FLUTD/FUS
Contact Author: Vick
Disclaimer: the information provided below is not intended
to replace or override the advice of your veterinarian. Both the author
and the site owner assume that this information will be used to work with
your vet in planning the best treatment plan for your cat
What are the symptoms?
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urinating outside the litter box
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frequent trips to the litter box with little or no urine passed
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blood in the urine
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crying in the litter box
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frequent licking in the genital area
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anorexia (not eating)
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vomiting
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hiding
Note: not all of the symptoms need be present for your cat to be in trouble.
If you notice any of these symptoms or are concerned your cat may be having
difficulty urinating call your vet immediately! If he or
she has a urinary blockage, they can die within hours.
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What is FLUTD?
The term Feline Lower Urinary Tract Disease is used to describe a host
of problems associated with a cat's lower urinary tract: inflammation of
the bladder and/or urethra; the formation of crystals and tiny stones in
the urine; and the partial or total obstruction of the urethra. FLUTD may
also be called Feline Urologic Syndrome (FUS), Lower Urinary Tract Disease
(LUTD) or Cystitis.
-
Cystitis is specifically an inflammation of the bladder. This may be a
result of a bacterial infection or from crystals irritating the bladder
wall. As in humans, cystitis generally results in frequent, scanty urination
and blood in the urine. Left untreated, a bacterial infection could progress
to the kidneys. Your allopathic vet will probably prescribe antibiotics.
However, according to the veterinary text The Cat: Diseases and Clinical
Management, most unobstructed cases will resolve themselves within 5 days
regardless of the treatment used. I usually take the antibiotics but don't
use them unless a few days of cranberry pills (which prevent bacteria from
adhering to the bladder wall) fail to provide my cat some relief.
-
Urolithiasis is the formation of stones in the bladder. Uroliths are hardened
solids composed of many crystals. The two major types of crystals are:
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struvite crystals which form in a urine that is too basic
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calcium oxalate crystals which form when the urine is too acidic
The Merck Veterinary Manual says crystals "are not produced unless:
1) sufficiently high urine concentrations of (crystal) -forming
constituents exist,
2) prolonged crystal transit time w/in the urinary tract occurs
and
3) favorable pH (for formation) exists.
These criteria can be affected by UTI, diet, intestinal absorption, urine
volume, frequency of urination and genetics."
-
Urethral obstruction occurs when the crystals in the bladder combine with
an organic matrix to form a paste-like plug that blocks the urethra. At
this point, your vet will need to insert a catheter to clear the obstruction
and allow the urine to pass. Do not delay medical treatment if you suspect
your cat is in trouble.
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What should I expect at the vet?
If they suspect a blockage, they will likely take your cat from the
exam room to a back area where they can work better. This is really easier
on the cat and them, so let them take him. Once in back, the vet will palpate
your cat's bladder and try to manually express it - basically, she'll squeeze
it gently to see if urine can pass through the urethra. If your cat is
blocked and urine cannot pass through, they will sedate your cat in order
to pass a catheter up his urethra into the bladder to clear the blockage.
A blockage generally means an overnight stay. They will use a couple
stitches to keep the catheter in place, attach a bag to collect the urine
and keep the cat under observation. At the clinic I worked at, we usually
gave subcutaneous or IV fluids too. After the cat has had the catheter
in for at least a day, the vet removes it and the cat is watched for a
while longer to be sure he can urinate on his own. Your vet will test your
cat's urine to determine what crystals led to the blockage, and then will
select a diet appropriate for the type of crystals your cat has.
If the cat is not blocked, your vet will do a urinalysis. Some vets
feel comfortable using a needle and syringe to collect the urine directly
from the bladder (this technique is called cystocentesis), while others
prefer to hold your cat for the day and wait for him to use an empty litter
box. Either way, they really need the sample to help you help your cat.
The urinalysis will tell them the pH, if there is any blood or bacteria
present and how concentrated the urine is. In addition, they will examine
any sediment in the urine to determine what type of crystals (if any) are
present. Again, the vet will make diet recommendations based on the crystal
type.
If your cat merely has a bladder inflammation, some vets will prescribe
antibiotics to kill the bacteria that are causing the inflammation. Sometimes
a vet will prescribe antibiotics even if no bacteria are found but they
think the crystals will scratch the bladder and lead to infection. Still
other vets will prescribe the antibiotics even if they can find nothing
wrong. This has happened to my cat Sam several times. The vets have told
me that even though they can't find the cause, the antibiotics always seem
to help. I believe this occurs because of the phenomenon I mentioned earlier:
unobstructed cases tend to resolve within 5 days regardless
of the treatment used. So now I tell them I have antibiotics at home and
save myself $20 if they can't find anything wrong with him :)
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Does my cat need a special diet?
That depends.
If your cat had a bladder infection, diet probably isn't to blame. But
if he had crystals or a blockage, look long and hard at what you're feeding.
In either of the latter two cases, your vet probably sent you home with
either a prescription food or recipes for a special diet anyways.
If you are free-feeding your cat a dry food, sometimes simply switching
to feeding 1 or 2 meals a day of at least a high quality canned food will
eliminate the problem. Better still, a switch to a raw diet cures many
chronic crystal producers. But not all of 'em. Of course, my Sam is one
of the exceptions (he exists to torture me:). I've tweaked his diet with
the help of a holistic vet and tried herbs, homeopathy and vitamins to
get his problem resolved, and none have afforded us a permanent solution.
I recently purchased a urinary acidifier in the hope that will do the trick.
We'll see.
The more water you get into the cat, the better, as it will help dilute
the urine and decrease the concentration of crystal components in the urine.
Add a little filtered water (not tap water) to your cat's canned, cooked
or raw food. Your cat's bladder is about the size of a walnut when empty,
so just getting a couple extra tablespoons of water in your cat will help.
If your cat is amenable to it, you can use a syringe to administer extra
water. I give Sam 5 cc's (5 mL or one teaspoon) at a time, several times
a day. I also add extra water to his food, and sometimes do sneaky things
like strain the liquid from tuna in spring water and add lots more spring
water to spread it out, then pour a tablespoon or so on his food. Or add
lots of extra water to a meat baby food and use that as 'gravy'.
I think the most helpful diet related thing you can do is stop leaving
out food all day and stop feeding dry food. Feed your cat two meals a day,
and clean up all traces of food after 1/2 hour of serving him. When cats
smell food all day, their bodies react by becoming more alkaline, and their
urine is affected as well. By leaving food available, you may actually
be helping create the crystals that are causing you (and him) so much distress.
If you'd really like to make your own food, and don't have a holistic
vet to work with, check the various food and supplement recommendations
below, then look through our cooked
diets or raw
diets to decide which appeal to you and talk to the people on the
mailing
list to see what's working for them. It's weird, but from what
I've seen, one thing that works for one cat may not work for another, so
ya gotta talk to people and see what's been tried.
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Is there anything I can do
that will help prevent later attacks?
Vitamins A, C and E are very helpful. Pitcairn recommends the following
for one month after an episode:
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250 mg of Vit C twice daily.
-
Vitamin E -- add an extra 25 to 50 IU daily to your cat's food.
-
Vitamin A -- 4 drops of cod liver oil to the food once a day or 10,000
IU A once a week.
For sub acute cases where the cat is uncomfortable but not obstructed:
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Pulsatilla 30C: This remedy is useful for the cat that does not
like heat in any form. Here is how you can tell. Put out a hot water bottle
or heating pad wrapped with a towel. If your cat is not interested in huddling
next to it and prefers to lie on something cool like cement, tile, linoleum
or even the bathtub or sink, then you will know it prefers coolness to
heat. Usually the urine is passed in small amounts and contains blood.
-
Rhus tox 30C: This remedy is indicated for the cat who likes to
sit around on cold cement, stones or steps when it is well. But then it
may get chilled and have an attack of cystitis. So the problem often crops
up after cold, wet, rainy weather. When sick, this cat will prefer to be
warm, will like a hot water bottle and wants to be touched or rubbed. However,
a cat with this problem does not rest quietly, but constantly changes position
or stretches its limbs. Its urine will be dark and scanty and may contain
blood. Urination is difficult and painful.
-
Sepia 30C: This medicine is indicated for the cat that has recurrent
attacks associated with an attitude of "touch me or not". These cats are
often unfriendly fellows, with a tendency to be aggressive to other cats
and to be difficult to handle or medicate. Getting pills down them is almost
impossible. There are also appetite problems -- rejecting many foods and
being very finicky. Many of the cats needing this remedy will continue
to produce a lot of crystals that are found in the urine.
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Mercurius vivus (or solubilis) 30C: The cat needing this remedy
will act very annoyed with his rear end, doing a lot of licking after urinating,
thrashing the tail around and straining to produce small quantities of
urine. Sometimes the straining is associated with passing stool. If the
cat also has become unusually thirsty before the attack, this is probably
the remedy to use.
** Give every 4 hours for a total of 3 treatments, then wait for
24 hours. If there is no improvement, reassess the situation. **
For chronic cases try shave grass, (a.k.a. horsetail) for two to three
weeks. Bring one cup of water to a boil. Pour it over one rounded teaspoon
of dried herb or one tablespoon of fresh herb. Cover and steep for 15 minutes.
Strain. Give this twice a day
Anitra Frazier looks more to vitamin and nutritional support. She recommends
that at the first sign of a urinary problem, withhold all solid
food and give your cat 500 mgs of Vitamin C, 100 IU Vitamin E and a teaspoon
of chicken broth. For the rest of the acute phase and during convalescence,
she bolsters her veterinarian's treatment plan with the following:
-
A High
Calcium Chicken Broth fast. Give 3 - 4 times a day for two days,
and mix 1/16 tsp (250 mgs) ascorbic acid crystals into each serving of
broth
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If your cat is on antibiotics, add 1/2 tsp of liquid acidophilous suspended
in water to food throughout treatment and continue for 2 weeks after antibiotics
are finished.
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Eliminate all stress in the cat's environment and provide it a warm, safe
place to convalesce
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Feed a high quality diet with as much raw food as possible. Use chicken
as the protein source; carrots, green beans or zucchini as the vegetable;
high calcium chicken broth as the liquid.
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Eliminate yeast from the Vita
Mineral Mix.... instead give around 10 mg of a low potency B complex
pill twice daily and 1 teaspoon of the yeast free MIx twice daily with
the cat's meal.
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Eliminate all organ meats (liver, kidney and the like) from the diet
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Add instead 1 raw, organic egg yolk each day; 100 units Vit E each day
for a month, then 400 units a week; 1/4 tsp cod liver oil to each meal
or
a capsule containing 10,000 units Vit A and 400 units Vit D once a week
Once the cat has recovered:
-
Never again feed dry food or fish
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only give organ meats occasionally
-
go back to the original Vita Mineral mix a month after the episode is over
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feed only two meals a day, and clean up all crumbs and dishes after a half
hour
-
continue to add organic egg yolk 3 times a week; 400 units Vit E a week;
1/4 tsp cod liver oil to each meal or a capsule containing
10,000 units Vit A and 400 units Vit D once a week; 1/16 tsp or 250 mgs
Vit C to each meal
-
continue to keep the litter box very clean
Dr William Winter suggests increasing water intake (of distilled, spring
or mineral water) by adding high water content foods, adding water to food
and regular fasting on water, broth, bouillon or juice. He also suggests
adding Sea Salt to the diet to encourage water consumption.
In addition, he recommends you try to acidify the urine by offering
tomato or cranberry juice; giving 1,000 mgs of Vit C 1 - 2 times a day;
offering a few drops of apple cider vinegar; or by use of a commercial
acidifier. You also want to make it as easy and pleasant as possible for
your cat to urinate. This can be accomplished by having multiple litter
boxes that you clean fastidiously. Also be sure the litter is one your
cat likes and you do not feed him anywhere near the box.
For cystitis, Dr. Winter suggests the following
Homeopathic Therapy:
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Urtica Urens -- for straining
-
Rhus tox -- if caught very early
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Apis -- for frequent, involuntary urination; scanty and highly colored
-
Cantharis -- for intolerable urging, constant desire to urinate
or great pain, urine may be bloody and w/ matter
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Nux Vomica -- if Cantharis does not afford relief
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Aconitum -- every 2-3 hours for feverish symptoms, frequent ineffectual
and painful attempts to urinate, pain from pressure in region of bladder,
scanty urine, turbid and bloody urine
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Thalapsi Bursa -- every half hour for blocked urethra
Herbs:
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Couch Grass Root -- steep 2 oz in 3/4 pint of boiling water. Add
1 tablespoon to food twice daily
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Bladder infection formula -- Nettles, Goldenseal, 2 part Buchu and
Flax seed. Mix and give 1/3 teaspoon twice daily.
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Birch leaves -- make a tea and add 1 teaspoon to food twice daily
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Nettles -- specific for urinary bleeding (also as a tea)
Supplements
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Vitamin C (500- 1,000 mgs a day)
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Sea Salt (1/8 tsp a day)
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V-5 enzymes (Ness V-5) -- high dosage for 1 month, then a maintenance
dose of Prozyme for life (the V-5 he has dosed at 1/2 tsp a day for
all dogs and cats, so I'm not sure what he means by "high". For Prozyme,
he lists 1/4 teaspoon per cup of food)
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Some totally resistant cases may require systemic antibiotics
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Sources Consulted
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Frazier, Anitra with Norma Eckroate. The New Natural Cat: A Complete
Guide for Finicky Owners. 1990.
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Pitcairn, Richard H. DVM, PhD and Susan Hubble Pitcairn. Dr. Pitcairn's
Complete Guide to Natural Health for Dogs & Cats. 1995.
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Siegal, Mordecai (editor). The Cornell Book of Cats. 1992.
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Various authors. The Merck Veterinary Manual. 1991.
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Winter, William G. DVM. The Holistic Veterinary Handbook. 1997.
All books are available through our bookstore
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