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.

In the case of unexplained weight loss, a thorough examination and blood work will be performed. A blood chemistry panel and urinalysis can reveal a number of disease processes that lead to weight loss. Routine wellness checkups can help monitor the pet’s weight to discover trends over time. Twice a year veterinary visits are recommended for all geriatric (over seven) pets. Because dogs and cats age much faster than a human, a year is almost the equivalent of a human decade.

The prognosis for managing a disease is always better when discovered early in its progression. The chance of slowing or even reversing the weight loss depends entirely on treating the underlying cause. Increasing the amount of food given to a pet is likely to be a temporary solution. The metabolic changes that are causing the pet to shed pounds cannot be overcome by increasing the calories.

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.

The veterinarian will confirm prostatitis by rectal palpation of the gland to feel for enlargement, asymmetry, obvious masses, or fluctuant areas (soft spots). Lab work should include a complete blood count, chemistry panel, and urinalysis. These tests are used to categorize the prostate disease and rule out other systemic illness. An x-ray or ultrasound of the urinary tract will help to visualize the degree of enlargement or masses associated with the gland. Urine sediment analysis may reveal increased numbers of red and white blood cells which are not found in healthy urine. Bacteria may be seen which would warrant a culture and susceptibility test. This would be indicative of primary or secondary bacterial prostatitis.

The most common type of prostate disease in dogs and man is benign prostate hyperplasia. This simply means non-cancerous enlargement. It is associated with changes in the male sex hormone levels as the dog ages. Neutering can reduce the chance of BPH significantly. Studies indicate that neutering at less than one year can all but eliminate BPH in male dogs. The treatment for BPH is in fact, neutering. This type of prostatitis is almost always chronic and recurrent if the dog remains intact. Secondary bacterial infection is common with BPH because the normal antibacterial secretions from the prostate are diminished and red blood cells provide food for the organisms.

Acute or chronic bacterial prostatitis occurs in both intact and neutered male dogs. Usually the bacteria has ascended the urethra from the outside world. Broad spectrum urinary tract specific antibiotics are prescribed while the results of a culture and susceptibility test is pending. Bladder stones and other urinary tract disease may be associated with bacterial prostatitis.

Prostatic neoplasia is the rarest of the prostate diseases comprising about 5% of all cases. Neoplasia means new growth and refers to cancer. In humans, there is an antibody specific to prostate cancer that can be measured in the blood. Unfortunately, there is no reliable blood test for dogs at this time. The prognosis for prostate cancer in dogs is poor. The cancer is aggressive and has likely metastisized to other organs by the time of diagnosis. A needle biopsy and histopathology report can help to diagnose prostatic neoplasia. Poor response to other treatments and progression of disease usually verifies cancer as the diagnosis.

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.

Before assuming that the cat’s reluctance to use the litter box is purely behavioral, a health reason must be ruled out. A simple examination and urinalysis can eliminate feline lower urinary tract disease (FLUTD) as the cause. If the cat’s water consumption has increased, there is likely a kidney or bladder problem responsible. Intestinal parasites can cause fecal urgency, and de-worming may be in order. The cat may begin to associate uncomfortable feelings with the litter box if it is painful when he urinates or defecates.

Marking behavior (spraying) is not the same as having accidents in the house. Marking can be done by both males and females and is almost always on a vertical surface. The cat will back up to a wall or a piece of furniture with its tail twitching and straight up. The cat will spray a small amount of urine and walk away. Neutering should be done at a young age before this behavior begins, as it can be difficult to stop once it starts.

When it is determined that the problem is definitely litter box avoidance, a few simple changes should be made. The litter box should be cleaned more frequently and scrubbed / disinfected twice weekly to see if the behavior improves. Cats are fastidious groomers and may choose not to use a dirty litter box. Try multiple litter boxes. Also, the area designated for elimination should never be close to food and water bowls. Cats will not urinate or defecate in areas where they eat.

If the type of litter was changed, switch back to the type that the cat was using before. If it wasn’t changed, try a different brand. Avoid perfumed litter, or types that contain additives like scent crystals or baking soda. Most cats will use plain, unscented, clumping type litter.

Cats prefer privacy when they use the potty, but they also want to keep a look out for surprises. If another animal in the house harasses the cat in the litter box, the cat will find refuge elsewhere. This situation is pretty easy to realize; but if no other animals are in the house, providing the right level of privacy can be a little harder to fine tune. Some cats prefer covered pans facing into the room so that they can keep watch for intruders. Other cats will simply not use a covered pan. Experiment with different styles to see what works for your cat. Make changes over several days however, to give the cat a chance to decide what he prefers. Again, try providing several litter boxes at the same time.

Anywhere the cat has soiled in the past should be thoroughly cleaned and disinfected to stop the association of the area with elimination. Covering the area with foil will discourage the cat from entering the area until he is retrained to use the litter box.

If all other attempts have failed in acclimating your cat to using a litter pan, discuss the situation with your veterinarian to see if antidepressant medications might help. While these medications may be of benefit, they rarely work alone without some behavioral modification.

Both male and female cats are capable of urine spraying. It is unlike normal urination, in that the urine is forcibly deposited onto vertical surfaces. The cat will raise and shake its tail and spray urine onto a wall, furniture, or even a television at about nose height. Intact (un-neutered) male cats are the most likely culprits of spraying behavior and leave a distinctive tom-cat odor behind that can last for months. Spaying and neutering cats before sexual maturity (around 6 months old) can prevent about 90% of marking problems.

About 10% of cats will continue marking, or simulated marking where no urine is sprayed, despite spaying and neutering. This commonly occurs during territorial disputes in multi-cat households, or when a spraying tom-cat marks outside the cat’s home. Cats may increase marking behavior during times of stress, or when a new pet – cat or dog – is introduced into the household. Besides spraying urine, a cat may rarely deposit stool during marking behavior.

Marking should be differentiated from other very common inappropriate elimination problems in cats. Urinating just outside of the litter pan can be a symptom of Feline Idiopathic Lower Urinary Tract Disease (FLUTD). If urine is found on the floor, or if no typical marking behavior is noticed, a urinalysis should be performed to rule out bladder and kidney stones or infections.

If the problem is indeed marking behavior, intact cats should be neutered or spayed. It may take weeks for hormone levels to subside and spraying to cease. Once spraying has begun, it can be very difficult to stop.

Changes in the cat’s environment such as new additions to the household including pets and people, and outdoor cat encounters, must be considered when a cat suddenly begins marking. The cat may need to be isolated in a separate room for a period of time until it can become acclimated to the changes. Occasionally, anti-anxiety medications can be used to help reduce stress in a persistent marker. All other forms of urinary tract disease must be ruled out before beginning any behavioral drug therapy.

If the problem arises from outdoor cats marking the house and yard, strategies to remove them need to be pursued. Closing curtains where indoor cats may observe the unwelcome intruders may help. Enzymatic odor neutralizers may help if it is possible to locate the source of the urine. They should also be used in the home where an indoor cat has sprayed in the past.

Even if the odors have been removed inside the house, a cat may continue spraying unless the cause is addressed. It may sometimes help curb spraying behavior by confining a cat to a very small room with only its own belongings. Cats are not likely to mark food bowls, litter pans, and personal bedding or toys.

Urinary tract infections (UTI) are very common in our canine companions. They are just as miserable and uncomfortable to them as they are to us. The urinary tract includes the urethra, bladder, ureters, and kidneys. Bacteria ascend through the urethra and into these normally sterile areas inside the body. These infections can be very persistent.
Symptoms of a urinary tract infection include increased water consumption and frequency of urination, voiding small amounts and straining, accidents in the house, leaking urine during sleep, strong smelling or atypically colored urine, and incessant licking at the prepuce or vulva. Difficulty in housebreaking a puppy can also be a sign of a UTI.
When a UTI is suspected, a urine sample is collected by the veterinarian in order to perform a 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 methods 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.
The urine may be sent to a reference laboratory for a culture and sensitivity (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.
When your veterinarian prescribes an antibiotic for your dog’s urinary tract infection, is critical to give it as instructed. Antibiotic resistance is a real problem in UTI. Also, the 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.

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.