Cats that can’t pee – stop everything!

If your cat has suffered bouts of FIC flare-ups, your vet probably has warned you to watch and make sure your cat is able to urinate. What’s the big deal?

Cats with FIC can develop sandy debris or stones in their bladders. When a male cat urinates and these try to pass, the long, skinny urethra (tube they pee through) is not very cooperative. Often these become lodged and cannot pass all the way out. When this happens, the cat is obstructed and cannot urinate at all. We vets call these “blocked cats.” Female cats can become blocked too, although it is much less common, as their urethras are wider and able to pass stones and sludge better than males.

A cat who can’t urinate is a big deal. It’s an emergency that brings a vet clinic to a hault. We have to drop everything and treat the cat. The guy waiting for his dog’s rabies shot just got pushed back at least a half hour, if things go very well. The emergency is this: the bladder gets as full as it can, but when the urine has nowhere else to go, it backs up into the kidneys. The kidneys begin to fail, and if the cat is not “un-blocked” promptly, the cat dies of kidney failure or, worse, the bladder ruptures. Kidneys are a picky organ, and if they get too damaged by all the urine backing up, they might not recover.

Saving the cat’s life involves sedation and passing a urinary catheter up the urethra. It’s a rubber tube that (we hope) pushes the stone back into the bladder, opening up the urethra, so the cat can then urinate. Let me emphasize this is not as easy as it sounds. Cat penis’s are teeny (not knocking anyone, but cats are small animals, so there ya go!). When I was in vet school and we were taught how to pass urinary catheters in cats, we all just laughed at first. Surely there is a hidden camera somewhere. No way this tube is going in this tiny hole! Of course, we learned. It’s never an easy task!

More importantly, the cat must be on aggressive IV fluids to flush out the bladder, as well as the toxins in the blood that built up from the kidneys not doing their job. We keep the catheter in the cat’s penis for a day or so, and measure how much urine is being produced to ensure the kidneys are working and producing urine.

We hope that during this flushing of the bladder, the debris and stones pass through the catheter and out of the cat. This doesn’t always happen. Sometimes these stones are so large, we must surgically remove them. Of course, we must get the cat stabilized first, get the kidneys happy, then take the stones out of the bladder.

Some cats are even more unlucky! Remember how we pass the catheter up the urethra and push the stone back into the bladder? Well, we don’t always get what we want in life, and some of these stones do not budge! If that’s the case, the cat may need an additional surgery. It sounds pretty brutal – some clients call it “making the boy cat into a girl cat.” Basically, we cut the end of the penis back to access and remove the stone, then we create a larger opening for the cat to urinate through. Hopefully this prevents them from becoming obstructed again, as they no longer have a long skinny urethra, but a short, wide one.

You’re probably thinking two things:

1 – If this is such a bad deal – how do you know if your cat is blocked or not? Yes, it’s hard to tell!

Cats with FIC urinate often, and it’s usually very small amounts. It’s common to see a cat with FIC spending  a lot of time straining to urinate in the litter box – or other places on the house. You might not see urine coming out every time (the bladder might be empty), so how to tell if your cat is blocked? It’s easy when they have been blocked for a day and are very sick – they are lethargic, vomiting, hiding – you know you have one sick cat! Ideally, we would catch it and intervene earlier than that. Early intervention means less suffering for the cat, and better prognosis.

If your cat has been trying to urinate, and you have not seen him produce urine for a few hours, it’s never a bad idea to have a vet feel of his abdomen. We vets can tell if a cat is blocked by feeling their bladder. Normal cats have very small bladders, or if they are large, they are not hard like rocks. A blocked cat will have a large bladder that is exceptionally hard and painful.

2 – Yes, all of this is VERY expensive! Just having a blocked cat that does not need bladder or penis surgery, but has to be unblocked and hospitalized for a couple days can run over $1,000.  Bladder stone removal can be another $1,000, and the penis surgery (called a P.U.) at a specialist can be at least another $1,000. This makes prevention far and away the best option for you and your cat! I have (kinda jokingly) told owners of cats with FIC that they should set up a savings account for their cat with at least $1,500 in it. That way, if they obstruct, they can afford to save their cat’s life. If they never obstruct, even better, but you’re prepared!

Finally, prevention is the best approach, but it does not always work. Some cats just have it in their DNA to make bladder stones, regardless of all the treatment and tricks we are doing. There are no guarantees in life. But we have to start somewhere.

Posted in Feline specific, Internal Medicine.

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