If your cat is going into the litter box frequently, straining to pee, or can't pee, stop what you're doing and bring them to your vet or the emergency vet immediately.
Thankfully, this was something I learned early on in my career here at Preventive Vet, because when my cat, Mazel, started exhibiting these symptoms I was able to jump into action and address what ended up being a urethral obstruction before it could do too much damage, or become fatal.
This episode, I share my story in the hopes that it will spread awareness and help others more quickly identify the symptoms, and Dr. J answers some of my post-hospital questions, as well as offers some tips for preventing re-obstruction.
Mia: Welcome back everybody to another episode of Paws and Play with Dr. J, I am your cohost, Mia, and Hello Dr. J, how are you doing?
Dr. J: Very well. Thank you.
Mia: Excellent. Well, today we actually have a very special episode that is near and dear to my heart, unfortunately. I had mentioned on our last show that I had had a really stressful week last week, and thankfully because of all of the awareness that I have had working here, I was able to get on it quickly.
Basically Mazel, our cat, had been going in and out of the litter box last Saturday, a little bit not doing anything but then going back in and peeing. I thought it was a little bit weird, but because he was peeing I thought it was okay.
But then the next evening he did the same thing, but this time made a yowling noise. So I brought him into the emergency vet, they checked him out and said that he wasn't obstructed at the time, but that it was a good thing that we brought him in because he was most likely having some urinary tract issues and straining to pee. And so they gave us pain meds and a pill to help, I think it's something to relax his urethra — which sounds a lot more fun than it probably is.
So the next morning he just made an awful yowling sound and I noticed that he couldn't, like nothing was coming out when he peed. So we brought him back to the E.R. and they admitted him right away, found an obstruction and put him on an IV and catheter and sent us on our way.
And really, thankfully when they took the catheter out the next day, they said he was able to pee and that we could bring him home.
So we picked him up and then it was just kinda like, what the hell do we do now? Because the way that he came home from, I mean, first of all, we were completely shaken by this happening to begin with, because I really felt like I was doing everything right to prevent this, but also the symptoms that made me bring him in in the first place, were now, when I called the E.R. to ask, they're now "normal" symptoms because he's dealing with the discomfort of having had the catheter in.
Mazel exhausted from his time at the hospital with his little shaved arms
I'm hoping that, through my experience, we can help others catch it in time. But also just figure out what the heck to do. So first of all, what is, where does this come...what the heck? I'd like to say something else, but I won't. It's a clean show.
Dr. J: What you're talking about is urethral obstruction, so this isn't like digestive obstruction, which is totally different. But a urethral obstruction, for all of you out there who are listening, who perhaps have never heard of it before, which unfortunately is a lot of people, a lot of cat owners are unaware of this until it happens to their cat, or they read about it on social media, or listened to the podcast, but urethral obstruction basically means that a cat is unable to get urine from their bladder to the outside world.
And it's the urethra that connects the bladder to the outside world. And it's unfortunately a pretty common condition in emergency, in cats, especially male cats. In fact, it's pretty much the main condition that caused me to start Preventive Vet back in 2011, because I had just seen so much of it in the emergency room.
And it is very devastating and unnerving for people. It's painful for cats. It can be pretty rapidly fatal. It's a pretty expensive condition to treat oftentimes, and it can recur. So awareness is crucial. So in male cats it's more common because their urethra gets more narrow as it courses from the bladder out through the penis and to the outside world.
And so because it narrows, any mucus that an inflamed bladder lining starts to secrete what we call grit, so, mineral crystals and other components that form in urine, especially when there's inflammation or they're dehydrated. So their urine is very concentrated. They can form bladder stones, they could get a pathologic narrowing, or what's called a stricture in their urethra. They can have tumors that cause it. Something prevents the flow of urine to the outside world.
And that could be pretty rapidly fatal because it's vitally important for a cat or a person, any animal that makes urine, to be able to get it out of the body because that is how you remove some of these metabolic toxins that build up through normal daily sort of life processes. And so if they can't, they wind up with very concerning electrolyte abnormalities, in particular a high potassium level that can stop the heart and cause cardiac arrest.
They wind up not being able to regulate their total body acid base balance because the kidneys and the urine are intimately associated with that. So that can then affect, again, proper functioning of the heart and all the other organs in the body.
Also, as you might imagine, it would be very painful, anyone that's had to "hold it in" while maybe like waiting for a plane to take off or something, that's quite an uncomfortable situation. It's that much moreso when you're not holding it in voluntarily, it's just you can't. So it's very distressing for cats. And these guys really need immediate recognition and appropriate care.
And unfortunately a lot of people, when they're not aware of the potential for urethral obstruction, they might see their cat doing a lot of things that Mia was seeing Mazel do and assume that their cat is, — maybe they're peeing outside the box, maybe they think that their cat is just being stubborn or spiteful or something like that. Or if they see them straining in the box, they might think that they're constipated, which certainly wouldn't be a comfortable thing, but probably isn't going to be fatal within about 24 to 36 hours. Whereas a urethral obstruction could very well be.
So I would highly encourage anyone that sees their cat, you know, the signs really are going to the litter box frequently and oftentimes not producing very much, maybe just getting out a few drops here or there or getting out no drops, vocalizing, licking around their back end incessantly.
Mia: Yeah, he did all of all of that. Definitely.
Dr. J: And so those are some of the earlier signs. As it progresses and they start having these acid base changes, and the potassium changes, these cats, they go off their food, they start to vomit, maybe, some of them stop drinking, others will drink a lot more initially to try and counterbalance those imbalances. They will maybe go hide and then they just, they won't be moving, so they'll just be laying around and breathing heavily oftentimes.
And a lot of these cats, if it's not caught in time, these cats can suffer cardiac arrest and die. So if you see those signs, if you see them going to the litter box frequently, if you see them licking around their back end incessantly, if you see them vocalizing in the litter box, it may be that they're constipated and it may be that they just are having a urinary tract infection — which actually are fairly uncommon in younger cats. They may just be having inflammation and discomfort or it may be a urinary obstruction.
Regardless though, err on the side of caution and take your cat to the vet asap, even if it's the middle of the night, don't wait until the next morning to go to your regular vet, go to an E.R. because the prognosis is significantly better and the costs are typically lower if you get them in early.
Mia: Yeah, I mean the cost is something we'll get into a little bit later. But suffice it to say, it costs a pretty penny. And I think we were pretty lucky since we only had him in the hospital for one night. I mean, you mentioned kind of the scientific causes of it inside of the urethra — which, you really took me on a journey, thank you. But, you know, I really felt like, because this has been pounded into me, I really felt like I did everything I could to prevent this. He drinks a lot of water. I've even mentioned I was proud of that fact on one of our past podcasts. You know, he has wet food. What, where did I go wrong?
Dr. J: I don't know that you necessarily went wrong. I mean, you know, as the Preventive Vet it may sound funny for me to say, so you can't prevent everything. Like, my dogs and cats have had digestive upset every now and again and you know, like pulled up lame, and like you can't prevent everything so you've got to be aware so you could recognize it. And so you succeeded highly there, you got him in and like you said, you only had to have him there one overnight and he didn't obstruct after they pulled the catheter. So you were successful as best you could.
I mean sometimes things happen, but the things that you said are crucial. So you know, just getting this out there for people for the steps you can do to minimize your cat's chances are making sure that they are drinking plenty of water.
And one of the easiest ways to do that is to feed them wet food and maybe even add a little bit more water to that wet food. So you want to get moisture going in because the more water moisture they're taking in, the more they're going to be flushing their kidneys through, the more dilute their urine is going to be and it's not going to be so concentrated with the things that can precipitate out and cause stones or crystals or inflammation and things of that nature.
So wet food, multiple water sources, little kitty water re-circulators are great. And then it's important to have the appropriate number of litter boxes. So ideally you have one more box than the number of cats you have and you really should be scooping them on a daily basis minimally, because a lot of cats will refuse to go to the box if there are too many deposits, either urine or stool in there.
So you want your cat to have the best experience possible going to the litter box because it can be problematic if they don't. So other ways to make that environment better, because stress is also a big contributor for urethral obstruction in cats, is use pheromone products like Feliway, which can help to decrease stress for cats and help them feel more comfortable and relaxed.
Make sure that there's no infighting amongst your cats or try and take steps to minimize that, enrich their environment, play with them more, give them vertical spaces to get onto, give them plenty of scratching posts, give them safe places to rest, things of that nature.
Unfortunately, when I was in the E.R. a lot of the times, and it was really sad, that you'd have people that will go away, say for a quick weekend, like to the coast and you think, okay, I'll put out a bowl of food and you know, I don't necessarily need somebody to come in and check on my cat.
Or they do have someone that comes in and checks on them, but only does it maybe every other day. And maybe doesn't always make sure to see the cat when they're in. And so that upset of their routine, that change can cause stress, and it's a fairly common time, unfortunately, for cats to develop a urethral obstruction. So people get back from this nice relaxing vacation only to find that their cat can't pee and maybe has already very advanced in this. And they bring them in and now they're faced with a very tough decision and a lot of costs and a lot of distress.
So those are a lot of the things that can really help to minimize the chances of it happening. But again, sometimes these things sneak through and it's a matter of recognizing them and taking them in for care.
I guess, like you said, we'll probably talk about costs later, but it can be a pretty devastating one. And it's unfortunately a condition where euthanasia, especially from economic reasons, is not uncommon because it's also not uncommon for that urinary catheter to be pulled after an appropriate period of time, for the cat to re-obstruct. And then the costs go up from there. The time, the stress and then they have to be catheterized and then they may re-obstruct and then, maybe looking at surgery. So, it's a devastating one again. And hopefully this awareness will help people prevent it or at least recognize it sooner and get them in.
Mia: Yes, yes, definitely. This is so important. Obviously we've touched upon the fact that we can't prevent everything. So I guess can you help me out a little bit with this aftercare? Because now it's going on — it's been a week actually, like basically right this second as we are talking is about the time that I picked him up from the hospital last week and it has been a very sleepless week.
I don't know if you can tell it from my brain, but I've really been following him like 24/7 around the house, just so that I can monitor how much he's peeing every single time. And I mean, like I said, right after he got home... I mean, I can't even tell you how many times I've called the emergency room and our regular vet and brought him into the regular vet to have his bladder palpated just to make sure that it was still going ok.
I can only imagine that the catheter would be incredibly uncomfortable. But it's like, how long after is it supposed to be okay. And also like, how many days can I go by without following him everywhere. I also feel like I kind of trained him or he trained me at this point to where if he makes a noise, any noise, I will run out and check on him. And he's been doing that a lot in the middle of the night lately. And I do kind of feel like at this point it's a game, but I, I'd rather play it safe.
Keeping track of what's happening.
I suddenly developed doctor handwriting.
Dr. J: I mean it could take a variable amount of time for them to return to normal. But a week, maybe even two weeks is not horrifically abnormal. I mean the catheter would be comfortable, but I mean they'll have pain meds on board while they're in the hospital. It shouldn't necessarily be painful, there may be some pressure and then there could potentially be some irritation of the urethra that was engendered by the presence of the catheter and then when it gets pulled out, there are still some residual inflammation and such.
But it's not uncommon for them to go to the litter box more frequently and just get out smaller amounts for several days, even up to a week if not a little bit longer. The big key is, are they peeing, are they starting to improve and return to more normal urinations? Are they eating for you?
Are they acting normally? So unfortunately when they come home you really do have to keep an eye on them. And that really means being even more diligent about scooping the litter box and if you've got multiple cats potentially giving them their own room. And I would totally put in a Feliway diffuser, the pheromone diffuser to help decrease the stress in there, especially if they're not normally used to being in their own room. But that way they have their own litter box — make it a big litter box so they can easily get in and out.
And then scoop it, ideally twice a day or anytime after they go to the litter box, walk in there and check and see if they actually got anything out because if they're not, if they're not getting progressively more urine out or if they're not getting any urine out, you need to know that sooner rather than later so that they could go back in and be reevaluated. They might need another catheter. So unfortunately it is one of those things that there really isn't an easy, like, don't worry about it, you don't have to follow them really. What you're doing is right. I mean, I know it's a disconcerting and causing you less sleep and more stress. But...
Mazel's double-wide litter box setup with two different litter options.
He has a third litter box in another bathroom but strongly preferred the litter that tracked throughout the house.
Mia: It's also kind of scary, right? Because I, because we can't be there all the time.
Dr. J: Right, totally. And you know, it's not to say like, if you check them in the morning, like really carefully in the morning to make sure that everything is normal and then you've got to go to work, then, you've got to go to work. But when you get home you check them or maybe you have somebody like a friend or a neighbor or a roommate or whatever, checking on them and during the middle of the day, just again to be on the safe side. I mean there comes a point where you can leave them for a work day and not have to worry about it, but it's just, you should be starting to see the pattern of them acting more normally, eating, things of that nature.
Mia: Yeah. Well, speaking of eating, that's a good point because there's definitely the prescription food for them and I went home with a few samples and Mazel did not care at all about any of it. And I mean, I tried — well we can give tips and I think that they are very useful tips to try. Mazel just was not interested at all. But one of the things I did was I boiled a chicken, completely on its own, no spices, no nothing else, just water and the whole chicken, and used the broth from that. So I basically made a chicken broth, and I tried to put a little bit in his water to tempt him and also put a little bit on top of after giving it to him to try on its own, the prescription kibble. I poured it on top of that.
Mazel's version of Old Country Buffet
He had zero interest in that. I tried an attractant. I tried the nutritional yeast. I tried to put — and when this was kind of a last straw, was putting some of his old wet food, not old but, but his regular wet food on top of the new stuff. And he just was not into it, which got me really concerned because I didn't want him to be eating the food that got him, you know, that didn't help him, I guess, not develop this. And here I was given the prescription food for him to help get rid of it.
I should also mention no other medication to actually, like I don't, it doesn't seem like there is another medication to actually deal with the obstructions or the breakdown in crystals that you can give on its own. Because the only things that I went home with are the pain medication and the urethra relaxer. That's not, it's not its real name, but...
Dr. J: Well close, it's urethral relaxant.
Mia: Oh, look at me.
Dr. J: Yeah, so there you go. Not too far off. Yeah. I mean there's not, you know, unless there's a specific cause identified, it's tough to give a specific medication. So you gotta manage the problems that you know or suspect are there. So certainly discomfort. So pain medication and then something to relax the urethra and decrease the likelihood that it'll have spasms and cause another obstruction.
You know, the prescription diets can be quite useful for some cats. It just depends on what they've got going on. But, it's not uncommon for cats to reject a new food outright, especially if they've just had a hospital stay and potentially if they were exposed to that food in the hospital, they might have an association of that food with the hospital.
So, it's not unheard of — I mean, again, when coming home, it is important to follow the vet recommendations, but if you're having trouble getting them to eat the food, talk to the vet and see if there's some, some leeway there, if there's another food that you can try. And oftentimes just getting more fluid into them can be very helpful.
You certainly don't want to try and out-stubborn a cat with eating, especially if they're overweight because you could wind up with some very significant problems. But there are some tricks that you could do and a lot of them will work for a lot of cats frequently, as far as like you were saying, the nutritional yeast, sprinkling on, or the grated cheese or the Fortiflora probiotic, a lot of cats love the flavor of those. Warming up the food.
There's a whole host of things that one can do, but I think, not trying to out-stubborn them and talk to your vet and see how imperative it is that they eat that food right out of the gate. Or is it something that you can transition them onto over time or is there some way to adjust their current food to make it that it's less likely to have a problem?
Mia: Yeah. Okay, good. That makes me feel a little bit better. He did end up eventually eating some of his kibble on its own, but it took a while and I had to give him his regular wet food, like I just couldn't have him not eating anything. But I also did talk to my vet beforehand who said it was okay. Another thing that's like, I guess I just would hope for a little peace of mind or something. I guess that maybe this is just a venting session for me. I'm not even sure.
But I just want to know how we break the cycle because this can be brought on by stress. I can't imagine what would be more stressful, me being away for a couple of days or him getting a catheter put up his little self and being in the hospital.
Like it just seems like to me that would be incredibly stressful and traumatic and I just want to make sure that it doesn't become a terrible cycle, especially because the discharge instructions said something about the likelihood of recurrence happening, and it happens like in 30% of cats who have had a urethral obstruction — which is a large percentage in my head — and that it usually happens within the first two to four weeks is what they said. But also, a cat that has gone through this is I guess more likely to have it reoccur in the future either way. So I guess like how do I sleep at night from now on?
Dr. J: Well, I think you continue doing the things to decrease the probability of it happening again. I think you take additional steps, if we're worried about stress, evaluate whether or not there's other things that can be done in the environment, adding additional litter boxes, changing the position of the litter boxes, adding Feliway, adding more play opportunities, things of that nature. All that stuff to decrease stress. And then you do, you keep a close eye, and maybe you increase the percentage of wet food that he's getting. Again, he might need the prescription diet longterm, it just, it really depends. And then if going to the vet is stressful for him, in future episodes where it's more of an elective visit, like say to go in and have his urine rechecked, talk to your vet about medications that can help that you can give at home to help try and decrease that stress so it's not as stressful for him.
So there are things that we can do to decrease the risk of it happening again, to decrease the stress associated with it. And that might predispose to it, but unfortunately, like you said, being in a hospital with a urethral catheter placed and stuff would be stressful. Yeah. I would imagine it would be, but it's necessary.
So sometimes we've got to do it and then we just try and mitigate the stress and the probability of it happening again. And I think you're doing all the right stuff. I mean, we've got the survey on the website that I think we've now got over 2,700 people that have taken the survey, whose cats have gone through urethral obstruction. And every story is different. Every story is quite heartbreaking. But there's a different solution to every case because there's a different predisposing factor or set of factors. So it's really taking stock and evaluation of the setup that you have in your home. And I'm not saying you specifically, but people with their cats either proactively to try and prevent this from ever happening or after the fact to try and decrease the risk of it happening again. And that's important. And then just continuing to keep an eye and being aware.
Mia: Yeah. Thank you. I will try to sleep at night. And you mentioned our survey, if any of you listening are interested in taking our survey, I will post a link to it. It is our urethral obstruction survey to talk about your experience or even just like if you just learned about it now, we'd like to hear about that too, right?
Dr. J: Well, and don't forget Mia, we've actually got the two surveys, the urethral obstruction one is specifically for people that have experience with urethral obstruction, that they've had at least one episode. But we do also have — so we should be sure to share the two — we do also have one that's just a general survey about how people feed and do the litter box set up for their cats, because what we're trying to find are any patterns that we could then add to the body of data to say, hey, this can help be protective. So yeah, if you have cats, there's definitely a survey for you to take. If you have a cat that's had a urethral obstruction episode, there's the one and then if you have a cat even that hasn't, then there's another survey for you to take. And to help us help more and more cat owners would be great.
Mia: Thank you for that clarification.
Dr. J: Yeah, it can be tough because we've got a lot of surveying, a lot of stuff on the site.
Mia: It's true. Well, we're running out of time here, but I just, we've been teasing to it a lot, but I just want to give a shout out to pet insurance. If anybody is questioning it. If it is within your budget at all, just really do yourself a favor and do it. Between the initial check, which was cheap compared to everything else, when we brought him in and he had to be hospitalized, if you added together, or even don't add together, on its own, it was $1,500.
Dr. J: And that's actually pretty common costs. When I was in the E.R. I'd always quote people, depending on where in the country I was, but I mean, expect it to be like $750 to $1,500 or so for urethral obstruction episode.
Mia: And that's for one night.
Dr. J: Yeah. And then it goes up from there if they re-obstruct.
Mia: Well I was quoted...So what happened was I was quoted for the low end, which would be for one hospital stay, and then quoted another quote for a two night hospital stay, and I had to, before we left I had to pay the entire
Dr. J: Low end.
Mia: Exactly. Which I get but, I was like, thank God I had room on a credit card. Like I don't, I honestly don't know how — it was scary! It was very scary.
Dr. J: And that's actually probably another podcast episode, Mia, about like being prepared financially for emergencies because there are, you know, Care Credit and other things, which is a really important topic. But yeah, these things are not inexpensive and certainly if they re-obstruct, and then if they obstruct three times you're looking at the decision for potentially a surgery called perineal urethrostomy, which can greatly help to decrease the chances of it happening again.
But again, that's additional cost and potential complications. But I would second your shout out for pet insurance because I think well, I don't think, I know it saved a lot of pets' lives. So at least insurance for accidents, illnesses and emergencies for your pets. I really can't recommend enough.
Mia: Yeah. This has been just a very eyeopening experience for me and thank God I did get it, but I was really hoping to never have to use it.
Dr. J: Well your goal with pet insurance, like homeowner's insurance and all that stuff is to lose money on it.
Mia: Right, absolutely.
Dr. J: Just to not have to use it. Unfortunately, oftentimes you have to use it. And you'll be thankful that it was there.
Mia: Dr. J, I mean, thanks for basically creating Preventive Vet around this.
Dr. J: Yeah. Now if we can just do away with cases of UO, or at least help people get to the E.R. early like you did, that's mission accomplished so far as I'm concerned.
Mia: Right on. Well, you've already helped me and looking at the comments section of some of our articles on UO, very helpful for others too, so thank you so much for that. As always, if you have a question for Dr. J, please feel free to write in, and we'll be back with another podcast soon. Thanks again, Dr. J!
Dr. J: Thank you for sharing your experience and give Mazel a little scratch on the chin for me.
Mia: Will do.