Nursing Insights: Feline Lower Urinary Tract Disease (FLUTD)
BY VICTORIA KOKS - AUGUST 23, 2021 - URINARY & KIDNEY
Feline Lower Urinary Tract Disease (FLUTD) is a relatively common illness seen in general practice veterinary clinics in Australia and New Zealand, affecting up to an estimated 3% of cats each year. However, unlike the name suggests, FLUTD isn’t actually one disease, but is a term used to describe a group of conditions that can affect the urinary bladder and/or urethra of cats.
Since it is common, it is important that veterinary nurses are familiar with this group of conditions and are able to provide care to the patient and client.
Clinical Signs of FLUTD
Cats with FLUTD usually present with one or more of the following signs:
- Dysuria: Difficult or painful urination, strain to pass urine, vocalisation if painful
- Haematuria: Blood in the urine, may be visually apparent or microscopic on dipstick
- Pollakiuria: Increased frequency of urination
- Periuria: Urinating outside the litter-box and in unusual or inappropriate places
- Over grooming: Over groom and lick around their perineum. This can be severe enough to cause loss of hair
- Behavioural changes: Behavioural changes such as loss of litter-box training, aggression, or irritation
- Stranguria: Blockage to the urethra – cats will strain to urinate and try to pass urine but will be unable to, which can be physical or functional
Some common pre-disposing factors increase a cat’s risk factors for developing FLUTD, including:
- Middle age
- Too little exercise
- Little or no access outside
Underlying Causes of FLUTD
Now as we mentioned, there are a range of different diseases that cause FLUTD in our patients. Underlying causes can include:
- Feline Idiopathic Cystitis, where no known or underlying cause can be found
- Urolithiasis, with the two most common types being struvite (magnesium ammonium phosphate) and calcium oxalate
- Urethral plugs, most commonly struvite form with proteins, cells and debris in the urethra and cannot be passed
- Less common causes:
- Bacterial infections – Uncommon, bacterial cystitis tends to be seen in older cats
- Anatomical abnormalities
- Neoplasia – Transitional cell carcinoma
In stepping through the diagnostic and therapeutic options for FLUTD patients, we can think of these patients in two categories – obstructed or non-obstructed to help guide our planning and nursing care.
Diagnostics and Treatments of Non-Obstructed Patients
Our diagnostics and therapeutic options are tailored to the frequency and severity of episodes for the non-obstructed FLUTD patient. We also want to uncover the underlying cause of the FLUTD. We have a range of diagnostic options to draw from, starting from performing a cystocentesis and urinalysis, radiographs and ultrasound and progressing to biopsy if indicated.
With regards to treatment, many patients will recover quickly with appropriate intervention, however ongoing management is often critical for these patients. Therapeutic options may include:
- Increasing the cats water intake through a variety of means – increase in food, water fountains etc.
- Stress management
- Dietary management, transition to appropriate food
- Crystal dilution or surgery if required
- Antibiotics, if bacterial cystitis
- Increase exercise
- Weight loss, if required
- Medications (as per veterinarians’ direction, anti-spasmodic, pain relief)
- Increase litter trays
- Chemotherapy (if neoplasia)
Diagnostics and Treatments of Obstructed Patients
By contrast, treating an obstructed FLUTD patient is a medical emergency. An obstructed patient is one where the urethra has become blocked, and our ultimate goal of treatment is to remove the blockage and restore the flow of urine. If left untreated, the patient may experience anorexia, vomiting, depression, dehydration, collapse, and eventual death as the problem progresses over several hours as the kidneys are unable to function. Due to this, toxins, potassium, and phosphorous build up and death often occurs secondary to a cardiac arrest due to hyperkalaemia.
For both obstructed and non-obstructed FLTUD patients, returning to normal homeostasis after the advent of the disease is of critical. In doing so, veterinary nurses are essential in educating and supporting clients in the ongoing management of their cats with FLUTD. Three key areas for the ongoing support of the FLUTD patient include environment, behaviour and nutrition.
We should work with the client to identify ways to enrich the indoor environment of cats with FLUTD. Any small adjustment we make can have a big impact for these patients. We can ensure cats have high places to jump, hide and sit, plenty of sunlight, opportunity for exercise and play and routine in their day. This all supports cats in managing their stress and wellbeing and yes, their ongoing FLUTD symptoms.
Feline behaviour is a continuously growing area of veterinary medicine and is directly linked to environmental enrichment but we should still consider it separately. Many feline patients may benefit from stress management support strategies that lie outside the typical environment enrichment box. Strategies such as medication, nutritional stress support and feeding plans can all actively work to further manage cats behaviour and reduce their FLUTD symptoms.
Nutrition plays a crucial role in the ongoing management of FLUTD patients. We need to ensure each patient has an individualized nutrition plan that is calculated and tailored to meet the goals and objectives required. For ongoing support of a FLUTD patient, the nutrition plan should contain the calculated feeding amount specific to the patients caloric requirements, the feeding plan, consideration for the specific macro- and micro- nutrients required to manage the underlying FLUTD condition and any other co-morbidities that may be present (such as obesity).
Whilst a relatively common occurrence in veterinary clinics, FLUTD can be life-changing for pet parents and their cats. Veterinary nurses can act has patient advocates and client educators in supporting the human-animal bond and helping clients and their pets through this difficult time in managing this complex, multi-factorial disease
Victoria Koks, Practice Development Advisor, BGenStud (Sec Ed), CVN, AVN, RVN, VTS (Nutrition)
For over 15 years Victoria has dedicated her career to the pursuit of knowledge and excellence. Victoria passion for the continued development of the profession, and for incorporating technology to raise the standard of patient care, has seen her sought after to deliver seminars and workshops to both domestic and international audiences.
Victoria has advanced through the roles of Veterinary Nurse Manager, Practice Manager, Regional Manager, Training and Development Manager and is now a Consultant for Animal Industries Resource Centre and Crampton Consulting Group. Victoria is a proud Veterinary Technician Specialist in the field of Nutrition.
This content has kindly been provided by Crampton Consulting Group. Visit the Crampton Consulting Group website and check out their Nursing The FLUTD Cat course here.
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