The Urinary Tract

Before we dive into all the different types of urinary tract diseases and other health concerns, I want to make sure we break down the different components of the urinary tract and understand why it is so important that it stays healthy and able to perform its duties. The urinary tract consists of the kidneys, ureters, bladder, and urethra. The ureters are tubes that connects the kidneys to the bladder. The urethra is the tube that carries the urine from the bladder to outside the body. The urinary tract can be separated into two parts to better identify a concern or describe a diagnosis. The upper urinary tract includes the kidneys and ureters. The bladder and urethra make up the lower urinary tract. An issue affecting urinary health can occur at any point, but concerns are most commonly seen in the lower urinary tract.

Urinary tracts perform several important tasks and can have big effects on health when not functioning properly. One key role it plays is filtering the blood of waste products from bodily processes such as converting food to energy. It also helps to maintain the correct balance of water and electrolytes and helps process vitamin D. The urinary tract has a role in the production of hormones that maintain healthy blood pressure, blood cell production and ensures our bodies are absorbing salt correctly.

Common Urinary Tract Issues & Symptoms

We are going to go through the common urinary issues and a few that are not too frequently seen but can be quite serious. One of the most common urinary issues, also well known for humans, is the UTI. It stands for urinary tract infection, but it is used to describe infection of the lower region of the urinary tract, the bladder and urethra.

Another term you may frequently hear if your pet suffers with a urinary issue, is Lower Urinary Tract Disease. This is a general term to describe multiple health problems of both the bladder and urethra. This could include infection, sterile cystitis (inflammation without infection), and the presence or signs of crystal formation.

Specifically for cats, the term FLUTD is used, meaning Feline Lower Urinary Tract Disease. It is not a specific condition but a general term to cover a variety of lower urinary tract issues like infections, crystal & stones, and FIC (feline idiopathic cystitis/inflammation). FIC is a very common condition where there is inflammation of the bladder from an unknown cause. This can lead into secondary infections, but the infection is not what causes FIC.

A urinary issue that can go unnoticed for quite some time is bladder stones, though these can be very serious when left untreated. This is when crystals have formed into stones in the bladder. These stones can build up and are more likely to block the opening from the bladder to the urethra. Some stones may even travel down the urethra and get stuck at a narrower opening, completely blocking the flow of urine. This results in the bladder filling up which causes a lot of pain and discomfort for our pets. This is called an obstruction and is an emergency situation as urine cannot exit the body. Since the urine has no where to go it can back up to the kidneys, causing permanent damage or it can rupture the bladder and release toxins into the abdomen, causing the patient to become septic. This helps explain why prevention is so crucial; it can go from completely unnoticed to an emergency situation within a day or two that could possibly result in death. We will get to treatment and prevention information, but identifying the type of stones comes first. The two most common minerals that make up the stones are calcium oxalate and struvite. Now slightly less common but still a concern is ammonium urate crystals and stones.

Sadly, some urinary issues can be explained by bladder cancer, though this is not nearly as common as the above lower urinary tract issues. The most common type is transitional cell carcinoma. It typically develops in the trigone area of the bladder which is where the urine exits into the urethra, and it is very painful. Its placement is what causes the similar symptoms to UTIs and lower urinary tract disease.

The last lower urinary tract issue we will discuss is urinary incontinence. It is most often seen in females, but it can also occur in males as well. It is the leaking or spotting of urine, in large or small volumes and our beloved pets are unaware it is happening. It is the loss of control that can happen while they are asleep/relaxed and may also dribble while standing or walking.

It is very hard to diagnose specifically between these issues just based on symptoms as they share many of the same, apart from incontinence signs. This includes frequent urination, small urine volume, blood in urine, straining to urinate, fever, and urinating in inappropriate places. You may see your pet frequently licking their genital area, hiding, or you may notice subtle, unusual behavioural changes. It is very important to take your pet in to be seen to ensure the correct treatment plan is administered for this specific concern.

Upper Urinary Tract Disease such as infections are much less common but can be very serious and painful for our beloved pets. This is the infection of the kidney or ureters. Kidney issues are not as common and not as high up on the list of concerns for urinary health, but it is still important knowledge to know. This includes issues like kidney failure, kidney infections and kidney stones. If they are experiencing a kidney issue it may be confused with a Lower Urinary Tract Disease because they show the same initial signs. Those experiencing kidney issues, such as kidney failure, may also experience decreased appetite, urinating in large volumes, weight loss, vomiting and diarrhea.

Causes & Predispositions

For many pet owners, the big question is “why did this happen?” Some pet parents will have cats and/or dogs with no history of urinary issues and then they have one pet that experiences reoccurring urinary issues with no obvious explanation. There are many factors that can affect our beloved pets’ urinary tract health, and it may be more than one depending on their circumstances. Age, breed, activity level, stress, diet, drinking habits, injury and underlying conditions can all play a role in the development of urinary tract issues.

Urinary Tract Disease/Concern	Potential Causes	Those at Increased Risk
Lower Urinary Tract Disease & Feline Lower Urinary Tract Disease	o Genetics o Cystitis (inflammation) o Diet o Dehydration o Imbalance of bacteria o Poor hygiene o Stress (FIC) o Sometimes unknown	o Age – our older pets have a decreased immune system performance and/or grooming issues due to mobility. ·  More likely for bacterial imbalance or inflammation to occur. o Those suffering from underlying conditions such as kidney disease, hyperthyroidism, and immunocompromising disease o Those with diabetes mellitus ·  Increased glucose in the urine making the perfect environment for bad bacteria to thrive. o Poor body condition ·  Are not able to groom themselves thoroughly and may result in bacterial imbalance
UTIs (Urinary Tract Infections)	o Abundance of bad bacteria · From outside the body to urethra and bladder · Most commonly E. coli o Can occur secondary to another underlying urinary problem (crystals, stones, or cancers) o Genetics o Diet o Dehydration o Cystitis (inflammation) o Poor Hygiene o Stress	o Females · More likely to experience UTIs as the vulva and anus are so close in proximity. o Pets experiencing gastrointestinal issues. · More likely to experience diarrhea or loose stools, leading to increased chance of bacteria entering the urethra. o Age – our older pets have a decreased immune system performance and/or grooming issues due to mobility. · More likely for bacterial imbalance or inflammation to occur. o Those suffering from bladder stones/crystals · Irritation of the bladder and urethral lining can lead to UTIs. o Those suffering from underlying conditions such as kidney disease, hyperthyroidism, and immunocompromising disease o Those with diabetes mellitus · Increased glucose in the urine making the perfect environment for bad bacteria to thrive. o Poor body condition · Are not able to groom themselves thoroughly and may result in bacterial imbalance.
Urinary Incontinence	o Weak Sphincter muscle control (at the bladder exit to urethra) due to: · Genetics · Injury · Cystitis (inflammation) · Stress · Cancer · Hormone imbalance · Sometimes unknown	o Age – Our older pets have decreased sphincter control. o High anxiety pets o Females – more likely to have/develop weak sphincter muscle control. o Urinary Tract Issue History · Damage from past urinary tract diseases/concerns o Urine retention · Holding urine from stress or fear
Calcium Oxalate Crystals/Stones	o Genetics o Cystitis (inflammation) o Diet o Dehydration o Imbalance of bacteria o Poor hygiene o Stress o Sometimes unknown	o Age · Our older pets have a decreased immune system performance. · Increased levels of calcium in the blood and urine o Those suffering from underlying conditions such as kidney disease, hyperthyroidism, and immunocompromising disease o Those with diabetes mellitus · Increased glucose in the urine o Urinary Tract Issue History · Damage from past urinary tract diseases/concerns o Miniature Schnauzer, Bichon Frise, Lhasa Apsos, Yorkshire Terriers, and Shih Tzus are genetically predisposed.
Struvite Crystals/Stones	o Genetics o Cystitis (inflammation) o Diet o Dehydration o Imbalance of bacteria o Poor hygiene o Stress o Sometimes unknown	o Age · Our older pets have a decreased immune system performance. · Increased risk of infection leads to struvite formation. o Is the most common stone found in younger pets as well due to hygiene and immune performance. o Those suffering from underlying conditions such as kidney disease, hyperthyroidism, and immunocompromising disease o Those with diabetes mellitus · Increased glucose in the urine o Urinary Tract Issue History · Struvite formation is commonly due to a UTI, bacteria produce urease (increases mineral concentration) · Damage from past urinary tract diseases/concerns o Miniature Poodles, Pekingese and Dachshunds are genetically predisposed.
Ammonium Urate Crystals/Stones	o Genetics o Cystitis (inflammation) o Diet o Dehydration o Imbalance of bacteria o Poor hygiene o Stress o Sometimes unknown	o Age · Our older pets have a decreased immune system performance. o Those suffering from underlying conditions such as kidney disease, hyperthyroidism, and immunocompromising disease o Those with diabetes mellitus · Increased glucose in the urine o Urinary Tract Issue History · Damage from past urinary tract diseases/concerns o Yorkshire Terrier, Maltese, Pugs, and Miniature Schnauzers are more likely to have a congenital liver condition that increases ammonia in the blood, leading them to be more likely to experience ammonium urate stones. o They may also be more predisposed if they have inherited a defect in uric acid metabolism, seen in English Bulldogs and Dalmatians.
Obstruction	o Build up of crystals and/or stones blocking the flow of urine	o Those with a history of bladder stones and UTIs o Male cats · Urethra is long and narrower than females

How Do We Diagnose & Treat

As many of the symptoms and potential causes overlap across different urinary tract diseases and concerns, diagnostic testing is key to pinpoint the problem and offer the most effective treatment. The minimum diagnostics performed for urinary issues is a physical exam and urinalysis. A basic urinalysis checks for specific gravity (ability to concentrate urine), pH levels, presence of bacteria, blood, protein, inflammatory cells, crystals, glucose, and other indicators or urinary tract health and abnormalities.

Your veterinarian may also suggest further testing such as bloodwork, x-rays, or ultrasound to get a better idea of any underlying conditions or structural abnormalities that may be contributing to urinary tract symptoms and concerns. For UTI suspicions they may also recommend a urine culture and sensitivity. This helps to guide antibiotic usage to ensure the treatment is effective and decrease the chance of developing antibiotic resistance.

While waiting for diagnostic results, they may prescribe a pain medication and/or anti-inflammatory, as these conditions can be very painful and stressful for our pets. These help to provide relief and decrease the inflammation of the bladder to aid in healing and discomfort during urination. If your pet is prescribed antibiotics, it is crucial to give the entire course! Do not stop the medication because your fluffy friend is feeling better and back to their normal selves. The infection can return very easily if not taken care of properly and can lead to antibiotic resistance and tougher treatment route down the road.

Treatment for urinary incontinence may be a combination of a few medications as well. The treatment plan can consist of medications for sphincter tone, hormone replacements, and anti-anxiety medications. For severe cases, surgical intervention is sometimes a suitable option too.

If your pet is experiencing or suspected of experiencing an obstruction, confirming with an exam and possibly x-ray will be the first priority before jumping right into treatment. Obstructions will require sedation, flushing, and placement of a catheter to relieve the blockage and pressure on the bladder. This is followed by a few days of hospitalization as the stones shifting and blocking the flow again is possible. This is then followed by treatment to dissolve the stones. If the stones are too large to dissolve, surgical intervention to physically remove the bladder stones may be required.

Many of the urinary tract diseases will include a recheck exam or repeat urinalysis within the treatment plan. This may seem like your veterinarian is over doing it, but it is to ensure any infection, inflammation or signs of stones are truly gone or to ensure there are no negative/unexpected side effects occurring. Severe UTIs may require a longer course of medication. If the symptoms are not improving, your veterinarian may request an additional urinalysis or further testing to ensure there is no underlying condition that is causing the persistent infections. We do not want to leave any underlying condition untreated as the pet is bound to suffer from another secondary health condition.

Prevention

Now you may be saying, “We have identified and treated the problem, but how do we stop it from happening again?” Now prevention is not guaranteed, as some causes are not fully understood, and some pets are prone due to their breed & genetics. About 50% of pets with bladder stones experience a reoccurrence within 2 years. With this said, many researchers have found preventative methods that can be used in combination to decrease the likelihood of a persistent urinary issue or developing a urinary issue to begin with. There are a few areas that we can implement changes to help boost urinary tract health. This includes their diet, hydration, grooming practices, bathroom practices, stress management, and supplements/medications.

Preventative Method	Details
Diet	o High moisture content o High in protein, low in carbohydrates · Quality ingredients help limit inflammation. · High carbohydrate diet is linked with stone formation. o Helps to prevent the formation of stones and flush out the crystals. o Foods low in phosphorus
Hydration	o Adequate water intake dilutes the minerals, toxins and irritants building up in the bladder. · Flush crystals before they can form. o Constant access to fresh, clean water o Entice them with running water or flavour with bone broth. o Cat water is a great option to help maintain the correct pH balance of the urinary tract. · Minimizing stone formation and bacterial imbalance.
Grooming & Body Condition	o Maintaining a healthy weight helps to ensure proper grooming practices and a healthy skin & coat. o Mats keep bacteria from urine and feces close to the urethral opening and leads to increased infections and possibly stone formation. o Regular brushing and/or bathing can help reduce matting and debris accumulation. o Pets who are overweight or suffer from arthritis are more likely to need assistance with grooming as they cannot reach the crucial areas.
Bathroom	o Dogs may benefit from more frequent bathroom breaks. o Provide an area to do their business that is a quiet and low traffic area. o Cleaning litter boxes more frequently · Helps to monitor any changes and catch the problem early. o Have an adequate number of boxes/cats.
Stress Management	o Stress can occur from anxiety over a recent change or addition in the house, boredom, or the inability to perform their natural tasks. o Work on anxiety coping training methods or medications. o Ensure cats have high places to relax in. o Toys, scratching posts, safe space and playtime can help limit their stress levels. o Feliway, Adaptil pheromone sprays and other calming products can help minimize stress when unavoidable circumstances occur
Supplements & Medications	o Your veterinarian may be able to prescribe calming medications to help ease their stress & anxiety levels. o They may also be able to provide medication to keep the urethra more open to allow for better urine flow. o Supplement antioxidants into their diet to support their natural defenses. · They protect against free-radicals that damage the tissues and can cause chronic urinary issues. · Free-radicals are produced as a product of inflammation, which occurs from irritants in the bladder. · Cranberries, blueberries, kale o Supplement anti-inflammatories into their diet to slow the effects of aging and boost the immune system. · Reduces pain & discomfort caused by inflammation of the urinary tract. · It blocks the production of prostaglandins which causes inflammation. · Turmeric, omega 3s, spirulina

Prevention may seem like extra research, work, and cost, but it helps to avoid the pain & discomfort our pets will experience, making it all worth while. Not to mention it helps to avoid those big vet bills.

If you have any further questions on urinary health and what you can do to boost their health, please see our Healthy Pet Care Specialists that are happy to discuss tips and tricks to maintain a healthy urinary tract.