Signs, Diagnosis, Nursing Care, and Management
By Animal Industries Resource Centre
Feline Lower Urinary Tract Disease (FLUTD) is a common and serious condition affecting
the bladder and urethra of cats. It is not a single disease but a term that encompasses
various conditions impacting the lower urinary tract, leading to discomfort, inappropriate
urination, and in severe cases, life-threatening blockages. Let’s explore the signs, diagnosis,
and how to provide effective nursing care and management for cats suffering from FLUTD.
What is FLUTD?
FLUTD is a broad term used to describe a group of disorders that affect the lower urinary
tract in cats. These conditions can include:
o Urethral plugs
o Feline Idiopathic Cystitis (FIC)
o Urinary tract infections
o Urolithiasis (bladder stones)
o Behavioural or neurological disorders affecting urination
It’s important to remember that FLUTD isn’t a single disease but a collection of symptoms
caused by different underlying conditions.
Signs of FLUTD
Cats suffering from FLUTD often exhibit several tell-tale signs:
o Straining to urinate
o Frequent attempts to urinate with little or no output
o Painful urination, with vocalisation during attempts
o Blood in the urine (haematuria)
o Urinating outside the litter tray
o Licking around the genital area excessively
o Lethargy and reduced appetite in severe cases
In male cats, urinary obstruction is a critical concern. Blockages in the urethra can be life-
threatening, as they lead to kidney failure, electrolyte imbalances, and even death if
untreated.
Diagnosis of FLUTD
Diagnosing FLUTD requires a thorough assessment by a veterinarian. This may involve:
o A physical exam, focusing on palpation of the bladder.
o Urinalysis to check for crystals, blood, or infection.
o Blood tests to assess kidney function and electrolyte levels.
o Imaging (such as X-rays or ultrasound) to look for stones or structural abnormalities.
In cases of Feline Idiopathic Cystitis (FIC), where no clear cause is found, stress is often a
major contributing factor. Thus, understanding the cat’s home environment and any
stressors is vital.
Nursing Care and Management of FLUTD
Managing a cat with Feline Lower Urinary Tract Disease (FLUTD) requires a multi-faceted
approach. This includes immediate intervention for obstructive cases, pain management,
stress reduction, appropriate dietary changes, and long-term care to prevent recurrence.
Immediate Care for Blocked Cats
For obstructive FLUTD cases, emergency care is crucial. Urethral obstructions, especially in
male cats, can lead to kidney failure, electrolyte imbalances, and death if untreated. The first
step is to unblock the urethra, typically by inserting a flexible, atraumatic catheter designed
for both unblocking and maintaining in place. Rigid catheters, while effective for initial
unblocking, can cause trauma if left in for long periods.
Once the obstruction is cleared, post-obstructive diuresis—a period where the cat produces
large volumes of urine—should be closely monitored. During this phase, significant fluid and
electrolyte loss can occur, necessitating careful adjustment of fluid therapy to avoid
dehydration and further complications. Using a closed collection system allows for accurate
monitoring of urine output, reducing the risk of infection and making fluid balance
adjustments easier.
Pain Management
FLUTD patients experience considerable discomfort, especially following catheter placement
or bladder distention. Managing pain is a key aspect of care. Initial treatment often
includes opioids for immediate relief, followed by NSAIDs once renal function is confirmed,
to reduce bladder inflammation. Analgesia should be assessed regularly to ensure that the
patient remains comfortable.
Stress Reduction
Stress plays a critical role in many cases of idiopathic cystitis, a leading cause of FLUTD.
Veterinary teams must prioritise reducing stress during hospitalisation by providing a quiet,
low-traffic environment, using soft bedding, and minimising handling. Stress management
should continue at home, with owners encouraged to remove stress triggers, such as
conflicts with other pets, and provide a safe, quiet space for the cat.
Dietary Management
Dietary changes are a cornerstone of FLUTD management. In cases where crystals are
present, a prescription diet like Hill’s Prescription Diet s/d is used initially to dissolve the
crystals and adjust the urine pH. After 1 to 3 months, the cat is transitioned to a maintenance
diet, such as Hill’s c/d, which helps prevent future crystal formation by keeping the urine’s pH
in an optimal range.
An often-overlooked aspect of dietary management is water intake. Increased fluid
consumption dilutes the urine, reducing the risk of crystal formation. Feeding a wet diet is
strongly encouraged, as it increases water intake naturally. Owners should provide multiple
fresh water sources and, where possible, consider water fountains to entice cats to drink
more.
Medical Therapies
While simple cases of idiopathic cystitis often resolve without the need for extensive medical
therapy, more severe or recurrent cases may benefit from additional
interventions. Glycosaminoglycan (GAG) supplements, which contain glucosamine and
hyaluronic acid, help replenish the bladder’s protective lining. Antispasmodics and muscle
relaxants may also be prescribed in cases of urethral spasm.
Long-Term Care and Client Education
Client education is crucial in preventing the recurrence of Feline Lower Urinary Tract
Disease (FLUTD). Owners must be instructed to closely monitor their cat’s urination habits,
including frequency, volume, and any signs of discomfort or straining. Changes in urination,
such as difficulty passing urine or signs of blood, can indicate a recurrence of FLUTD, and
early intervention is key to preventing more serious complications such as urethral
obstruction. Owners should also be encouraged to maintain a clean and accessible litter
tray, as many cats are averse to using soiled or difficult-to-access areas, which can add
unnecessary stress, a significant trigger for FLUTD.
Dietary management is one of the most effective long-term strategies in reducing FLUTD
recurrence. Owners should be instructed to continue feeding the prescribed diet, such
as Hill’s c/d or other urinary-specific formulas, which help maintain the appropriate urine pH
and reduce crystal formation. Equally important is increasing the cat’s water intake, as
diluting the urine decreases the likelihood of crystals forming and helps flush the bladder
more frequently. Wet food is often recommended to achieve this, but owners can also use
water fountains or place multiple water sources around the home.
Stress management is another critical aspect of FLUTD prevention. Stress is closely linked
with idiopathic cystitis, one of the main causes of FLUTD, and reducing household stressors
can significantly reduce the recurrence of this condition. Owners should be made aware of
common stress triggers, such as changes in the home environment, conflicts with other pets,
or neighbourhood animals that might provoke anxiety. Behavioural modifications,
environmental enrichment, and providing safe, quiet spaces for the cat can help reduce the
stress burden. Veterinary teams can offer advice on using calming supplements or
pheromone diffusers as additional tools to reduce feline stress.
Conclusion
FLUTD is a complex and sometimes recurring condition, but with early detection, appropriate
veterinary care, and diligent nursing, cats can recover and live comfortably. The key is a
combination of immediate intervention for obstructive cases, ongoing management with diet
and hydration, and reducing stressors in the home. Educating pet owners about the
importance of proper care, diet, and monitoring will help ensure their feline companions
remain happy and healthy.
Want to know more?
This ProSkills Short Course discusses everything about FLUTD in detail, including, types,
causes, signs, common treatments, and a case example of a blocked cat from initial
contact with the clinic, patients’ examination and assessment, diagnostic tests, treatment,
post procedure care, urinary closed collections system, diet and homecare advice.
Check out this ProSkills Short Course here. https://www.provetccg.com.au/product/the-
flutd-cat/
The course is also available with a month-to-month, individual or team subscription to all
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Bibliography
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Veterinary Internal Medicine Nursing. (2024). All about feline lower urinary tract
disease. Veterinary Internal Medicine Nursing. Retrieved
from https://veterinaryinternalmedicinenursing.com
Sævik, B. K., Trangerud, C., Ottesen, N., Sørum, H., & Eggertsdóttir, A. V. (2011). Causes of
lower urinary tract disease in Norwegian cats. Journal of Feline Medicine and Surgery, 13(6),
410-417. https://doi.org/10.1016/j.jfms.2010.12.012
Forrester, S., & Roudebush, P. (2007). Evidence-based management of feline lower urinary
tract disease. The Veterinary Clinics of North America: Small Animal Practice, 37(3), 533-
558. https://doi.org/10.1016/j.cvsm.2007.01.009
International Cat Care. (2020). Feline lower urinary tract disease (FLUTD). International Cat
Care. Retrieved from https://icatcare.org/advice/feline-lower-urinary-tract-disease-flutd/
