Feline Lower Urinary Tract Disease Aka: FLUTD

FLUTD is a term that is used to describe a cluster or urination-related symptoms that cats often display when they are having bladder issues. 


  1. Straining to pee (often confused with constipation)
  2. Peeing small frequent amounts
  3. Bloody pee
  4. Peeing outside the litter box
  5. Painful urination (crying when peeing, licking vulva/prepuce)
  6. ‘Block’ or inability to pee, at all (almost only happens in males)


  1. Bladder stones
  2. Urethral blockage
  3. ‘True’ urinary tract infection
  4. Urinary tract cancer
  5. Trauma to the urinary tract (ie: was hit by a car)
  6. Idiopathic (no known cause)


About 50% of all cats presenting with these symptoms will not be able to find a cause, despite extensive testing.


Because all of the above disease conditions can cause similar symptoms in cats, it is important to run the proper tests to find the cause, and thus be able to treat appropriately. We usually start off with a urinalysis (‘analysis of urine’) to discover if there are any bacteria, crystals, blood cells etc. present in your cats sample. X-Rays can be used to rule out the 2 most common bladder stones found in cats (struvite and calcium oxalate stones). Urine culture might be required in older cats or in cats that have had a lot of UTIs already. This allows us to grow the bacteria and test out exactly which antibiotics will kill it and which won’t. An ultrasound may also be helpful in diagnosing stones or cancers in the bladder or along the urinary tract. It is also, very important to get a detailed history to determine if your cat is peeing out of the box because of inflammation (FLUTD) or because of a behavioral problem (marking, stressed, litter box aversion).

Signs that your cat may be “Urine Marking” or has “Territorial Anxiety”:

  • Urine is sprayed on an upright surface (vs squatting on the floor)
  • Pees in the litter box sometimes, but also outside the box (vs not using the box at all, as in litter aversion)
  • Will defecate in the litter box, but not urinate.
  • Your cat is not neutered.
  • Any new changes in the house, for instance: new pet (or old pet ‘removed’), new roommate (or removed), just moved, remodelling, new furniture (or just re-arranged), new litter, new cats visible (or smell-able) outside, owners went on vacation, etc.
  • The area ‘marked’ is near a door or window or involves the bed or laundry, and is in the same spot each time.


If all of the above tests were done and you and your vet feel it is not a behavioral problem, then your cat likely has “Idiopathic FLUTD” (much like “idiopathic cystitis” in women).

Treatment Options:

If your vet has found an identifiable disease, they will recommend the appropriate treatments (ie: antibiotics for infections, diet therapy or surgery for stone removal, etc.).   If no cause was identified, then the following could be available options/tips/tricks:

  1. Litter: To ensure a happy cat household, you should accommodate 1 box per cat, plus an additional box (in different rooms or even floors of the home) to allow each cat to have their own “territory”.  These should measure at least 1.5 times the length of your cat’s body, and should be scooped at least 1-2 times daily.  Clumping litter should be changed monthly and non-clumping litter twice a week.  The boxes should be washed with soapy water (no strong smelling cleaners) with each change of litter.
  2. Stress: This is felt to worsen or even cause iFLUTD.  If they can be identified, reducing or removing stress (when possible) can help resolve symptoms.  “Busy Cats are Happy Cats” – Help your cat relax by providing scratching posts, window perches, kitty condos, safe plants to nibble on, and new (or clean old) toys (with CATNIP).  Play games with them (ie: laser pointers, “fishing”-rod toys) and just spend time with them (cuddle, pet, groom, watch TV).  Also, pheromones (*Feliway) can also help calm and curb the urge to ‘mark’.    However, if the stressor cannot be realistically removed (ie: new baby), then there are some medications that can help, such as: Clomicalm, Prozac, Buspar, Amitriptyline, Valium.  Please ask your vet for more information and if these medications are appropriate for your pet.

Check out https://indoorpet.osu.edu/cats/ for great tips and trick on keeping indoor cats happy!

  1. Water: Dilution is the Solution!  By increasing water intake, you can dilute your cat’s urine and make it a lot less irritating on the bladder wall.  To do this , you can:  
  • Provide lots of clean and fresh water sources
  • Make sure the bowls are cleaned regularly and water is changed at least twice daily.    
  • Switch or incorporate wet food (healthy) to your cat’s diet.
  • Provide a moving water source, such as a fountain or running faucet.


  1. Diet Therapy:  Certain veterinary diets have been formulated to prevent (and even dissolve) crystal formation, reduce bladder inflammation, and increase water intake (high in sodium) to aid in urine dilution.  Ask your vet if these diets could be appropriate for your cat.


  1. Glucosamine, Chondroitin, and PGAGs:  Interestingly enough, the protective fluid of joints and the mucus lining of the bladder are very similar chemically.  So it’s been theorized that these nutritional supplements which help relieve joint inflammation might also help with bladder inflammation.  So far, they show promising results (in conjunction with other treatment options) and have very few side effects. 


  1. Pain Medications or Muscle Relaxers:  Depending on the severity of your cat’s symptoms and response to other treatments, your veterinarian may provide these medications short term.   If long term or frequent use is deemed necessary, your vet will likely recommend general blood work to screen organ function.


Answers to Have Ready When you Call Your Vet:

  • How is your cat actually urinating: squatting or standing? Small (quarter sized) amounts or large (spilled cup of water).  Any blood? Stronger smell than usual?
  • Where is your cat urinating?  On the bed, in the laundry, etc? In one area or all over the home?
  • Is there a pattern to when your cat does this?  After you have guests?  During the day or at night?

Please Don’t Give Up!

Many cases of idiopathic FLUTD can resolve within 4-7 days, without medical treatment, though recurrence is common.  Medical/neutraceutical  treatment can help with symptoms and reduce recurrence.  The number of recurrence tends to lessen at the cat ages and rarely causes long term consequences (unless he blocks!).