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                                               FELINE CYSTITIS

What is cystitis?

The term "cystitis" literally means inflammation of the urinary bladder. Although this term is rather general,
there is a common form of cystitis that occurs in males and females. This disease is also known as Feline
Urologic Syndrome (FUS) or Feline Lower Urinary Tract Disease (FLUTD). It affects the bladder (not the
kidneys), resulting in the production of tiny crystals and blood urine. The pet often urinates much more
frequently than normal, usually with the passage of only a few drops of urine. This is often confused with
constipation. This disease will cause many pets to urinate in places other than the litter box, often on hard
surfaces such as tile floors, countertops, sinks, and bathtubs. They should not be punished for doing so.

What are the causes?

We are not completely sure of the cause of this problem. Bacterial infections are the most common cause of
cystitis in dogs and humans, but most cats with cystitis do not have bacteria in their urine. Early neutering of
male cats and feeding of dry cat food have been proposed as potential causes, but these have been disproved as
initiating factors. It is true, however, that many dry foods may aggravate the problem after it begins. A herpes
virus has been incriminated and someday may be proven to be the cause. Despite extensive research, the cause
remains elusive.

What are the clinical signs?

Most pets with cystitis exhibit blood in the urine and discomfort in urinating. The discomfort is usually mild but
can become much worse if it is not treated. In addition, many dogs have discomfort when urinating; they will
spend several minutes passing only a small amount of urine, and they may urinate more frequently than
normal. The signs will be determined by the specific cause of cystitis. Bacterial infections usually cause
hematuria and dysuria (straining to urinate.) Bladder stones are often very rough; they cause irritation to the
bladder as they rub against the bladder wall also creating hematuria and dysuria. Tumors or polyps are usually
not highly irritating to the dog’ bladder, but they can cause bleeding and mild straining to urinate. A
diverticulum is a small pouch in the wall of the bladder that usually causes hematuria and dysuria secondary to
the chronic bacterial infection that occurs. Bacteria often reside deep in the diverticulum and are nearly
impossible to remove without surgery.

How is cystitis diagnosed?

Male cats may develop enough crystals in the urethra (the narrow tube carrying urine out of the body) to cause
an obstruction. This obstruction prevents elimination of urine from the bladder. If the obstruction is not
relieved within 48 hours, most cats will die from kidney failure and the retention of toxins that were not
removed by the kidneys. Because the urethra is relatively larger in the female cat, the emergency posed by
complete obstruction is almost always limited to male cats.

A history of hematuria, dysuria, and increased frequency of urination is strong evidence of some form of cystitis.
When these are seen, several tests are appropriate.
The first group of tests include urinalysis, urine culture, and bladder palpation (feeling with the fingers). A
urinalysis consists of several tests to detect abnormalities in the urine, including abnormalities in the urine
sediment. These are generally adequate to confirm cystitis, but they are usually not adequate to determine the
exact cause. A urine culture determines if bacteria are present and what antibiotics are likely to be effective in
killing them. This is appropriate because most cases of cystitis are caused by bacteria which may be eliminated
easily with antibiotics. Bladder palpation is the first “test” for bladder stones, since many are large enough to
be felt by experienced fingers.

What is done if cystitis is present, but the culture is negative for bacteria and stones cannot be felt?

This scenario occurs about 20% of the time. When it happens, it is important that more tests be performed so
that a diagnosis can be achieved.

Plain radiographs (x-rays) are taken to further evaluate the bladder because many stones can be seen with this
technique. However, the mineral composition of other stones requires that special radiographs, using contrast
materials, be utilized. Plain radiographs are usually not able to visualize bladder tumors, polyps, or diverticula.
A plain radiograph can be made without sedation or anesthesia in a cooperative dog.

An ultrasound examination is also useful in evaluating the bladder. This technique uses sound waves to
visualize stones and some tumors and polyps. It may also identify other abnormalities of the bladder wall,
including wall thickening. It, too, can be performed without sedation or anesthesia in a cooperative dog.

Contrast radiographs are taken when plain radiographs and an ultrasound examination do not render the
diagnosis. The bladder is filled with a negative contrast material (usually air), a positive contrast material (a
special radiographic dye), and then a little positive contrast material with a negative contrast material (double
contrast study). A radiograph is taken each time. These three procedures permit visualization of otherwise
unseen bladder stones, tumors and polyps, diverticula, and wall thickening. It is necessary to pass a catheter
into the bladder and to distend it with the contrast materials; therefore, general anesthesia is required.

Dogs showing other signs of illness, such as fever, poor appetite, or lethargy, should also be evaluated for
systemic diseases and bleeding disorders that may be causing hematuria. For these dogs, a chemistry profile and
complete blood count (CBC) should be performed. If a clotting problem is suspected, a bleeding profile is

How is it treated?

Each pet with cystitis is treated according to the changes in the urine (pH, crystals, blood, etc.), the type of
crystals present, the presenting clinical signs (straining, increased frequency, etc.), and the presence or absence of
a bladder stone or urethral obstruction.

If neither a bladder stone nor urethral obstruction is present, proper medication will generally relieve the
discomfort. A urinalysis is necessary to determine the proper medication. A special diet, explained below, will
help to dissolve some of the crystals in the urine and hasten recovery.

If the pet has an obstruction of the urethra, a catheter is passed into the bladder while he is under a short-acting
anesthetic. The catheter is frequently left in place for about 24 hours. The pet is discharged from the hospital
when it appears unlikely that obstruction will reoccur, usually 1-2 days later. If he is experiencing kidney failure
and toxemia, intravenous fluids and additional hospitalization are needed.

How long will treatment take?

Following initial treatment, it may be necessary for you to return your pet in 7-10 days for a recheck of its urine.
This is very important because some pets will appear to feel much better, but the urine is still bloody or contains
crystals. If medication is stopped based on how the cat appears to feel, treatment may be terminated
prematurely and a relapse will probably occur.
Is it likely to happen again?

Many cats have a recurrence of cystitis. This is one reason that a virus is suspected as the cause. It is also the
reason that a proper diet should be fed in the future.

Can it be prevented?

Although we do not believe that any type of commercial cat food causes cystitis, we know that certain things
can be done to the diet to minimize a recurrence. However, dietary prevention depends upon what type of
crystals are present.

If struvite crystals are present, they can be dissolved in acidic urine. Therefore, diets that cause urinary
acidification are recommended for these cats. However, if your cat's crystals are not struvite, acidification may
actually make recurrence more likely so a non-acidified diet is the appropriate one. Therefore, if at all possible,
the crystals in the urine should be analyzed for their composition. This is the most important step in preventing
future problems.

Can urethral obstructions have complications?

Yes, for some cats. The most common complication of urethral obstruction is bladder atony. Atony means that
the muscles of the bladder wall are unable to contract to push out urine. This occurs when they are stretched to
an extreme degree. Not all cats with obstructions develop atony; in fact, most do not. However, if this occurs,
longer hospitalization is necessary. The muscles will nearly always rebound and become functional again, but
this may take several days to as long as a week.

Another complication that occurs occasionally is kidney damage. Although feline cystitis does not directly affect
the kidneys, if the bladder becomes extremely enlarged, urine may backup into the kidneys and create enough
pressure to temporarily or permanently damage them. If this occurs, prolonged hospitalization will be necessary
to treat the kidney damage. However, with aggressive treatment, most cats will recover their normal kidney

It should be noted that both complications, bladder atony and kidney damage, are the direct result of the
bladder becoming extremely enlarged. Both problems may be prevented by prompt recognition of the
problem and prompt medical care.

What can be done to prevent another urethral obstruction?

Male cats that have more than one urethral obstruction can benefit from a surgical procedure called a perineal
urethrostomy. The purpose of this is to remove the narrow part of the urethra that is the typical site of the
obstruction. Although this prevents future obstructions, some of these cats will still have an occasional
recurrence of cystitis, though usually not as severe.

This surgical procedure is also performed if the urethral obstruction is so severe that normal urine flow cannot
be reestablished or if there are permanent strictures that develop in the urethra.

Surgically changing the cat's urethra makes him more prone to bacterial infections in the bladder and bladder
stones. Therefore, this surgery is only recommended if other means of prevention or treatment are not
successful. However, the complications associated with the surgery are not life-threatening like urethral
obstructions, so the surgery generally offers a significant benefit for the cat that really needs it.

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