Not enough testing for urinary woes in pets

Cats can develop bladder stones, cystitis and other urinary troubles. Only a complete work-up can reveal the source of the problem.
Cats can develop bladder stones, cystitis and other urinary troubles. Only a complete work-up can reveal the source of the problem.Getty Images File
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If you've ever suffered a bladder infection, you know that aching, urgent feeling of needing to go right now and then not having much success at it. So you call your doctor, describe your symptoms, get some antibiotics, and that's the end of it. It's not so easy with cats and dogs.

Urinary problems of various types are common in both dogs and cats, with each species prone to different conditions. Dogs get bladder stones and infections. Cats younger than 10 years get bladder stones, idiopathic cystitis (bladder inflammation of unknown cause) and, in males, urethral plugs, which occur when minerals, cells, cellular debris and mucus-like protein build up in the urethra and obstruct it. Bladder infections are rare in cats, and when they do occur it’s usually in cats that are older than 10 years.

The one thing all these conditions have in common is that antibiotics aren’t always the answer, especially if a urine culture isn’t performed to confirm an infection.

“Many vets and physicians, including me, often skip this test and are successful in simply choosing an antibiotic that usually works," says Roger Ross, a veterinarian at the FoxNest Veterinary Hospital in Seneca, S.C. "But it's a little gamble, and if we're wrong, then we have to start over, the patient was in discomfort longer than needed, further damage was done to the bladder and urethral lining that could be permanent, and we could possibly be contributing to the problem of bacterial resistance to antibiotics.”

Diagnosing bladder problems in pets is a challenge on a par with solving one of those Agatha Christie mysteries in which everyone is a suspect. Signs such as straining, difficulty urinating, pain on urination, or blood in the urine don’t tell your veterinarian the why of a bladder problem, just where it’s originating — in this case, the lower urinary tract, says Katherine James, veterinary education coordinator at Veterinary Information Network in Davis, Calif.

“We do see bladder infections … and they’re important to get diagnosed, but we should never assume them because we don’t want to miss stones and we don’t want to miss other diseases that cause those same signs,” James says. “What’s involved in diagnosing the problem depends a little on whether we’re talking about a dog or a cat, what age group the animal’s in and what sex it is.”

To get a diagnosis, a urine sample is analyzed to determine such things as whether it contains crystals that could indicate the presence of stones or white blood cells, which can be a sign of infection. Then the urine is cultured to determine whether there’s an infection and identify the bacteria causing it. Without a culture, your veterinarian can only make a guess as to what antibiotic is appropriate or indeed if one is even necessary.

“Generally, antibiotics are not indicated except for known, documented, proven-with-a-culture urinary tract infections,” James says. “Bacteria are very clever and they learn not to care about antibiotics and not to be responsive to them. By using antibiotics when they’re not indicated, you just make that problem worse.”

Pet owners contribute to the problem
One of the biggest problems in diagnosing urinary tract problems is in persuading pet owners that a complete work-up is of value, says veterinarian Joe Bartges, a professor of medicine and nutrition at the University of Tennessee’s College of Veterinary Medicine in Knoxville.

While a good physical exam and taking a medical history provide a lot of information, evaluating a urine sample helps with many urinary problems. “The cost of a urine culture is often well worth it,” he says.

Sometimes, diagnostic sleuthing goes beyond urinalysis and urine cultures. When stones are suspected, blood work and X-rays can provide more clues. “Most of the time, that will get us an answer,” James says. “Sometimes it won’t and we have to do fancier procedures: X-rays with dye, sometimes ultrasound, sometimes a procedure called cystoscopy, where we use an endoscope to look at the urethra and bladder areas of the dog or cat.”

Stress may be a culprit
Depending on what problem is diagnosed, your veterinarian may prescribe a special diet to dissolve stones; recommend switching from dry food to canned food to increase the amount of water your pet takes in; prescribe antibiotics to clear up an infection; or suggest stress-relief techniques, which may help in cases where no cause is apparent.

Cat owner Marcella Durand of New York City is familiar with the vagaries of trying to diagnose and treat urinary tract infections. Her 13-year-old female calico, Perdita, has had an ongoing problem with them for six years.

“We first recognized the problem when she started crying and licking herself constantly and then saw blood in her urine,” Durand says. “She was diagnosed, after an ultrasound and urine analysis, as having calcium oxalate crystals, so we put her on a canned food prescribed by the veterinarian.”

That helped for a couple of years, but then the problem recurred — again and again. In addition to the calcium oxalate crystals, Perdita also developed struvite crystals. Antibiotics helped for a while, but the crystals continued to return. Stress seemed to be a factor — Perdita had recurrences every time the Durands went away — and Durand also noticed that the episodes were seasonal, occurring most commonly in early spring and fall.

She tries to keep Perdita’s urinary tract problems at bay with dietary management and stress-relief techniques that include regular play sessions with a fishing-pole toy, catnip parties, an unvarying routine, and limiting visitors and overnight guests, especially children. “One of her worst episodes came after a 7-year-old visited for a few hours,” Durand says.

The idea that stress is a factor in urinary tract problems — especially in idiopathic cystitis — is a relatively new one and not yet proven, James says, but taking steps to reduce a pet’s stress falls into the “does no harm” category of interventions. They include keeping the litter box scrupulously clean, switching to a larger litter box or adding another litter box, encouraging the animal to take in more liquids by offering liquid treats such as low-sodium chicken broth or lactose-free milk, and providing plenty of exercise and playtime, especially for indoor cats.

Kim Campbell Thornton is an award-winning author who has written many articles and more than a dozen books about dogs and cats. She belongs to the Dog Writers Association of America and is past president of the Cat Writers Association. She shares her home in California with three Cavalier King Charles Spaniels and one African ringneck parakeet.