A kitten outside the litter box, looking embarrassed and ashamed.
A kitten outside the litter box, looking embarrassed and ashamed. Photography ©ysbrandcosijn | Getty Images.

Feline Lower Urinary Tract Disease — Get the Facts

Paying attention to your cat’s bathroom habits and catching feline lower urinary tract disease early could save your kitty’s life.


Feline lower urinary tract disease (FLUTD) in cats is serious. Casey, my 4-year-old orange tabby, sports a sleek coat, always aces his annual wellness exams and regularly made healthy deposits in his litter boxes — until one Sunday night.

I noticed he was taking a long time standing in the litter box. Then I heard his moan-filled cry as he squatted briefly before springing out of the litter box. I inspected to find a tiny circle of urine with blood.

As a master certified pet first-aid instructor, I knew this was a medical emergency. I placed Casey in his travel carrier, gathered the urine sample in a bag and took him to Hillside Veterinary Clinic, a 24/7 animal emergency center in Dallas.

The veterinarians were able to quickly unblock his urethra to allow the remaining backed-up urine to spill onto the steel examination table. As a precaution, they kept Casey overnight to monitor him and perform further tests.

As I handed Casey to the veterinarian for his overnight stay, I will never forget what she said to me: “I am so glad you brought Casey in immediately. If you would have waited until the morning to bring him in, Casey may have died.”

What is feline lower urinary tract disease or FLUTD?

A cat in a litter box.
What exactly is FLUTD? Photography ©St_Aurora72 | Getty Images.

All cats can be at risk for urinary stones or crystals, blockages, infections and a host of other issues. Plumbing problems like feline lower urinary tract disease, especially in male cats, come in many forms and can strike quickly.

“When a cat has a urinary obstruction, it is a true medical emergency,” says Lisa Lippman, DVM, a house call veterinarian in New York City with experience working at an emergency veterinary clinic. “When a cat can’t urinate, toxins build up in the blood and the condition can cause life-threatening organ failures, including to the heart.”

What are the signs of feline lower urinary tract disease or FLUTD?

  1. Crying while urinating
  2. Excessive grooming of the genitals
  3. Bypassing the litter box to urinate elsewhere
  4. Having difficulty urinating
  5. Seeing blood in your cat’s urine

Any and all of these signs can indicate a blockage in the urethra, the development of urinary or bladder stones, stress-induced urinary tract infection, bladder wall inflammation or a host of conditions that fall under the blanket term known as feline lower urinary tract disease (FLUTD).

How to treat feline lower urinary tract disease or FLUTD

Depending on the issue, your veterinarian will perform a thorough exam that often includes taking blood and urine samples and performing an ultrasound. Your veterinarian may prescribe medications to relax muscles, reduce stress or fight infections in your cat and, in some cases, surgery may be required. “We often use an ultrasound to look at the bladder wall surface for evidence of stones or crystals,” says Hazel Carney, DVM, MS, DABVP, a board-certified veterinary practitioner at WestVet in Garden City, Idaho, who serves as chair of the American Association of Feline Practitioners Guidelines Committee. “And we do abdominal radiographs and analyze the urine for the concentration, the pH (acid base level), whether there are intact red blood cells, any signs of sugar glucose in the urine and any indication of infection.”

Cats recovering from feline lower urinary tract disease, including Casey, are then often switched to therapeutic diets made by major pet food companies, such as Hill’s, Purina and Royal Canin, to reduce the chance for another urinary issue.

Your veterinarian may also recommend adding key supplements to your cat’s diet. Popular go-to choices include Zylkene and Cosequin. Zylkene, a stress-reducing supplement, is made from casein, a milk protein with calming properties. Cosequin is a natural supplement used to help cats address bladder and joint issues. It comes in capsule form to sprinkle on a cat’s food or as a chewable treat.

How to prevent feline lower urinary tract disease or FLUTD

Entice your cat to drink more water to keep him hydrated and prevent “plumbing” problems.
Entice your cat to drink more water to keep him hydrated and prevent “plumbing” problems. Photography ©Lightspruch | Getty Images.

While not all feline lower urinary tract disease cannot be prevented, you can play a vital role in your cat’s health and survival. That starts by paying attention to your cat’s bathroom habits. Know what is normal for your cat in terms of frequency and size of the deposits in the litter box. And, strive to increase your cat’s water consumption to prevent dehydration that can exacerbate urinary issues. Dr. Carney says many studies suggest that offering canned food might decrease the recurrence of urinary diseases.

“But if your cat does not like canned food, you need to have multiple water bowls in your home away from their food bowls,” she says. “Why? Because cats do not naturally eat and drink in the same location. If they stay in one location too long, their sense of vulnerability (to perceived predators) increases.”

You can also take these effective preventive measures against feline lower urinary tract disease (FLUTD):

  1. Provide one more litter box in your home than the number of cats you have. Intentionally place each litter box in different locations, not lined up in a row, to prevent stress-induced issues triggered by one cat bullying another who needs to urinate.
  2. Keep the litter boxes clean by scooping daily. Cats possess heightened senses of smell and may seek a different bathroom location (like your bed or living room rug) if they deem their litter boxes to be too dirty to use. “It is a myth that cats do things out of spite, like urinating outside the litter box,” says Stephanie Karpf, DVM, who co-owns For Cats Only, a feline-exclusive veterinary practice in West Palm Beach, Florida. “I tell my clients the importance of having plenty of litter boxes in different locations that are scooped daily for the health sake of their cats.”
  3. Enrich your indoor cat’s environment with cat trees, interactive toys and bedding in safe, elevated areas to reduce the risk of stress that can take a toll on a cat’s body. Dr. Carney’s parting message: “Any cat who goes into the litter box, postures to urinate and does not produce any urine or just small drops of urine needs to be seen immediately by a veterinarian. This is a serious medical emergency.”

YES, female cats get urinary issues, too!

In most cases, a cat most at risk for feline lower urinary tract disease (FLUTD) tends to be an indoor-living male, young to middle-aged, who generally eats dry food and is overweight. However, female cats can also cope with plumbing problems. “Females more often present for feline interstitial cystitis (FIC) and, to a lesser degree than males, urinary tract infections,” says Hazel Carney, DVM, MS, DABVP, a board-certified veterinary practitioner who has focused on feline medicine and behavior for three decades and practices in Garden City, Idaho.

Because a female cat’s urethra is shorter and wider than a male’s urethra, urinary tract blockages are not as common — but they do occur and go unnoticed more by owners.

“The problem is that owners wait longer to bring in a female cat who is going back and forth to the litter box than they will for a male cat,” Dr. Carney says. “Some female cats may not pass blood, but have pain twinges and not cry out as a male cat would who has an obstruction. Owners may notice a cat is overgrooming her tummy, but fail to realize that could be an indication of bladder pain that needs veterinary attention to determine if it is due to stress, a skin disease or a urinary issue.”

Thumbnail: Photography ©ysbrandcosijn | Getty Images.

Suffering from urinary tract infections yourself? Here’s how to prevent UTIs >>

About the author

Arden  Moore is a pet behavior consultant, author and master pet first-aid instructor who often teaches hands-on classes with her cool cat, Casey, and very tolerant dog, Kona. Each week, she hosts the Oh Behave Show on Pet Life Radio. Learn more at ardenmoore.com and follow Arden on Facebook and on Twitter @ArdenKnowsPets.

Editor’s note: This article originally appeared in Catster magazine. Have you seen the new Catster print magazine in stores? Or in the waiting area of your vet’s office? Click here to subscribe to Catster and get the bimonthly magazine delivered to your home. 

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