This week, Dante’s problem finally cleared up. Dante is a seven-year-old ginger tom-cat who was rescued off the streets with a broken hip, nursed back to health and adopted by a loving family complete with nine other cats and a dog. His owners describe him as very calm and independent, allowing affection only when he wants it. He is also a crafty cat and is perfectly capable of opening the kitchen cupboards, luring in the other cats and closing them inside. But on the day Dante was brought to the clinic, mischief was the last thing on his mind.
Having drawn him protesting out of his cat box, he lay hunched on the examination table and any attempt to move him prompted piteous yowls. Dante was in considerable pain. His owners noted that he had been unusually withdrawn. Dante’s stance prompted me to palpate his abdomen… and there it was – a bladder the size of a grapefruit. Dante had clearly not urinated for some time.
As with most mammals, in both male and female cats, urine flows from the kidneys and makes its way down to the bladder where it is stored until the cat decides to empty its bladder. But sometimes, the urethra gets obstructed. The two main reasons for the obstruction: stones and urethral plugs.
Owners of male cats may be aware of the high risk of stones developing in the male cat. But where infection or inflammation of the bladder is present, a urethral plug can develop and cause a blockage. Urethral plugs are made up of mucous protein and cellular debris combined with minerals or crystals present in the urine; there may also be tiny stones that bind together with the rest of the mucous and debris. Where stones are solid and hard, the urethral plug is less rigid and takes on the shape of the urethra.
Plugs can form at any location within the urethra but usually become lodged within the lower end of the penis. The reason for this happening mostly in male cats is because the urethra in males is considerably narrower than that of females. With the plug firmly lodged in the penile segment, it starts to accumulate more and more debris and continues to grow in size. When this happens, the urethra becomes blocked and the cat can no longer urinate.
Owners of male cats may be aware of the high risk of stones developing in the male cat
Urethral plugs form due to an unnatural amount of proteins, cells, crystals and debris that stick together and form a plug that cannot be passed. In Dante’s case , not only did he have a urine blockage yet also the whole external immediate area surrounding the penis was highly red, raw, pussy and inflamed.
Water intake and diet quality are the two main reasons for cats developing urinary problems and urethral plugs. Some cats are lazy drinkers and it’s mostly in these cats that problems develop.
One way of avoiding this is not to feed dry food to these cats and, anyway, to keep the amount of dry food to a minimum in all cats.
One important thing to remember, if you have a new kitten, is not to get it accustomed to a dry food diet as this may be hard to change later on in life.
There are some claims that neutered cats and cats that are house-bound are more likely to suffer from this condition than cats that roam outdoors. However, this might be linked to a problem of overfeeding and obesity. Interestingly, situations that increase stress in the cat, such as a house move, sudden change in diet, a new baby or other animals welcomed into the household, have been found to similarly increase the chance of urethral obstruction in the cat.
Middle-aged cats, or cats living in a household with many other cats, tend to be more likely to suffer from urethral obstruction. Unfortunately, cats that have already experienced this condition remain predisposed to contracting the same condition again.
The problem starts with repeated trips to the litter box. The cat may cry, it might repeatedly lick its penis, lose its appetite, and prefer to hide away. As the situation worsens, it will stagger about as if drunk, it may start to vomit and, as the pain increases, it may become aggressive when handled. As the clinical signs escalate they are increasingly symptomatic of an escalating intoxication of the body.
Under normal circumstances, the function of the kidneys is primarily to flush away the build-up of toxins in the body. But when the cat’s urethras back up, the kidneys no longer function properly and poisons start to accumulate in the bloodstream. This build-up of toxins from urine is referred to as uremia and typically starts to develop within the first 24 hours after the blockage occurs. The condition is extremely painful for the cat, but for the first 12 hours, it might not even show that it is in pain.
Left too long, the urethra will become permanently scarred, leaving the cat prone to further relapses at a later stage. The bladder may stretch so much with the accumulation of urine that the muscle function is lost, which means that the cat will no longer be able to pee unaided. In extreme cases, it may rupture and this may prove fatal to the cat. Left untreated, the cat could fall into a coma and die of heart failure – most cats die within 48 hours. Few make it beyond and those that do are likely to suffer permanently damaged kidneys and bladder.
You need to be observant of your cat’s toilet routine and regularly check its litter for signs of pink tinging as this could suggest that there is blood present in the urine. In all cases, if you suspect that your cat is having difficulty peeing, you must treat this as an emergency and contact your vet immediately.
Having established that your cat is indeed blocked, there are several approaches towards diagnosis and treatment depending on the case. Emergency treatment will aim to stabilise the cat. Your vet may first try to express the urine by pressing the bladder. If the urethral plug is firmly lodged and this fails, an attempt would be made to unblock the urethra and introduce a catheter. This would be done under heavy sedation or anaesthesia.
It would be nice to say that most cats recover from this condition, yet, especially in male cats, all urinary problems should be taken seriously as they could prove fatal. It is important to discuss your cat’s diet with your veterinarian even from an early age in order to avoid these problems. And also, as in Dante’s case, to rush to the vet with even a hint of this problem.
This week, Dante’s problem finally cleared up. In fact, it took a whole week of veterinary treatment and care by Dante’s owners. Each day we could see a slight improvement and finally, after seven days, Dante’s water works were flowing loud and clear. What a relief.
Dr Martin Debattista is a veterinary surgeon.
thisweekwiththevet@gmail.com