Zac's stress leads to urinary tract disease

Zac, a handsome 4 year old domestic long haired cat, has been a patient of Vetwest Canning Vale since he was a kitten. He has always been a healthy chap and we have generally only seen him over the years for his annual check ups. However, Zac presented to Vetwest Canning Vale one Saturday morning after a stressful night in the ICU at Murdoch Pet Emergency Centre. Zac’s owner had taken him to the centre overnight as she had noticed Zac repeatedly straining to urinate without producing any urine and he seemed very uncomfortable. The veterinarians at the emergency centre discovered that Zac was suffering from a urethral obstruction - often referred to as a blocked bladder.

This condition stems from a relatively common condition known as Feline Lower Urinary Tract Disease (FLUTD). It is a disease seen predominantly in indoors cats and is thought to result from an abnormal stress response, leading to over-stimulation of the bladder wall. Many of these cats will then bleed from the wall of the bladder and large amounts of debris from the inflammation can build up. In male cats, this can lead to an obstruction/ blockage of the urethra (the pipe emptying the bladder). This blockage can have fatal consequences as urine backs up causing damage to the kidneys and toxins/ waste products that would normally be removed from the body with the urine can’t escape and end up back in the blood stream. If left untreated, it can lead to severe distention and even rupture of the bladder and subsequent peritonitis.

The vets at the emergency centre anaesthetised Zac and placed a soft silicone catheter into his bladder to allow a patent pathway for urine flow.  Blood work was obtained to ensure his kidneys had not been damaged with the obstruction, and he was placed on supportive intravenous fluids to dilute his urine and support his kidneys until he was able to urinate on his own.

The following morning, Zac’s owner brought him in to Vetwest Canning Vale for his ongoing care. Our veterinarian Nicole established that he had a good flow of urine through the catheter, but his urine was still bloody and very concentrated so the catheter had to remain in place for another 24 hours. Once the urine became clear the following day his catheter was removed in the hope Zac would now be able to urinate on his own, but much to the disappointment of Zac, his owners and the Canning Vale staff, Zac still struggled to pass urine unassisted. It then became apparent he was suffering from a combination of urethral spasm and probable bladder atony (severe inflammation of the urethra causing the muscles in the pipe to spasm and bladder wall muscle damage respectively), which is an uncommon and frustrating sequel to urethral obstructions.

Zac subsequently had to remain in hospital with ongoing pain relief and medications to relieve the muscle spasms and required repeated urethral catheterisation. After a long 5 days in hospital Zac had improved, and after proving that he could urinate sufficiently, he was discharged from hospital to receive ongoing outpatient care. Zac’s very patient owner brought Zac back to the clinic twice daily for ongoing manual expression of his bladder for another 5 days till Zac finally was able to successfully fully empty his bladder without assistance at home.

So how can we manage or prevent these FLUTD episodes?

Many therapies have been trialled to reduce the frequency of episodes but the only clinically proven therapy is to reduce the concentration of urine - as dilute urine is less likely to stimulate the sensitive bladders of affected cats. Reducing the concentration of urine in cats can be very difficult and usually involves the use of a wet/canned food only. Sometimes a special diet is prescribed by your veterinarian. Encouraging cats to drink more can involve adding tuna broth to water, using water fountains and trialling different types of water containers (including dog bowls).

Other therapies include behavioural modification to reduce stress in affected cats. This may include altering the environment to allow for more natural behaviours such as climbing, scratching, hiding and resting. In multi cat households reducing the competition for resources such as food, water, litter boxes and hiding spots. Many veterinarians may prescribe pain relievers during an acute episode and anti anxiety medications for more long term control. Whilst sometimes antibiotics are prescribed, they have little impact in the control and management of this condition.

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