Urinary Problems in Cats

Lower urinary tract inflammation in cats and its treatment

 

Question:  One of my cats ("Bart") has blood in his urine and is going in and out of the litter box all day (since 2/1). My vet has tried Baytril, Clavamox, Dibenzyline, and Prednisone - nothing is working. Now we are trying Orbax in combination with Amitriptyline (just started - but I am not optimistic.) I should also add that 2 years ago he had the same thing and Baytril worked. He was flushed yesterday with a catheter and there was lots of blood in his urine. It is being sent for a culture and sensitivity analysis - should have the results in a week.  An Xray did not show any stones and my vet said he is not "blocked" - his bladder was empty. Other info: He is about 3 years old, neutered and a feral cat that I have been socializing -  so not easy to pill. We just moved to Florida (1/21) from New Jersey and the UTI started a two weeks later. He's had 2 courses of Baytril (one pill a day) for 14 days each time - crushed in beef baby food. It seemed to work for the first 10 days - then he started back into the litterbox. Three questions: 1) Is Baytril as effective if it is crushed and added in food or does it have to be "pilled"? 2) I read that Orbax may cause crystals in urine. Is this drug good for UTI? 3) Do you have any suggestions as to what else I can to to help "Bart"? Thank you! Audrey 

Answer: Audrey-

1) Baytril comes in a chewable tablet form (as well as pill form) so it seems unlikely that there is any problem with crushing the tablet and mixing it with food.

2) If enrofloxacin (Baytril Rx) didn't work it is really unlikely that orbafloxacin ( Orbax Rx) will work because they are closely related medications. Once in a while there are situations in which one of these medications will work when the other one didn't but that is not usually the case. I am under the impression that all of the fluoroquinolone antibiotics can cause crystal formation in the urine but I am not certain that is correct -- the only reports I know of for certain concern ciprofloxacin (Cipro Rx), which has been reported to cause crystal formation in the urine in humans in some circumstances such as when the patient is dehydrated. Enrofloxacin is metabolized to ciprofloxacin in the body and so it seems reasonable to assume that this effect might occur in pets, as well. Whether any of the fluoroquinolones (ciprofloxacin, orbifloxacin, enrofloxacin, marbofloxacin and others ) are helpful when there are signs of lower urinary tract inflammation in cats primarily depends on whether there is actually a bacterial infection. It is estimated that less than 5% of male cats with signs of urinary tract discomfort and inflammation have bacterial infections. The rest have other problems.

3) The veterinary communities understanding of lower urinary tract inflammation in cats is still evolving. We do not have many definite answers for people. At the present time the folks who study urinary tract inflammation in cats seem to agree on some basic things but there are also a lot of questions about what these things mean ultimately for treating affected cats. There is a feeling now that these are the most important preventative measures for lessening the frequency and duration of attacks of urinary tract inflammation in cats?

a) Limit stress as much as possible. Unfortunately there are times when you have to do things like move and cats are very stressed by this. Keeping more than 2 cats seems to significantly increase the stress in households with cats, as well. Try to have more litter pans than you have cats and try to make sure the litter pans are located in quiet areas in which the cats can have some privacy while urinating or defecating.

b) Increase water intake as much as possible. Use canned food (if your cats accepts it readily) for its water content, encourage water drinking and when there are severe attacks consider supplementing oral fluid intake with subcutaneous fluids or IV fluids.

c) Feed foods that you cat eats readily and try to stick with a small number of foods rather than giving a large variety of foods. This seems to aid in limiting stress. The use of urinary tract acidifying diets should be reserved for cats who have a known problem with struvite stone or crystal blockages of the urinary tract or inflammation that seems very likely to be due to crystals. Remember that just seeing crystals in the urine is not enough to warrant the use of acidifying diets as this is a common finding in normal cats.

d) Ensure that there isn't a problem like bladder stones, consider a urine culture done on urine drawn directly from the bladder with a needle (cystocentesis) to find out if a bacterial infection is likely and consider more advanced testing if the problem persists. Checking for urinary tract infection from cats by taking urine from a catheter will give more false positive culture results than cystocentesis.

d) Wait out the attack. In most cases these will resolve within 3 to 10 days on their own whether you treat or not, as long as the cat doesn't develop a urinary tract blockage in the meantime. If a blockage does occur (very frequent trips to the litter pan, howling when attempting to urinate, straining without visible urination and rapidly becoming lethargic are all signs that a blockage might be present. Unfortunately, these measures are not very satisfactory to cat owners who have a very uncomfortable cat and want some relief for it. Consequently there are a large number of things that people do that don't work very well in studies, including giving antibiotics, using pain relief medications, using amitryptilline or other medications to relax the bladder or for stress reduction effects, using corticosteroids and using polyglycosamines. Even though there is little evidence that any of these therapies work in all cats or even most cats, there does seem to be some response in a few cats. Therefore, it is reasonable to try some of these therapies, especially the ones that aren't likely to be harmful. We have had the best success with amitriptyline, which may be due to pain relieving effects or to stress reduction effects. We have had some luck using glucosamines. We have tried Adequan (Rx) injection and Elmiron (Rx). They both seem to work in some cats, at least subjectively. Other vets seem to have better luck with other medications. We have recently noticed (again this is subjective until studied) that some of our patients we are treating with fluoxetine (Prozac Rx) for urinary marking behaviors seem to have less urinary tract disease when on this medication. With increasing evidence that urinary tract information in cats seems to be related to stress it is possible that this would explain a mechanism of action for fluoxetine. I wish that I did know something that would reliably end these attacks in my patients but I don't. Hopefully as Bart gets more used to his new surroundings and relaxes a little it will help to alleviate this problem.

Mike Richards, DVM

 

Bladder Unable to Empty  

Question: I need some help to clear my mind. My cat Sammy who is about 3-4 years of age, ( adopted from a co-worker who had moved ) had a lot of blood in his urine. I took him to the vet, and he found that his bladder was VERY enlarged, ( had pushed all other organs up into his rib cage ). His little body couldn't release the urine, so his bladder kept on stretching. My vet said he couldn't find a reason since this is very rare. He called the vet school, and still couldn't find an answer. It was like he was living with an infection for some time, and kept getting worse ( we had him for only 2 months ) Poor thing. I ended up putting him down, which was very hard. Have you ever heard of a thing like this?  Melanie

Answer: Melanie- Trauma is the most common cause of inability to empty the bladder in cats. This is most commonly associated with spinal cord injury, often due to a condition referred to as "tail jerk" in which the tail is pulled or held still while the cat continues to move (such as when it is caught under a rocking chair). If there is no chance of trauma then it is harder to figure out a cause for the this problem but an inapparent blockage of the urethra (the urine channel the runs from the bladder to the tip of the penis) or nerve damage for other reasons such as cancer of the spine or parasite infection affecting the nervous system (a rare problem) would be other possibilities. There are probably other possibilities that I am not able to recall at this time.

Mike Richards, DVM

 

 

Odor Problem and Difficulty Treating Cat with Chronic Bladder Problems

 

Question: Hi Dr. Mike,

Thanks for that comprehensive info on pH from last time.

Lacey, my 14.5 yr old,  is really smelling horrifying again. I had a basic urinalysis done and it showed a pH of 8 and enormous amount of bacteria. It wasn't a "clean" sample but I know she's infected. Anyway, my vet suggested 1000mg Vitamin C and 500mg amoxycillin split in 2 doses. But it is impossible to get medication into her. If she suspects there is some pill hidden in anything she spits it out and bites at me if I try to force it. I am afraid she will die of an untreated infection that spreads. I have taken to spraying her rear fur with Febreeze because of the strong stench. And 3 out of 5 times I have put her into the tub against her will to wash down her rear quarters she has defecated into the tub or on the floor. She has also bitten me several times in the last few weeks when I go to clean her up.

My vet has no solution. I have tried hiding the pills in chopped liver, tuna salad, egg salad, peanut butter, baby food, etc. but she is totally recalcitrant. What are any other options for treating her? Every time I miss a dose I feel that her system will build up an immunity to the antibiotics and they will never work. In November she had 2 weeks of Orbax but that clearly didn't fix anything. This has been going on again since the start of December. I can't do liquid in her mouth because she will bite me again.

If I leave her somewhere for IV antibiotics would it help or would she just die from heartbreak? She is rarely alone. I am at a loss.

I would appreciate hearing your opinion.

Thanks, DEE

Answer: Dee-

The best approach to this problem would be to obtain a urine sample for culture by withdrawing it directly from the bladder with a needle, to try to identify the bacteria involved and to pick the best possible antibiotic based on sensitivity testing, which can be done in conjunction with the culture. Even with the signs you are seeing there is a small chance that there isn't a bacterial infection but it does seem likely. If the urine cultures were negative it would make the possibility that the problem is due to other causes, such as chronic interstitial cystitis, more likely. This is a hard condition to treat but there are medications that seem to help some cats.

As far as the antibiotics go, I think that you have several choices. The first is to use an antibiotic that has been made into a flavored gel or liquid by a compounding pharmacy. There are enough flavors that it is usually possible to find one that a cat will eat when it is mixed with their food. Many antibiotics can be mixed with flavorings without altering their effectiveness. There is also the possibility of making the antibiotic into a transdermal gel, which is applied to the skin and carries the antibiotic into the body. This approach works well with some antibiotics. I am willing to dispense injectable antibiotics that can be given subcutaneously after showing my clients how to administer them, but a lot of vets won't do this. The antibiotics do sting in most cases and it is important to realize that and to be careful not to get bitten or scratched when the cat gets tired of the injections and starts to retaliate for them. The last choice is to arrange for hospitalization long enough to administer a complete course of antibiotics, or to bring her in daily for injections (which usually means your vet has to come in on his or her days off to give them unless the clinic is open 7 days a week). Most cats actually do fine when they are hospitalized, even some that don't otherwise leave their homes. However, it is more stressful.

If this is a bacterial infection it would be a good idea to look for an underlying cause of recurrent bladder infections, such as bladder stones, pyelonephritis, diabetes, Cushing's disease (uncommon in cats), feline leukemia virus, feline immunodeficiency virus and sometimes hyperthyroidism. If none of these things is found and the problems continue to recur it may be necessary to do urine cultures a week or two after stopping antibiotics and continuing them again if the cultures show bacterial growth, then repeating the process until the cultures are negative may be necessary. This is a tough situation to be in with a cat like Lacey who doesn't like to be medicated but if the flavored medications or transdermal gels work for her, it wouldn't be too bad.

I hope that this helps some. If your vet is unfamiliar with transdermal gels a compounding pharmacist familiar with medications for cats should be able to help in finding an appropriate medication.

Mike Richards, DVM

 

 

Fluoroscein Dye for Urine

 

Question: Hi, Dr. Richards...

I'm a subscriber to VetInfo (and plan to re-subscribe, as I LOVE your monthly newsletter!)

I'm trying to find out about the product that you can give a cat to make his urine show up differently (under black light?) than the other cats' in the household -- for example, if you're trying to figure out who's peeing in the corner.

Do you know the name of the product? Does it have to come from a vet, or can it be obtained OTC? How does it make the urine distinctive? Does normal cat urine show up under black light? Does is "glow?" How would you tell "marked" urine from normal urine?

Thanks, and Purrrrrrs... Wendy  

Answer: Wendy-

The product you are looking for is fluoroscein dye. This is used to make corneal (eye) ulcers show up better. It used to be possible to buy the dye in little bottles of the liquid version but now I can only find it in test strips. This might sound a little odd, but if you cut up several of the test strips into small pieces (four to six of the size that contains 9mg of fluoroscein per strip seems to be about the right number) and then stuff the strips into a capsule and give it orally the same effect can be obtained as with the liquid.  You can buy empty gelatin capsules from your vet or from your pharmacy.

Urine from the cat who has been administered the dye will show up light yellow-green even to the naked eye, if you have really good vision. It is easier to find with a black light, though.   The urine that contains the dye will fluoresce well. Normal cat urine does not fluoresce. This  testing is usually done in multiple cat households when one or more cats are spraying furniture but it is hard to determine who the culprit is. If you use it for this purpose try to remember that there can be more than one culprit, so it may be necessary to continue testing even after identifying one cat who is urine marking.

The urine will fluoresce in as short a time as a half-hour or so and will continue to fluoresce for about 24 hours or so. This means that you have to be prepared to do all your searching within the day after administration of the fluoroscein dye. I am not aware of any serious complications from using this dye in this manner but it is definitely not an officially approved use.

Hope this helps some.

Mike Richards, DVM

 

 

Bacterial Cystitis

 

  Question: In your reply to my question, you state that bacterial cystitis is pretty rare. But my vet tells me that he can see  lots of bacteria in my cat's urine. If what he is seeing is not actually bacteria, what could it be and how do we  identify it? Munchie is being treated on the basis of the visual condition of her urine, not on any clinical signs.   If she does not have bacterial cystitis, but she is a CRF and hyperT cat, how should we proceed? She is   currently taking another three weeks of antibiotics, Trimethoprim/Sulfa, which I know is not recommended for   CRF cats, but the vet is afraid that the bacteria(?) will go to her kidneys if it isn't knocked out. I am totally   confused now!   Anne

Answer: Anne-  

Most of the internal medicine specialists who deal with cystitis problems in cats agree that bacterial cystitis is rare in cats and that it usually occurs when there is a primary problem like bladder stones, immune system suppression, diabetes or something like that.

Bacteria are difficult to identify with certainty in urine (there are artifacts that look like bacteria in urine at times) and many of the stains used to make urine easier to examine can harbor bacterial growth --- so when the stain is mixed with the urine, so are bacteria.

To prevent confusion over this issue, the best approach is to culture urine that has been withdrawn from the bladder through a needle. It is usually pretty easy to obtain urine with a syringe and needle in cats.

I would be uncomfortable treating a patient repeatedly for cystitis based on seeing what I thought were bacteria in the urine without clinical signs. If I was pretty sure that the bacteria were really there I would want to do a urine culture to prove this to myself and also to get an idea of what antibiotics might work based on sensitivity testing.

Mike Richards, DVM

 

 

Cystitis in Kitty and Hyperthyroidism

 

Question: My vet has not actually seen my kitty (Fiona) but from description of symptoms has diagnosed cystitis.  It is a 5 year old female, for the past 4 days she has been scooting her behind along the carpet, licking that area alot, and acting restless.  Yesterday she's started squatting like she's trying to pee outside the litterbox (on my clothes, etc) without any result. She did do a few drops on white fabric and it was pinkish red as if blood was present.  The vet said to gradually switch her food to one designed to prevent urinary problems, which we have started to do. She also prescribed 500mg vitamin C twice a day to acidify her urine. Is this enough, or should we be doing something else?  Is there a medication (antibiotic) she should be taking?  I guess I'm leary because no blood/urine samples were taken, although on the other hand I can't really afford any more high vet bills because my 17 yr old Topaz has been having health problems lately too. I guess I'd just like you to confirm my vet's diagnosis and treatment plan.    

Answer: Andrea-

I think I'd be more comfortable about a patient with suspected cystitis if an antibiotic was administered. I don't like to use the urine acidifying diets until there is a clear indication that cystitis is going to recur on a regular basis. These diets promote the formation of calcium oxalate bladder stones and so they aren't risk free.  I think they are a good idea when cystitis is recurrent but hesitate to use them on the first incidence of it.  So for Fiona, I would probably take a different approach than your vet took but your vet's actions aren't unjustified. Many times the symptoms of cystitis in cats are from inflammation rather than bacterial infections. When this is the case, antibiotics probably aren't helpful. It may be just as reasonable to take your vet's approach as it is to take my approach.

Good luck with Fiona's  problems.  I would recommend having her examined by your vet, if that is possible for you to manage.

Mike Richards, DVM

 

 

Urinary Problems

 

Question: Dr. Richards,

I have a situation with my cat Jasper that has been going on since around mid-December. I have tried to list all the relevant information below. FYI: He eats IAMS dry for less active cats and IAMS or Science Diet Wet for feline   maintenance.

On, 12/15/99, after two days of Jasper not using his litterbox (he was going to the bathroom everywhere but the litterbox) I decided to take him to the vet. He also seemed to only be going to the bathroom once a day. He was not acting abnormal except for the litterbox behavior.  He was eating normally and was energetic. When I took him into the vet they could not take a urine sample because his bladder was not full. They decided to treat it as a urinary infection and prescribed Clavamox (1 1/2 droppers 1x a day).  We   gave him the Clavamox until it ran out.  He was extremely stressed whenever we did this (drooling, etc.).

About a week later things were a little better, he was using his litter box and the carpet.  He was always   going to the bathroom right outside the box at this point, if he didn't use the box.  He seemed like he was   going to the bathroom more than once a day, but not all the time. I had plans to fly east on 12/23/99 so I   made a second appointment for him on 12/22/99.  When I took him in his bladder was not full enough to   get a sample so they asked me to leave him there for a few hours to get a urine sample.  They were finally   able to and they said there was no sign of infection, but a small amount of blood, which was probably due   to inflammation.  I debated whether to board him because he is a strictly indoor cat and does not get   exposed to many people and has become VERY skittish.  If anyone other than myself or my boyfriend   come in the door he bolts to go underneath the bed.  I was trying to weigh whether it would be more   stressful for him to be at the vet or at home.  I had a relative (who always watches him while I am away)   checking in and feeding him everyday.  I asked the vet what she thought and she said that he would   probably be fine but I could sign a permission for treatment as a precautinary measure.  She gave him a   steroid shot to reduct inflammation and prescribed Amitriptyline for me to start when I got back on 12/28.  

  When I got back on the evening of 12/28 Jasper came out of the bedroom to greet me but he was wheezing   and sneezing, his eyes were watery, his face was swollen and his ears were bright red.  His food from that   morning (wet & dry) had not been touched.  I took him to the emergency vet.  I told them about the past   week's incidents.  They were not sure what was going on and decided to do a blood test.  Here are the   results:

  ALB 2.4    ALP 23    ALT 46    AMY 657    TBIL 0.7    BUN 12    CA++  9.1    Chol 146    CRE 1.8   GLU 134    K+ 1.6    TP 6.7    GLOB 4.4

  WBC   4.0        HGB  13.0        RBC  9.76        HCT 46.8

  His temp was 100.2.

  They said that his white blood count was low, but he didn't have a fever.  They also said that his creatine   was slightly high but nothing to be concerned with.  They decided that is was probably a combination of   an allergic reaction and an upper respiratory infection.  They gave him fluids for dehydration, Benadryl,  B   Complex, Dexamethasone and Baytril shots.  They also prescribed Baytril tablets and gave me 2 cans of   Science Diet A/D.  When we took him home and gave him food he ate right away.  He also went to the   bathroom (outside the litterbox).

  I took him to the regular vet the next day and they gave him another injection (Benadryl ?).  My vet   thought that it was probably an allergic reaction to Clavamox and an upper respiratory infection that he   probably picked up while he was at the vet for them to get a urine sample.  They gave me some more of the   prescription diet and told me that if the respiratory infection did not go away to bring him back in.

  Since then the Upper Respiratory Infection has gone completely away and his energy level is normal.   However, his litterbox habits have not dramatically improved.  He is eating more wet and less dry food, his   weight is good (it hasn't dropped) and his energy level is good.  He had been going to the bathroom   pretty much 2x a day right outside of the litterbox in the same areas every time at about the same time   everyday.  We put a mat down, so its not as problematic for us to clean up.  The urine is always very   strong smelling and sometimes dark.  One time last week there was alot of mucus in his stool, but other   than that normal.

  On saturday, 1/29, he only went to the bathroom once and has done that up to today 2/1.  Today he   urinated but a smaller than normal amount considering he hadn't gone in more than 24 hours.  I am really   getting concernced and have no idea what to do.  He has changed some of his behavior as far as areas he   is sleeping in, but seems normal other than the litterbox behavior.

  Do you have any idea what this could be?

  Thank you in advance,   Kimberly

Answer: Kim-

There are a couple of things that I think would be a good idea at this time.

If the mat is waterproof and you can get a small urine sample by sucking the urine up in a syringe, eye dropper or pipette it might help to get your vet to examine it.  Sometimes, having several urine samples to look at is very helpful.

Cats that have urinary tract infections will quit using the litterpan sometimes. It can help to move the litterpan to a new spot, to add a second litterpan in another room or to change the type of litter.  I think the ideal approach is to add a second litterpan with a different type of cat litter. This will often work to get the cat back to using a litterpan. Then you can try to move the litterpan to where you want it and you can probably get back to using one litterpan (but not always).  If you are using a covered litterpan sometimes it helps just to take the cover off the pan (worked for my cat).

If adding a litterpan and changing the litter type doesn't work, sometimes behavioral medications will. Amitriptyline is actually a good medication to try because it seems to help with bladder pain or spasms and also to have beneficial behavioral effects.  Other possible choices are diazepam (Valium Rx) and buspirone (Buspar Rx).  Your vet can help you sort through which medicine is most appropriate for your cat.

The important thing to remember is that most of the time it is possible to get cats back in the habit of using the litterpan but that it might take several tries to figure out what approach to doing that will work best for a particular cat.

At some point, I'd recommend rechecking the labwork, too. At least the BUN and creatinine levels and the blood cell counts.  Keeping track of which direction the creatinine is going in (up or down) would help to determine if there is a tendency towards kidney failure. Keeping track of the urine or blood glucose occasionally is a good idea, too.  Especially if Jasper is older than 10 years of age. Once in a while diabetes seems to sneak onto the scene when there are difficult bladder infections and easily acquired infections of other types in older cats.

Hope this works out well and quickly.

Mike Richards, DVM

 

 

Strong Urine Odor

 

  Question: Dear Dr. Richards,

  I'd like to say thank you for your website. I adore all animals and love to see that other people care, especially when they care enough to try to make an improvement to their well being.

  I have to DSH cats ages approximately 6 and 4 years old.  They eat ProPlan turkey and barley dry food and no canned food. They get cat snacks (crunchy kind for plaque removal) a couple of times pre week. They are also given, by their ill behaved humans, occasional pieces of chicken of turkey. Occasionally meaning three times per week or more. We know this is bad, we're so weak whne it comes to those faces!

  Neither cat is overweight, surprisingly, or has had any medical complications with urinary tract infections or blockage since I have been taking care of them (both were dumpster kitties their first years of their lives to the best of my knowledge). Both drink a good amount of water and have no problems urinating. In the past few days it seems like their urine has taken on a very strong odor. I believe it is the younger cat's urine. I clean the box twice per day as the norm. I also clorox clean the box once per week. Even with the cleaning I come home and the whole house smells. I have checked everywhere to be sure they are not urinating outside the box, which they are not.

  Can you think of anything that would give their urine such a strong odor?

  Thank you again for your kindness and assistance.

  Kathleen

Answer: Kathleen-

You didn't say, but I am assuming that the cats are either spayed or neutered. It would be unusual for urine odor to take this long to develop in an intact male, but sexual maturity is definitely one of the times when people notice that urine suddenly has a lot stronger odor to it. Male cats who are not neutered will sometimes begin spraying later in life and they only spray small amounts of urine in many cases, making it pretty hard to find the urine spots. Look really hard for signs of urination around the litterpans and on vertical surfaces (walls, furniture, etc.) around where the odor seems to be coming from.

There are occasional reports of cats developing hormonal disorders which produce enough hormonal changes to make a neutered cat develop the stronger odor associated with intact tomcat urine. While I think this is rare, if no other explanation is found as you search for a cause of the increased urine odor, it may be worth thinking about.

Cats with cystitis (bladder infections) or other lower urinary tract inflammation or infection will sometimes develop strong urine odors. Signs of cystitis include straining when urinating, multiple visits to the litterpan, blood in the urine, increased urine odor and

Cats who are dehydrated, for any reason, can have an increase in the odor of their urine. This can happen with inflammatory bowel disease, fevers, kidney disease or anything else that causes the cat to become dehydrated.

Some cat owners mistake the smell associated with anal sac secretions with urine odor. The anal sacs are located at about the 4 o'clock and 8 o'clock positions relative to the anus and they contain a strong smelling exudate which is sometimes expressed during bowel movements or even voluntarily by the cat. It is a good idea not to forget about these glands when exploring causes of increased odors that seem to be from the urinary tract in cats.

Diabetes is sometimes noticed by owners due to an increase in urine odor, although it is more common for owners to notice increases in drinking and urinating before changes in urine odor. Weight loss and an unthrifty appearance also occur with diabetes.

Hyperthyroidism sometimes causes an increase in urine odor. I am not sure why this occurs and it has not been reported in the literature, as far as I can remember, but some cat owners have noticed this and remarked on it when we were running down the list of symptoms associated with their cat's illness. This may be due to an increased tendency to urine mark in cats with hyperthryoidism -- a case in which people just notice the urine odor more, probably.

Some herbal products and some medications are supposed to cause increases in urine odor but I can't actually recall a case in which an owner noticed increases in urine odor due to medications.

Those are some of the causes of increased urine odor.

The way to sort through them is to start by looking carefully around the house for signs of urine marking (dark spots on furniture or walls, changes in the places where urine odor occurs).  If you find any evidence of urine marking, make sure your vet gets that information.

A physical exam, including checking the anal sacs and analysis of a urine sample and possibly a blood chemistry panel and blood count would be the next steps to take. This would help to determine if there is cystitis, kidney disease, diabetes or other systemic conditions contributing to the urine odor.  If nothing is found up to that point, it may be a good idea to consider X-rays of the bladder and lower urinary tract, just to be sure there aren't bladder stones or other problems that might show up on an X-ray.

If all of these things are normal, then it becomes hard to decide what to do. If your cats feel well but there continues to be strong urine odor in the house it may be a good idea to consider borrowing a black light (Wood's lamp) and administering fluoroscein dye (under your vet's direction) to the cats and then searching the house with the black light, looking for fluorescent stains that indicate urination outside the litter box. I'd recommend this earlier in the diagnostic process except that I have this fear that someday I'm going to cause problems with the fluoroscein dye administration in a cat (hasn't happened yet) since this is definitely not an approved use.

Hope this helps. Since your cats seem to feel well, based on your note, there may not be a need to rush through a diagnostic process but this should give you some idea of the directions  you can go in to find an answer.

Mike Richards, DVM

P.S. -  I feed my pets all sorts of treats. They like it and I like it and I think that is important in our relationship. I just try to keep the treats that aren't balanced nutritionally o less than 10% off their diet.    

 

 

Urinary Problems and Baytril

 

Q: Several weeks ago, while emptying our cat's litter box, we noticed that there was blood in his stools. We were told that it wasn't anything to worry about. Charlie was acting normal and he didn't seem to be uncomfortable.  After talking with several people we were told it wasn't uncommon for cats to have blood in the stools, so we decided to just wait and watch him. In the last two weeks we noticed that he had been acting rather sluggish and just not himself. He's a very active and playful cat with a lot of personality, but was being very lazy and sleepy--very cuddly in our laps-more than usual. He was hardly eating and not nearly his active self. We thought that maybe he was depressed being a single cat (He's a 2 year old tabby that we adopted back in June--before that he had other 'neighbor' cats he would play with). He would go in the bathroom and meow very loudly at night and get up in our faces and meow. We thought at the time he was just being a cat. Then we noticed that he was doing a lot of funny squatting. He looked as if he was sitting, but his legs were spread--He would do this on everything from our wood floor, to socks, to plastic bags. We watched him more closely because his tail would stick straight up when he squatted. After a few 'squats' there would be a few drops of urine. We would take him to his litter box where he'd done nothing (He has never gone to the bathroom anywhere other than his litter box). Over the weekend, we noticed that he was still squatting to urinate in strange places, and it looked as if there was blood in the urine.  Being alarmed with his new behaviour (the 'depression', squatting, and blood in his urine), I made an immediate appt with a local vet. 

I took him in that afternoon. At the vet clinic they took his temperature (they didn't say if he had a fever or not).  I explained the previous blood in his stools, his depression, his diminished appetite, and what I thought was blood in his urine. They catheterized Charlie and took a small urine sample. After testing it on some sort of 'stick' they said he had a bad bladder infection and said he was in a lot of pain. They gave him 3 shots--they said that 2 were antiobiotics and 1 was a painkiller. Five minutes after the shots, Charlie vomited. They seemed to act as if it was nothing. I assumed it was just a reaction to the painkiller and all the trauma (He was hissing, growling at the slightest touch---I'd never seen him like that). The doctor prescribed BAYTRIL 50mg (the package also says Enrofloxacin) and said to give him one at the same time everynight. The doctor said he should feel better by the following night and we should see a difference in him. He's been on this medication for 6 days and Charlie is still urinating only a few drops at a time, and you can see a lot more blood in it. Sometimes it looks as if it is pure blood. When we are there to catch him squatting and place him in the litterbox, he will sit in the litterbox for 10-15 minutes, with his tail perfectly still or twitching, and only urinate a few drops--if at all. We don't have children yet, and Charlie is our "Baby". We are quite worried about him and the fact that we haven't seen any type of change in him at all. The doctor said to bring in a urine sample on Monday and that he should be okay by then (How do you get a urine sample from a cat, especially when he is hardly urinating???).

I'm concerned that the doctor blew off the fact that he has been acting odd for several weeks, the blood in his stools, and the fact that Charlie is still urinating blood (German doctors *including vets* have a VERY different bedside manner). Including the time it took filling out paperwork and everything, Charlie and I were in and out of the Vets office in 15 minutes. I just can't help but feel that the doctor didn't check him out as well as he should have. We are limited in where we can take him to the vet because we have to take him to a vet that speaks some english. Even speaking some english I know there were questions I was asking that he didn't quite comprehend. Charlie is an indoor cat that has lots of toys he likes to play with and that we play with him with. He's a very affectionate and outgoing cat. Charlie leads a pretty normal life, he likes to eat a lot and watch everything going on outside the windows. He's a very curious cat. Charlie weighs about 10-12 pounds. We feed him once a day. He gets about 1/2 a cup of dry food mixed with about 1/3 can of wet food. Sometimes at night if he's eaten all of his food he gets dry food. He always has plenty of fresh water in 2 places in the house. We give him a treat of about 1/4 cup fresh milk about once a week. I was giving him a cat multi-vitamin every other day, until he started seeming depressed. In the last several days we have noticed he has been cleaning himself a LOT, shedding a lot, and seems almost as if he has dandruff (flaking skin). We really don't know too much about cats, simply what we know from growing up with cats in the house. We act like worried parents with sick child *Charlie* He really is our baby.

We give him a lot of love and affection just like a child. We are afraid that there must be something more wrong with him-- he is more alert now, but the blood in the urine seems to be worse and he has only had 2-3 bowel movements in the last week. All of the cat owners and resources we have turned to, which are so limited because we are here in Germany, seem to think there must be something more wrong if he isn't responding to the meds. My questions are--should we have Charlie checked out for more problems?? If so, what direction should we look towards?? Are than any specific questions we should try to ask the vet?? Have you ever heard of this drug the doctor has prescribed for Charlie *Baytril*?? Is it an antibiotic?? (that was my impression). What would make his behaviour change so drastically in regards to his 'depression', lack of appetite, laziness, etc.??? Is the dandruff because of all of the stress?? (taking pills, etc.) We usually give him a treat of catnip about once a week also. I know it has a drug like affect on him, should we avoid the catnip while we have him on the medicine?? We have given him a little more milk lately trying to get more fluids into him simply because he's hardly drinking any water-- Is that okay to do while he is on the meds??? And, Again, how do you get a urine sample from a cat? (When I asked the vet, he looked at me as if I was nuts.) We REALLY do appreciate your time and any advice you can offer us!! Thank you! Faith &Jon  

A: Faith and Jonathan=

Baytril is an antibiotic. 50mg would be a pretty high dose of this antibiotic for a cat, so I am hoping that is a misprint but Baytril is relatively safe so it shouldn't cause much problem even if the dose is high (the recommended dosage is 2.5 to 5mg/kg of body weight, so a 10 lb. cat would get about 20mg).

I think that you need to take Charlie back for a re-exam if he continues to be ill. There are a lot of possible problems, such as feline leukemia virus or feline immunodeficiency virus interfering with immunity, interstitial cystitis which might respond better if anti-inflammatory medications are added, a bladder stone, bladder cancer or diabetes. With the dander, depression and other signs I would be especially worried about the possibility of systemic disease such as feleuk or diabetes (except that diabetes should have showed up on the initial urinalysis). X-rays and additional lab work are probably in order if Charlie is still sick.

We usually draw urine samples directly from the cat's bladder with a syringe and needle. It gives us the cleanest samples and is easy to do in most cases. However, you may be able to get a sample by removing the litter from the litterbox and collecting urine directly from the box. This only works if a cat will use the litterbox when it is empty but many will. Other cats are OK if you substitute a non-absorbent material like plastic beads for litter and then strain the urine out of plastic and box.

Mike Richards, DVM     

 

 

Improper Urination - Medical or Behavioral

 

Q: What steps are necessary to diagnose whether a cat has a behavior disorder or a valid medical condition?  My 10 month old cat, BC, urinated in the middle of my bed for no apparent reason.  A neutered male (since 5 months old), he has had perfect litter box behavior since he was adopted into my home.  He shares the litter box with a 5 year old spayed female.  He has shown aggressive play behavior towards her but is not viscous or mean; she is submissive, hisses, and runs away when approached by him.  Nine weeks ago, I took in two kittens to foster.  They have not been living in the same living area as BC but he has sniffed them a couple of times but was not aggressive towards them, only curious.  Could he be jealous of the kittens or what medical conditions should I suspect?  Also, are there any good laypersons books on cat behavior I could refer to?

Thanks for your public service website!  

A: Tricia-

Your question is an interesting one because it is often difficult for veterinarians to tell when a problem associated with urination is behavioral. There are a lot of possible medical conditions that can lead to inappropriate urinary behaviors and it is actually pretty hard to devise a plan to rule all of them out without spending a lot of time and money running all kinds of tests.

It is important to remember that what we consider to be problematic urinary behavior can be viewed as completely normal urinary behavior based on the cat's perspective of the situation. Feral cats mark their territory very frequently, sometimes as often as 6 to 10 times an hour as they move about. Most of this marking is done by spraying. This type of urination is recognizable because the cat normally is standing, normally has its tail held erect and often hits a vertical surface with the urine. Some cats will spray on beds or carpet. The stance is the same but the urine spot looks like a spray pattern (linear) rather than a pool of urine. Spraying is strongly associated with behavioral urinary problems. A common error in thinking about urine marking behavior is the failure to realize not all marking is done by spraying -- some cats mark with normal urination so a pool of urine in a high spot or at a doorway or somewhere like that may indicate marking behavior even though it is not from spraying.

Cats that are having difficulty urinating tend to spend a great deal of time in the litterpan but it may appear that little or no urine is produced. Many people mistakenly assume that their cat is constipated due to the straining efforts. Cats may urinate in odd places but they are usually straining rather than exhibiting spraying type posturing. Blood in the urine is a sign of a medical problem rather than a behavioral one.

Unfortunately, much of the time it is a lot harder to figure out whether there is a medical problem than when one of the above behaviors is clearly evident. In this case, the only thing to do is to start looking for problem and work through the diagnostic effort as logically as possible.

The first step in a multiple cat household is often identification of the cat with the problem. In some cases a videocamera can be really helpful in figuring out who is urinating inappropriately, if the urination is occurring in roughly the same spot all the time. In other cases it can help to give individual cats fluoroscein dye orally and watch for greenish colored urine, or urine that is visible by blacklight. The cat getting the dye is the culprit in that case.

After the cat is identified (not a problem in single cat households, obviously), then a diagnostic workup can be started. The first step is to check a urinalysis, fecal exam if stool soiling is a problem, complete blood count (CBC) and chemistry panel. If this lab work does not identify a problem it is more likely that a behavioral problem exists than a medical one. There is no easy way around this testing. It almost has to be viewed as the minimal database necessary to start ruling out medical problems. Most of the time it is possible to obtain urine by cystocentesis, which is withdrawing a small amount of urine from the bladder directly with a small gauge needle and a syringe. This helps a lot in cats since clean urine can be hard to obtain. In some cases it is advisable to do other testing such as X-rays, testing for feline leukemia virus, hyperthyroidism or other more specialized tests as indicated by the physical exam and the original labwork.

If a medical problem does not seem likely after the lab work is evaluated then it is possible to start sorting out the various causes of urinary problems in cats.

Adding cats to the household increases the potential for urinary marking behavior dramatically. I am not sure there there is a general agreement on exactly where the risk becomes 100% but somewhere between 5 and 10 cats in a household pretty much guarantees that one of the cats will urine mark. Having four cats instead of two cats probably doubles or triples the risk that one of the cats (in this case probably BC) will urine mark due to territorial pressure. It is not exactly jealousy but I guess that is a reasonable way to think about it. His territory is being invaded and he may be feeling as if there simply isn't enough territory to go around and that he must defend what is his. Sometimes it is possible to alleviate these feelings somewhat with behavioral modifications or with medications such as anti-anxiety medications such as diazepam (Valium Rx) or buspirone (Buspar Rx).

Dr. Karen Overall's book "Clinical Behavioral Medicine for Small Animals" and Dr. Beaver's book "Cat Behavior" (I think that is the whole title) are not too difficult to read and would be good sources of in-depth information.

If the problem continues and you can send along information on what behaviors have developed since you originally wrote to me I will try to provide more specific information.

Mike Richards, DVM  

 

 

Urinary Problem

 

Q: Dear Dr. Mike:

I'm so glad I found your web site--what a wonderful resource!  I have a 4-year-old female cat who has been straining to use the litter box every 10 minutes or so, for the past 4 days.  Her vet did a chest x-ray and determined that she has no blockages and is not constipated (although there were some feces in her intestines she wasn't distended).  He also took a urine sample and determined that she doesn't have a urinary tract infection.  He sent her home with a stool softener and told us to watch her over the weekend and bring her back on Monday.  He said he's not entirely sure what's causing her to strain and not deficate, though.  Any thoughts you had would be greatly appreciated.  Thanks.  Karen  

A: Karen-

I think that I would worry a lot about this being a urinary problem, whether or not it seems to be based on a urinalysis. If there was enough intestinal content to obscure the bladder it may be worthwhile to retake the X-rays to try to rule out a bladder stone. It may also be worthwhile to check her anal sacs and to palpate her rectum digitally to make sure there is not a polyp or problem there. I think that confusion over whether straining is related to constipation or urinary tract irritation is very common among pet owners and even veterinarians. Four days is a long time to have this much straining. If it is still going on tomorrow, it really seems like a recheck then would be a better idea to me, but you have to remember that your vet may be in a better position to evaluate that need than I am.

Mike Richards, DVM    

 

 

Periodic Urinary Problems

 

Q: Doc, we have a cat that has been with the family 5 years. A serious urination problem reoccurs about once a year. Local vets have prescribed the hill prescription. It usually lasts about 2 weeks but causes a great deal of problems within the household. We would like to know if there is a better diet food or food that would help us in eliminating these annual reoccurrances of this problem. We have tried both and none are working. Would like some feedback thank you! Joy!

A: Joy- In brief, the answer is no. The Hill's diet is as good as any that I know of for controlling periodic problems with urinary tract disease associated with crystal formation in the urine. Of course, the corollary of that is that most of the other diets that claim to control urinary tract pH probably work pretty well, too.

If this problem occurs at roughly the same time each year I'd think long and hard about what goes on at that time. Some cats seem to be able to develop urinary tract pain and problems from the effect of stress. Also, allergic inflammation is thought to occur in the lower urinary tract in some cases. If the problem is very seasonal or occurs close to the same time each year it might be worth considering treatment with a medication that controls allergic symptoms prior to the expected time of an attack or at the very first sign of problems. In a few cats there just doesn't seem to be an identifiable cause of the problems they are experiencing. Some of these cats will get better more quickly when a problem occurs if pain relief medications or amitriptyline are administered near the onset of clinical symptoms of a lower urinary tract problem.

Mike Richards, DVM    

 

 

Urinary Problems - Incontinence Possible

 

Q: Dr. Mike - HELP! We are desperate. We have 2 female spayed cats. They are 8yrs & 2.5yrs old. Our first problem deals with the younger cat who is extremely overweight (19.6 lbs.), she was perfectly healthy up until approx. 3 months ago. She had developed a urinary infection which is common in obese cats, and has been fighting it for these past months. Most symptoms have subsided, except hear butt/vulva area are constantly moist and discolored, and she smells of urine - this symptom remains and the vet insists that she has no bacteria in her urine. She is very happy, affectionate and playful. Our actions have been

#1. she has been dieting - .5 cup of light formula Science Diet, daily --she lost 2 lbs, but in turn gained 1 back this past month

#2 repeated visits to the vet, which they discovered crystals in her urine, she now eats a special food for the next few weeks to clear that up- yet, her butt doesn't seem to be getting better.

#3 we clean her vulva with diaper wipes every other day, a process she hates, gets very anxious - she is always trying to clean herself; however, she can't reach

#4 she is now back on an antibiotic (Clavamox) 2 pills a day due to a return urinary infection.

In light of all these events, our other cat (8 yr old) has recently - (past month)- taken to urinating & defecating outside the litter box. She has done this on our bed, carpet in the entrance way, small carpet near the litter box- which we through out, now she goes where the carpet used to be. Now, in response to this, we initially started cleaning the litter box twice daily, which worked for awhile. Until recently, we then got another litter box (2 total). Which worked for about a week. Today, about 10 minutes after both boxes were cleaned, we walk into the room to find a puddle of urine. Now this is something she has done infrequently in the past if the litter box was not clean; however it has become a daily occurrence, clean or not. We have moved recently (about 1.5 months ago) but these 'circumstances' started before the move. We are reaching exasperation between the cat we can't get healthy and the cat who seems destined to ruin our furniture. I'm fearing our only option will be to give away the cats, but who will take them under these circumstances? Anything you can offer, would be greatly appreciated. Thank you. Debra

A: Debra, Your younger cat may be incontinent (she may be leaking urine because she does not realize she is urinating or can't control the urine flow). This could easily lead to chronic irritation around the vulva and inguinal region in an overweight cat. There are a number of possible causes of incontinence and it can take a fair amount of testing to sort through the possible problems. Hormonal incontinence is less common in cats than it is dogs. This is also true of physical problems like ectopic ureters which lead to incontinence, but these conditions are possible. Neurologic deficits can lead to incontinence. Some cats will develop incontinence due to the presence of infection or inflammation in the urinary tract, so control of crystal formation can be helpful if it is causing inflammation and controlling inflammation from other sources is important, too. It is also a good idea to be certain that there is not a reason for increased urine production which can make a problem with incontinence worse. Examples of diseases which cause increased urination are diabetes and kidney failure. I know you are frustrated with this situation and have tried to correct it but it may help to discuss further testing with your vet or to ask for referral to an internal medicine specialist.

When one cat is urinating outside the litterbox it is not uncommon for other cats in the household to begin urinating outside the litterbox. Despite this, it is important to rule out a physical cause in your older cat, too. If there is not a physical cause attempting some of the treatments in our cat information / behavior area may be helpful.

Mike Richards, DVM    

 

 

Blood in Urine After Antiobiotic Therapy 

 

Q: Hello, I don't know if you are taking questions here, but I really need help. My husband and I have just taken on the care of his 13year old female family cat. She has been with us for just a few months now. Only a couple weeks after she came to live with us, I noticed large amounts of blood in her urine. She was brought to the vet right away and put on antibiotics for a bladder infection. After she had been done with the antibiotics for just a couple weeks I noticed the blood again. I also noticed a very strong ammonia smell when I cleaned her litter box. I took her back to the vet. She actually saw a different vet this time and he not only found a large quantity of blood in her urine and some white cells, but also abnormal cells. He put her on a different antibiotic and said that she most likely either has sharp kidney stones or cancer. He said that we can only find out by doing a special x-ray which would cost around $200. As we are a young couple, we don't' have much money and don't want to rush into anything, but we want our cat to get better. I don't know what to do... Thank you , Lori and Dan

A: Lori and Dan- When blood returns in the urine shortly after antibiotic therapy, repeatedly, there are several possible causes. The two most common causes in an older cat are bladder stones and bladder cancer. Other possible causes are resistant bacterial infections, interstitial cystitis, diverticuli (pockets) in the bladder wall, bleeding disorders, and bleeding from kidney problems.

Bladder stones are often visible on a "plain" radiograph -- just an X-ray of the bladder area. There are bladder stones that are not visible on X-rays, though. Bladder cancer does not show up well at all on plain X-rays. Therefore, it can be necessary to inject air or a contrast dye or both in order to make the stones or cancer visible. If a plain X-ray has been taken and nothing showed on it, then it may be a good idea to consider contrast X-rays. The abnormal cells noted make cancer more likely and may be the reason your vet is considering contrast X-rays at this time rather than waiting.

A urine culture may help to determine if there is a resistant bacterial infection. Most of the time this won't be the case but it may be worth considering if you wish to rule out one cause of persistent bladder infections prior to looking for more problems.

It is sometimes less expensive to have an exploratory surgery done than to do all the diagnostic testing to decide what is going on. Since surgery is necessary for many of the possible causes of the symptoms this can be a reasonable option when cost is a major factor. It allows a definite diagnosis and the opportunity to attempt treatment immediately if it seems advisable. You may want to discuss this option with your vet. In general I think most veterinarians would prefer to have a diagnosis through less invasive means than surgery but there are times when it is reasonable to consider surgery as an efficient diagnostic test.

Mike Richards, DVM  

 

 

Inappropriate Urination and Hair Pulling 

 

Q: We have a male Siamese cat that is 9 years old. Last August he started pulling out his hair on his hind quarters and tail. Along with this came the annoying behavior of urinating on our belongings- mainly our daughter's bed. The cat box is kept very clean and has no cover. We have taken him to the vet many times. He has been checked for medical problems and none have been found. We changed his food and gave him a cortisone shot which helped temporarily. He has now received 3 or 4 shots in the past 9 months, but they don't seem to be helping anymore. About 1 month ago we changed him to a diet of raw meat with vegetables and bonemeal. We are trying to go a more holistic way since the original change of food and the cortisone shots didn't seem to help. Any suggestions would be greatly appreciated. We are very frustrated with this problem.

A: jklm- It is hard to say if your cat has two problems, one causing the hair pulling behavior and one causing the inappropriate urination or if he has one problem causing both problems.

Occasionally cats who are experiencing pain from cystitis or lower urinary tract disease will chew on their hair in the inquinal or rear areas. If this was the case, it may help to use an antispasmodic or pain relieving medication. Even though it is usually used as an anti-anxiety medication, amitriptylline will sometimes help in this particular situation.

If the hair pulling is the result of allergies or immune mediated disease the cortisones should work at least short term. If this is a food allergy, modifying the diet may be beneficial. Sometimes anti-histamines will help in allergic cats