FELINE LOWER URINARY TRACT DISEASE (FLUID) FELINE LOWER URINARY TRACT DISEASE (FLUID)Principal Natural Treatments
Natural diet, cranberry extract
Other Natural Treatments
Coenzyme Q10, omega-3 fatty acids, vitamin E, antioxidants, Bach flower essences (emotional component), herbs: alfalfa (to alkalinize the urine), dandelion leaf, echinacea, goldenseal, horsetail, marshmallow, plantain, Oregon grape, uva ursi, yarrow
Feline lower urinary tract disease (FLUTD, formerly called FUS, feline urological syndrome) is the most commonly diagnosed disorder of the bladder in cats.
Clinical signs of FLUTD include increased frequency of urination, painful urination or a burning sensation during urination, excessive licking at the genitals, and occasionally blood in the urine. Owners commonly and mistakenly assume that cats with FLUTD are constipated, as affected cats spend a lot of time in the litter box attempting to eliminate. Increased thirst, increased volume of urine, and urinary incontinence are rarely associated with bladder disease and are more typical of kidney disease and diabetes.
FLUTD is a common problem in cats of any age, usually resulting from struvite crystals forming in urine with an alkaline, or (high) pH, which irritate the bladder (and may form struvite stones). Some cats have FLUTD without the presence of crystals, and in whom the urine is an acid (low) pH. About 25% of cats with FLUTD have an anatomic abnormality called a vesicourachal diverticulum. This pouch on the end of the bladder predisposes the animal to bladder disease. Most cases occur in cats (male or females) between 2 and 6 years of age, although struvite stones are most commonly seen in female cats that are between 1 and 2 years of age. Male cats are more likely to develop obstruction of the urethra (the tube leading from the bladder to the urethral opening) due to their anatomy (a long, narrow urethra, compared with the female cat’s short, wide urethra). Cats with FLUTD may show any of the following signs: increased frequency of urination, painful urination or a burning sensation during urination, excessive licking at the genitals, and occasionally blood in the urine. Urethral obstruction is caused by mucus and/or crystals which “clog up” the urethra. Cats with urethral obstruction often spend a large amount of time in the litter box, causing many owners to mistakenly believe that the cats are constipated, but, in fact, true constipation is rare in dogs and cats.
The cause of FLUTD is unknown, although many doctors believe that cats eating dry foods (which in general contain more minerals such as magnesium per kcal of food than wet foods) predispose cats to this problem. Many holistic doctors claim that cats eating any processed foods are more likely to present with FLUTD, whereas switching to a homemade natural diet is preventative/curative. While some cats (2% or so) may have urinary tract infections, most cats have idiopathic disease (meaning the cause is unknown). Decreased water intake and therefore decreased urination may predispose cats to FLUTD.
While mineral (specifically magnesium) content of food has been blamed on causing FLUTD, it appears that the pH of the urine has more influence on the development of the crystals which are often seen in cats with FLUTD. Cats fed processed food tend to have a higher pH (which favors struvite crystal formation) than cats fed meals at specific times.
A natural diet with no dry food (and preferably no processed foods) and cranberry extract are the main natural treatments.
The same diet recommended for controlling struvite bladder stones is recommended for cats with FLUTD. If processed foods must be fed, most holistic veterinarians prefer canned diets (which contain large amounts of water) rather than dry foods.
Dietary therapy is a useful adjunct (and possible preventive measure) for cats with struvite crystals and stones. Since the struvite stones most commonly form in alkaline urine (urine with a high pH) when the urine is saturated with magnesium, ammonium, or phosphate, diets should help maintain an acidic urine (low pH) as much as possible. Diets with animal-based protein sources are most important in maintaining an acidic pH (vegetarian or cereal-based diets are more likely to cause an alkaline urine).
In cats, struvite crystals and stones most commonly form in the absence of a bladder infection (unlike the situation in dogs, in which a bladder infection is usually the initiating factor in causing the formation of stones). Unless a secondary infection is present, large amounts of urinary bleeding are encountered, or surgery is performed for stone removal; antibiotic therapy is usually not needed in cats with struvite bladder stones.
Crystals, stones, and the condition called feline lower urinary tract disease (FLUTD), most commonly form in cats (which are true carnivores adapted to eating meat-based diets) fed dry commercial foods (which are usually high in vegetable materials and grains). Most holistic veterinarians see a lower incidence of these urinary disorders in cats fed meat-based homemade diets.
Diets designed for cats with struvite crystals or bladder stones are designed to produce an acid urine (pH lasting 4 to 6 hours after feeding, which allows for crystals and stones to be dissolved. While some commercial foods have decreased levels of magnesium and phosphorus, it has recently been shown that these minerals only contribute to stone formation if the urine is alkaline. If the urine can be maintained with an acidic pH, the dietary concentrations of magnesium and phosphorus do not need to be lowered below recommended daily amounts. In fact, reducing the magnesium levels in cat food can cause increased excretion of calcium from the kidneys, leading to the formation of calcium oxalate stones in the bladder. In fact, the increased incidence of calcium oxalate stones in cats and dogs has coincided with an increased use of commercial “stone” diets containing reduced magnesium and phosphorus (often labeled under the term “ash”). Feeding recommended levels of phosphate to normal cats does not promote stone formation. Phosphate is needed to allow the urine to maintain an acid pH, which helps discourage crystal and stone formation. To increase urination (which reduces the amount of time crystals can form and remain in the bladder), extra salt (sodium chloride) can be added to the diet.
While urinary acidifiers can be useful, some doctors discourage their use as the exact dosage that is safe and effective is often not known. If urinary acidifiers are used for short-term acidification, a natural therapy such as cranberry extract might be preferred to conventional medications (such as methionine).
Note: Before you start to feed your dog or cat a home-prepared diet, it is strongly recommended that you discuss your decision with your veterinarian or a holistic veterinarian in your area. It is essential that you follow any diet’s recommendations closely, including all ingredients and supplements. Failure to do so may result in serious health consequences for your pet.
3 ½ ounces firm raw tofu
2 ¼ ounces sardines, canned in tomato sauce
½ ounce clams, chopped in juice
½ yolk of large hard-boiled egg
¾ cup long grain, cooked brown rice
2 teaspoons chicken fat or canola oil
½ ounce brewer’s yeast
100 mg taurine
This diet provides 501 kcal (enough to fulfill the daily amount required for a 16-pound cat), 37.4 gm protein, 29.6 gm fat, 62.2 mg sodium/100 kcal (a high-sodium diet).
Substitute 2 ounces of tuna (in water without sodium), 2 ounces of canned salmon (with bones), 2 ⅔ ounces of chicken breast, 4 ounces of lean ground beef, or 4 ounces of lean ground lamb for the sardines.
Substitute ¾ cup of potato, cooked with the skin, or ¾ cup of cooked macaroni for the rice.
Supply vitamins and minerals as follows: 1 bonemeal tablet (10-grain or equivalent) or ¼ teaspoon of bonemeal powder to supply calcium and phosphorus with a multivitamin/mineral supplement, using the label instructions. Alternatively, use a natural product from Standard Process (1 Calcifood Wafer or 2 Calcium Lactate tablets for each 2 bonemeal tablets).
When possible, use natural vitamins made from raw whole foods, rather than synthetic vitamins (although both can be used in combination), as the natural vitamins also supply plant phytochemicals, enzymes, and other nutrients not found in chemically synthesized vitamins. Use either Catalyn from Standard Process (at a dose of 1 Catalyn per 10 pounds) or NuCat from VetriScience (following label dosages) as the natural vitamin for this recipe.
For extra nutrition and variety, use fresh, raw or slightly steamed vegetables, such as carrots or broccoli (approximately ½ to 1 cup per recipe) as a top dressing for the diet. (Many cats, however, will not eat vegetables.) Most vegetables provide approximately 25 kcal per ½ cup.
Add supplements that can be beneficial, such as omega-3 fatty acids, plant enzymes, and a super green food or health blend formula.
Note: If adding vegetables or other supplements, urine pH should be monitored when feeding the diet with these supplements and without the supplements to be sure the pH does not change from acid to alkaline.
Diets for cats with struvite stones should contain 20 to 40 mg/100 kcal of magnesium and 125 to 250 mg/100 kcal of phosphorus. These levels are higher than those recommended by the NRC for adult cats. Eliminating the oil and rice from this diet will further increase the magnesium and phosphorus.
The cranberry plant, a relative of the common blueberry plant, has been used as food and as treatment of bladder diseases.
Research has shown that drinking cranberry juice makes the urine more acidic. Since common urinary tract infections in pets (especially dogs) are caused by bacteria such as E. coli, which function best in alkaline urine, many holistic doctors promote cranberry juice extracts for treating bladder infections. In addition, since the most common bladder stones in dogs and cats, and the sand-like gravel and microscopic crystals that are often encountered in cats with feline lower urinary tract disease (FLUTD, formerly called FUS) form in alkaline urine, acidifying the urine with supplements such as cranberry extracts may prove helpful.
However, contrary to early reseach in people, it now appears that acidification of the urine is not so important as cranberry’s ability to block bacteria from adhering to the bladder wall. Preventing bacterial adhesion to the bladder wall prevents infection and allows the bacteria to be washed out with the urine.
Cranberry juice is believed to be most effective as a form of prevention. When taken regularly, it appears to reduce the frequency of recurrent bladder infections in women prone to developing them. Cranberry may also be helpful during a bladder infection but not as reliably. Similar findings are lacking in pets but may be applicable.
In people, the recommended dosage of dry cranberry juice extract is 300 to 400 mg twice daily, or 8 to 16 ounces of juice daily. Pure cranberry juice (not sugary cranberry juice cocktail with its low percentage of cranberry) should be used for best effect.
For pets, the recommended dosage varies with the product. One recommended product used in cats recommends a daily dose of 250 mg of cranberry extract. Cranberry juice is not recommended, as it is all but impossible to get most pets to drink enough of the juice to be effective.
There are no known risks of this food for adults, children, or pregnant or nursing women, nor are there any known risks in pets. However, cranberry juice may allow the kidneys to excrete certain drugs more rapidly, thereby reducing their effectiveness. All weakly alkaline drugs may be affected, including many antidepressants and prescription painkillers.
In dogs and cats, the push to acidify the urine through prescription-type diets has led to a slight increase in oxalate stones in the bladder, which are more common in acid urine. Pets taking cranberry extract would be more prone to develop crystals and stones such as oxalate stones which are more common in acid urine. However, since the crystals and stones that form in alkaline urine are much more commonly diagnosed, pets with chronic stones (and cats with chronic FLUTD) would probably benefit from acidification of the urine even with the slight risk of stones forming in acid urine. Discuss this with your veterinarian.
Coenzyme Q10, omega-3 fatty acids, vitamin E, antioxidants, Bach flower essences for the emotional component. Use the following herbs: alfalfa to alkalinize the urine, dandelion leaf, echinacea, goldenseal, horsetail, marshmallow, plantain, Oregon grape, uva ursi, and yarrow.
These natural treatments are widely used with variable success but have not all been thoroughly investigated and proven at this time.
The treatment of FLUTD is controversial because the exact cause is unknown. Cats with an anatomic problems (such as bladder stones or vesicourachal diverticulum) should have these problems corrected through surgery (although some stone-dissolving diets might help correct certain types of bladder stones in cats). Cats with FLUTD have improved with no treatment, with antibiotic treatment (even though less than 10% of cats with FLUTD have bladder infections), and with antianxiety medications (such as amitriptyline). Cats with urethral obstruction must be anesthetized and have a urethral catheter placed through the urethra and into the bladder in order to allow urination.
There are several prescription-type diets available through veterinarians that may decrease the formation of crystals. These diets typically contain reduced ash (mineral) content and high amounts of urinary acidfiers. Urinary acidifiers can also be used for the prevention of FLUTD. There is an increased incidence of oxalate stones in cats who maintain an acid urine as the result of using acidifiers (oxalate stones form in acid urine, whereas the more common struvite stones prefer alkaline urine).