Urinary blockages in cats are serious business. I’ll review signs and symptoms, as well as share a personal experience that was extremely stressful. I never want to scare anyone, but my goal is always education to help other cat owners prepare for the unexpected.
After a urinary blockage, my cat Beaker struggled to recover. I felt completely unprepared and uneducated. One of my foster cats had a super smooth recovery after a blockage, so when Beaker was struggling, I was baffled. A learned a small percentage of cats have an extremely hard time recovering. By sharing Beaker’s experience, I hope you’re better prepared than I was IF it happens to one of your cats.
Side note: I’m not in the veterinary field, so this is a very laywoman’s simplistic explanation of the condition.
What Are Urinary Blockages?
Mucus plugs are most often the culprit of urinary blockages. They’re composed of crystals and mucus (I know, ew). They are more common in males because they have a longer urethra than females. The plug blocks the urine from passing. Since the cat can’t pee, toxins build up in their system, and if the cat doesn’t have the blockage removed, it can be fatal. Outside of plugs, other causes for urinary blockages include bladder stones or tumors. Urinary blockages can also occur from inflammation or spasming of the urethra.
What Causes the Physical Urinary Blockage to Form?
The actual cause of these issues is unknown (many theories, but no conclusions). Science seems to support some combo of genetic makeup, breed, age, diet, hydration, urine concentration, urine pH, and stress. We’ll look specifically at crystals, since they are the most common culprit. Keep in mind, the presence of crystals alone are not a problem. Issues arise when they are in high enough levels, with high (or low) urine pH. They sometimes clump together and the cat is at risk for a mucus plug or bladder stone, which causes a blockage.
The Role Players That Lead to Crystals
To understand what’s going on in a cat’s body, we have to look at their origins. Cats are obligate carnivores, eating diets that are mostly protein and fat, with very little carbohydrates. Their ancestors hunted prey in deserts. Hydration came from consuming their prey since water was scare. Because of this, cats have a low thirst drive and don’t tend to drink a ton of water. Their urine pH would also be slightly acidic in the wild, which is important for urinary health. Merck Veterinary Manual recommends a healthy cat’s urine pH to fall between 6.3-6.6, and slightly on the acidic side (with 7 balanced between acidic and alkaline).
Now, we’ve brought cats inside where they don’t have to hunt, which caused a lot of changes.
Diet & Urine pH
Cats’ diets have changed and most commercial food contains carbohydrates, which they encounter on a minimal basis in the wild. Commercial foods also affect their urine pH, putting them at a higher risk for two types of crystals:
- Foods with too much magnesium, ammonium, and phosphate can lead to the formation of struvite crystals and a higher, more alkaline urine pH. Studies have shown a high-protein diet may make the struvite crystals dissolve (supporting how they would successfully live in the wild without issues).
- More acidic magnesium-restricted diets can lead to calcium oxalate crystals and a more acidic urine pH. (A push for these diets occurred to combat struvite crystals, but now calcium oxalate crystals are more common than they were before, so it might have pushed too far in the opposite direction.)
Hydration matters too. Where cats used to eat prey to get moisture, cats now eat dry food, which contains around 10% moisture, or wet food, which has around 70%. Since cats already have a low thirst drive, they aren’t drinking as much water as they should, which makes it more difficult for the kidneys to flush out bad stuff. I often recommend water fountains to help encourage cats to drink more water.
Less water leads to more concentrated urine. Since the urine is more concentrated and the cat isn’t drinking and peeing frequently, the crystals are at risk for clumping together, or at a minimum, creating inflammation in the bladder or urethra. This contributes to an increased risk in urinary blockages.
How Blocks Form
A plug can form if the struvite crystals and mucus clump together. Once the plug blocks the urethra, a cat can’t pee. The plug must be removed. For long-term treatment to prevent more urinary blockages, cats are typically fed a prescription food to treat and dissolve the struvite crystals.
Now, when calcium oxalate crystals can clump together, they form bladder stones, which need surgical removal. Long-term treatment is a prescription diet low in calcium and oxalate that also increases the urine pH.
Genetic predisposition and stress can exacerbate any type of blockage.
Cat Study: Beaker’s Urinary Blockage
Now that you have a little bit of background, I want to share what happened to my cat Beaker when he was just over four years old. Beaker had been peeing on vertical surfaces, which would typically be marking behavior, but marking involves a small amount of pee. Beaker would empty his entire bladder on vertical places.
During his annual visit, we discussed this and ran a urinalysis. It was positive for struvite crystals. The challenge was crystals probably contributed to the behavior, but there was probably a behavioral component as well. With a revolving door of fosters in my home, Beaker faced a lot of change. At the time, my super senior Vito’s health was a declining, adding even more stress to the home. I had tried some prescription urinary food, but he didn’t seem to like it and it didn’t decrease the peeing. After some rough research, I decided to give him just OTC wet food, and hopefully that would help the issue.
One day, I saw him jump into the litter box, then jump out, then jump back in. What was going on? I walked over and watched as he was straining to pee but nothing was coming out. Although I knew he had crystals, I was hopefully it was only inflammation, and it would be a quick ER visit.
The vet called, “Beaker is completely blocked. We’ll need to anesthetize him, remove the blockage and keep a catheter in him for 24-48 hours. After we remove it and he pees on his own, you can take him home.”
There wasn’t really a choice because without the procedure, toxins would build in his system and he would die, so I told them to do it. After removing the blockage, the vet informed me it was very gritty, so likely from struvite crystals. The good news was based on his bloodwork and the color of the urine, I caught the blockage immediately when it happened (otherwise his urine would have been extremely dark and his bloodwork abnormal). Because I caught it so quickly, I assumed his recovery would be smooth sailing. I was wrong.
The vet sent Beaker home with buprenorphine for pain and prazosin, a vasodilator that helps with urethral spasms. I also received a prescription for Urinary S/O by Royal Canin, a prescription diet that would dissolve the crystals.
The discharge instructions included a warning to keep an eye out because the next week was the most sensitive time for another blockage. He may strain to pee and go in and out of the box, almost acting like he has a UTI (urinary tract infection). As long as some pee comes out, he’s not blocked. If he gets reblocked, we’d need to consider a very invasive and expensive surgery called a perineal urethrostomy (PU), where the narrowest part of the urethra is removed and new urethra opening is created. This is sort of like turning the male’s urethra into what a female has. Not the exact same, but a similar idea. Obviously, we wanted to avoid that at all costs.
I was so happy to have him home, and decided I’d confine him to my room so I could keep an eye on his litter box habits.
Pee Here, Pee There, Pee Everywhere
It didn’t take long for the strange behavior to appear. As the vet predicted, Beaker started going in and out of the box. Then, he would just pee a few drops, so the litter box had tons of tiny little clumps in it. I mean, it was good he wasn’t blocked, I guess. Then he started meowing, growling, and hissing.
Beaker would frantically pace and cry until he would eventually lie on his side, meowing loudly while pee dripped out of his urethra. The pee would puddle on the floor and get all over the side of him that was in contact with the floor. He would also constantly lick himself, trying to either clean or just soothe his penis. This became a routine for him every few hours, and it was so, so, so hard to watch.
I called the ER again, and they told me he wasn’t blocked, so there was nothing to be done, and to make sure I kept him on the meds. Then, they suggested adding gabapentin, which I did.
The following day, these episodes continued, but this time, there was blood in his urine. Did he get a UTI from the catheter? I took him to his normal vet, where they told me the blood was from inflammation. They added Oncior, the only anti-inflammatory approved for use in cats, as well as a cone so he would stop licking himself, which was likely causing further irritation.
His episodes were still happening, and I just felt so badly for him. Although they were getting shorter, I still didn’t understand why he was having such a hard time. I caught the blockage immediately and was following all the instructions. Why was he still leaking pee everywhere?
Finally, I spoke to two different vets who explained a very small percentage of cats (maybe 10%) have these difficulties when recovering from a urinary blockage. Plus, the crystals were likely still dissolving, and their presence would cause more irritation and inflammation. It can take weeks for the crystals to dissolve while on a prescription diet. Plus, a high-stress environment, like one with lots of foster cats (aka my house) would make the inflammation worse.
The best course of action was to extend the Oncior, and keep him on a tight schedule of gabapentin and prazosin for at least a month. Although his episodes would continue, as long as they were getting shorter, he was healing. Our goal: Keep his stress low and him physically comfortable.
Thankfully, this solution worked.
Urinary Blockages Are Behind Us … Hopefully
I wanted to share what happened to Beaker to prepare you that this could happen to your kitty too. Yes, a majority of cats with urinary blockages don’t have this experience. But there are some, like Beaker, who have a really hard time, and will need ongoing treatment and meds to help them feel comfortable and heal. It’s really important to tell your vet what you’re seeing and get feedback. Additionally, the entire experience is very stressful for your cat, so managing their stress will be key to their recovery.
Sources: Learn More
Barnette, Catherine. VCA Hospitals, Oxalate Bladder Stones in Cats, https://vcahospitals.com/know-your-pet/oxalate-bladder-stones-in-cats
Brooks, Wendy. Veterinary Partner, Bladder Stones (Struvite) in Cats, https://veterinarypartner.vin.com/default.aspx?pid=19239&id=5152119
Coates, Jennifer. The Spruce Pets, Cats’ Urinary pH and Their Health, https://www.thesprucepets.com/the-impact-of-cats-urinary-ph-on-their-health-4107365
Darwin’s Natural Pet Food, Urinary Crystals in Cats, https://www.darwinspet.com/health-issues/urinary-crystals-cats.html
Dowling, Patricia M. Merck Veterinary Manual, Controlling Urine pH, https://www.merckvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-urinary-system/controlling-urine-ph
Feinstein, Jill. Happy Tails From Husse, Urinary Crystals and Stones … What Are They? https://happytailsfromhusse.com/2015/11/18/urinary-crystals-and-stoneswhat-are-they/
Grauer, Gregory F. Today’s Veterinary Practice, Feline Struvite and Calcium Oxalate Urolithiasis, https://todaysveterinarypractice.com/feline-struvite-calcium-oxalate-urolithiasis/
Meeks, Cathy. PetMD, Wet vs. Dry Cat Food: Which Is Better, https://www.petmd.com/cat/nutrition/wet-cat-food-vs-dry-cat-food-which-better
Minnesota Urolith Center. University of Minnesota, Feline Struvite Uroliths, https://www.vetmed.umn.edu/sites/vetmed.umn.edu/files/feline_struvite_uroliths.pdf
Union Park Veterinary Hospital. A Day in the Life of Union Park Veterinary Hospital, Struvite Crystals … Pesky Buggers, http://unionparkvethospital.com/blog/2016/06/03/struvite-crystals-pesky-buggers