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Veterinary Forum April 2007 (Vol 24, No 4)

Feline lower urinary tract disease — a multifaceted disorder

by Rebekah Cintolo

    LAS VEGAS— Many risk factors are associated with a diagnosis of feline lower urinary tract disease (FLUTD); however, additional studies are needed to demonstrate definitive cause-and-effect relationships, experts said here at the Western Veterinary Conference.

    Regardless of the cause of the disorder, FLUTD is characterized by similar clinical signs, including hematuria, pollakuria, stranguria and/or periuria. About 64% of cats with these signs have no identifiable underlying disorder and are, therefore, diagnosed with feline idiopathic cystitis (FIC).

    Although FLUTD is a common problem evaluated by veterinarians, the estimates of its frequency are variable in clinical trials. According to data from Veterinary Pet Insurance (VPI) published in 2005, FLUTD was the most common reason owners took cats to a veterinarian. In addition to quality-of-life issues and an adverse effect on the human"animal, rather family"pet, bond, inappropriate urination is a common reason cats are surrendered to shelters. In one study, cats that urinated outside their litter box once or more per week were most likely to be given away. This is a problem that veterinarians must recognize and remedy.

    Multiple causes

    The most common causes of FLUTD in cats younger than 10 years of age are FIC, urolithiasis and urethral plugs, according to S. Dru Forrester, DVM, MS, DACVIM, of the department of scientific affairs at Hill's Pet Nutrition, Inc. in Topeka, Kan. Less commonly reported disorders include anatomic defects, behavioral disorders, urinary tract infection (UTI) and neoplasia.

    Behavioral disorders should be considered after medical disorders have been ruled out. It also is possible that pain and discomfort associated with many lower urinary tract diseases, such as FIC or urolithiasis, may lead to continued inappropriate urination even after the underlying medical disorder has been controlled. Although UTI is rare in young to middle-aged cats with signs of FLUTD, it is more common in older cats or those with chronic kidney disease. Cats that are immunocompromised are more likely to have UTI.

    Many risk factors have been identified in cats with FLUTD, but it is likely that a combination of causes, such as genetic, environmental and nutritional factors, play a role in this multifactorial disease (see tableon causes of FLUTD). Purebred, Persian and/or overweight cats are at a higher risk for FIC and FLUTD, according to Forrester, as are cats that live with other cats, those that are in conflict with another cat and/or cats that have moved to another home in the past 3 months. Dry food and decreased water intake also have been associated with an increased risk for FIC, Forrester said.

    The only treatment that has been shown to be beneficial in a controlled, clinical environment is feeding moist, rich food; therefore, initial management of cats with FIC should include increasing water consumption. This may be most easily accomplished by gradually changing to a moist food. Other strategies, such as adding broth to food, using water fountains and feeding several meals daily instead of a single meal, may help increase water intake, as well, Forrester suggested.

    Other risk factors

    Jacqueline C. Neilson, DVM, DACVB, from the Animal Behavior Clinic in Portland, Ore., said that obesity is another risk factor for FLUTD. "Inactivity may be linked to obesity, and by increasing the cat's activity level, more calories will be burned, which may result in weight reduction," she explained. "However, free-choice feeding, overfeeding and/or highly palatable foods may contribute to persistent obesity despite increased activity." Owners should be careful not to contribute to their cat's weight problem.

    Stress is another risk factor for FLUTD, Neilson said, suggesting that predictable routines and interactions may help reduce stress in the cat. "A cat that is allowed to scratch on furniture one day and is punished for the same behavior another day is likely to have higher levels of stress, so such inconsistent interaction should be avoided," she explained.

    Environmental enrichment may be helpful to decrease stress, Neilson offered. Cats need to be encouraged to scratch, play and explore their surroundings. In a household with multiple cats especially, it is important to use vertical space to create a larger living space so cats are not forced to cross paths when they want to have a meal or use the litter box. If the cats that share a home do not get along, forced interaction may cause unnecessary stress.

    Modifying behavior

    Although data show that a relatively low percentage (9%) of FLUTD cases are attributable to behavioral problems, Neilson said that behavioral intervention may be helpful in many areas of FLUTD management.

    "Since FLUTD can be such a frustrating problem for cat owners, it is critical that they are supported in every possible way," Neilson said. "By addressing the behavioral aspects associated with FLUTD, treatment success may be enhanced."

    A medical problem, such as FLUTD, may initiate a behavioral problem, such as periuria. After resolution of the medical problem, the undesirable behavioral pattern may be maintained for a variety of reasons.

    Neilson suggested that classical conditioning could play a role in persistent litter box avoidance. She explained that the cat associates the litter box with the pain and discomfort that it experienced when it urinated in the box while afflicted with FLUTD. The cat continues to avoid the litter box, despite the resolution of FLUTD. In this scenario, the box must be modified so that it is no longer associated with the painful experience. Moving the box to a different location, changing the physical characteristics of the box or changing the type of litter may have a positive effect. It also is important that the litter box is cleaned as frequently as possible.

    For more information

    Forrester SD, Lulich JP, Neilson JC, Gavzer K. Feline lower urinary tract disease: thinking outside (and inside) the litter box. Presented at: Western Veterinary Conference; Feb. 18-22, 2007; Las Vegas.

    The symposium was sponsored by Hill's Pet Nutrition.

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