Urinary Incontinence in Cats
What Is Urinary Incontinence in Cats?
Urinary incontinence is the involuntary (accidental) leakage of urine. In cats, it can be a congenital (birth defect) or acquired (occurring later in life) problem with either storing urine or urinating. In normal function, the bladder wall will relax to allow urine to collect until a certain point. Once full, the bladder wall will contract to empty the bladder, while the urethral sphincter muscle relaxes to allow the urine to flow easily. When something goes wrong with this process, urine leaks or pools out—this is urinary incontinence.
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Symptoms of Urinary Incontinence in Cats
Urinary incontinence in cats can easily be confused with inappropriate urination (urination that occurs anywhere other than outdoors or in the litter box). Inappropriate urination is more common, but it is a voluntary (purposeful) action. Urinary incontinence will happen involuntarily, without the cat’s knowledge.
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Symptoms of involuntary leakage of urine (urinary incontinence) include:
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Not squatting or in position to urinate
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Cat unaware of urination
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Urine found in bed during sleep or rest
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Urine staining or smell near the urethral opening (under the tail). This can be seen as a skin infection.
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These symptoms can be seen in both urinary incontinence and inappropriate urination:
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Excessive grooming in urethral area
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Symptoms of inappropriate urination that are not seen with urinary incontinence include:
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Posturing to urinate
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Straining to urinate
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Pain during urination
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Reoccurring urination in certain areas of the house
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Urination on vertical surfaces (behavioral)
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Causes of Urinary Incontinence in Cats
Congenital
Congenital causes are seen when the anatomy of the bladder or urethra did not correctly develop when the cat was in the womb. These causes are present from birth:
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Ectopic ureter is when the ureter (the tube between the kidney and bladder) is attached in the wrong location. It is usually seen attached to the urethra, the tube through which urine is eliminated from the bladder to outside the body. This causes the urine to leak directly out instead of pooling in the bladder.
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The urethral sphincter (the muscle that controls the flow of urine from the bladder) may not form correctly, which allows the urine to flow out once any pressure is applied to the sphincter. It is usually associated with other congenital abnormalities (born with one kidney, small vagina, renal aplasia).
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Spinal/vertebral abnormalities can cause damage to the nerves in either the bladder wall or sphincter.
Acquired
Acquired urinary incontinence is when the inability to urinate begins after birth and is not associated with a birth defect. It is most commonly due to trauma.
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Injury to the spine or vertebrae can affect the nerves in the bladder or sphincter.
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Decrease in nerves to the bladder wall allows the bladder to overfill or not empty completely.
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Decrease in nerves to the urethral sphincter causes the sphincter to not close properly.
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Urethral blockage is the most common cause seen in cats. This occurs when an object obstructs the flow of urine in the urethra, causing overflow of the bladder so that urine leaks out around the obstruction.
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Feline leukemia virus has been suspected to cause acquired urinary incontinence, resulting in occasional dribbling during times of relaxation.
Mimics of Urinary Incontinence
Several metabolic diseases can be mistaken for urinary incontinence. They do this by increasing the amount of urine that is produced, thereby increasing urinary accidents. Some examples are: diabetes, liver disease, hyperthyroid, and renal disease.
How Veterinarians Diagnose Urinary Incontinence in Cats
Your veterinarian will perform an exam and diagnostic tests to check your cat’s urinary system. A physical exam with a correct history is the most important step. Clinical history is needed to figure out if the issue is truly urinary incontinence or inappropriate urination.
Your veterinarian will need to palpate (feel) the bladder’s size and thickness. The bladder will be large if the bladder wall is allowing the bladder to overfill or if the urethra is blocked. The bladder will be empty and soft if the urine is bypassing the bladder or excessive urination is occurring. A thickened bladder wall is more often seen with irritation or infection of the bladder. On palpation, the veterinarian may be able to feel a bladder stone.
After the physical exam, further tests may be needed:
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Urinalysis, to check the status of the urine itself: This allows the veterinarian to know if an infection or crystals are present in the urine.
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Analysis of the blood chemistry and blood cells will help find the underlying cause. Blood cell counts may be altered with an infection.
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Radiographs, ultrasound, or endoscope can be used to look at the anatomy of the bladder and urethra. These tests can also check for stones and masses of the lower urinary tract.
Treatment of Urinary Incontinence in Cats
Treatment of urinary incontinence in cats is based on the underlying cause. Medications, supportive care, and symptomatic treatment may be tried until the best combination is found. Treatment may be needed for a couple of weeks to months or as lifelong therapy.
Medications
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Antibiotics are needed to remove any infection that was found. Infection of the urinary system can cause false results of the testing and compound the clinical symptoms.
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Several medications can allow the bladder to empty easily. They are needed when the urethra is swollen, overly stimulated, or a blockage is possible. Medications can accomplish this by:
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Decreasing urethral spasms. Prazosin is a commonly prescribed medication in cats.
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Increasing relaxation of the urethra
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Decreasing bladder wall spasms
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Decreasing stress, allowing the cat to relax more
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Stimulating the bladder wall to contract
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IV fluids are needed to correct renal imbalances and remove toxins from the body after urethral blockage. Toxins, electrolyte imbalances, and kidney malfunction can lead to death if not corrected completely. IV fluids are usually only temporary.
Surgical Repair
Depending on the cause of the urinary incontinence, surgery could be an option. A bladder stone must be removed if it is causing bladder or urethral irritation. A urethral catheter can be placed temporarily to remove urethral blockage and allow urination until the swelling has resolved. Periurethral surgery (commonly referred to as a PU surgery) is used when male cats have several episodes of blockage. A PU surgery widens and shortens the urethra permanently in male cats. This surgery cannot be performed in female cats. If a back injury is the underlying cause, surgery can be used to correct the pressure on the spine. Some congenital causes (depending on their severity) can be corrected with surgery as well.
Your veterinarian will evaluate the cause of the urinary incontinence to help decide if surgery is an option.
Recovery and Management of Urinary Incontinence in Cats
Recovery time depends on the underlying cause. It can range from days to months for the body to reset to normal. Following your veterinarian’s orders closely and watching your cat’s symptoms will help decrease the recovery time. Keeping a close eye on your cat is very important to allow the quickest recovery.
Sometimes urinary incontinence cannot be fully resolved and only managed. Diet change may be needed to prevent urinary crystals or stones. This is commonly used if there has been an earlier urethral blockage. Royal Canin® S/O, Hill’s Science Diet C/D, and Purina® Pro Plan®, Veterinary Prescription Diet UR are commonly prescribed as recommended vet diets. Increase in water intake can help dilute urine if crystals are present, which makes a urethral blockage less likely. An easy way to increase water intake is to feed canned food.
Acupuncture and hyperbaric chambers may help with healing and repair of tissues. The litter pan must be easily accessible to your cat. A litter pan with lower walls may be needed to allow your cat to enter and leave without straining their back or rear limbs. Pheromones (Feliway®), vitamin supplements (Solliquin®), and prescription medications have been used to decrease stress that can be the underlying cause of lower urinary tract disease in cats.
Discuss your cat’s prognosis, recovery, expectations, and long-term care with your veterinarian to understand your cat’s situation better. You may need only to change one thing or several things depending on the cause of urinary incontinence.
Prevention
Not every cause of urinary incontinence can be prevented, but some predisposing conditions can be avoided.
Weight Management
Weight management is key to preventing many diseases, including feline lower urinary tract disease and diabetes. Be aware of your cat’s body condition score; you should feel their ribs easily without seeing them and they should have an abdominal tuck (a slant up after the ribs when seen from the side). Work with your veterinarian if your cat needs to be on a weight management plan.
Food Quality and Type
Lower-quality food has been linked to urinary tract diseases. The concentration of certain electrolytes affects the pH of the urine, allowing crystals and stones to form. Canned food has also been linked to decreasing occurrence of feline urinary tract disease. Feeding good-quality food with the inclusion of wet food is ideal. Royal Canin®, Hill’s Science Diet, and Purina® Pro Plan® are commonly recommended by veterinarians. Discuss the best food options with your veterinarian.
Urinary incontinence is typically uncommon in cats. But feline lower urinary tract disease is very common—and it is sometimes difficult to see the difference between the two diseases. Medical intervention is needed for both diseases. It’s important to stay up to date on your cat’s annual exam to catch underlying diseases that must be treated immediately.
Featured Image: iStock.com/vadimguzhva
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