When a cat appears with related symptoms, it should be examined by the veterinarian as soon as possible. A urinalysis, blood panel, and x-ray are performed as an initial diagnostic profile. A urine sample is collected by the veterinarian in order to perform the urinalysis (UA). Care should be taken to avoid contaminating the sample with artifact. The “cleanest” method of collection is called a cystocentesis – passing a very fine needle through the abdominal wall directly into the bladder. Less ideal respectively are passing a urinary catheter and collecting a voided sample, since contaminate may be introduced from outside of the body.

The urine sample is analyzed for blood, inflammatory cells, bacteria, and crystals. A specific gravity measures urine dilution caused by increased water consumption or kidney dysfunction. A reagent dipstick tests for nitrite (bacterial metabolite), pH, glucose (to screen for diabetes), and bilirubin (produced by the liver). A portion of the sample is centrifuged to separate solids from the urine such as cells, casts of the renal (kidney) tubules, bacteria, and crystals. This material is called urine sediment. Bacteria observed in the sediment are diagnostic for infection but are not always observed.

The urine may be sent to a reference laboratory for a culture and susceptibility (C&S). The sample is incubated in a special agar or broth, a food medium to grow bacteria. When bacterial growth is present, the organisms are isolated and tested to determine their species. Then they are exposed to a battery of antibiotics on a susceptibility disc. This information will tell the doctor which antibiotic to prescribe and what dose will be effective. Also, the C&S will give some idea as to how the infection will respond to treatment.

Abdominal x-rays are taken to check for the presence of bladder and kidney stones, especially if crystals are found in the urine sediment. If bladder stones are discovered, they must be removed or dissolved if possible. The stones will harbor bacteria and make resolution of the infection impossible. X-rays can also reveal a congenital defect in the bladder wall called a persistent urachus. This is a remnant of the tube that connected the bladder to the umbilicus before birth. It can also harbor bacteria and make the infection persist despite antibiotic therapy.
A blood count and chemistry panel will help determine whether the bladder infection is secondary to underlying organ dysfunction. Kidney disease is very common in older cats.

When your veterinarian prescribes an antibiotic for your cat’s bladder infection, is critical to give it as instructed. Antibiotic resistance is a real problem in bladder infections. Also, a urinalysis should be repeated at the end of the treatment period to gauge the response to the antibiotic. If time lapses between treatment and rechecking, the infection may recur, causing the need to repeat diagnostics.

When you take your cat in for a wellness exam, the veterinarian will want to know about any changes you’ve noticed in your cat’s behavior. Changes in water consumption, grooming, activity, frequency of vomiting, loose stools, amount of urine production, and appetite are all very important to discuss with the doctor.

Anyone who has owned a cat for its lifetime is familiar with the appearance of the “skinny old cat”. It is not normal for an older cat to lose interest in food and drop in body weight. In fact, by the time weight loss is observed, significant changes are already occurring. Usually, other symptoms preceded the weight loss. In some cases, the cat is still eating normally, or even ravenously, but they continue to lose weight. When a ten pound cat sheds two pounds, or twenty percent of its normal weight, that is the equivalent of a 200 pound man losing 40 pounds!

Some of the ailments and organ dysfunctions seen in older cats that can be treated, delayed, or prevented are listed here along with the symptoms associated with them. The symptoms alone are not a diagnosis of disease. Examinations, blood-work, and radiology are used in conjunction with history to confirm a disease.

Reproductive hormone (estrogen) responsive urinary incontinence is rarer in cats than in dogs. The cause of estrogen responsive urinary incontinence is not completely understood, but the fact that it occurs in spayed females and responds to estrogen supplementation leads us to believe that the mechanism involves reduced levels of the hormone or reduced estrogen-receptor function. Urine is kept in the bladder by a sphincter muscle at the top of the urethra, the tube that carries urine outside the body. In older spayed female cats, this sphincter muscle loses tone, and urine begins to leak. During rest and sleep, the muscles especially relax, leading to complete incontinence. Obesity further complicates this condition, probably from excess weight pushing on the bladder. Not all spayed female cats will develop urinary incontinence; therefore, the exact role that estrogen plays is uncertain.

When uncomplicated urinary incontinence is diagnosed, treatment with synthetic estrogen (diethylstilbestrol – DES) may be prescribed. DES has a wide margin of safety in cats; however, over-dosage can result in serious side effects, and long term usage can cause bone marrow suppression, reducing the cat’s white blood cell count. Blood counts should be measured periodically on cats that take DES. Reduced availability of the drug has caused veterinarians to seek alternative therapies.

Phenylpropanolamine (PPA) may be used as an alternate drug to DES. It is a neuro-stimulant that improves bladder muscle tone and is safe for use in healthy cats. It must be used with caution in kidney and heart failure patients, and those with high blood pressure. Side effects are dose dependant; so the amount may be reduced, but efficacy in controlling incontinence may diminish. A low-dose combination of DES and PPA may be a good solution for cats who do not tolerate therapeutic doses of either drug. If symptoms suddenly worsen, or if inappropriate urination occurs outside of sleep, a bacterial infection or other disease process should be considered.

Bladder infections are common in dogs and cats and may be straight forward ascending bacterial infections (bacteria enters the bladder through the urethra), or they may have complicating factors such as bladder or kidney stones. A persistent urachus is a congenital deformity where the tube that connected the bladder to the umbilicus stays partially intact after birth. It can harbor bacteria making infections persistent and recurring. An x-ray can be used to diagnose stones and abnormalities in the urinary tract anatomy. Bladder infections can be secondary to metabolic disease. Diabetes causes high levels of glucose (sugar) in the urine which can feed bacteria. Any disease that causes increased water consumption and urination makes the pet more susceptible to infection.

Cats can be diagnosed with feline idiopathic lower urinary tract disease (FLUTD) wherein there is no primary infection causing inappropriate urination. It is an inflammatory process in the bladder that causes blood in the urine, straining and accidents. Bacterial infections can become established secondarily to FLUTD.

Inappropriate defecation (bowel movements) may accompany urination or may occur alone. Causes of increased frequency of defecation and straining include intestinal parasitism (giardia, worms, coccidia) and inflammatory bowel disease (IBD). In IBD, the immune system attacks the tissues of the intestinal wall and ultimately leads to bloody diarrhea. Food allergies may contribute to IBD, especially in cats.

Behavioral disorders that cause inappropriate elimination include separation anxiety, status related stress in cats, and incomplete house training in dogs. A medical cause of the behavior should always be ruled out first. Anti-anxiety medications may be prescribed along with behavioral modification training and desensitization.

More than half of cats with FLUTD under the age of 10 years will have an undetermined cause of their symptoms. Twenty percent may develop bladder stones or urethral blockage. Male cats have a tapering urethra, the tube that carries urine outside of the body. Because it narrows toward the opening, cells and mucous may dam up and form a blockage. This is called a urethral plug, and it is a life threatening emergency. The cat will usually howl or growl in pain while it strains to urinate, but it will be unable to do so or pass tiny drops of blood-tinged urine. Females rarely develop a blockage, but it does occur.

For cats over 10 years old with FLUTD, more than half will have a concurrent bladder infection and some degree of kidney dysfunction. Therefore, while extensive testing for a cause of symptoms may not yield results in younger cats, older cats with FLUTD should be screened for kidney failure.

Idiopathic cystitis describes a chronically inflamed bladder with an unknown cause. Cats may strain, urinate outside of the litter pan, and pass blood. No infection is associated with this condition.

When a cat presents with any of the symptoms listed above, a urinalysis is performed to categorize the type of urinary tract disease. Cells found in the urine sediment can allude to a bacterial infection as a primary or secondary factor. Antibiotics are prescribed any time a large number of white blood cells, the cells that fight infection, are observed. Sometimes, bacteria are obvious under the microscope. In this case, a culture and susceptibility should be run to determine the type of bacteria present and whether it has any antibiotic resistance. Most cats with FLUTD will have a large number of red blood cells present on urinalysis. Blood may be obvious to the owner, or it may be occult, revealed only on microscopic examination. X-rays and/or ultrasound of the urinary tract may be performed on all symptomatic cats to rule out bladder stones. Bladder stones are less common in cats than in dogs, but if they are present, symptoms will not resolve until they are removed surgically or dissolved with special diets. A chemistry panel, blood count, and electrolytes may be checked to discover other illnesses that may contribute to FLUTD.

Treatment for feline lower urinary tract disease depends on what is found during diagnostics. For the cat without infection, antibiotics are pointless. Cats diagnosed with idiopathic cystitis may be started on one or a combination of various medications which may include pain medications, antidepressants, and/or glycosaminoglycans. The exact mechanism by which these drugs work is unclear. Many cats respond well to amitriptyline, a tri-cyclic antidepressant that is given orally once or twice daily.

Urinary Tract Illness
When a cat begins urinating outside the litter box, the first possibility to be considered is illness. Cats with bladder irritation or infection frequently urinate in unusual places including potted plants, sinks, and bathtubs. There is often only a tiny amount of urine in each place, and it may be bloody. Kidney failure, diabetes, and some medications can cause cats to urinate more. They may be unable to wait to go outside or to get to the nearest litter box. They generally produce large amounts of watery urine. A physical examination, urine and blood tests can identify or rule out medical causes for elimination disorders.

Urine Marking Behavior
Spraying urine is a normal marking behavior in un-neutered male cats. Spraying differs from ordinary urination because the cat remains standing and the urine is sprayed onto a vertical surface behind him. Neutering male cats as early as possible reduces this behavior. However, neutered males and female cats can spray too. This is more likely when the cat is distressed or anxious and occurs more often in multi-cat households.

Aversions and Preferences
Some cats develop aversions or preferences with regard to locations or substrates for urination. The most common sources of aversions are dirty litter boxes, strongly perfumed litter, and litter boxes placed in busy areas where the cat may feel insecure. Some cats develop a preference to urinate only in a particular spot in the house, or only on a certain material such as carpeting or plastic.

Treating Inappropriate Urination
After ruling out medical concerns, the veterinarian must address underlying emotional issues. Removal of stressful stimuli such as dogs and other cats may help. Antidepressant and antianxiety medicines are sometimes used. A spray that mimics a natural calming hormone of cats has shown benefit as well. Litter boxes are adjusted to encourage the cat to use them. Boxes can be provided in preferred locations and with preferred substrates. Aversive factors should be eliminated. This can involve a lot of trial and error, such as providing numerous litter boxes or different types and observing which are most preferred. Unfortunately, behavioral elimination disorders in cats can be difficult and frustrating to treat.

Preventing Inappropriate Urination
Since its so difficult to treat, its a good idea to try to prevent abnormal urination behavior. A helpful tip is to provide plenty of clean litter boxes, preferably without perfumed litters. The rule of thumb for the number of boxes to have is that there should be at least as many boxes as there are cats and at least as many boxes as there are stories in the house. Most cats prefer a large, open litter box in a quiet location as opposed to litter boxes with hoods, which may trap odor.

Male cats should be neutered. Always remember that cats are territorial by nature. Cats housed singularly are less likely to have behavioral elimination problems, probably because they experience less territorial stress.