples to look at is very helpful.Cats that have urinary tract infections will quit using the litterpan sometimes. It can help to move
the litterpan to a new spot, to add a second litterpan in another room or to change the type of
litter. I think the ideal approach is to add a second litterpan with a different type of cat litter. This
will often work to get the cat back to using a litterpan. Then you can try to move the litterpan to
where you want it and you can probably get back to using one litterpan (but not always). If you
are using a covered litterpan sometimes it helps just to take the cover off the pan (worked for
my cat).If adding a litterpan and changing the litter type doesn't work, sometimes behavioral medications
will. Amitriptyline is actually a good medication to try because it seems to help with bladder pain
or spasms and also to have beneficial behavioral effects. Other possible choices are diazepam
(Valium Rx) and buspirone (Buspar Rx). Your vet can help you sort through which medicine is
most appropriate for your cat.The important thing to remember is that most of the time it is possible to get cats back in the
habit of using the litterpan but that it might take several tries to figure out what approach to doing
that will work best for a particular cat.At some point, I'd recommend rechecking the labwork, too. At least the BUN and creatinine
levels and the blood cell counts. Keeping track of which direction the creatinine is going in (up
or down) would help to determine if there is a tendency towards kidney failure. Keeping track
of the urine or blood glucose occasionally is a good idea, too. Especially if Jasper is older than
10 years of age. Once in a while diabetes seems to sneak onto the scene when there are difficult
bladder infections and easily acquired infections of other types in older cats.Hope this works out well and quickly.
Mike Richards, DVM
2/4/2000
Question: Dear Dr. Richards,
I'd like to say thank you for your website. I adore all animals and love to see that other people care,
especially when they care enough to try to make an improvement to their well being.I have to DSH cats ages approximately 6 and 4 years old. They eat ProPlan turkey and barley dry food
and no canned food. They get cat snacks (crunchy kind for plaque removal) a couple of times pre
week. They are also given, by their ill behaved humans, occasional pieces of chicken of turkey.
Occasionally meaning three times per week or more. We know this is bad, we're so weak whne it
comes to those faces!Neither cat is overweight, surprisingly, or has had any medical complications with urinary tract
infections or blockage since I have been taking care of them (both were dumpster kitties their first
years of their lives to the best of my knowledge). Both drink a good amount of water and have no
problems urinating. In the past few days it seems like their urine has taken on a very strong odor. I
believe it is the younger cat's urine. I clean the box twice per day as the norm. I also clorox clean the
box once per week. Even with the cleaning I come home and the whole house smells. I have checked
everywhere to be sure they are not urinating outside the box, which they are not.Can you think of anything that would give their urine such a strong odor?
Thank you again for your kindness and assistance.
Kathleen
Answer: Kathleen-
You didn't say, but I am assuming that the cats are either spayed or neutered. It would be unusual for
urine odor to take this long to develop in an intact male, but sexual maturity is definitely one of the
times when people notice that urine suddenly has a lot stronger odor to it. Male cats who are not
neutered will sometimes begin spraying later in life and they only spray small amounts of urine in many
cases, making it pretty hard to find the urine spots. Look really hard for signs of urination around the
litterpans and on vertical surfaces (walls, furniture, etc.) around where the odor seems to be coming
from.There are occasional reports of cats developing hormonal disorders which produce enough hormonal
changes to make a neutered cat develop the stronger odor associated with intact tomcat urine. While I
think this is rare, if no other explanation is found as you search for a cause of the increased urine odor,
it may be worth thinking about.Cats with cystitis (bladder infections) or other lower urinary tract inflammation or infection will
sometimes develop strong urine odors. Signs of cystitis include straining when urinating, multiple visits
to the litterpan, blood in the urine, increased urine odor andCats who are dehydrated, for any reason, can have an increase in the odor of their urine. This can
happen with inflammatory bowel disease, fevers, kidney disease or anything else that causes the cat to
become dehydrated.Some cat owners mistake the smell associated with anal sac secretions with urine odor. The anal sacs
are located at about the 4 o'clock and 8 o'clock positions relative to the anus and they contain a
strong smelling exudate which is sometimes expressed during bowel movements or even voluntarily by
the cat. It is a good idea not to forget about these glands when exploring causes of increased odors
that seem to be from the urinary tract in cats.Diabetes is sometimes noticed by owners due to an increase in urine odor, although it is more
common for owners to notice increases in drinking and urinating before changes in urine odor. Weight
loss and an unthrifty appearance also occur with diabetes.Hyperthyroidism sometimes causes an increase in urine odor. I am not sure why this occurs and it has
not been reported in the literature, as far as I can remember, but some cat owners have noticed this
and remarked on it when we were running down the list of symptoms associated with their cat's
illness. This may be due to an increased tendency to urine mark in cats with hyperthryoidism -- a case
in which people just notice the urine odor more, probably.Some herbal products and some medications are supposed to cause increases in urine odor but I can't
actually recall a case in which an owner noticed increases in urine odor due to medications.Those are some of the causes of increased urine odor.
The way to sort through them is to start by looking carefully around the house for signs of urine
marking (dark spots on furniture or walls, changes in the places where urine odor occurs). If you find
any evidence of urine marking, make sure your vet gets that information.A physical exam, including checking the anal sacs and analysis of a urine sample and possibly a blood
chemistry panel and blood count would be the next steps to take. This would help to determine if
there is cystitis, kidney disease, diabetes or other systemic conditions contributing to the urine odor. If
nothing is found up to that point, it may be a good idea to consider X-rays of the bladder and lower
urinary tract, just to be sure there aren't bladder stones or other problems that might show up on an
X-ray.If all of these things are normal, then it becomes hard to decide what to do. If your cats feel well but
there continues to be strong urine odor in the house it may be a good idea to consider borrowing a
black light (Wood's lamp) and administering fluoroscein dye (under your vet's direction) to the cats
and then searching the house with the black light, looking for fluorescent stains that indicate urination
outside the litter box. I'd recommend this earlier in the diagnostic process except that I have this fear
that someday I'm going to cause problems with the fluoroscein dye administration in a cat (hasn't
happened yet) since this is definitely not an approved use.Hope this helps. Since your cats seem to feel well, based on your note, there may not be a need to
rush through a diagnostic process but this should give you some idea of the directions you can go in
to find an answer.Mike Richards, DVM
3/2/2000P.S. - I feed my pets all sorts of treats. They like it and I like it and I think that is important in our
relationship. I just try to keep the treats that aren't balanced nutritionally o less than 10% of their diet.
Q: Several weeks ago, while emptying our cat's litter box, we noticed
that there was blood in his stools. We were told that it wasn't
anything to worry about. Charlie was acting normal and he didn't seem to be
uncomfortable. After talking with several people we were told it wasn't
uncommon for cats to have blood in the stools, so we decided to just wait
and watch him.
In the last two weeks we noticed that he had been acting rather
sluggish and just not himself. He's a very active and playful cat with a
lot of personality, but was being very lazy and sleepy--very cuddly in our
laps-more than usual. He was hardly eating and not nearly his active self.
We thought that maybe he was depressed being a single cat. ( He's a 2 year
old tabby that we adopted back in June--before that he had other 'neighbor'
cats he would play with. ) He would go in the bathroom and meow very
loudly at night and get up in our faces and meow. We thought at the
time he was just being a cat.
Then we noticed that he was doing a lot of funny squatting. He looked
as if he was sitting, but his legs were spread--He would do this on
everything from our wood floor, to socks, to plastic bags. We watched him
more closely because his tail would stick straight up when he squatted.
After a few 'squats' there would be a few drops of urine. We would take
him to his litter box where he'd done nothing. (He has never gone to the
bathroom anywhere other than his litter box. ) Over the weekend, we
noticed that he was still squatting to urinate in strange places, and it
looked as if there was blood in the urine. Being alarmed with his new
behaviour ( the 'depression', squatting, and blood in his urine,) I made an
immediate appt with a local vet. I took him in that afternoon. At the vet
clinic they took his temperature, ( they didn't say if he had a fever or
not). I explained the previous blood in his stools, his depression, his
diminished appetite, and what I thought was blood in his urine. They
catheterized Charlie and took a small urine sample. After testing it on
some sort of 'stick' they said he had a bad bladder infection and said he
was in a lot of pain. They gave him 3 shots--they said that 2 were
antiobiotics and 1 was a painkiller. Five minutes after the shots, Charlie
vomited. They seemed to act as if it was nothing. I assumed it was just
a reaction to the painkiller and all the trauma. (He was hissing, growling
at the slightest touch---I'd never seen him like that) The doctor
prescribed BAYTRIL 50mg (the package also says Enrofloxacin) and said to
give him one at the same time everynight. The doctor said he should feel
better by the following night and we should see a difference in him.
He's been on this medication for 6 days and Charlie is still
urinating only a few drops at a time, and you can see a lot more blood in it.
Sometimes it looks as if it is pure blood. When we are there to catch
him squatting and place him in the litterbox, he will sit in the litterbox for
10-15 minutes, with his tail perfectly still or twitching, and only urinate
a few drops--if at all. We don't have children yet, and Charlie is our
"Baby". We are quite worried about him and the fact that we haven't seen
any type of change in him at all. The doctor said to bring in a urine
sample on Monday and that he should be okay by then. (How do you get a
urine sample from a cat, especially when he is hardly urinating???)
I'm concerned that the doctor blew off the fact that he has been
acting odd for several weeks, the blood in his stools, and the fact that
Charlie is still urinating blood. (German doctors *including vets*
have a VERY different bedside manner.) Including the time it took filling out
paperwork and everything, Charlie and I were in and out of the Vets office
in 15 minutes. I just can't help but feel that the doctor didn't check
him out as well as he should have. We are limited in where we can take him
to the vet because we have to take him to a vet that speaks some english.
Even speaking some english I know there were questions I was asking that he
didn't quite comprehend.
Charlie is an indoor cat that has lots of toys he likes to play with
and that we play with him with. He's a very affectionate and outgoing
cat. Charlie leads a pretty normal life, he likes to eat a lot and watch
everything going on outside the windows. He's a very curious cat.
Charlie weighs about 10-12 pounds. We feed him once a day. He gets
about 1/2 a cup of dry food mixed with about 1/3 can of wet food. Sometimes at
night if he's eaten all of his food he gets dry food. He always has plenty
of fresh water in 2 places in the house. We give him a treat of about 1/4
cup fresh milk about once a week. I was giving him a cat multi-vitamin
every other day, until he started seeming depressed. In the last several
days we have noticed he has been cleaning himself a LOT, shedding a lot,
and seems almost as if he has dandruff (flaking skin). We really don't know
too much about cats, simply what we know from growing up with cats in the
house. We act like worried parents with sick child * Charlie* He really
is our baby. We give him a lot of love and affection just like a child.
We are afraid that there must be something more wrong with him-- he is
more alert now, but the blood in the urine seems to be worse and he has
only had 2-3 bowel movements in the last week. All of the cat owners and
resources we have turned to, which are so limited because we are here in
Germany, seem to think there must be something more wrong if he isn't
responding to the meds.
My questions are--should we have Charlie checked out for more
problems?? If so, what direction should we look towards?? Are than any
specific questions we should try to ask the vet?? Have you ever heard of
this drug the doctor has prescribed for Charlie *Baytril*?? Is it an
antibiotic?? (that was my impression) What would make his behaviour
change so drastically in regards to his 'depression', lack of appetite,
laziness, etc.??? Is the dandruff because of all of the stress?? (taking
pills, etc.) We usually give him a treat of catnip about once a week also.
I know it has a drug like affect on him, should we avoid the catnip
while we have him on the medicine?? We have given him a little more milk lately
trying to get more fluids into him simply because he's hardly drinking any
water-- Is that okay to do while he is on the meds??? And, Again, how do
you get a urine sample from a cat? (When I asked the vet, he looked at
me as if I was nuts.)
We REALLY do appreciate your time and any advice you can offer us!!
Thank you!
Faith &Jon
A: Faith and Jonathan=
Baytril is an antibiotic. 50mg would be a pretty high dose of this
antibiotic for a cat, so I am hoping that is a misprint but Baytril is
relatively safe so it shouldn't cause much problem even if the dose is high
(the recommended dosage is 2.5 to 5mg/kg of body weight, so a 10 lb. cat
would get about 20mg).I think that you need to take Charlie back for a re-exam if he continues to
be ill. There are a lot of possible problems, such as feline leukemia virus
or feline immunodeficiency virus interfering with immunity, interstitial
cystitis which might respond better if anti-inflammatory medications are
added, a bladder stone, bladder cancer or diabetes. With the dander,
depression and other signs I would be especially worried about the
possibility of systemic disease such as feleuk or diabetes (except that
diabetes should have showed up on the initial urinalysis). X-rays and
additional lab work are probably in order if Charlie is still sick.We usually draw urine samples directly from the cat's bladder with a
syringe and needle. It gives us the cleanest samples and is easy to do in
most cases. However, you may be able to get a sample by removing the litter
from the litterbox and collecting urine directly from the box. This only
works if a cat will use the litterbox when it is empty but many will. Other
cats are OK if you substitute a non-absorbent material like plastic beads
for litter and then strain the urine out of plastic and box.Mike Richards, DVM
Improper urination - medical or behavioral
Q: What steps are necessary to diagnose whether a cat has a behavior
disorder or a valid medical condition? My 10 month old cat, BC,
urinated in the middle of my bed for no apparent reason. A
neutered male (since 5 months old), he has had perfect litter box
behavior since he was adopted into my home. He shares the litter
box with a 5 year old spayed female. He has shown aggressive play
behavior towards her but is not viscous or mean; she is
submissive, hisses, and runs away when approached by him. Nine
weeks ago, I took in two kittens to foster. They have not been
living in the same living area as BC but he has sniffed them a
couple of times but was not aggressive towards them, only
curious. Could he be jealous of the kittens or what medical
conditions should I suspect? Also, are there any good laypersons
books on cat behavior I could refer to?Thanks for your public service website!
A: Tricia-
Your question is an interesting one because it is often difficult for
veterinarians to tell when a problem associated with urination is
behavioral. There are a lot of possible medical conditions that can lead to
inappropriate urinary behaviors and it is actually pretty hard to devise a
plan to rule all of them out without spending a lot of time and money
running all kinds of tests.It is important to remember that what we consider to be problematic urinary
behavior can be viewed as completely normal urinary behavior based on the
cat's perspective of the situation. Feral cats mark their territory very
frequently, sometimes as often as 6 to 10 times an hour as they move about.
Most of this marking is done by spraying. This type of urination is
recognizable because the cat normally is standing, normally has its tail
held erect and often hits a vertical surface with the urine. Some cats will
spray on beds or carpet. The stance is the same but the urine spot looks
like a spray pattern (linear) rather than a pool of urine. Spraying is
strongly associated with behavioral urinary problems. A common error in
thinking about urine marking behavior is the failure to realize not all
marking is done by spraying -- some cats mark with normal urination so a
pool of urine in a high spot or at a doorway or somewhere like that may
indicate marking behavior even though it is not from spraying.Cats that are having difficulty urinating tend to spend a great deal of
time in the litterpan but it may appear that little or no urine is
produced. Many people mistakenly assume that their cat is constipated due
to the straining efforts. Cats may urinate in odd places but they are
usually straining rather than exhibiting spraying type posturing. Blood in
the urine is a sign of a medical problem rather than a behavioral one.Unfortunately, much of the time it is a lot harder to figure out whether
there is a medical problem than when one of the above behaviors is clearly
evident. In this case, the only thing to do is to start looking for problem
and work through the diagnostic effort as logically as possible.The first step in a multiple cat household is often identification of the
cat with the problem. In some cases a videocamera can be really helpful in
figuring out who is urinating inappropriately, if the urination is
occurring in roughly the same spot all the time. In other cases it can help
to give individual cats fluoroscein dye orally and watch for greenish
colored urine, or urine that is visible by blacklight. The cat getting the
dye is the culprit in that case.After the cat is identified (not a problem in single cat households,
obviously), then a diagnostic workup can be started. The first step is to
check a urinalysis, fecal exam if stool soiling is a problem, complete
blood count (CBC) and chemistry panel. If this lab work does not identify a
problem it is more likely that a behavioral problem exists than a medical
one. There is no easy way around this testing. It almost has to be viewed
as the minimal database necessary to start ruling out medical problems.
Most of the time it is possible to obtain urine by cystocentesis, which is
withdrawing a small amount of urine from the bladder directly with a small
gauge needle and a syringe. This helps a lot in cats since clean urine can
be hard to obtain. In some cases it is advisable to do other testing such
as X-rays, testing for feline leukemia virus, hyperthyroidism or other more
specialized tests as indicated by the physical exam and the original labwork.If a medical problem does not seem likely after the lab work is evaluated
then it is possible to start sorting out the various causes of urinary
problems in cats.Adding cats to the household increases the potential for urinary marking
behavior dramatically. I am not sure there there is a general agreement on
exactly where the risk becomes 100% but somewhere between 5 and 10 cats in
a household pretty much guarantees that one of the cats will urine mark.
Having four cats instead of two cats probably doubles or triples the risk
that one of the cats (in this case probably BC) will urine mark due to
territorial pressure. It is not exactly jealousy but I guess that is a
reasonable way to think about it. His territory is being invaded and he may
be feeling as if there simply isn't enough territory to go around and that
he must defend what is his. Sometimes it is possible to alleviate these
feelings somewhat with behavioral modifications or with medications such as
anti-anxiety medications such as diazepam (Valium Rx) or buspirone (Buspar
Rx).Dr. Karen Overall's book "Clinical Behavioral Medicine for Small Animals"
and Dr. Beaver's book "Cat Behavior" (I think that is the whole title) are
not too difficult to read and would be good sources of in-depth information.If the problem continues and you can send along information on what
behaviors have developed since you originally wrote to me I will try to
provide more specific information.Mike Richards, DVM
Q: Dear Dr. Mike:
I'm so glad I found your web site--what a wonderful resource! I have a
4-year-old female cat who has been straining to use the litter box every 10
minutes or so, for the past 4 days. Her vet did a chest x-ray and determined that she has no blockages and is not constipated (although there were some feces in her intestines she wasn't distended). He also took a urine sample and determined that she doesn't have a urinary tract infection. He sent her home with a stool softener and told us to watch her over the weekend and bring her back on Monday. He said he's not entirely
sure what's causing her to strain and not deficate, though. Any thoughts
you had would be greatly appreciated. Thanks. Karen
A: Karen-
I think that I would worry a lot about this being a urinary problem, whether or not it seems to be based on a urinalysis. If there was enough intestinal content to obscure the bladder it may be worthwhile to retake the X-rays to try to rule out a bladder stone. It may also be worthwhile to check her anal sacs and to palpate her rectum digitally to make sure there is not a polyp or problem there. I think that confusion over whether
straining is related to constipation or urinary tract irritation is very common among pet owners and even veterinarians. Four days is a long time to have this much straining. If it is still going on tomorrow, it really seems like a recheck then would be a better idea to me, but you have to remember that your vet may be in a better position to evaluate that need than I am.Mike Richards, DVM
Q: Doc, we have a cat that has been with the family 5 years. A serious urination problem reoccurs about once a year. Local vets have prescribed the hill prescription. It usually lasts about 2 weeks but causes a great deal of problems within the household. We would like to know if there is a better diet food or food that would help us in eliminating these annual reoccurrances of this problem. We have tried both and none are working. Would like some feedback thank you! Joy!
A: Joy- In brief, the answer is no. The Hill's diet is as good as any that I know of for controlling periodic problems with urinary tract disease associated with crystal formation in the urine. Of course, the corollary of that is that most of the other diets that claim to control urinary tract pH probably work pretty well, too.
If this problem occurs at roughly the same time each year I'd think long and hard about what goes on at that time. Some cats seem to be able to develop urinary tract pain and problems from the effect of stress. Also, allergic inflammation is thought to occur in the lower urinary tract in some cases. If the problem is very seasonal or occurs close to the same time each year it might be worth considering treatment with a medication that controls allergic symptoms prior to the expected time of an attack or at the very first sign of problems. In a few cats there just doesn't seem to be an identifiable cause of the problems they are experiencing. Some of these cats will get better more quickly when a problem occurs if pain relief medications or amitriptyline are administered near the onset of clinical symptoms of a lower urinary tract problem.
Mike Richards, DVM
Urinary Problems - Incontinence possible
Q: Dr. Mike - HELP! We are desperate. We have 2 female spayed cats. They are 8yrs & 2.5yrs old. Our first problem deals with the younger cat who is extremely overweight (19.6 lbs.), she was perfectly healthy up until approx. 3 months ago. She had developed a urinary infection which is common in obese cats, and has been fighting it for these past months. Most symptoms have subsided, except hear butt/vulva area are constantly moist and discolored, and she smells of urine - this symptom remains and the vet insists that she has no bacteria in her urine. She is very happy, affectionate and playful. Our actions have been
#1. she has been dieting - .5 cup of light formula Science Diet, daily --she lost 2 lbs, but in turn gained 1 back this past month
#2 repeated visits to the vet, which they discovered crystals in her urine, she now eats a special food for the next few weeks to clear that up- yet, her butt doesn't seem to be getting better.
#3 we clean her vulva with diaper wipes every other day, a process she hates, gets very anxious - she is always trying to clean herself; however, she can't reach
#4 she is now back on an antibiotic (Clavamox) 2 pills a day due to a return urinary infection.
In light of all these events, our other cat (8 yr old) has recently - (past month)- taken to urinating & defecating outside the litter box. She has done this on our bed, carpet in the entrance way, small carpet near the litter box- which we through out, now she goes where the carpet used to be. Now, in response to this, we initially started cleaning the litter box twice daily, which worked for awhile. Until recently, we then got another litter box (2 total). Which worked for about a week. Today, about 10 minutes after both boxes were cleaned, we walk into the room to find a puddle of urine. Now this is something she has done infrequently in the past if the litter box was not clean; however it has become a daily occurrence, clean or not. We have moved recently (about 1.5 months ago) but these 'circumstances' started before the move. We are reaching exasperation between the cat we can't get healthy and the cat who seems destined to ruin our furniture. I'm fearing our only option will be to give away the cats, but who will take them under these circumstances? Anything you can offer, would be greatly appreciated. Thank you. Debra
A: Debra, Your younger cat may be incontinent (she may be leaking urine because she does not realize she is urinating or can't control the urine flow). This could easily lead to chronic irritation around the vulva and inguinal region in an overweight cat. There are a number of possible causes of incontinence and it can take a fair amount of testing to sort through the possible problems. Hormonal incontinence is less common in cats than it is dogs. This is also true of physical problems like ectopic ureters which lead to incontinence, but these conditions are possible. Neurologic deficits can lead to incontinence. Some cats will develop incontinence due to the presence of infection or inflammation in the urinary tract, so control of crystal formation can be helpful if it is causing inflammation and controlling inflammation from other sources is important, too. It is also a good idea to be certain that there is not a reason for increased urine production which can make a problem with incontinence worse. Examples of diseases which cause increased urination are diabetes and kidney failure. I know you are frustrated with this situation and have tried to correct it but it may help to discuss further testing with your vet or to ask for referral to an internal medicine specialist.
When one cat is urinating outside the litterbox it is not uncommon for other cats in the household to begin urinating outside the litterbox. Despite this, it is important to rule out a physical cause in your older cat, too. If there is not a physical cause attempting some of the treatments in our cat information / behavior area may be helpful.
Mike Richards, DVM
Blood in urine after antibiotic therapy
Q: Hello, I don't know if you are taking questions here, but I really need help. My husband and I have just taken on the care of his 13year old female family cat. She has been with us for just a few months now. Only a couple weeks after she came to live with us, I noticed large amounts of blood in her urine. She was brought to the vet right away and put on antibiotics for a bladder infection. After she had been done with the antibiotics for just a couple weeks I noticed the blood again. I also noticed a very strong ammonia smell when I cleaned her litter box. I took her back to the vet. She actually saw a different vet this time and he not only found a large quantity of blood in her urine and some white cells, but also abnormal cells. He put her on a different antibiotic and said that she most likely either has sharp kidney stones or cancer. He said that we can only find out by doing a special x-ray which would cost around $200. As we are a young couple, we don't' have much money and don't want to rush into anything, but we want our cat to get better. I don't know what to do... Thank you , Lori and Dan
A: Lori and Dan- When blood returns in the urine shortly after antibiotic therapy, repeatedly, there are several possible causes. The two most common causes in an older cat are bladder stones and bladder cancer. Other possible causes are resistant bacterial infections, interstitial cystitis, diverticuli (pockets) in the bladder wall, bleeding disorders, and bleeding from kidney problems.
Bladder stones are often visible on a "plain" radiograph -- just an X-ray of the bladder area. There are bladder stones that are not visible on X-rays, though. Bladder cancer does not show up well at all on plain X-rays. Therefore, it can be necessary to inject air or a contrast dye or both in order to make the stones or cancer visible. If a plain X-ray has been taken and nothing showed on it, then it may be a good idea to consider contrast X-rays. The abnormal cells noted make cancer more likely and may be the reason your vet is considering contrast X-rays at this time rather than waiting.
A urine culture may help to determine if there is a resistant bacterial infection. Most of the time this won't be the case but it may be worth considering if you wish to rule out one cause of persistent bladder infections prior to looking for more problems.
It is sometimes less expensive to have an exploratory surgery done than to do all the diagnostic testing to decide what is going on. Since surgery is necessary for many of the possible causes of the symptoms this can be a reasonable option when cost is a major factor. It allows a definite diagnosis and the opportunity to attempt treatment immediately if it seems advisable. You may want to discuss this option with your vet. In general I think most veterinarians would prefer to have a diagnosis through less invasive means than surgery but there are times when it is reasonable to consider surgery as an efficient diagnostic test.
Mike Richards, DVM
Inappropriate urination and hair pulling
Q: We have a male Siamese cat that is 9 years old. Last August he started pulling out his hair on his hind quarters and tail. Along with this came the annoying behavior of urinating on our belongings- mainly our daughter's bed. The cat box is kept very clean and has no cover. We have taken him to the vet many times. He has been checked for medical problems and none have been found. We changed his food and gave him a cortisone shot which helped temporarily. He has now received 3 or 4 shots in the past 9 months, but they don't seem to be helping anymore. About 1 month ago we changed him to a diet of raw meat with vegetables and bonemeal. We are trying to go a more holistic way since the original change of food and the cortisone shots didn't seem to help. Any suggestions would be greatly appreciated. We are very frustrated with this problem.
A: jklm- It is hard to say if your cat has two problems, one causing the hair pulling behavior and one causing the inappropriate urination or if he has one problem causing both problems.
Occasionally cats who are experiencing pain from cystitis or lower urinary tract disease will chew on their hair in the inquinal or rear areas. If this was the case, it may help to use an antispasmodic or pain relieving medication. Even though it is usually used as an anti-anxiety medication, amitriptylline will sometimes help in this particular situation.
If the hair pulling is the result of allergies or immune mediated disease the cortisones should work at least short term. If this is a food allergy, modifying the diet may be beneficial. Sometimes anti-histamines will help in allergic cats and they have fewer side effects than cortisones.
If the urinary problem is behavioral it might help to put a plastic sheet over your daughter's bed or just restrict access to that room. Cats usually won't walk on plastic if they don't have to. In some cases, medications such as diazepam (Valium Rx) or buspirone (Buspar Rx) are helpful in inappropriate urination behaviors but it is better to try to get the situation under control through behavioral modification if possible. Cats urinating in one spot like this will sometimes respond to being distracted right as the urination begins with a loud noise, like from an airhorn. Some cats just need a second litterpan and will improve their behavior when they get it.
Raw meat diets have the same risks for pets as they do for humans, including infection with toxoplasmosis (a parasite) and E. coli or Salmonella bacteria. There are no proven benefits to feeding meat raw that I know of.
Mike Richards, DVM
Q: Our cats have used a spot in our house to urinate. I believe the problem started when the female had a bout with cystitis. I do not believe we ever completely removed the odor and it is drawing them back to the spot. What would you recommend cleaning the area with? We have cleaned the carpet, replaced the pad and even replaced the wood strips. The female does experience recurring cystitis. It may be that she uses this area only when the cystitis flares up. However I do not understand why she uses the same spot if it is not the odor drawing her back. Any suggestions? Thanks, K.
A: It helps a lot to use an enzymatic type odor remover. There are several of these on the market. Feline Odor Neutralizer (F.O.N.) is a good product for this that we use in our practice. I have seen many recommendations for Equalizer and Nature's Miracle as well. There may be other good ones that I haven't heard of. Removing the odor will usually help a lot. Cats do like to urinate where they have urinated before. It's kind of like finding that gas station with the really nice rest rooms -- you look for it the next time!
Putting a thick plastic wrap or a plastic carpet runner over the spot often helps because most cats don't like to walk on plastic and will avoid it.
It can also help to put the litterpan there and then sloooowwwwlllyy move it to where you want it. Generally you have to move it an inch or so per day at the most, so it really takes a while to get it where you want it to be.
Using one of the cystitis controlling diets can be helpful, too.
Mike Richards, DVM
Q: Dear Dr. Mike: I have an 8 yr old male cat who began having problems about a year and a half ago with crystal blocking his urethra. He was catheterized and treated with antibiotics twice and put on a special diet but continued to have difficulties. Just over a year ago, he had a perineal urethrostomy. This seemed to have solved his problem, but occasionally, I would find a small puddle of urine somewhere in the house. Recently, this has been happening quite frequently. He does not return to the same places to spray (he has sprayed the living room wall, the dining room floor, the microwave and the stove on the kitchen counter, the stereo and other spots). He is an outdoor cat and I have seen him digging in the dirt outside, so I know he is also going there. I keep two clean litter boxes in the upstairs bathroom which is a fairly quiet and private area. The only other cat in my home is a female who is also the male cat's mother. He does not appear to be in any distress and is just as friendly as always. He is eating and drinking fine. I love this animal dearly and invested quite a sum in trying to resolve his urinary difficulties. I wonder if you can offer any advice or suggestions. Thank you. Tami
A: Tami-
Perineal urethrostomy prevents (most of the time) the complete blockage of the urethra that can lead to death quickly in male cats. This is definitely worthwhile but it doesn't stop the whole problem. It is still a good idea to try to identify and treat the cause of the urinary problems, if possible.
This can be difficult. Dietary control of urine acidification is a good approach for most cats but in some cases it does not help. Identification of any bacterial infection and proper treatment is obviously a good idea as well. In some cases treatment for pain or discomfort using amitriptylline is a good idea. There are other medications that may help in some instances, too.
It may be worthwhile to ask your vet about referring you to a veterinary school or large referral center. An internal medicine specialist who works with lower urinary tract disorders may be able to help your cat.
Good luck with this.
Mike Richards, DVM
Feline lower urinary tract disorders (FLUTD)
Q: Subject: urinary tract infection - cats My 13 year old tabby cat was diagnosed with a urinary tract infection in February of this year. He was put on antibiotics. This seemed to clear it up. One month later we noticed vast quantities of blood in his urine. We phoned the vet and they said that this was normal. So we let it slide a little longer. He seemed to get better and then about 4 weeks ago we took him back to the vets because he couldn't urinate at all. This was on a Saturday. They kept him till Tuesday and said that he had crystals. They had catherized him and put him on antibiotics and special food. When we brought him home he still wasn't urinating that much .. a few drops here and there. I brought him back on Friday just to be checked (because we were moving on Saturday so I wanted to make sure he was okay!). They said that his bladder was half full and he seemed fine. One week later he was completely blocked again and we brought him in the following Monday. He relieved himself in the truck on the way in. They kept him for the day and catherized him again (This was the monday just past!). They put him on more antibiotics and said that he "should be fine". I brought him back in yesterday (Friday) because he couldn't go again!. They catherized him and found some more crystals and said that he is very inflamed. They said continue with the antibiotics but if he gets plugged (what a horrible word to use!) that we might want to consider a sex-change operation. He seems to be going a few drops at a time now and I know that by Monday he will most likely be blocked again!. I do not think that I will do the sex-change operation as he is 13 years old and I am not sure that that would end his suffering. Would he still have this problem after that operation? What causes crystals. The Vet says that all urine has crystals in it? Is this true? Is there anything else I can try to help my cat. I would hate to have him put to sleep but if that will end his suffering I will do it!. Let me know if you can assist him. He is my friend and has been with me 13 years and I would hate to let him down!. Debbie.
A: Debbie- The standard treatments for feline lower urinary tract disorders (FLUTD) are the antibiotics and urinary acidification diets. In some cases they will not be sufficient. It is a little unusual for a cat to suddenly develop the typical FLUTD syndrome at 13 years of age. It may be necessary to take X-rays or even contrast x-rays in which an iodine compound is instilled into the bladder to help visualize things like tumors, scarring or unusual bladder stones that may not show up on plain X-rays. If nothing is found it can be helpful to use amitriptylline to reduce inflammation in the urethra. This helps some cats with FLUTD. You may want to ask your vet to refer you to a veterinary school or internal medicine specialist if that is an option in your area for a second opinion from someone who sees more unusual cases than the average practitioner. Cats are living longer now. If the perineal urethrostomy (doesn't really change their sex but does give the outward appearance of doing so) is necessary it may be worth considering after making sure that cancer or other serious illness is not the problem, due to his age.
Mike Richards, DVM
Recurrent lower urinary tract disease
Q: Dear Dr. Mike: I have a six year old female cat. Every few weeks she needs to squat every few minutes. Sometimes everything comes out normally, sometimes a spot of blood with very little urine. When she is going through this, she will squat everywhere. When it is not happening, she uses the litter pan faithfully. I have had her to two vets and one with extensive tests and xray and VERY costly. One vet said it could be an ecoli (sp) infection and had her on keflax(sp) for cats for what seemed an eternity. During the treatment, she stopped the urgent need for awhile and then it came back as it has before. She also stops and returns to normal without medication. She has been going through this for about a year. She is otherwise healthy, a bit overweight though. She and the other two cats are indoor cats, one male and one female. All neutered and very much cared for and about. The drop of blood doesn't occur much but her need to squat usually produces nothing. I have felt her lower belly to make sure there was no hard swelling due to a complete blockage. She and the others have a low magnesium,ash dry food (Dad's was lower than the Purina urinary brand and the IAM's brand). A tablespoon of Nine Lives canned Tuna in Sauce in the evening. She drinks as much water as the other two cats. When she is over her "attacks" she is playful with the young male and seems okay. After spending almost $600 at one vets for all the testing and over $100 for the other vet, I have little faith that they can find what is happening. I have watched her in the litter pan and even during this feeling like she has to pee stage, occasionally she will gush and go back to the pan five minutes later and squat for a long time again with no results. There doesn't seem to be any pain and there is no meowing during her squatting. Then it just goes away. I have asked the vet if it was cystitis and they both treated her for an infection. I don't know if cystitis is an infection. I think she should be treated for it since they both prescribed antibiotics for her with no results. Thanks for your ear, Len
A: Len - Recurrent lower urinary tract disease in cats is a really difficult problem to control in some cases. There are a number of possible problems when cystitis is present. Cystitis is technically infection of the bladder but is commonly used to describe inflammatory non-infectious bladder disease as well. It is also possible for the inflammation and symptoms to arise from urethral infection or inflammation.
A careful examination and labwork to rule out as many causes of this problem as possible is a good idea. We have even resorted to doing exploratory surgery to examine the bladder for diverticuli, bladder stones that might not show up on X-rays and bladder tumors.
Many times, even after extensive work it is not possible to pinpoint the exact cause of the lower urinary tract inflammation. In these cats, we try to treat the pain and discomfort symptomatically. We have had some success using amitriptylline to cut down on spasms of the bladder. This seems to provide a measure of comfort to cats chronically affected with lower urinary tract inflammation in many cases. There are other medications sometimes advocated for this as well. It might be worth discussing the use of amitriptylline or similar medications with your vet.
Mike Richards, DVM
Urinary tract problem and Inflammatory bowel disease
Q: My cat's a (beautiful!) 7 yr old domestic longhair. Fed Iams dry for 6 yrs, then started doing 1/2 Iams and 1/2 canned. Developed a urinary infection 6 months ago, on antibiotics for a month. Was on W/D, now on 1/2 Iams & 1/2 Science Diet Feline Maintenance. Gave her Petromalt, threw up a hairball, now 4 days later is still throwing up. Eats little, throws it up later with dry heaves too. After second day, she drank a lot of water and threw it up in about 1 minute. Spent $250 at vet, no answer yet. Detailed blood work all normal. No crystals in urine, some white cells, am waiting for results of culture. On Baytril now. The day before I gave her Petromalt she had just finished a 2 week course of Cefa from another vet I took her to for a check since she had dribbled urine once but wasn't straining or showing any other signs of any problem. I feel like I KNOW something's still wrong, but I don't know how to find an answer. How can I get her to stop throwing up and keep some food down? She's been using the litter, so she must be keeping some water down somewhere. Can you help? Thank you!
A: You may have two problems going on at the same time with what you describe.
The urinary tract problem may be cystitis, bladder stones, bladder cancer, incontinence or may relate to problem encouraging urine production (although most of those, like diabetes and kidney failure) would show up on normal labwork. This problem may be under control at this time based on the history you gave.
Vomiting is sometimes associated with urinary tract disease in cats but that isn't the most common cause. Inflammatory bowel disease is the most common cause of chronic vomiting in older cats and hyperthyroidism is the second most common cause, probably. Neither of these diseases show up well in labwork because the values all tend to be normal. Some blood panels do include T4 levels, which can indicate hyperthyroidism if they are elevated. Not eating can lead to hepatic lipidosis. Cats with this condition often have nearly normal lab values on routine test panels, too. It may take a couple of visits to your vet to sort through these possible causes of the symptoms you are seeing. Please continue to work with your vet to resolve this problem.
Mike Richards, DVM
Q: Dr. Mike I found your column and am hoping you can provide some guidance. I am the owner of 2 neutered male domestic short-hairs who live indoors and have been having on and off bouts with FUS. I read in the book The New Natural Cat by Anitra Frazier that there are certain dietary changes that I can make to make the cats urine more acidic and reduce the chances of crystal buildup. For example, she recommends mixing in a raw egg yolk once a week or adding a methionine supplement to their diets--does this type of change help or hurt what has so far been a mild condition? And yes, we have been feeding them the vet precscribed Hills C/D and S/D though they seem to have grown tired of this. Whatever advice you can offer would be appreciated.
A: I am not a proponent of feeding raw meat or raw eggs to pets. The same problems that occur in humans who eat raw or undercooked meat and eggs occur in pets. I do not believe that the benefits outweigh the risks. It is unlikely that once weekly feeding of raw eggs would actually produce urine acidification sufficient to help in FUS, as well.
dl-methionine at a dosage of approximately 0.5 to 1 gram/cat/day has been recommended for FUS. It is not considered to be the most reliable urinary acidifier but may be beneficial. Ammonium chloride is used at dosages of 20mg/kg of body weight twice a day and is probably more effective as a urinary acidifier.
Feeding the urinary acidifier as part of the diet helps to reduce urine pH in a more effective manner, since the absorption of food tends to increase the urine pH and it is very helpful if the acidifier is absorbed at that time to combat this effect.
There are a number of cat foods available now that promote urinary acidification. I have not seen data comparing them all but I suspect the formula for making foods that acidify urine is well known by now and that most of them work. That is a guess, though.
Mike Richards, DVM
Trickling urine, licking behind
Q: Our cat, Peabody, is about 1 1/2 yrs old. About a month ago, we noticed he was displaying signs of depression, along with an unusually large amount of time spent licking his behind. A few times, we awoke in the middle of the night to his "howling/groaning" while licking his behind. We took him to the vet, fearing a urinary tract infection. We were told that his depression was probably caused by "sibling rivalry" with his brother. He told us to monitor his eating and urinating habits. During the past week, Peabody has been "trickling" urine throughout the house and has even urinated on the couch. He has never done this before. The "groaning" occurs occasionally, but he is constantly licking his behind. His eating habits have diminished slightly, and when we noticed him "pawing" the carpet, we placed him immediately on the litter box. He did urinate (after a few minutes of "trying", passed a little gas, and had a bowel movement, which was rather loose (this also occurred after quite a while of squatting to no avail). His stool seem almost "grainy and woodlike" in appearance, and even appear to have long strands of twine (thicker than string) and hair in them. I would appreciate any advice you could give. I am planning on getting him back to the vet tomorrow, along with a stool specimen. I am very concerned, after reading about urethral blockages and urinary tract infections. Thank you for your time. L.A.
A: Taking Peabody back to the vet is the right thing to do. If you haven't already gone, write down the symptoms like you did in this letter and bring it with you. It is hard to distinguish between urinary problems, anal sacculitis and colon/rectal problems when a cat is licking a lot at its rear end. Examining the anal sacs and the stool could be very helpful. Abdominal palpation (feeling the internal organs from the outside) may reveal excessive stool accumulation or problems like bladder stones.
Cystitis and lower urinary tract disease can be very difficult to diagnose since we can't ask cats where they hurt or what they are feeling but they have to be kept in mind with the symptoms you are seeing and it is justifiable to treat for these problems when signs suggest they are present, even if a definite diagnosis can not be made.
Hope this helps.
Mike Richards, DVM
Q: DEAR DR MIKE, I HAVE A 5 1/2 YEAR OLD PERSIAN CAT WITH A MAJOR ATTITUDE. I GOT HIM NEUTERED WHEN HE WAS APPROXIMATELY 9 MONTHS OLD. AT THE SAME TIME I HAD HIM DECLAWED. EVEN BEFORE ALL OF THIS HE HAD A BAD HABIT OF NOT USING THE LITTER BOX ALL THE TIME. HE IS VERY PICKY. HE EXPECTS SOMEONE THE WITH A SCOOPER IN HAND FOR WHEN HE'S DONE USING IT YOU'RE SUPPOSED TO CLEAN IT. IT'S IMPOSSIBLE FOR ME TO DO THAT! SO, HE GOES EVERYWHERE ON THE BASEMENT FLOOR. ESPECIALLY BY BOXES OF OUR CLOTHES OR THE BABY'S THINGS THAT ARE STORED AWAY. I REMEMBER READING ABOUT A PRODUCT CALLED ODOR MUTE (I BELIEVE THAT'S WHAT IT WAS CALLED). IT IS SUPPOSED TO CLEAN UP THE URINE SMELL OFF OF CONCRETE. I HAVE ASKED AROUND ABOUT IT BUT NO ONE KNOWS WHAT I'M TALKING ABOUT. CAN YOU HELP. I WOULD REALLY APPRECIATE IT.
A: It might help to give him two or three litterpans. I know that is a lot more work but it might be better than what is going on now!
I have not heard of Odor Mute but there are a number of enzymatic odor removing products. Feline Odor Neutralizer (F.O.N.) is pretty good, as is Equalizer, Nature's Miracle and X.O. Your vet may have one of these products or you may be able to find them in a pet store. These products have enzymes that help to eliminate the odors rather than just masking them.
Mike Richards, DVM
Michal response: X-O Plus has my vote, but F.O.N is very good for cat urine.
Q: I was wondering if you could give me some information on what might be wrong with my cat. She is about 15 years old. For the last two days she has been urinating blood and meowing painfully. She has always been in perfect health so that is very different for her behavior. Thank you,
A: The most likely problem is a urinary bladder infection (cystitis) but bladder stones, bladder cancer and bleeding disorders are also possible. The only way to know for sure is to take your cat to your vet for an exam and possibly testing.
Please have her examined soon.
Mike Richards, DVM
Q: Dear Dr. Mike: I have a 17 year old mixed breed house cat that has had a urinary infection for about two years. My vet has been successfully maintaining her urinary health with a medication 'Cefa..' . Recently a friend told me that there is a condition in cats where they lose the mucus lining which prevents the bacteria from getting to the bladder wall. My vet has not heard of this. Is there such a condition? Also my friend told me that there is a new medication for maintaining urinary health being used in cats called Amitriptyline, is this true? I read that Amitriptyline is used as an antidepressant in people. If you are familiar with either the bladder condition or using Ami.. in cats, can you point me to any literature on the subject.
A: I am at home and the best reference I have on this subject is at work -- it is a volume of Clinics of North America on lower urinary tract disease in cats (March and May issues, 1996).
Amitriptylline is an anti-depressant but it is used in chronic cystitis cases for pain relieving or antihistamine effect. I can't remember the exact mechanism of this effect but it is different from the anti-depressant effect. It is bitter and cats tolerate it better if the tablets are put into gel capsules prior to administration. Some cats do get sort of "zonked" on this medication but most don't. It is advocated for use in interstitial cystitis which may be the condition you are referring to. It is thought that the protective layer of mucous like substances (glycosaminoglycans) may be missing in these cats, allowing penetration of the bladder musculature by bacteria.
Mike Richards, DVM
Q: hi- I need to keep my cats urine acidic. currently I'm giving him 500-600 mg of ascorbic vitamin c a day with food. I've heard of UROEZE and would like some more info. What is in UROEZE? Do you know of any other acidifiers I could give or is the vitamin c ok?
A: It is my understanding that Vitamin C does not provide long term acidification of the urine, so its usefulness in conditions in which that is desirable (like chronic cystitis) is limited.
The best approach is supposed to be dietary control because diets made to acidify urine provide the best longterm control. Examples would be Purina's UR and Hill's c/d diets. There are also diets such as Purina Special Care and Alpo Urinary Formula that control urine acidification.
An alternative is medical control. This is necessary when cats won't eat the special diets or they are not possible to use for other reasons. Uroeze is a combination of ammonium chloride and d,l methionine, I think. Many vets use it and feel that it keeps the urine pH acidic satisfactorily. I have not personally used this medication and can not give any personal insights.
Mike Richards, DVM
Feline Chronic Renal Failure Information Center -This is an excellent source of medical information and support.
Last edited 06/19/05
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