Bloody Urine. What to do when it's your cat's?

Cameron

The cosmos is sending me a flurry of bloody urine kids recently. As Sherlock Holmes would say, "There has to be a reason?" I guess without being able to put my finger on it I am left to deduce that is just the universe begging me to put another blog out for others to benefit from. (After 5 pets I got the message and got my butt to the desk to type this).

There are two ways these cases present at the clinic.

1. Due to the lack of an opposable thumb your cat is unable to grab a marker and write on the walls "Need a little assistance here!" and so they are left with the next best way to inform you of their plight by peeing on your clothes, your bed, the carpet, or whatever place that isn't the one you provided. After the anger passes you notice that there is a pink tinge to the urine and you think, "Huh? maybe Fluffy is trying to tell me something?"
2. Your cat seems to have developed a special affinity for the litter box and is repeatedly posturing to urinate/defecate, or you hear screams, moans, whimpers from the box as they are straining to take care of business.

To cement my point;

Your cat is only NOT GOING IN THE BOX, BECAUSE THEY NEED YOUR HELP.

They are not mad at you, they do not harbor spite, regret, ill-will, or any tiny yearning for you to look at them with disapproval, disappointment, disgust, or the most popular reason cats are sent to shelter/ purgatory/death.

Every cat with abnormal or inappropriate urination, (or even acting oddly in any way shape or form), warrants a trip to the vet.

Every vet has seen a cat die from a urinary blockage. A blocked cat is, in almost all cases, a treatable, reversible condition that if treated early enough can be completely cured.

Which leads us to discussing;

What are the urinary health clues to look for;

1. Any cat appearing to have difficulty passing urine,
2. Licking at the genitals,
3. Frequently visiting the litter box,
4. Producing small amounts of urine,
5. Any change in color to the urine, (Even absence of color denotes a possible medical problem),
6. Foul smelling urine,
7. Not using the litter box, (going outside of the box),
8. Painful belly,
9. Distended belly,
10. Reluctant to move,
11. Lethargic,
12. History of urinary tract infections, urinary blockage, crystals in the urine, etc.

Cameron snuggles with his mom.

My opening line to any and every urinary tract patient, suspected or otherwise, is the same. It is a simple and time proven dialogue.

Start with a physical exam! Because if your cat is blocked you won't be able to get a urine sample, (as you are waiting your cat might be dying). If you see your pet straining, or producing small amounts of urine bring in a urine sample if or when possible.

Cameron arrived with his mom and a small pill bottle sample of red urine. Cameron had a history of urinary problems. His writing on the wall is peeing in the dirty laundry bin. Of great benefit to both all of the laundry was done and the urine was visibly bloody. Mom poured a sample into a bottle and headed to us for a visit.

It is worth mentioning that there are a few important things to discuss about urine samples;

1. The urine sample must be fresh. Get it to the vet as soon as possible. If you can't deliver it immediately place it in the refrigerator for storage. After 24 hours it should be thrown out.
2. If, and when possible, obtain and use the first morning urine sample. These are the most accurate when we are analyzing concentrating ability, (i.e. how well your kidneys are working).
3. Catch the sample midstream in a clean dry vessel. Last week a client delivered a sample that they had "scraped off the ground." We cannot separate dirt, mud, asphalt, cat litter (they do make sterile plastic litter for use in trying to get a urine sample from cats), or the dirt, bacteria and normal floor flora of your home. Don't waste your money analyzing a contaminated sample.
4. Urine samples are best analyzed in the clinic as soon as possible. Crystals and sediment is influenced by time delay, shipping and handling. 
5. Cystocentesis is the preferred method of collection in many cases. I know it sounds scary but veterinarians routinely use a needle and syringe to collect a urine sample from the bladder. 
6. An ultrasound can be invaluable at looking at the internal surface and contents of the bladder. It is also very helpful in obtaining a cystocentesis in a small bladder.
7. There are those urine samples that are so bloody they are difficult to assess for bacteria. If this is the case do a follow up urine sample as the color of the urine returns to clear or yellow.

Here's the thumb nail version of my bloody urine speech. Hematuria (blood in the urine) is a sign of a problem. The presence of blood DOES NOT diagnose infection. To diagnose a urinary tract infection you must have BOTH BACTERIA AND WHITE BLOOD CELLS in the urine. Sometimes we do see blood concurrently with infection, but often we do not. 

Hematuria

In veterinary medicine we do a very poor job of differentiating and diagnosing INFECTION VS INFLAMMATION. We skip a lot of important steps (often to save money), but we do so at the expense of our patients.

Inflammation will often cause blood to appear in the urine. 

There are a few things that influence urinary tract problems. They include; 

• Genetics. We can't change your genetics, so, we move on to..
• Exercise. There is a correlation to obesity and overall general health. Keep your pet at a healthy weight, trying to treat other diseases without addressing this is almost always futile, and ultimately costs your pet their quality of longevity.
• Diet. This is imperative to be talking about. Listen to your vet and keep your mind open to different foods that just might cure your cats urinary problem. Heck, in almost all urinary disease cases I believe the diet CAUSED the urinary issues. I suggest a high quality wet food with added water. I see most of the UTI cases eating cheap, poor quality dry cat food.
• Disease. Recurrent UTI's warrant further diagnostics. Look for things like diabetes, allergies, bladder stones, etc.

If you or I saw blood in our urine we would go to our doctor, provide a fresh urine sample that would be immediately checked with a urine dipstick. From the doctors office the sample would go to a lab where it would be grown in a petri dish to diagnose the type(s) of bacteria present AND the best antibiotics to treat that specific bacterial infection. This is called a culture and sensitivity. We often skip this test due to cost (about $100) and just provide antibiotic for two weeks.  

Without a C &S we guess what bug your pet has AND we guess which antibiotic is best to use AND we guess that we gave you enough to kill every bug. If the infection returns we don't know if we guessed any of these wrong. Guess less by doing a C & S.

A few  keys take home points:

1. A straining cat can be a blocked cat and THIS CAN BE FATAL QUICKLY. Get to the vet immediately.
2. Once you have one infection you are predisposed to others. Watch the size of the urine clumps in the litter box and encourage water intake. I love water fountains.
3. Talk about diet and change the diet if needed. You get what you pay for and you are what you eat. I don't quite know why but vets don't discuss enough about why these happen, how to best diagnose them, treat them, or avoid them. It is my goal to not have your pet suffer twice with the same affliction. This is only attainable by discussing your pet with your vet.
4. A cat not using the litter box is a cat begging for help. Not a reason to surrender, euthanize and NEVER EVER PUNISH A CAT. It is ineffective in all cases and will back fire on you every time.

Our last batch of summer 2014 babies up for adoption.

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If you want to talk to me about a pet care related item you can find me in person at the Jarrettsville Veterinary Center, in Jarrettsville Maryland.

You can also find me on Twitter @FreePetAdvice.