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Stress and Lower Urinary Tract Disease in Cats

Lower urinary tract disease is the number one reason cat owners bring sick cats to veterinarians.(1)  Lower urinary tract disease includes problems with the bladder and urethra, and can include feline idiopathic cystitis, urinary stones, and urinary tract infections.  With feline idiopathic cystitis or urinary stones making up about 80% of feline lower urinary tract disease cases,(2) management of these conditions is essential to the wellbeing of a large number of cats.  Clinical signs of lower urinary tract disease in cats include straining to urinate, urinating outside the litter box, and having blood in the urine.
Management for lower urinary tract disease can be medical, surgical, or nutritional.  Medical management can include antibiotics to treat urinary tract infections, or pain medications to help alleviate discomfort associated with lower urinary tract disease.  Surgical management may be needed for urinary stones, but the necessity for surgery depends on the type of urinary stone present.  Nutritional modification with a therapeutic urinary diet can be utilized to dissolve struvite stones, and diet can also help prevent recurrence of both calcium oxalate or struvite stones.
Many cats with feline idiopathic cystitis or urinary stones have other health conditions in addition to lower urinary tract disease.  Conditions such as skin conditions, obesity, and stress are seen frequently in cats and can occur in conjunction with lower urinary tract disease.  Multiple health conditions can occur simultaneously and are fairly common in cats.  One common issue is concurrent stress/anxiety and lower urinary tract disease in cats.
Signs of stress and anxiety in cats are commonly in response to environmental changes or stimuli.  Examples of environmental changes include a new baby in the house, moving, a new pet in the house, or owners going out of town.  Clinical signs of stress include urinating outside the litter box, digestive problems such as diarrhea or constipation, and excess grooming, which can cause issues with hairballs and hair loss.  It is often difficult to tell when cats are stressed, and signs of stress can frequently manifest as physical health conditions.
Management for stress and anxiety in cats can include environmental modification to reduce stress, medications, and diet.  Environmental enrichment includes litter box management such as increasing the number of litter boxes in the household, changing the litter box type, and/or changing the litter type.  Environmental enrichment can also include increasing ways for cats to interact with their environment such as toys, scratchers, and climbing places.  Medications can help reduce anxiety.  Finally, dietary components can help reduce stress.
When both stress and lower urinary tract disease are present, stress may worsen the clinical signs of urinary disease.  Stress can be a component of feline idiopathic cystitis, the most common cause of lower urinary tract disease.  Managing both conditions can be tricky, especially since medications are difficult for cat owners to administer.  Diet is often a good option to treat these conditions, as mentioned above.
Often, veterinarians are forced to prioritize problems when there are multiple issues present that both require nutritional management.  However, if your cat has multiple health conditions, your veterinarian will be able to help determine how to treat both conditions in your cat.  In some cases, if the cat has more than one issue, there may be a diet that can help treat both conditions.  Veterinary therapeutic diets are frequently required to manage these multiple condition cats and your veterinarian can help advise you on the best option for your pet.


Visiting your veterinarian at least twice yearly for check-ups and for any health problems that may arise in between those visits can help your veterinarian catch issues early, allowing for better management of one or multiple health conditions.


  1. Top 10 Most Common Medical Conditions for Dogs and Cats, VPI, data from 2014.
  2. Gerber et al. Evaluation of clinical signs and causes of lower urinary tract disease in European cats.  J Small Anim Pract, 2005; 46:571-577.
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