The “Stoned” Cat

Your cat has always been faithful to the litter box. But suddenly Tom leaves damp messages on the carpet, Sheba cries and squats right in front of you, and bloody urine puddles in the bathtub.

Cats are known to suffer from a group of disorders, including stones, as a part of Feline Lower Urinary Tract Disease or FLUTD. Male and female cats are affected equally.  Urinary bladder stones occur in only about 20 percent of cats suffering from LUTD.

Actual “stones” of pebble-size and larger can develop but more commonly the tiny mineral deposits (called urolithiasis) are microscopic to sand-size. A mucous-crystal matrix can plug the urethra and prevent the bladder from emptying. Just think back to your childhood, remember a never-ending car trip with no bathroom access–multiply that discomfort tenfold to understand how the blocked cat feels.

Signs of urinary stones may include any one or combination of a break in housetraining, dribbling urine, straining in the litter box or spending lots of time “posing” with little result, bloody urine or urine with a strong ammonia smell, crying during urination, or excessively licking the genitals.

Diagnosis is based on these symptoms, urinalysis, and/or X-rays to reveal stones in the urinary tract. Without prompt medical attention, the blocked cat will die when toxins build up in the bloodstream, the kidneys stop working, or the bladder ruptures.

Creating Kitty Crystals

Not all stones are the same. Crystals and/or stones form when specific minerals and organic substances are present in the urine in the right concentrations. In addition, the urine must be the right pH (acid/base balance), and must stay in the bladder long enough for crystals to form. Consider pancake syrup in a pan–if it sits still long enough, crystals form. Therefore, formation of stones depends on volume of urine, concentration and type of minerals, frequency of urination, and genetics.

Cats evolved as desert creatures, and consequently conserve water extremely well. They may urinate only once every 24 to 48 hours, which means urine sits in the bladder for long periods and becomes more and more concentrated. Cats also drink sparingly, and seem to prefer to get water from their diet rather than lapping from a bowl. These instinctive tendencies predispose felines to develop bladder stones. Some kinds of crystals like struvite can be managed easily with diet, while others like calcium oxalate stones are a challenge–and diets that prevent one actually promote the other kind. Yikes!

The cause of feline crystals often can’t be identified. Diet can play a role in the formation of certain types of feline stones. And because up to 70 percent of cats have repeated episodes of stones, diet has become the standard way to treat and in some cases prevent them.

The Struvite Solution

A dozen years ago, 80 percent of feline bladder stones were struvite and developed in part due to alkaline urine. Pet food manufacturers discovered they could counter this and create acidic urine (and therefore prevent struvite formation) by adjusting the formulation of cat diets. Bless their furry lil’ hearts, nearly every commercial cat food on the market today has been designed to reduce the chance of struvite formation, by increasing the acidity of the urine.

When the diet has undergone expensive tests to prove this effect, the label may say, “for urinary tract health.” Honestly, though, all of the major cat food brands do pretty much the same thing–they just haven’t spent extra money on these tests and so legally can’t place a claim on the label.

A percentage of cats still develop struvite stones despite eating good foods. Special veterinary diets can dissolve existing stones and/or prevent formation of new ones, and most of the major pet food manufacturers offer therapeutic options. Therefore, if your cat hates the first food offered, ask about another therapeutic alternative. Diets only work if the cat eats them.

Cats that become blocked from urethral plugs–crystals mixed with mucus that get stuck in the urinary track–typically are unblocked with catheters to reestablish flow from the bladder. But repeated catheter use may cause scar tissue in the urethra that makes the problem even worse. Perianal urethrostomy surgery may be an option for these cats. The procedure shortens the male cat’s urethra—removes the penis—which creates a wider conduit for release of urine so the urethra doesn’t block as easily even if crystals continue to form.

Calcium Oxalate Conundrum

Today calcium oxalate stones are becoming most common. Struvite seems to affect younger cats while calcium oxalate more often impacts aging felines. In fact, some calcium oxalate uroliths, especially those in the kidneys, may not cause obvious health problems for months to years. As the cat ages, the bladder becomes less elastic and may not empty totally each time the cat urinates. Over time, this may lead to increased susceptibility to infections and large bladder or kidney stones.

The change in commercial diets to reduce struvite actually promoted a rise in calcium oxalate stones. These struvite-prevention diets increase blood-acid levels, which also tend to leech calcium from the bones. When this calcium is spilled into the urine it can form calcium oxalate stones. Calcium oxalate stones most typically block the ureters–the conduits leading from the kidneys to the bladder–and if too big to pass, require surgery to remove.

Stopping the Stones

So, what can a cat lover do? Be alert for signs of distress. Consider a blocked cat a life-threatening emergency and see your veterinarian immediately. Do your best to reduce cat stress, since that can predispose kitties to repeated episodes.

If your cat has been diagnosed with FLUTD, your doctor likely will analyze the crystals (if present); determine if infection is involved and prescribe medication and recommend an appropriate diet. Remember that an old cat with calcium oxalate crystals should NOT eat a food designed to prevent struvite, or vice versa. In addition to diet change, avoid giving any kind of mineral or vitamin C and D supplementation to cats, which can predispose to calcium oxalate formation.

Increase your cat’s water intake by feeding canned diets, which typically feature 70 percent water. Cats seem to drink more when the water remains fresh or running, so provide a feline drinking fountain, available from pet products stores. More water helps dilute the urine and encourages the cat to use the litter box more often, so the bladder doesn’t remain full for long periods of time.

While filtered or bottled water isn’t routinely recommended, it probably won’t hurt and might help especially if it encourages your cats to drink more. Try flavoring the water with liquid drained from water-packed tuna or a bit of no-salt chicken broth. All’s fair in keeping cats healthy–sometimes despite themselves.

Seren has been remarkably healthy and (knock wood!) hasn’t had problems with hit or miss litter box issues. What about your cats? Have they had problems missing the box? Crystal issues? What has been your kitty experience with regard to lower urinary tract issues?

I love hearing from you, so please share comments and questions. Do you have an ASK AMY question you’d like answered? Do you have a new kitten and need answers? Stay up to date on all the latest just subscribe the blog, “like” me on Facebook, listen to the weekly radio show, check out weekly FREE PUPPY CARE newsletter, and sign up for Pet Peeves newsletter. Stay up to date with the latest book give aways and appearances related to my  THRILLERS WITH BITE!

Comments

The “Stoned” Cat — 15 Comments

  1. Excellent article. I went through something similar with my first cat, Bobo. He began throwing up white foam for HOURS. Turned out he had SIX kidney stones and he required emergency surgery (be careful…one emergency vet wanted $3000 the one I took him to who did a fabulous job charged $1500!). Had I not opted for immediate surgery he would have died.

    Guess who else has OXALATE stones based on the type of kidneys that I have……..ME!!! I have medullary sponge kidneys…it is a congenital condition that will never go away :(

    • Oh no! So do you have to avoid certain foods or take special medication to manage the condition?

      Glad you found a good (and more economical) veterinary service for Bobo. I remember when I was a vet tech and we had a cat that repeatedly blocked, and we ended up doing the P/U surgery on him. The article I wrote about that for Cat Fancy (years ago!) was one of the first that I had published–and I can still hear the relief in the vet’s voice when she told the cat’s owners, “Yes he’s fine now–he’s peeing a river!”

  2. “Cats also drink sparingly, and seem to prefer to get water from their diet rather than lapping from a bowl.”

    Clearly nobody ever told Simba that. LOL You add fresh water to the bowl, she HAS to be the first one to it. I consider this a good thing since the vet said drinking more water will help keep the cystitis at bay. The basic gist of what I was told is that they are finding her type of cystitis may have something to do with holes in the lining of the urinary tract. So far they haven’t found much in the way of treatment, only that diazepam helps them relax and get through it faster with less pain. I forget what he said they were trying in lab tests… something directly inserted via catheter that seemed to be working, same thing they tried adding to diet that didn’t work (it was whatever that lining’s made of, and I forget now, it’s been so long since she had a flareup) – but he kinda cringed at the thought, something about cure being worse than the disease. I gotta agree with him on that one.

    It should also be noted that ESPECIALLY if you see that your male cat has a blockage, call the vet IMMEDIATELY. While it isn’t as dire for females, males can die within hours from this.

    I was on vacation for Simba’s first flareup, came home to find her peeing blood and PANICKED. About clobbered my sister for not noticing and telling me (she felt bad, of course, and drove us to the vet in the morning).

    • Seren loves drinking from her Cat-It water fountain, too. *s* It’s become a ritual for her.

      The idiopathic cystitis (sometimes referred to as interstitial cystitis) can be very tough to manage. No crystals, just lots of pain and inflammation, and yes, stress related so drug therapy can help relieve anxiety. They’ve tried a number of treatments for this. The chondroitin/glucosamine oral meds have been said to help some cats.

      • Thankfully she hasn’t had a flareup since she got used to Anubis being here. At first it was worse because she was all hissy over the new cat in the house, but ever since about 6 months after he moved in, she hasn’t had another issue. :)

  3. Many years ago (40??) YIKES! Was the only time I’ve had a cat develop urinary health issues. Peeing in the sink and the urine was red. I took him to the vet. The vet probably gave me something to give him which I don’t remember, but I’ll never forget his long term advice: “add salt to his dry food so he will drink more water.” For many years I did just that. I shudder to think what that was doing to the systems of my cats over the years. I did not see any urinary issues after that, but suspect it may be because I had predominately female cats. I now know that an all wet food diet, high in animal protein with water added is really the way to go for prevention and certainly a “must” for any cat prone to urinary problems. I have used the fountains but my cats didn’t show much interest in them, and ultimately keeping them clean wasn’t worth the effort. Although my cats drink very little since they get a lot of water in their food, I do notice that when they do drink, it’s out of bowls I place in high traffic areas … for example a bowl that they walk past often.

    • Molly, I remember hearing the advice to “salt the food” too and it wasn’t 40 years ago, either! Yes, we know lots more now. And my cat also likes drinking as a social activity. So I have water bowls at each sink, and TWO fountains at the vanity in my office bathroom. :)

      • Interesting! Then it’s not just my faulty memory. :D WHEW! I just caught one of my cats drinking out of a cup of water I keep to dip the grooming comb in. The love new and interesting things in new places to investigate. Which might actually be an interesting exercise in getting them to drink more.

  4. Bless you, Amy, you seem to always know exactly what I’m worried about at the moment. My cat has started veering away from the water dish, and I’ve been telling myself it’s simply because it’s turned cooler and she has canned food each day. And while I go through this same “should I worry?” session every year on this, your post today gave me the calm I needed right now. Thanks so much!

    Oh, and I am enjoying Lost and Found!

    Joanie

  5. We had a VERY close call with our dear who had these problems — a stone got stuck in his penile urethra. In retrospect there were clues (hugging my husband’s leg but being unable to say what his beef was for one example), but we were moments away from having lost him forever when we realized there was a urinary problem and whisked him away to the vet. We were leaving for a long Friday afternoon/evening away and I happened to notice he was STILL in the litter box, called The Perfect Vet and got his nice partner, also a good vet, and she said it had better be checked. Off we went IMMEDIATELY and the beginning of a very long month for all. He was totally blocked and it was STUCK. Fortunately we live close to the vet ER so when we had to run back and forth we knew the way fast. (The story was long and more complicated, including that he went psycho with one type of sedative and the vet tech warned us against touching him at that point but I pulled him out of the cage anyway. (We were there to run him to The Perfect Vet who has handled these cases without operations, only diet.) His eyes were glowing red at the back of the cage and he was growling when I picked him up, seemed not to remember me. He had somersaulted across the room before we got there poor dear they said. (Anyway, naturally I figured a few scratches or bites would be fine for me as long as we saved him so I picked him up and we got him across town to the vet and he saved the day and everyone lived happily ever after thus far a year and a half later.)

    Biggest lesson learned: you need to know what they are trying to say & if you don’t there is always a potential big problem you haven’t translated . This happened at a time that he was always beefing about his sweet feral outdoor relatives traveling through his property (he’s indoor, they are outdoor). This was one reason we didn’t get the earlier hints before the pivotal last chance came.

    • Wow, Brenda, what a close call! Yes, understanding what the pet tries to tell us is key. So glad you and your great vets managed to take care of this! My Seren had a similar bad anesthesia experience…some cats react very poorly to certain agents, and now she has that flagged on her vet chart.

  6. Very informative article. None of my cats over the past 40+ years ever had any stones but oh yes I did have one that decided to tee-tee in my clean dish drainer once and I saw it was bloody – took him to the vet and got medicine to clear it up. He also told me to put my cats on distilled water and none of my cats have ever had another infection.

    • Patricia, cats seen to KNOW when they’re in trouble–and often will squat right in front of the person to say “I hurt, help!” Glad he only had that one instance.