Sam Taylor, ex-FAB resident at Bristol University, reports on the case of one of her favourite patients

I have met nearly 300 cats during my time as FAB Resident at Bristol University Feline Centre. All of them are special, but some stand out in particular and Charlie became one of my favourite patients. Charlie was a two-year-old, male neutered Persian and our first meeting was certainly an uncomfortable one for him!

Charlie has a sweet, gentle nature and lives the life of luxury with two other Persians, a room of his own full of toys and a very devoted owner. Despite this he was easily upset by events such as changes in the house, loud noises and being left on his own, and this upset seemed to manifest as urinary problems.

When I first met him he had been suffering episodes of cystitis (bladder inflammation) for some time, and had even had an episode of being ‘blocked’. This occurs when a cat cannot urinate at all, usually due to a blockage in the urethra, but can also be the result of urethral spasm, where the pain of bladder inflammation causes the urethra to close down and prevent normal urination. This problem usually only occurs in male cats, as the female cat’s urethra is wider and less prone to blockage. It is obviously very uncomfortable as the bladder becomes over-full. This is a life-threatening emergency and warrants immediate veterinary attention. In Charlie’s case, as well as episodes of blockage, his owners had seen blood in his urine and he had been urinating in unusual places round the house. All in all, Charlie was not a happy chap and his owners were understandably distressed that he wasn’t improving, and their carpets were getting ruined.

When Charlie was first examined he wasn’t ‘blocked’ but his bladder was sore when palpated and he was clearly uncomfortable, suggesting cystitis. He would go to the litter tray frequently to pass small amounts of urine. Our first priority was to give Charlie some pain relief as cystitis is a very painful condition in both people and cats. Once he felt more comfortable, we started to investigate if there was an underlying disease causing his urinary problems.

Blood samples returned normal results and so we went on to have a closer look at Charlie’s urinary tract. An abdominal ultrasound showed the bladder wall was thickened and both kidneys had several fluid-filled cysts, consistent with
PKD – polycystic kidney disease (see above), an inherited kidney disease seen in Persian cats and their relatives. Charlie’s owner did not know if Charlie’s parents had been tested for this disease, but this finding showed that at least one of them must have carried the abnormal gene (click here for more information). Although this was a worrying finding, we did not think this was the cause of Charlie’s problems as he showed no sign of kidney failure (which often occurs when the cysts in the kidneys get bigger), such as drinking more orweight loss, and his appetite remained normal. Therefore we continued to look for other reasons for his problems.

A urine sample was taken and this showed the urine was very concentrated, with blood present but no indication of infection. Further X-rays showed no problem with the urethra itself and no other reason that Charlie should have problems urinating. The tests excluded underlying disease and therefore we diagnosed Charlie with idiopathic cystitis.

As we know behavioural problems are associated with this condition, Charlie’s owner spent time with a veterinary behaviourist to discuss why he felt stressed and what we could do about it. Charlie was very close to his female owner and seemed unable to cope without her close to him all the time. He had been like this since he was a kitten and he may not have learnt enough ‘life skills’ from his cat mum. In fact we learnt just how closely Charlie bonded with people when he suffered a bout of cystitis while hospitalised at the Feline Centre, when his favourite vet student left to move to another rotation! Charlie seemed to have forgotten he was a cat and needed to learn to cope without his owner around 24 hours a day! The behaviourist and Charlie’s owners worked very hard to help him learn to cope with everyday stresses and after a few months he seemed more relaxed and suffered less frequent episodes of cystitis. In parallel with the behavioural therapy we started to try and dilute Charlie’s urine. He took to a water fountain well, was changed to a wet food-only diet with added water and he actually liked to drink water straight from a syringe! We re-checked his urine and found it was a lot less concentrated and there was no trace of blood.

Over the next 12 months Charlie suffered the occasional set-back but we managed to avoid further urethral blockage by using pain killers and drugs to relax the urethra and increasing his water intake even further. We also added
medication to try and improve his bladder lining. During this time we monitored Charlie’s kidney function with blood and urine tests and repeated his ultrasound.

Currently Charlie shows no evidence his kidneys are failing and although the PKD cysts are slowly increasing in size we hope they will not cause him a problem for many years yet. Now he is a happy cat and his owners even dare to go on holiday and leave him with family (including dogs) with no recurrence of his cystitis. Despite my having to prod and poke him to perform various tests, Charlie holds no grudge and is always pleased to see me.

Feline lower urinary tract disease

FLUTD is a term used to describe the signs of urinary problems, such as blood in the urine and difficulty urinating. Other common signs include very frequent attempts to urinate, and producing only small drops of urine. Some cats will urinate in inappropriate places as they associate the litter tray with pain urinating. Although there are many diseases that result in such signs, in most cases despite investigation, we never find a cause and the condition is termed ‘idiopathic’. However in some cases a problem can be identified such as:

• Bladder stones (note this is very different from crystals in the urine, which can be seen in normal cats)
• Anatomic abnormalities (cats can be born with abnormal urinary tracts, or suffer damage to the urethra causing it to narrow)
• Types of urinary tract cancer (this is unusual and likely to be seen in older, rather than young cats)
• Traumatic damage (damage to the bladder/urethra in a road accident for example)
• Urinary infection (note this is very unusual in cats compared with dogs and usually only seen when the cat has a disease causing their urine to be too dilute, eg, kidney disease)

If these problems have been ruled out (as in Charlie’s case with blood samples, X-rays and ultrasound) then the cat is likely to have idiopathic cystitis.

Idiopathic cystitis
This condition is seen in humans as well as cats and is the result of complex interactions with the nerves of the bladder, stress and the concentration of the urine. The result is an inflamed, painful, thickened bladder wall. This condition can result in urethral blockage as the angry, inflamed bladder sheds cells and debris that then block the male cat’s narrow urethra. Also it is so painful to urinate that the urethra can ‘spasm’ and prevent urination without a physical blockage. The condition is very uncomfortable and pain relief is a must when treating affected cats. Although most cats (if not ‘blocked’) will recover in a few days, treatment is aimed at preventing a recurrence. Treatment should be approached from all angles and include pain relief during an episode and behavioural therapy involving identification of causes of stress, such as other cats coming into the house (try a microchip cat flap), litter tray conflicts (ensure adequate numbers of trays, kept very clean), or as in Charlie’s case behavioural modification to reduce his stress and dependence on his owners. Consultation with a veterinary behaviourist is very useful in ‘thinking cat’ and identifying and preventing stress. We can also try to change the urine itself to reduce the concentration (change to a wet diet, add water to the food, use water fountains). Other treatments have involved trying to improve the bladder’s mucous layer, to protect the sensitive nerves in the wall.

This condition can be very frustrating for the owner and veterinary surgeon involved but with appropriate treatment (medical and behavioural) this need not be a lifelong problem. If you notice your cat having trouble urinating consult your veterinary surgeon immediately as a blocked bladder requires emergency treatment.

July 2009