We were in for a real treat as Professor Danièlle Gunn-Moore from Edinburgh University took to ‘The Webinar Vet’ stand to deliver a practical and information packed webinar on a disease we see all too much of in practice, Feline Lower Urinary Tract disease (FLUTD). Many of us are likely to have participated in CPD covering this topic over the years but as our host Anthony Chadwick stated, what was accepted as the correct treatment for an FLUTD cat five or even two years ago could now be deemed as the wrong course of action. Professor Gunn-Moore’s webinar draws on current up to date evidence to deliver take home messages on the causes and management of FLUTD which may be very different to the information we were given at historical CPD events.

Professor Gunn-Moore firstly explained that feline idiopathic cystitis (FIC) accounts for somewhere between 55-74% of cat’s with FLUTD and it is now known that FIC develops as a definite response to stress. Urethral plugs also account for 20% of cats with FLUTD and as these plugs are formed secondary to inflammation caused by FIC we can now state that around 75% of cats with FLUTD develop their condition as a result of stress. Cats suffering from FIC show an altered response to stress compared to normal cats which is based on genetic and developmental factors. This abnormal response to stress is seen as an uncoupling of the hypothalamus-pituitary-adrenal axis which prevents the appropriate release of cortisol. These altered responses cause an increase in pain fibres and pain receptors in the bladder wall which can be triggered by central stress or a local trigger. The stress response may also affect the GAG layer which lines the bladder leading to an increase in bladder permeability and the increased likely hood of stones adhering to the bladder wall. On top of this the naturally high specific gravity of a cat’s urine (up to 1.070) will increase the acidity of the urine which is noxious to the already leaky bladder wall.

With all the combined effects of stress it is perhaps not surprising that stressed cats are likely to suffer from FIC and why Professor Gunn-Moore labels this condition a ‘bladder migraine’. The good news however is that with this level of understanding about the effects of stress on these sensitive cats an appropriate strategy can be put into place to help cats with recurring FIC and urethral obstruction. There are many stressors which could trigger FIC including multi cat households and moving house. However cats can also develop FIC in single cat households and this stress often develops as a result of a relationship between a cat and owner which just doesn’t work. Professor Gunn-Moore explained that in her experience these single cat household stressed cats are often owned by a very specific type of owner who can be very intense and highly strung. In these cases it may be that the personality of the cat and the owner just don’t work well together. In order to reduce the stressors which could trigger FIC a behavioural consult is a must and this cannot be achieved in 5 minutes over the consult table. This  should be carried out by someone who has a real interest in feline behaviour and has the time to educate owners about the environmental changes required to minimise a cat’s stress. This behavioural intervention is  known as multimodal environmental modification (MEMO).

An appropriate urinary diet also plays a key role in managing FLUTD and in Professor Gunn-Moore’s opinion, these diets really do save the lives of cats with recurring FIC and urethral obstruction. The dried or moist diets formulated by the well known food companies are designed to reduce the specific gravity of the cat’s urine which helps to reduce the noxious effects of urine contributing to signs of FIC.

Drug wise, Professor Gunn-Moore explained there is no magic bullet to make patients with FLUTD better, altering diet and behaviour is the key to managing this disease successfully. The use of tricyclic anti-depressants such as amytriptyline and SSRI’s such as fluoxetine appear not to be of any help and there is also no evidence to suggest that the addition of GAGs to a cat’s diet is in any way beneficial. However Professor Gunn-Moore does find the smooth muscle relaxant prazocin useful in cats with urethral spasm.

I wanted this blog to highlight the real take home messages from Professor Gunn-Moore on how to manage cases of feline FLUTD. These include the use of ‘MEMO’, reducing stress, feeding an appropriate diet and using anti-spasmolytics such as prazocin. However Professor Gunn-Moore also discussed the practicalities of unblocking an obstructed cat which should prove invaluable to any of us who have spent time sweating over what can sometimes appear an impossible task. Tips include always aseptically preparing a cat for urinary catheterisation and to always rectal any obstructed cat. Performing a rectal examination is essential as it may be possible to palpate stones, tumours and urethral spasm which after gentle massage could relax and allow the release of urine. Needless to say I advise all of you to log in and watch this webinar delivered by a world class speaker who offers practical, relevant and up to date advice on a challenging and frustrating condition for the vet, owner and most importantly the ‘stressed’ cat.