Dear Dr. Barchas,

My cat Nashville is two-and-a-half years old, and he keeps squatting like he has to have a BM, but nothing comes out. It wouldn’t be so horrible if he did it in the litter box, but he’s doing it all over our apartment. Is it constipation? if so, what do I give him for that?

Kelly

Traverse City, MI

House soiling — that is, defecating or especially urinating outside of the litter box — is absolutely the No. 1 behavioral complaint I receive from cat owners. It also is, by a mile, the most common subject in questions submitted to me online from cat owners. I have written extensively about behavioral house soiling and its treatment in the past.

But I’ll jump straight to the chase in this matter: I don’t think Nashville has a behavioral problem. I think he has a medical problem, and I’m worried that it’s not constipation. I am concerned that Nashville may be suffering from urinary obstruction.

First, I should say that from Kelly’s description I cannot ascertain whether Nashville is having trouble urinating or defecating. Kelly states that Nashville appears to be be struggling to defecate; however, since nothing is coming out, it can be very difficult to ascertain what Nashville’s trying to do.

Constipation certainly is miserable. And it can become life threatening if it goes on long enough. But as bad as it is, constipation cannot hold a candle to urinary obstruction. And here’s what makes me really worried: In my experience, urinary obstruction is far more common than constipation in young cats.

Urinary obstruction occurs most frequently as a complication of a nebulous syndrome known as FIC/FLUTD/FUS (short for feline idiopathic cystitis, feline lower urinary tract disease, and feline urological syndrome, respectively). As I often say, when the experts can’t even agree on a name for a syndrome (and one of the names includes the word idiopathic, which means “occurring due to unknown causes”), you can bet that they don’t know what causes it.

FIC (which is the currently favored name) is linked to irritation of the bladder. The symptoms are often indistinguishable from those of a urinary tract infection; irritation is not caused by bacteria. Symptoms may include urinating outside of the litter box, passing bloody urine, pain, and aggression. Most (but not all) experts agree that body chemistry imbalances — probably linked to improper formulation of cat foods — play a big role in FIC. Cats are more likely to experience the symptoms of FIC when they suffer stress such as re-housing, the addition of a cat to the house, or any significant life change. Overweight cats suffer more frequently than cats who are thin.

Urinary obstruction occurs as a complication of FIC in male cats. It is almost unheard of in females. Males are predisposed for anatomical reasons. Their urethras (the tubes that connect the bladder to the outside world by way of their penises) are very narrow. FIC appears to cause swelling in the urethra, which can reduce the flow of urine. Then a plug of crystalline debris or mucus, or a strong muscle spasm, can block off the urethra completely. The result is that the cat can’t urinate.

If you think that sounds painful, you are correct. It’s every bit as miserable as you can imagine, but it’s also much worse. As the bladder fills to its limit, there is no place for urine (which is produced by the kidneys) to go. The kidneys therefore stop producing urine. This is a type of kidney failure, and it progresses rapidly. A miserable death from kidney failure and electrolyte imbalances can occur in less than one day.

Symptoms of urinary obstruction start off like the ones Kelly described. They then progress rapidly to lethargy, loss of appetite, vomiting, collapse, coma, and death.

Treatment involves passing a catheter into the bladder to allow it to drain. The catheter is generally left in place for two to four days, and the cat must be hospitalized during this time.

Recurrent episodes are common. Therefore, once they go home, cats who have suffered urinary obstruction often receive medications (such as prazosin) that help to facilitate urination. Diet changes (wet food is recommended, and so are special diets designed to address this problem) are a mainstay of home care. Weight management and stress reduction are also recommended.

If your male cat is struggling to “go” — even if you can’t tell whether he’s trying to urinate or defecate — you should consider it a medical emergency. Do not wait for other symptoms to develop. Do not waste time submitting queries to Internet vets. Do not even call your vet for an appointment. Pack up your cat and head to the vet. Call the vet on the way to let her know you’re coming. If you are told that your cat can’t be seen, say you’re coming anyway, and you can sort the matter out in the lobby. I recommend that you ask the vet to palpate your cat’s bladder immediately. This takes only a couple of seconds, and it almost always yields a diagnosis.

Many medical problems will resolve on their own if the patient is given some time to heal at home. Urinary obstruction is not one of them. The problem is painful and deadly, and I therefore treat it with the utmost urgency.

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