Photo by Natalie Rowe

When something happens to stem the flow of a cat's urine, trouble ensues - and fast.

Urine has lots of good things in it. In many cases, they are substances that cats or people can’t live without, such as potassium, sodium, and water. The kidneys sense and adjust the composition of bodily fluids and drop the excess into the urine. If a person eats a large order of fries, covered with salt, the kidneys dump the unwanted excess of sodium into the urine. The same is true with many other substances, like water, that need to be regulated. Urine is (usually) sterile, so unless there is a urinary tract infection, urine is pure. It’s not the terrible stuff that many third graders make it out to be. True, it does have the waste products of metabolism in it, which a body needs to remove.

And that’s where some of the problems begin. If the flow of urine stops, those waste products build up and negatively impact the way the body works. One of the most common ways that happens is when a cat’s urethra (the tube that carries urine from the bladder to the litter box) gets blocked. Known in veterinary parlance as a ‘blocked cat’ or ‘blocked tom,’ this poorly understood disorder is seen with alarming frequency in veterinary hospitals and ERs.

Many ERs see about two to three cats per week who cannot urinate. Cats can be in all stages of the disease, from the early onset ones who just seem a little painful and have a big, hard bladder to the nearly dead ones that are in many cases beyond saving.

The actual plug that stops the flow can be made of bladder stones (often erroneously called kidney stones), tumors or a gooey mix of mucus and protein known as ‘matrix’ that has the consistency of toothpaste. How and why matrix forms, no one knows, despite a few decades of investigation. Adding to the confusion, the name of the disorder has changed no less than four times in the past 20 years from feline lower urinary tract disorder (FLUTD) to feline urologic disorder (FUS) to feline interstitial cystitis (FIC) to the most recent iteration of Pandora Syndrome, which hasn’t really caught on yet.

The causes go beyond a mucousy plug, as well. A host of other factors, such as stress, lack of access to water, diet, infectious agents, indoor lifestyle, and many other causes have been implicated as being responsible for the lead-up to getting blocked. Those little plugs don’t form in a vacuum: something causes them to form, and we don’t know with any certainty what factors contribute to it.

Cats that are blocked often show the following signs:

• Straining repeatedly in the litter box (often mistaken for constipation)
• Crying or howling
• Licking at the genitals/below the base of the tail
• Hiding

If you notice your cat showing any of the above signs, get right in to see your veterinarian or go to your nearest ER as soon as possible. Don’t delay as a few hours can make a big difference. The longer those toxins circulate unchecked, the more pain the cat experiences, the more work the veterinarian has to do, and the bigger the final bill will be.

In advanced cases, where the urine flow has been stopped for more than 24 hours, cats can become systemically ill from retained toxins and start vomiting, or become very weak and lethargic. Death usually happens within 48 hours, and it’s not a pleasant way to go. The pain with this disease is immense, and some cat owners understandably choose euthanasia over trying to reestablish the flow of urine.

The course after unblocking these cats is just as unpredictable and mysterious as the factors leading up to the obstruction; some cats are released from the hospital never to suffer another episode, while others will have repeated occurrences days, weeks or years later. This is an inhumane disease.

Managing these cases medically can go way beyond relieving the obstruction in some cases. First priority is fixing the plumbing problem: getting urine to flow. This is usually done with anesthesia and a catheter to remove the obstruction. Managing the havoc wreaked by the toxins is next. This can necessitate some medical dancing as veterinarians try to put things back in place. Disorders of deadly potassium, elevated renal values, and severe dehydration can mean days in the hospital, even long after the urine is flowing again. It can get complex, expensive, and can wear down even the most committed of owners for the really medically complex (and expensive) ones.

However, getting the urine to flow and taking the cat home is the easy part. After this episode, lifestyle changes are necessary: medication tweaks, medical rechecks, and diet changes that try to extend the initial complexity of this disease across months or years.

Compared to 20 years ago, cats with this disease do go home and get better, even some of the tough cases.  Someday, science will provide an answer and veterinarians will have some means to prevent this disease in the first place, or some surefire way to treat it. Until then, rush your cat in to be seen if you see the signs.