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The Inappropriately Peeing Cat: UTI’s, Stones, and Stress

When it comes to peeing inappropriately, abnormal urinary behavior in cats can have a lot of causes, some being simple to figure out with others being frustrating to resolve.

In this article we’re going to talk about the importance of urinary and bladder health in cats, some causes of changes in bladder health that lead to inappropriate urination, and some steps you can take to keep your kitty’s bladder and urinary tract healthy.

Why is Bladder Health Important in Cats?

Blog-Cat-Cranberry-1When it comes to cats, bladder health appears to be far more intimately associated with signs of well-being when compared to dogs or people.

A cat’s very emotional health and stability can play a big part in their urinary behavior and even the very health of the tissues of their urinary tract, which is something we simply don’t really see in dogs or people.

What is Feline Lower Urinary Tract Disease in Cats?

Feline Lower Urinary Tract Disease (FLUTD), also called Feline Urologic Syndrome (FUS) is a collection of underlying causes that all lead to very similar urinary tract signs in cats, including straining to urinate, frequent urination, urinating in inappropriate places, and blood in the urine. The following is a short summary of conditions that fall under this FLUTD umbrella.

Urinary Tract Infections

Urinary tract infections (UTI’s) in cats are usually the first thing a kitty parent thinks of if their cat starts urinating inappropriately in the home.

A cat urinary tract infection is caused by bacteria making their way up the urinary tract into the bladder, where they adhere to the bladder wall lining. The inflammation this causes is what leads to signs of discomfort and frequent straining to urinate.

Blog-Cat-Cranberry-5Cat UTI’s most commonly occur in female cats, because their urethra is very short, closely associated with the anal opening, and because when squatting to pee, a female’s urinary tract tends to get much closer to the ground.

Overweight and obese cats are also at higher risk due to excessive skin folds surrounding the urinary tract and a decreased ability to groom and keep private areas clean.

Urinary Crystals

When urinary crystals are present in a high enough concentration and amount, they cause a lot of irritation along the bladder and urethral lining, leading to inflammation, straining and discomfort. A cat showing signs of disease from urinary crystals will look very similar to a cat with a UTI.

There are two main types of urinary crystals found in cats. The first are magnesium-ammonium-phosphate, also simply called struvite crystals. The second are calcium oxalate crystals.

Which type of crystal is present can depend on pH of the urine, diet, and genetics.

Bladder Stones

Urinary crystals are microscopic but crystals can also aggregate together over time to form actual solid stones.

Bladder stones continue to cause irritation and inflammation of the bladder wall from their abrasive presence, but they also present a much higher risk: urinary tract obstruction.

Blog-Cat-Cranberry-3If one of the stones, even a small one, exits the bladder and makes its way into the urethra, it can get lodged in the narrow tube, preventing urine from passing. This is especially a risk for male cats, who have longer, more narrow urethras compared to female kitties.

Urinary obstruction is life-threatening for cats, and they can deteriorate very quickly if a blockage is present for more than just a couple hours. Any cat that is found to be straining to urinate but unable to produce urine within just a one hour period of time should be immediately taken to a veterinarian for assessment.

Urethral Plugs

Stones aren’t the only risk for urinary obstruction in cats. Chronic bladder wall inflammation leads to the production of mucus. This, combined with crystal sediment, inflammatory cells, and other cell debris, can form into what is known as a mucus plug.

Mucus plugs, just like bladder stones, can also get lodged in the narrow urethra. In younger cats, urethral plugs are generally appreciated to be more responsible for urinary obstructions compared to actual stones.

Urinary Tract Cancer

Fortunately, cancerous tumors of the urinary tract in cats are very rare. Transitional Cell Carcinoma (TCC), which originates from the cells that line the bladder wall, is the most common in cats, but is still exceedingly rare. According to a 2018 article published in Veterinary Sciences, the incidence of TCC is less than 0.2% in cats when compared to dogs.

Feline Idiopathic Cystitis and Stress

Feline Idiopathic Cystitis (FIC) is the final category under the FLUTD umbrella of conditions. FIC is essentially what is left behind after infection, urinary crystals, bladder stones, and tumors, have all been ruled out as causes.

FIC is also sometimes called Pandora Syndrome, because its underlying causes have been found to be multifactorial, but largely associated with environmental stressors. The stresses we may not even consider stressful ourselves. This can include interactions with other pets in the home, a home environment that is overstimulating or one that is too understimulating.

Not every cat will develop signs of FIC during times of stress. It is thought that these cats that are “poorly wired” to handle stress have responses different from other cats in their nervous and hormonal systems, that leads to inflammation in the bladder wall. When the bladder wall becomes “leaky”, urine can penetrate the tissues, causing further inflammation and pain.

How Does My Vet Figure This Out?

Because all of these conditions under the FLUTD umbrella look very similar--frequent peeing, straining to pee, peeing in inappropriate places, and blood in the urine--your vet needs to determine which of the causes is happening.

Blog-Cat-Cranberry-8When you bring your cat into the vet, the basic physical exam lets your vet make sure your cat doesn’t have a urinary obstruction, and to check if the bladder is painful.

A urine sample helps to check for most urinary tract infections, and the presence of crystals. In veterinary practices where an ultrasound is used routinely to collect urine samples, the bladder is viewed, which is helpful for ruling out the presence of bladder stones, tumors, and debris accumulation.

Your vet may also recommend an x-ray, which is fairly definitive to rule out the presence of bladder stones.

If no UTI, bladder stones, crystals, or bladder masses are found, FIC is typically the remaining diagnosis to discuss and treat.

How Are These Conditions Treated?

UTI’s are treated with antibiotics. Your veterinarian will choose the best one based on the likelihood of success or the results of a urine culture in some cases.

Prescription diets specially formulated to keep the pH of the urine in a neutral range can help to prevent the formation of urinary crystals. Struvite stones and crystals can be dissolved by these prescription diets. Unfortunately, calcium oxalate stones can only be removed, typically through surgery.

While cancerous tumors of the bladder in cats are very rare, some can be surgically removed. Other medical therapies may also be possible if the specific type of tumor can be diagnosed.

FIC is a bit less straightforward to treat, given that it may have many underlying triggers. However, all of them are related to underlying environmental stressors. Cats that routinely suffer from FIC episodes are not neurologically “wired” the same as other cats.

It’s important with FIC to figure out what the stressor(s) is/are. While anxiety and pain medications may help an FIC kitty, environmental management is key to long term success.

When helping these cats in their home environment, we need to cater to both their more private natures and their need for stimulation. Here are some suggestions.

Blog-Cat-Cranberry-6Make sure your cat has a private, quiet area he can retreat to. This is especially important in homes with multiple young children or other pets.

Ensure that there are enough litter boxes in the home. The general rule is to have one box per cat plus one. Keep a box accessible on each floor of the home in a quiet, private area.

Keep food and water bowls in lower traffic areas and make sure to keep feeding times as consistent as possible. Anyone with a cat knows that our furry friends are very strict when it comes to their feeding schedules and delays or irregularities can be stressful for them.

Provide environmental stimulation. Cats are very social creatures despite their common reputations, so stimulation is also really important. Have windows or perches where an indoor cat can look outside or bask in some warm rays of sunshine.

Encourage play or activity through hunting behavior. If your cat isn’t really into playtime with toys, you can simulate the hunting instinct by “hiding” small morsels of the daily food allowance around the home. There are even toys designed just for this purpose.

Reduce stress and anxiety through the use of feline calming pheromone products. Available in diffusers, sprays, and collars, these pheromone products mimic the calming pheromones that cats themselves produce, which can greatly help them calm down and reduce inappropriate urinary behavior when related to stress.

Supplements can be helpful. Marshmallow root is an herb that can help to support urinary tract health. A 2016 paper published in the Journal of Pharmacognosy and Phytochemistry suggests that it can relieve irritation and inflammation of the urinary tract. Holistic veterinary practitioners often employ marshmallow root as part of a supportive strategy for cats with FIC.

Through the actions of proanthocyanidins, cranberry extract may help reduce bacteria adherence to the bladder wall. Quercetin and ursolic acid, two other components of cranberries, have good antioxidant potential and inflammation mitigating properties.

A very recent study published in 2021 in Natural Products Research found that after about 60 days, lower urinary tract signs in a small group of cats with FIC were significantly reduced when fed a cranberry extract product. This is promising since FIC is typically a condition requiring lifelong management.

Last, oregon grape root (which is not actually related to grapes at all and is very safe for cats) carries some anti-inflammatory, anti-microbial, and antioxidant properties as well and may be commonly found in some urinary health supplements for pets.

With any supplements, there is almost no regulation in terms of quality of ingredients, so it is very important to find a high quality supplement, especially if you’re trying to help keep your kitty’s urinary tract supported and healthy.

Just like you might look for the distinctive US Pharmacopeia (USP) Verified Mark on a supplement or multivitamin for yourself, you need to look for evidence of a similarly high standard for your cat.

When looking at products made for cats, always look for the National Animal Supplement Council (NASC) Quality Seal. In order to have permission to display the NASC Quality Seal, member companies must voluntarily follow very strict measures including independent facility inspection, random product testing, adverse event reporting, and strict labeling guidelines. This helps to ensure a safe and quality product for your furry friend.

Conclusion

Urinary health is vitally important in cats, as any kitty parent who has had to deal with unwanted inappropriate urinary behavior has figured out.

Blog-Cat-Cranberry-7Keeping the urinary tract healthy and your kitty stress free with the right environment along with regular consulting with your vet is the best place to start to keep your kitty peeing free and easy (and in the litter box).

Behavior that includes frequent trips to the box, very little urine output, and straining to pee can be just as likely from a urinary obstruction as from a UTI, so it’s always best to have your friend checked out by your vet if you see these signs develop.

Remember, if your cat can’t produce urine over the course of one hour while making frequent attempts, you should consider this an emergency.

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