Feline Lower Urinary Tract Disease (FLUTD) or Feline Urologic Syndrome (FUS) are both used synonymously as umbrella terms covering a variety of urinary conditions. These conditions include bladder inflammation (cystitis) with or without a bacterial infection, and with or without crystals (struvite being the type that form in alkaline pH).
FUS/FLUTD usually presents with cats jumping in and out of the litter box each time urinating only small amounts (due to inflammation). If there is pain while urinating, they might arch their back and cry out. If irritation in the urinary tract continues, there can be blood in urine (hematuria).
It can be accompanied by frequent almost obsessive licking of the nether regions; sometimes cats can be constipated as well, so this confuses the symptom picture.
Any or all of these symptoms are very serious, and if enough crystals/uroliths form, kitty can have a potentially life-threatening urethral blockage. So this is not a time for going at it alone unless you are well-versed in homeopathy, actually maybe not even then; when in doubt, always get a vet visit in even if it means a trip to the emergency vet.
Feline Idiopathic cystitis (FIC)
The most common presentation for cats is bladder inflammation (cystitis) without bacterial infection. Stress has been talked about in veterinary journals (by professors Buffington and Obsorne in particular) as a contributing factor for IC in cats.
In another paper by Drs Westropp, Welk and Buffington, they documented the effect of stress. To wit, they found that "Mean weight and volume of adrenal glands were significantly smaller in cats with FIC than in healthy cats"
Bacterial infections are not as common in cats as one might believe. Yet antibiotics are prescribed quite freely if people who have joined my list are any indication. If there is suspicion of bacteria, make sure your vet performs a culture and sensitivity (C&S) test for bacteria in the urine (usually drawn with a needle - cystocentesis). This will tell you exactly which type of bacteria are the problem, and which antibiotic will be effective against that bacteria.
Causes of FLUTD
There are two major types of crystals:
- struvite crystals which form in urine with elevated pH (>6.8, even more likely with continued levels above 7.0)
- calcium oxalate crystals which form in too acidic urine (<6.0)
Struvite crystals can be addressed with diet, however if your cat has oxalate crystals, that’s a lot trickier to deal with. There are no cat-safe herbs for oxalate crystals so please beware of herbal formulas e.g. those labeled “stone-breakers”. Homeopathy (meaning a properly chosen single remedy, not a combo product) is the only safe non-surgical option for oxalate stones.
Before acidifying diets started getting “prescribed”, oxalate crystals were less commonly seen. Struvite crystals are still far more common. The 2 main risk factors for struvite crystals are:
- (1) alkaline urine
- (2) Concentrated urine
The biggest culprit for both (1) and (2) is grain-based kibble. Grains and plant matter can contribute to alkaline urine; meat on the other hand naturally promotes a slightly acidic (6.0-6.5 pH) urine. Dry food typically contains 10% moisture and given cats simply cannot and will not drink enough water to make up the deficit (prey/canned food contains at least 75% moisture), they are chronically dehydrated leading to concentrated urine. Meat however with its high moisture content keeps cats’ urine appropriately dilute.
Many cats’ problems go away with a switch to a grainless fresh meat-based raw/canned diet. Additional moisture can be provided by making food soupy and by providing access to a fountain.
Long-term there is no better way to keep FUS at bay than by ditching kibble, and switching to a raw diet (or grain-free canned high in meat) with or without extra water.
For help with making and switching to a raw diet as well as to share ideas that have worked, visit our "Keeping Your Cat Well-Fed” section and/or join us on the Holisticat forum.
Note: there is no empirical evidence other than one solitary paper that Vit C acidifies urine; the evidence is more mixed for cranberry. However, cranberry has a poor record of helping cats on my list. There are many reasons to avoid cranberry including the (albeit not huge) amount of benzoic acid it contains.
A better option is a sugar contained in cranberry - D-Mannose. This is available in mild-tasting powder which dissolves easily in water. It can be given alone, or added to food. All one needs is 1/8 -1/4tsp (corresponds with 250-500mg) daily for a few days. Use D-Mannose only if dealing with 2 bacteria - e. coli and Klebsiella. Research support is sparse, so at this point anecdotal support is what we've got to work with.
Colloidal Silver is effective against 3 of the usual bacterial culprits in cat pee - e. coli, Pseudomonas aeruginosa, and Enterococcus faecalis. This info as per the silvercollids.com site listed in References. Stick to Source Naturals Wellness, MesoSilver, and Sovereign Silver brands <30ppm.
Needless to say, use your judgement on D-Mannose and/or Colloidal Silver. Incidentally the EPA states
the maximum amt of CS for a person weighing 170 lbs should be 14 tsps of 5ppm per day:
1 tsp = 5ml, so 70ml is their idea of a human dose.
I am not saying you shouldn’t give your cat antibiotics when warranted. If your cat has a bacterial infection, and a C&S has been done, please use the prescribed antibiotic. Just providing some gentler options should they fit your cat's situation.
Preparation method: Bring one cup of water to a boil. Pour it over one rounded teaspoon of dried herb or one tablespoon of fresh herb. Cover and steep for 20 - 30 minutes. Strain. Give via dropper or needle-less syringe or add to treats e.g. yogurt, baby meat food without onion powder, meat broth/stock, etc.
These herbs are demulcent, rich in mucilage, and have a soothing effect on mucous membranes. They have all been used to help kitties with bladder pain and soothe their urinary tract:
- Couch Grass Root - loose dried form or powdered (in bulk section or capsules)
- Cornsilk – loose dried form or powdered (in bulk section or capsules)
- Marshmallow root OR Slippery Elm Bark – loose dried form or powdered (in bulk section or capsules)
Tinctures can be used but they are not without their challenges. Alcohol can harm cats so if using a tincture with alcohol, this will need to be dealt with. As for glycerin-based tinctures, many cats are fine with it but some dislike the taste so hiding in food isn’t always an option. Others foam at the mouth. If your cat exhibits any of these behaviors and can be pilled, you can put drops of glycerin tinctures in a small capsule.
At the acute stage, might need to give up to 3-4 tablespoons (15-20mls) daily for 7 – 10 days, then drop down to 1 tbsp a day for another week or so. If bladder inflammation is severe, both Cornsilk and Marshmallow root/Slippery Elm Bark can be continued for another 4-6 weeks or even longer if needed with breaks every now and then.
- Vitamin C (500- 1,000 mgs a day) – only in acute stage (and only for cats who do not have CRF or any other condition contributing to metabolic acidosis) because in times of stress Vit C levels can decline. All other times, it's debatable if cats need Vitamin C because cats produce Vitamin C. Note: there is no reliable evidence at this time to count on Vitamin C acidifying urine.
- Glucosamine Sulfate and Chrondroitin Sulfate: acute stage 500mg daily, then 250 mg intermediate healing stage, and 125 mg longer-term (if needed).
Glucosamine sulfate has anti-inflammatory action and also helps rebuild/support the protective mucosal surface/GAG layer of the bladder. So it helps with bladder spasms. Chondroitin sulfate keeps the GAG layer from being broken down so it's more of a defense player whereas Glucosamine plays offense
Cats' mental component is just as important so plug in Feliway pheromone diffusers (at least one per 150-200sq ft room), spritz Feliway spray, and lavender hydrosols.
If your cat doesn't have a bacterial infection, and his/her FLUTD is idiopathic, stress could be playing a role. If so, adrenal glandulars e.g. Drenatrophin PMG and Adrenal Dessicate by Standard Process, could help. Ditto L-theanine (found in green tea) which one can give around 25mg 2x daily at the acute phase. The study referenced below on which this recommendation is based was for a 30 day period. I wouldn't give L-Theanine long-term to a cat but perhaps 25mg during a flare-up is a possibility. The safest brand for cats is NOW which contains Suntheanine as was used in the study, made from Decaffeinated Green Tea.
Flower essences would have to be tailored to the individual cat because the underlying reason for stress would have to be addressed e.g. if cat is stressed out due to being picked on, that'll call for a different essence or set of essences than a situation where the cat is naturally high-strung, and/or a change in the cat's home life that precipitates stress.
If you'd like help with a health, diet, or behavioral issue, click here for a consult.
Notes and References
- Silver-Colloids site reporting efficacy against e. coli, Pseudomonas aeruginosa, and Enterococcus faecalis.
- D-Mannose summaries, about the most scientific I could find
In these 2 chapters from the same textbook, there is mention of the fact that “bacterial urinary tract infections are reported to occur in 2 to 3% of dogs and in less than 1% of cats” with Escherichia coli bring the most common:
- Lulich JP, Osborne CA, Bartges JW, et al. Canine lower urinary tract disorders In: Ettinger SJ,Feldman EC, eds. Textbook of veterinary internal medicine. 5th ed. Philadelphia: WB Saunders, 1999.
- Osborne CA, Kruger JM, Lulich JP, et al. Feline lower urinary tract diseases In: Ettinger SJ,Feldman EC, eds. Textbook of veterinary internal medicine. 5th ed. Philadelphia: WB Saunders, 1999
- Very comprehensive notes from a vet school; includes results from Buffington et al's JAVMA paper and magnesium-pH info Discusses various urinary conditions and research findings related to FUS/FLUTD issues including this one from Buffington - 65.4% of the 109 cats in the sample had idiopathic cystitis (IC)
These researchers found that a high-protein (55% i.e. close to a mouse’s protein level) diet “is preferable as a urine acidifier for the prevention of struvite crystal formation in clinically normal cats”:
- Am J Vet Res. 2003 Aug;64(8):1059-64. Effects of a high-protein diet versus dietary supplementation with ammonium chloride on struvite crystal formation in urine of clinically normal cats. Funaba M, Yamate T, Hashida Y, Maki K, Gotoh K, Kaneko M, Yamamoto H, Iriki T, Hatano Y, Abe M. Laboratory of Nutrition, Azabu University School of Veterinary Medicine, 1-17-71 Fuchinobe, Sagamihara 229-8501, Japan.
Study showing that high starch and fiber levels in diets promote struvite crystals formation. Plug in this Pubmed #: 14974568 if the link doesn’t work: http://www.ncbi.nlm.nih.gov/sites/entrez
- “Evaluation of effects of dietary carbohydrate on formation of struvite crystals in urine and macromineral balance in clinically normal cats.”, Funaba M, Uchiyama A, Takahashi K, Kaneko M, Yamamoto H, Namikawa K, Iriki T, Hatano Y, Abe M. Am J Vet Res. 2004 Feb;65(2):138-42.
Mixed results for cranberry in this one – urine pH went up in fresh urine:
- http://www.ncbi.nlm.nih.gov/sites/entrez Pubmed # 7546109
"Cranberry juice and its impact on peri-stomal skin conditions for urostomy patients." Tsukada K, Tokunaga K, Iwama T, Mishima Y, Tazawa K, Fujimaki M., Ostomy Wound Manage. 1994 Nov-Dec;40(9):60-2, 64, 66-8.
- "Small adrenal glands in cats with feline interstitial cystitis", Westropp JL, Welk KA, Buffington CA., J Urol. 2003 Dec;170(6 Pt 1):2494-7.
- "Clinical efficacy of L-theanine tablets to reduce anxiety-related emotional disorders in cats: A pilot open-label clinical trial", V. Dramard, L. Kern, J. Hofmans, C. Halsberghe, and C.A. Rème, Journal of Veterinary Behavior, Volume 2, Issue 3, Pages 85-86 (May 2007)