Cystitis and FLUTD in Cats: Signs, Causes and Care

At a glance

What it is	A group of conditions affecting the bladder and urethra, including cystitis (bladder inflammation), crystals, stones and blockages
Who's at risk	Any cat, but more often indoor cats, cats on dry diets, overweight cats, stressed cats and young to middle-aged adults. Male cats are at greater risk of blockage
Main signs	Straining, frequent trips to the tray, passing small amounts, blood in the urine, crying while weeing, peeing in unusual places and licking the genital area
Contagious?	No
Can it be prevented?	Not always, but more water, wet food, reduced stress and good litter tray set-up can lower the chance of flare-ups

What it is

FLUTD stands for feline lower urinary tract disease. It is not one single illness but a name for a collection of problems that affect the lower part of the urinary system: the bladder, which stores urine, and the urethra, the narrow tube that carries urine out of the body.

Possible causes under this umbrella include:

• Idiopathic cystitis. "Idiopathic" simply means there is no single identifiable cause. This is one of the most common forms of FLUTD in cats. The bladder lining becomes inflamed and sore, and stress appears to play a big part. It often comes and goes in episodes.
• Crystals and stones. Minerals in the urine can form tiny crystals or larger stones, which irritate the bladder and can cause blockages.
• Urethral plugs. A mix of crystals, cells and mucus can form a plug that blocks the urethra, particularly in male cats, whose urethra is longer and narrower.
• Bacterial infection. True urinary infections happen in cats, but they are less common than many owners expect, especially in younger cats. They are seen more often in older cats or those with other conditions.
• Less common causes, such as growths, injuries or problems with the anatomy of the urinary tract.

Because the signs look similar whatever the cause, it is important that a vet works out what is going on in each case.

Signs to watch for

Cats are good at hiding discomfort, so changes in toilet habits are often the first clue. Look out for:

• Straining or squatting in the litter tray for a long time
• Going to the tray far more often than usual
• Passing only small amounts of urine each time
• Blood in the urine, which may look pink, red or rusty, or show as spots on the litter or floor
• Crying, growling or seeming uncomfortable while weeing
• Peeing outside the tray, often on cool, smooth surfaces such as baths, sinks, tiles or plastic bags
• Licking the genital area more than usual
• Being restless, irritable or hiding
• In more serious cases, vomiting, lethargy and not eating

Peeing in the wrong place is sometimes mistaken for bad behaviour, but it is very often a sign that something hurts. Our guide to litter tray problems covers other reasons this can happen, and the symptom checker can help you organise what you are noticing before you speak to a vet.

When to see a vet

A cat straining with nothing coming out is an emergency. This is especially true for male cats. A blocked urethra stops urine leaving the body, and within a short time this can lead to dangerous changes in the blood, severe pain and life-threatening illness. If your cat is going in and out of the tray, straining and producing little or no urine, or crying in pain, contact a vet immediately, day or night. Our article on a cat straining in the litter tray explains why this matters so much.

Also contact a vet urgently if your cat:

• Is vomiting, very quiet, collapsing or hiding
• Has a tense or painful belly
• Has stopped eating

Book a prompt appointment, ideally within a day, if your cat:

• Is going to the tray more often or passing blood but is still producing urine
• Has started peeing outside the tray
• Has had cystitis before and you see the signs returning

It can be hard to tell whether a cat is passing urine or not, so if you are unsure, treat it as urgent and call your vet for advice.

How vets diagnose it

Your vet will start by asking about your cat's habits, diet, home life and any recent changes, then examine them. Gently feeling the bladder helps them tell whether it is small and empty or large and firm, which can suggest a blockage.

Tests often include:

• Urine tests. A urine sample is checked for blood, concentration, crystals, bacteria and other changes. Your vet may collect the sample directly from the bladder to get the clearest result, or give you a special non-absorbent litter to collect one at home.
• Urine culture. If infection is suspected, the sample may be sent to a laboratory to grow and identify any bacteria.
• Imaging. X-rays or an ultrasound scan can show stones, a thickened bladder wall or other problems.
• Blood tests. These may be advised, particularly for older cats, blocked cats or those who seem unwell, to check kidney function and general health.

Idiopathic cystitis is usually diagnosed once other causes have been looked for and ruled out.

Treatment and management

Treatment depends on the cause and how unwell your cat is. Your vet will tailor a plan to your cat.

• Blocked cats need emergency treatment, usually in hospital, to relieve the blockage and stabilise them. Some cats need further care afterwards to reduce the risk of it happening again.
• Pain relief is an important part of treatment for many cats, as cystitis is genuinely painful. Your vet will decide what is suitable.
• Infections, when confirmed, are treated by your vet.
• Crystals and some stones can sometimes be managed with a vet-prescribed urinary diet. Other stones may need to be removed.

For idiopathic cystitis, the focus is on long-term management to make flare-ups less frequent and less severe. This usually includes:

• More water. Diluting the urine is one of the most helpful things you can do. Water fountains, wide shallow bowls, several water stations around the home and bowls placed away from food can all encourage drinking.
• Wet food. Moving some or all of your cat's diet to wet food increases their water intake. Make any diet change gradually, and ask your vet first if your cat is on a prescribed diet.
• Vet-prescribed diets. Some cats benefit from a specific urinary diet. Only use one on your vet's advice, and stick to it as directed.
• Reducing stress. See the next section for practical ideas.

Prevention

Not every episode can be prevented, but these steps can help reduce the risk:

• Enough litter trays. A common guide is one tray per cat plus one extra, placed in quiet spots away from food and from busy areas, and not all in the same room.
• Clean trays. Scoop daily and clean regularly. Many cats prefer an unscented, fine litter.
• Steady routines. Cats like predictability. Try to keep feeding times, play and household changes as steady as you can.
• Safe spaces. Provide places to hide and high perches, particularly in multi-cat homes. Make sure each cat can reach food, water and a tray without passing another cat.
• Play and enrichment. Short daily play sessions and food puzzles can reduce boredom and tension.
• Healthy weight. Keeping your cat trim lowers their risk.
• Plan for change. Moving house, new pets, building work or visitors can trigger flare-ups. Keep a close eye on your cat during these times.

Living with it

Many cats have one episode of cystitis and never have another, while others have flare-ups from time to time. If your cat is prone to it, getting to know their early signs means you can act quickly. Keep a note of what seemed to trigger each episode, so patterns become easier to see.

Above all, remember the most important rule: if your cat is straining and nothing is coming out, do not wait. With quick action in an emergency and thoughtful everyday care, most cats with cystitis can live comfortable, contented lives.