Difficult Urination in Cats

Difficult urination can be caused by issues in the upper urinary tract (composed of the kidneys and ureters) or the lower urinary tract (containing the bladder and the urethra). A veterinary examination is needed to locate the exact area of the obstruction. Diagnosing and treating this complication early is linked with higher success. Dysuria is often referred to as feline lower urinary tract disease (FLUTD) or feline urologic syndrome (FUS). Male cats experience these syndromes more often than female cats. Cats who are overweight, neutered, and who live indoors also have higher instances of difficult urination.

A healthy cat will not have difficulty urinating. When dysuria, or strained urination, is noted, it should be taken as a symptom of a potentially severe underlying problem. If no urine is passing at all, a medical emergency is at hand and the cat requires immediate hospitalization. Difficult urination is often caused by a partial or complete blockage somewhere in the urinary tract. This can cause the kidneys to fill with urine and shut down, releasing toxins into the bloodstream. The bladder also may rupture in rare cases, spilling urine into the abdominal cavity. Both of these scenarios are life-threatening.

When any symptoms are noticed, take the cat to a veterinary clinic or animal hospital as soon as possible. If a complete obstruction has occurred, the cat may not have much time before internal organs begin to shut down. Signs to watch for include:

• Pollakiuria (frequent urination with small amounts of urine released)
• Urinating outside of the litter box
• Hematuria (blood in urine)
• Polydipsia (increased thirst)
• Anorexia
• Vomiting
• Vocalization 
• Excessively licking the genital area
• Distended and painful abdomen
• Lethargy
• Collapse

Cats who experience dysuria often have a form of bladder inflammation called “cystitis”. This issue has many primary health problems related to it. Diet may play a large role in the development of many diseases that lead to difficult urination. Possible causes are as follows:

• Urinary tract infection caused by bacteria
• Feline interstitial cystitis
• Reactions to medication
• Genetic predisposition (as seen in the Himalayan cat breed)
• Blood clot
• Buildup of scar tissue
• Urinary tract stones or crystals
• Benign or malignant tumors 
• Urethritis
• Muscle spasm of the urethra
• Stress
• Injury
• Foreign body from previous surgery (often a catheter)

You will need to bring your cat's full medical records for the veterinarian to look over. This can help identify potential causes of dysuria. The vet will then perform a physical examination of the cat, palpating the bladder and kidney areas to feel for enlargement and test for a pain response. If there is obvious organ enlargement, an obstruction is likely. This may require immediate surgical attention. 

Urinalysis will be needed to verify the presence of blood, struvite or calcium oxalate crystals, bacteria, or elevated protein levels in the urine. It can also determine the pH of the urine. Kidney function can be assessed by these results. Blood may suggest that urinary tract stones or crystals are rubbing against internal organ linings and causing extreme irritation. An x-ray or ultrasound of the abdomen may help locate any blockages and confirm if tumors or foreign bodies are present. A culture of the urine may be done to identify bacteria if any exists. Full blood work including a complete blood count and a biochemical profile will need to be run.

The appropriate course of treatment will vary based on the underlying cause of dysuria that has been identified. Certain health issues will require ongoing care.

Emergency Exploratory Surgery 

If a complete obstruction exists but the location and exact cause can not be confirmed by diagnostic imaging, emergency surgery may be performed on a last resort basis to save the cat's life. Once the abdomen has been opened, the surgeon will look for any possible causes of urine blockage and relieve it if possible. A biopsy of the bladder wall may also be removed for further testing and diagnosis.

Surgical Removal 

If stones have been confirmed within the urinary tract, they may be flushed out. If this proves unsuccessful, surgical removal of the stones will be necessary. If tumors are present, they may also need to be surgically removed. Both procedures carry risks, as certain portions of a cat's urinary tract are extremely narrow and difficult to operate on. General anesthesia is required for the surgery to be performed.

Antibiotics

A course of bacteria-specific antibiotics may be prescribed if a bacterial infection has been diagnosed in the urinary tract. As a preventative measure, a broad spectrum antibiotic may be administered after a surgical procedure. These prescriptions generally last from one to four weeks.

If your cat has undergone abdominal surgery, be sure to follow all at-home care instructions closely. Monitor the incision site daily to ensure it is clean and that no signs of infection exist. Prevent the cat from licking or scratching at its stitches. An Elizabethan collar may help in keeping the cat from interfering with the incision. Administer all medications as prescribed to promote proper healing.

Supplementing your cat with glycosaminoglycans may be recommended to help build up the bladder lining and limit the amount of inflammation that may be caused by urine. It can be easily added to your cat's food. Ensure that you are feeding your cat a species-appropriate, high-quality diet. This diet should contain low amounts of magnesium and ash. Your veterinarian may temporarily prescribe a specific diet to help dissolve small stones that may exist in the urinary tract. Provide fresh water to your cat multiple times a day. Put out at least one litter box per cat and clean them daily. Encourage your cat to exercise by playing with it and offering it ample space to run.