When Your Cat Has To Go…But Can’t
By: Dr. Ryan Llera, B.Sc., DVM | Aug 8, 2018
Imagine yourself on a cross-country road trip. Now come to the realization you have a small child in the back who needs to use the bathroom really, really bad. Incessant cries come from the back seat, “I gotta go to the bathroom!” ringing out every 2 minutes. Do you remember what it was like when you were that kid? Good, now you know what some male cats may experience. Yes, this is all about blocked cats, or more appropriately named urethral obstruction.
This is a condition that is almost exclusively involving male cats but we do see a rare female urinary obstruction. It also can occur in dogs but with less frequency. There may be some warning signs before a full-blown obstruction and you should heed them to potentially avoid more significant health problems and to help lower the costs of veterinary care.
The cause of a urethral obstruction can take some time to figure out and the cause may not always be apparent. A urinalysis will need to be done to help rule out causes. Urinary tract infection (UTI), idiopathic cystitis (bladder inflammation for an unknown reason), and mucus plugs can be some causes. More commonly, we will find urinary crystals or even bladder stones as the main cause for obstruction.
One of the main things I find when I take a history on these patients is the type of diet these cats are on tends to be a poorer quality diet. By this I mean, less expensive diets that are readily available in most grocery chain stores. Now, this is not to say that the type of food is the primary or only cause for crystals and stones. In dogs, UTIs contribute to the formation of struvite stones but we do not see the same phenomenon in cats (there are multiple types of stones/crystals but for now we will focus on struvites). Over-saturated urine, alkaline urine levels (the opposite of acidic), and increased magnesium and phosphorous levels are also implicated in the development of struvite crystalluria.
So back to our road trip analogy… The first sign people may notice is their cat crying when it is in the litterbox. This can be an incredibly painful condition. Sometimes they will still be able to urinate and maybe just producing a few drops but it is not enough. The urine may also be bloody which owners may notice if their cat is not using the litterbox, which is often the first sign of many urinary tract problems. Cats can also be found making frequent trips to the litterbox.
The longer the obstruction lasts, more severe illness will follow. Essentially, we will see the signs of kidney failure. For cats that are not presented to a veterinarian as soon as signs are noted, their bladder obstruction will cause a back up affecting the kidneys. Lethargy, vomiting, decreased appetite, and trouble breathing can all be seen. Some heart arrhythmias can also be noted with significant electrolyte imbalances. These cats can still be helped but the road to recovery may be a bit rougher. In the worst case I’ve known, the bladder ruptured and the patient died within minutes but the family had waited 3 days to bring this cat in.
By now, cats like these should be at the hospital. But what exactly will happen now? After the initial examination and going over an estimate of costs, we will get the patient sedated and place an intravenous catheter. IV fluids are necessary to help a patient produce enough urine to clear out their bladder as well as to help correct electrolyte imbalances which can be common with a blocked cat. Next, they are placed under general anaesthesia and the process of unblocking begins. A urinary catheter is passed to relieve the obstruction and then the bladder is emptied. A urine sample is kept for analysis and the bladder is flushed out before a new catheter is placed that will remain in place for 24 hours. I always recommend a radiograph as well to see if there are stones that may be contributing to the problem.
After 24 hours with the catheter running well and a return of normal blood values, we remove the catheter and monitor the patient for another 24 hours. If all is going well, they can go home with appropriate medications that were started in a hospital or diet changes depending on the urinalysis findings. Medications will often include pain medications and urethral muscle relaxants. But if they re-block, which is certainly a fair possibility, another catheter must be placed and the whole process repeated. If they reblock again, a surgery may be discussed called a perineal urethrostomy in which the urethra is actually widened. Simply put, it’s sort of like a sex change for a cat…but that’s a discussion for another time.
Long-term care of these patients doesn’t have to be complicated. Follow your veterinarian’s recommendations regarding diet choices and follow up visits for rechecking a urinalysis (can be as often as every 3-6 months). Good compliance on your part can keep your cat happy and healthy. If you see your cat straining in the litterbox, passing small amounts of bloody urine, or vocalizing while trying to pee, get them to the veterinarian as soon as possible. The longer you wait, the worse it will be for your cat and your wallet. Remember what it was like a kid to have to wait on that road trip and don’t put your cat through the same experience.
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