Urinary Tract Disease & FLUTD

The signs of urinary tract disease are usually hard to miss, though their cause varies widely and accurate diagnosis requires more than the symptoms alone:

• Straining to urinate — crouching and pushing with little or no urine produced
• Frequent trips to the litter box or squatting repeatedly outside
• Blood in the urine (hematuria) — pink, red, or rust-colored urine
• Crying or vocalizing when trying to urinate
• Urinating in unusual places — on cool surfaces, outside the litter box, or in small spots around the house
• Licking the genital area more than usual
• Reduced or absent urine production despite repeated attempts — a critical warning sign of obstruction
• Lethargy, vomiting, and loss of appetite in conjunction with straining — signs that a blockage or infection has become systemic

A cat that is straining and producing no urine is a medical emergency. Even a few hours of complete obstruction can cause fatal potassium build-up and kidney damage.

The most likely cause differs by species, sex, and age:

• Bacterial urinary tract infection (UTI) — more common in dogs (especially females due to a shorter urethra) and in older cats; uncommon in young cats despite similar signs
• Feline idiopathic cystitis (FIC) — the most common cause of lower urinary signs in cats under 10; caused by stress and altered bladder lining function rather than infection; diagnosis of exclusion
• Urinary crystals and bladder stones — struvite (linked to infection or diet) and calcium oxalate (more diet- and genetics-related) are the most common types; stones cause irritation, bleeding, and blockage
• Urethral obstruction — most common in male cats (narrow urethra) with a mucus plug, crystals, or small stone lodged in the urethra
• Urethral plugs — protein and debris that block male cats; distinct from true stones
• Anatomical abnormalities — an ectopic ureter or urethral defect can cause leaking or infections in young pets
• Underlying conditions — diabetes, Cushing's disease, and chronic kidney disease can predispose dogs to UTIs

Accurate diagnosis is essential because the treatment for a UTI is very different from the treatment for FIC or a stone. Our work-up typically includes:

• Urinalysis — evaluates pH, protein, cells, crystals, and casts; collected by cystocentesis (a quick sterile needle draw from the bladder) for the most accurate results
• Urine culture and sensitivity — identifies the specific bacteria and the best antibiotic; only performed when infection is actually suspected, to avoid over-prescribing
• Abdominal radiographs (X-rays) — most calcium oxalate and struvite stones are visible on plain X-ray
• Abdominal ultrasound — evaluates the bladder wall, kidneys, and identifies stones or masses; helps differentiate FIC (thickened bladder wall) from stones or infection
• Blood panel — checks kidney values, electrolytes, and looks for underlying disease in chronic or recurring cases

Treatment is specific to the cause, which is why working up the diagnosis properly pays off:

• Bacterial UTI — targeted antibiotic therapy based on culture results; a follow-up urine culture after treatment confirms the infection has cleared
• Feline idiopathic cystitis — stress reduction (environmental enrichment, multiple litter boxes, water intake, puzzle feeders, pheromone diffusers), increased water consumption, and sometimes urinary diets or prescription pain relief; antibiotics are not helpful and are not given
• Struvite crystals/stones — in dogs and cats these often dissolve with a prescription dissolution diet; once dissolved, prevention is maintained with diet and hydration
• Calcium oxalate stones — do not dissolve; cystotomy (surgical removal) or cystoscopic basket retrieval are required; prevention relies on diet and urinary acidifiers or alkalizers depending on stone type
• Urethral obstruction in cats — emergency catheterization to relieve the blockage, IV fluids, hospitalization, and management of potassium-related heart effects; recurrent obstructers may benefit from perineal urethrostomy (PU surgery)

Any male cat that appears to be straining and producing little or no urine should be seen within hours — do not wait overnight. For dogs and female cats, a same-week appointment for straining, blood in the urine, or accidents in the house is appropriate. Cats with recurrent episodes of lower urinary signs — even if self-resolving — benefit from a proper diagnostic work-up to identify the underlying pattern and prevent the next crisis. Our Calabasas team has the urinalysis, imaging, and surgical capabilities to diagnose and treat the full range of urinary conditions in-house. Book an appointment or call us if you are concerned your pet may be obstructed.