How to Manage Lower Urinary Tract Signs in Cats
Chronic recurrent idiopathic lower urinary tract signs (LUTS), commonly diagnosed in feline medicine, are often managed rather than cured.
When a cat presents with LUTS, I provide owners with a better understanding of the disease by comparing management of these signs to that of lactose intolerance; although we cannot replace the gene for lactase, the patient can avoid lactose. This analogy often helps prepare clients to provide appropriate resources and interact with their cat in nonthreatening ways, which can result in significant improvement in LUTS.1,2 Documenting prevalence and frequency of signs at the start of therapy helps clients see improvement in the cat’s condition and sustains motivation to continue therapy. In addition, because this condition has been associated with stress, clients may need to provide additional support during stressful periods (eg, holidays, parties, workers in the home).
Severe recurrent disease may result from early adverse experiences that create a susceptibility that is later unmasked by a provocative environment.3 Even healthy cats sometimes engage in sickness behaviors, including those associated with LUTS, during stressful periods. According to studies in rodents and humans,4-6 effective environmental enrichment can mitigate adverse events associated with early life experience, suggesting that the best prevention for unmasking underlying vulnerabilities and expression of sickness behaviors is creation of appropriately enriched environments.
For cats with chronic recurrent idiopathic LUTS, I divide treatment into acute and chronic cases and consider various factors related to the client, cat, and environment.7,8 In an appropriately enriched environment, the prognosis is excellent. Success depends less on the cat and more on environmental modification and owner ability to implement necessary changes.
How I Treat Chronic Recurrent Idiopathic LUTS: Acute Cases
Establish client communication
Increase client empathy regarding the cat’s pain and lessen client perception of the cat as being “mean”
Recurrent LUTS is similar to having a headache in the bladder; both recur unpredictably, are influenced by stress, and respond positively to environmental changes that reduce perception of stress
Explain the problem and clarify misconceptions
Review all body systems and environment to support the presence or absence of a systemic disorder (eg, Pandora syndrome)9 and determine prevalence of sickness behaviors
Confirm all relevant information with clients; do not assume clients have supplied all relevant information
Identify modifiable factors in the cat’s environment
Examine & Treat the Patient
Use only feline-friendly handling techniques10
Check for other problems in addition to LUTS
Cats commonly have signs related to other organ systems (eg, excessive hairballs, lower intestinal tract dysfunction, asthma-like behavior, decreased appetite, behavioral changes [fearful, needy])
Initiate analgesic therapy11
I commonly prescribe the injectable form of buprenorphine transmucosally (squirted directly into the mouth)12,13 at 5–20 µg/kg q6–12h for 5 days after administering a single initial IM injection of 20 µg/kg
If tranquilization is necessary, injectable form of acepromazine PO at 2.5 mg/cat q8–12h for 5 days may be considered, with attention to its precautions and contra-indications12
If the cat excessively salivates when given acepromazine, administer one-quarter of a 10-mg tablet in a Greenies Pill Pocket with canned food, or as a suspension with an oral syringe
Evaluate environment
Review environment for stimuli that could threaten the cat’s perception of control and predictability:
Factors related to other animals or humans, including placement of food, water, and litter box; location of hide, perch, rest, and play areas; environmental noise, odors, and temperature; or disturbance of daily routine
Work with clients to resolve any identified issues
Recommend changes after the acute period to avoid overwhelming clients
Harmony at Home?
Ask the client:
Does each cat have its own food and water bowl?
Does each cat have a perch to look down on surroundings?
Do you spend time petting each cat? (If so, for how many minutes?)
Does each cat have toys that mimic quickly moving prey?
How I Treat Chronic Recurrent Idiopathic LUTS: Chronic Cases
Establish client communication
Assign clinician extender (eg, technicians, assistant) to help clients identify problem areas, brainstorm solutions, and create specific, workable plans to increase the cat’s perception of control and predictability through environmental enrichment
Implement agreed-on plan
Follow up within a week to review recommendations
Follow up at 3 weeks to assist with implementation of changes
Determine cat’s response to available types and locations of food, litter, and scratching surfaces
Troubleshoot inevitable impediments
Continue to provide coaching and encouragement for change efforts
Follow up at 3 months to assess progress, unless additional contact is needed in the interim
Consider referral to a behavior specialist if no progress is made or the clinician’s or patient’s relationship with the client becomes strained
Treat the patient
Readjust Diet
Note that no nutrient or ingredient has been demonstrated as effective treatment
What, where, and how the cat is fed may influence its perception of control and predictability, lessening its expression of LUTS and other signs
Ask client about the cat’s feeding preferences and encourage client to offer dietary options in individual containers at mealtime; discuss the cat’s responses with client
Feeding from food puzzles provides activity and mental stimulation
Consider introducing Greenies Pill Pockets as a treat to prepare the cat for potential drug therapy
Implement Medication
If environmental modification is insufficient for resolving clinical signs, another course of buprenorphine, possibly at a higher dose, may be tried
If the cat tolerates administration of oral medications, consider an antidepressant such as amitriptyline or clomipramine at 5–12.5 mg/cat PO q24h, always using the lowest possible dose13,14
Should be given for ≥3 months, after which the dose can be tapered gradually and stopped if possible
Avoid using these drugs in cats with heart disease; perform a CBC and serum biochemistry profile to monitor platelet/WBC counts and liver enzyme activities before and at 1, 3, and 6 months of therapy
Consider pheromone therapy (Feliway) if patient fails to improve in an enriched environment
Note that various drugs and remedies not recommended here have proven ineffective in clinical trials; signs usually resolve within days without drug therapy, and many cats seem to perceive oral medication as threatening6,7
Forcing oral medications may add a level of threat that exacerbates the problem, frustrating the client and weakening the animal–human bond
Evaluate environment
Evaluate influences of a multicat household
Resource conflict with other cats is often an overlooked source of threat
Monitor the effect of changes on other animals in the environment
Although owners may have separate food bowls for each cat, placing food, water, and litter boxes out of sight of another cat’s resources often improves outcome
Take-Home Points
To sustain motivation to continue therapy, help clients recognize improvement in their cat’s condition.
Don’t assume clients have supplied all relevant information.
Review environment for stimuli that could threaten the cat’s perception of control and predictability.
Encourage clients to offer dietary variety.
When administering antidepressants to cats, always use the lowest possible dose; avoid using antidepressants in cats with heart disease.
Success depends less on the cat and more on environmental modification and owner ability to implement necessary changes.
Consider referral to a behavior specialist if no progress is made.
Correction (Print Issue):
In the September 2012 print issue, page 32, in the article titled Lower Urinary Tract Signs in Cats, the prescribed dose of buprenorphine is accurate as follows:
“I commonly prescribe the injectable form of buprenorphine transmucosally (squirted directly into the mouth)12,13 at 5–20 mcg/kg q6–12h for 5 days after administering a single initial IM injection of 20 mcg/kg”
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C. A. TONY BUFFINGTON, DVM, MS, PhD, DACVN, is professor of clinical nutrition at Ohio State University. His research interests include small animal clinical nutrition and feline lower urinary tract disorders. Dr. Buffington has been published in numerous peer-reviewed publications and book chapters. His research into disease risks for indoor cats led to his creation of the Indoor Cat Initiative. He received all of his degrees and completed his residency at University of California, Davis.