What to Expect at the Vet's if your CAT has a
Lower Urinary Tract Problem
(Of course, your vet may do things differently)
I suspect that outdoor cats suffer a lot of urinary tract problems without anyone noticing, but if your cat spends much time indoors, it's usually pretty obvious that something is wrong. Most people notice the problem when their cat not only pisses on the floor instead of the litter box, but also notice a little blood in the urine.
Cats with urinary problems typically strain to urinate or make frequent trips to the litter box and get in the position but not much comes out; that's because the bladder is more or less empty, but the inflammation and irritation of the disease makes them think it's time to go.
Time out: Sometimes we mistake the discomfort of colon impaction and lower bowel problems for urinary straining or squatting. it's easy to suspect urinary tract trouble when the real trouble is a bowel problem or vise versa.
At any rate, the most common signs are increased frequency of urinating or trying to urinate, urinating in inappropriate places, and noticing abnormal urine. Otherwise, most cats act pretty normally, or if you're really tuned in to your cat's moods and behavior; "not quite right".
However: certain urinary tract problems can make your cat deathly ill. This is especially true of male cats that become "blocked" and can't urinate due to a urethral obstruction. Typically these cats moan, stay positioned in their litter boxes, are very tender, don't want to be picked up, and as the day goes on, become more and more listless, weak and sick. Vomiting is common. These cases are true emergencies, so don't wait until the next day "to see what happens".
Know that our thinking about feline lower urinary tract problems is changing. Veterinary professors are now telling us that many bladder infections aren't really infections at all but inflammation associated with stress, behavior, or neural disease
The nervous system affects bladder tone, bladder emptying, and sphincter control.
EXAM and History:
Much of the time, we don't learn much on the initial exam. In other words, the temperature, lymph nodes, heart rate, external genitalia, and even bladder palpation are typically within normal limits.
It's the history of frequent urination, urinating on the floor (or bathtub), straining to urinate, and/or blood in the urine that leads us to suspect a urinary tract problem.
The exception is in the male cat with a blocked urethra...in these cases there are many abnormal exam findings including the palpation of a huge and painful bladder.
Nonetheless, a good vet will perform a head to toe exam. Some things going through our minds during this exam are...is the animal in heat?....has there been a recent stress or water deprivation?...is this the first urinary tract problem for this patient?...is there an underlying metabolic problem involved like diabetes?...are there oral/gum infections? (cats and dogs spend a lot of time licking you know where, and if they have a high oral bacteria count due to oral disease, they may be seeding their urinary tract...another reason for dentistry!) ...does the patient have a good vaccine history? (protected from leptospirosis)...is the patient also being treated with meds that affect the urinary tract such as steroids? Are there signs of kidney disease? What kind of diet is the cat getting?
Understanding that there are so many different factors is yet another reason to trust urinary tract problems to your veterinarian and not attempt home treatment without first getting a sound diagnosis.
Also, don't delay too long before getting professional help: a bladder problem left untreated for very long will lead to damage to the urethral and bladder wall, causing it to lose it's super smooth interior lining and ability to stretch and expand. This leads to more likely future infections.
DIAGNOSTICS (Lab Tests and Radiographs) Detailed comments about the tests your veterinarian will recommend:
It's fairly expensive to run every test for every case suspected of a bladder infection or other urinary tract problem, but depending on the age of your pet, the severity of the symptoms, and whether or not your pet has had previous problems will determine which of the following tests will be recommended. On the other hand, an accurate diagnosis based on these tests often prevents inadequate treatment which sometimes leads to unnecessary discomfort and possible permanent damage to the urinary tract system.
Here's a summary and a few comments about the tests your vet is likely to recommend if your pet is suspected of having a lower urinary tract disease.
Urinalysis: the most obvious test is a good look at the urine and with the help of some inexpensive chemical "dip sticks" , careful technique, a good microscope, and some training, we can determine with different degrees of accuracy if there's blood, sugar, pus, ketones, bilirubin, crystals, or kidney casts in the urine. We can also tell if the urine pH is ideal and if the kidneys are able to concentrate the urine normally. The only trouble is getting a clean and fresh urine sample.
Collecting the urine sample: There are 4 basic ways to collect urine, each with advantages and disadvantages. Those 4 methods are
1. collecting the urine from the cage, exam table, or from plastic, nonabsorbable litter left with the cat in a cage.
2. manual expression ... often with the help of sedation or light anesthesia
3. via a urethral catheter also under light sedation, and
4. via cystocentesis which is a fancy name for sticking a sterile needle very carefully through the abdominal wall into the bladder which, believe it or not, we can often do without sedation in many cats. This last method is considered the best in general and critical if a culture for bacteria is being done which we will discuss in a moment.
Isn't this fascinating?
Once we collect the urine sample, we analysis it. Well duh.
First we stick in an inexpensive urine chemistry strip which isn't very precise, but does gives us a crude warning if urine glucose, ketones, bilirubin, leukocytes, occult blood, or excessive proteins are present. If any of these are abnormal, that's a good clue about which disease is present. A high urine protein, for example, could mean that there's a lot of pus in the system...or that the kidney, which is supposed to allow water and electrolytes to pass through it's filter is damaged allowing larger protein molecules to pass through the system.
The next part of the urinalysis is to centrifuge the urine in order to separate the water from any cells, molecules and other solids present, and to examine the result under a microscope. One of the things we can see under the microscope is pus. In the example about high urine proteins in the paragraph above, if we don't find pus, then we can correctly assume that the protein in the urine indicates kidney disease, and more specifically, glomerulous disease. (The glomerulous is the filtering system in the kidney, that when healthy, prevents protein loss through the urine.)
What are we able to see under the microscope?:
White Blood Cells (WBC's): high numbers indicate infection from bacteria. Pus is the macroscopic result of large numbers of white blood cells. Finding pus in the urine confirms that there's a bladder infection (it doesn't mean there aren't additional problems), it justifies the use of antibiotics, and by later repeating the urinalysis, we can tell whether or not the treatment was successful.
Red Blood Cells (RBC's): a clue to the degree of inflammation and irritation
Casts: these are little plugs of dead cells from the kidney and large numbers indicate kidney disease.
Crystals: The presence of crystals often ... but not always, indicates a need for diet modification and also increases the possibility that there may be bladder stones present.
Culture and Sensitivity: Another thing we can do with the urine is culture it.
The disadvantage of culturing is that it requires a fair amount of time, expense, and attention to detail by everyone involved to get reliable culture results. It's kind of like cooking a souffle...everything has to be just right...sterile collection of fresh urine, sterile transport on culture broth at the right temperature, transfer to culture plates and incubation for the proper amount of time at the proper temperature, choosing useful sensitivity discs, and reliable, readable records written by reliable lab techs. A lot can go wrong, so don't be surprised if the results are discounted or need to be repeated. Also, it takes about 1-2 weeks to get results back.
What makes all this trouble worthwhile is that we learn which bacteria or combination of bacteria is causing the trouble and which antibiotics are likely to kill it. In addition, we also know that certain types of bacteria (pseudomonas, for example) require not only special antibiotics but long term treatment for success.
Many vets and physicians, me included, often skip this test and are successful in simply choosing an antibiotic that usually works, but it's a little gamble, and if we're wrong, then we have to start over, the patient was in discomfort longer than needed, further damage was done to the bladder and urethral lining that could be permanent, and we could possibly be contributing to the problem of bacterial resistance to antibiotics.
If the urinalysis indicates the presence of white blood cells in significant numbers, then there's an infection and a culture and sensitivity should seriously be considered.
Specific Gravity: A screening test for kidney function
Another thing we do with urine is check it's specific gravity. Pure water has a specific gravity of zero (at sea level). At any rate, it's a measure of urine concentration. In other words...how much of the urine is water and how much is made up of molecules, urea, and the other waste materials the body has to eliminate each day. This concentration changes normally within a range depending on all kinds of factors like hydration, fever, medications etc, but numbers outside the normal range tell us that something is wrong with the kidneys, and this information combined with BUN and Creatinine results help tell us what kind of kidney disease the patient is suspected.
Creatinine and BUN: Common screening tests for kidney disease
These blood tests tell us whether or not the kidneys are working adequately, and when the tests are repeated, they tell us whether or not kidney health is improving or getting worse. To truly diagnose exactly what type and extent of kidney disease a patient has often requires biopsy, ultra sound, special x-rays or other newer imaging techniques, but we can get a good idea with just creatinine and BUN results which are relatively cheap and easy to obtain.
The only big trouble with this pair of tests is that there can be a fair amount of disease or kidney cell destruction going on and yet the test results will be normal...
But if the results aren't normal, we know that's significant.
We are discussing lower urinary tract disease at this point, so why run tests for upper urinary tract disease you might be thinking.
The obvious reason is to make sure... the upper and lower tracts are, of course connected and related...and there's a chance that your patient has both lower and upper tract disease.
Blood Glucose Screen: Used to check for diabetes if history or chem strip results make us suspicious.
CBC-Chemistry Panel: Instead of doing BUN, Creatinine, and Blood Glucose as separate tests, we often choose to run a complete chemistry panel which includes these three test plus screening tests for liver disease, pancreatitis, thyroid disease, protein and globulin levels, and when a CBC (Complete Blood Count) is added, we also learn about whether or not there is anemia, bleeding disorders, high white blood cell counts in the blood and so forth.
Why do we often elect to do all these additional tests? Partly because the cost for doing the whole panel is only slightly more than running individual tests, but mainly because when an organ as important as the kidneys are diseased there is often collateral disease in the rest of the body. We are so used to breaking down everything into organ systems because it's easier and useful for communicating and understanding our complex bodies, but we need to keep reminding ourselves that the body is a holistic organism.
Radiographs and special contrast radiographs: I recommend considering radiographs for all UTI patients but especially for those patients who have recurrent urinary tract problems. Why? Because the problem is sometimes a kidney, bladder, or urethral stone. Radiographs will usually detect these stones. In addition, radiographs are sometimes useful in detecting cancers, urethral tears, diverticuli (little outpouches that harbor bacteria), abnormalities in the size and shape of kidneys, ureter damage, and thickened bladder walls.
UltraSound: Also useful in finding stones and tumors. Unfortunately, I don't have an ultra sound machine at my practice, but many vets do.
Stone analysis: This test is done only if we have a stone to test...usually after surgical removal. There are several different types of stones, each of which can be largely prevented if the right diet is chosen. Each different type of stone has a different diet that is most likely to control and prevent further disease. There's an article about bladder stones below.
Treatment Choices
(Of course, other vets may do things differently)
Antibiotics: If infection is present or suspected, or to prevent infection in the presence of blood or inflammation, your vet will recommend an appropriate antibiotic. Which antibiotic and for how long will depend on your vet's experience, budget, drug tolerance, and such practical factors such as ease in giving.
Anti-Inflammatories and other supplemental Treatments:
Glucosamine, MSM, and vitamin C are all possibly helpful in increasing lubrication of the tract and/or reducing irritation.
Prednisolone or other steroids for short periods are often used to stop bleeding, irritation, and increase water intake, but potential problems with steroid use make it's use controversial.
Phenobarbital or valium is often helpful with urethral spasms and discomfort.
I like Durlactin, a brand of flavored suspension containing omega fatty acids, lysine, and patented anti-inflammatories made from hyper-immunized cow milk. It helps a llot with pain, inflammation, and healing.
Stress Management: Since stress or anxiety seems to be a big factor in lower urinary tract diseases ... especially of young cats ... your vet may recommend diazepam or Prozac or similar medications. Or pheromone therapy.
Prescription or Therapeutic Diets for the Treatment and Prevention of Stones or Crystals and Recurrent Infections:
Increased Water Intake:
In many cases, this might be one of the most effective treatment if you can figure out how to get your cat to do it. Feeding canned or wet food helps in this regard. Cats are very fussy about the water they drink, so your vet may talk to you about making the water you offer your cat more enticing; making sure it's fresh or offering a fountain of some type; cats like flowing or dripping water.
Hospitalization, catheterization, and surgery if needed for a blocked bladder or bladder stones or cancer or trauma.
Follow Up: It's important to pay attention to your patient after initial treatment, especially if you skipped doing blood work or radiographs. Usually it's good practice to repeat the urinalysis after about 3 weeks to help make sure the infection/inflammation is really cured.
TREATMENT OF THE WHOLE BODY:
This represents a whole new subject. Disease is not an isolated event. If the rest of the body is sickly from malnutrition, parasites, lack of exercise, and maybe from lack of purpose and love, then disease is more likely to flourish. When one organ system is sick, other organ systems are affected. At any rate, we will address the patient as a whole and make appropriate recommendations. They might include diet changes, I.V. fluids and electrolytes, vitamins and minerals, and so forth.
REFERRAL TO A SPECIALIST: If your patient needs advanced care or surgery of the urinary tract, consider taking advantage of the skills and equipment available at a veterinary urologist. They're available at most large cities and veterinary universities now. Your vet will recommend this option to you when appropriate.
