Feline Urethral Obstruction, a Common Cat Emergency

I'm superstitious and I know it. I holler at my staff when they exclaim what a peaceful day it has been in the clinic. Such statements practically guarantee that a complicated life threatening emergency will walk in the door at 4:55 p.m. I find myself "knocking on wood" to secure little blessings and remarkable recoveries. Also, I am convinced bad things (or just plain weird things) happen in threes.

Within a 24 hour period this week, we had three feline emergencies -- urethral blockage.

Male cats have a narrow urethra, the tubular passage from the urinary bladder to the outside world. Because it is so narrow any number of things can plug it up causing an excruciating and life threatening emergency. Bladder stones, "crystals," mucus and blood clots can get stuck anywhere along the urethra preventing the cat from emptying his bladder.

Signs this is happening include spending an inordinate amount of time in the litter box, licking excessively under the tail (specifically the penis), straining so hard to urinate that stool comes out (or vomit), yowling in pain (especially when touched on the belly), walking funny (because the bladder, located between the hind legs, is distended and painful), decreased appetite or thirst, or hiding.

A male cat crying while repeatedly posturing
to urinate yet producing little or no urine
can signal urethral obstruction, a life
threatening veterinary emergency

By the time most owners notice these signs, the cat has already been blocked for several hours. A "wait and see" attitude in a blocked kitty will result in a dead kitty. If the cat is not seen by a veterinarian for treatment the bladder will continue to stretch (sometimes causing permanent damage to the muscles and nerves involved in contraction) and may rupture, kidney function will be compromised, and vital electrolytes will go haywire. In particular, if the potassium gets high enough the cat can have a heart attack and die.

Any time an owner calls worried about a male cat yowling in pain or straining to "poop or pee" I want to see it immediately. Urethral blockage is usually pretty simple to rule out, so I'd rather be safe than sorry if the cat is acting weird for some other reason!

No two "blocked" kitties are the same. However, I generally follow a certain diagnostic and treatment protocol initially:

Yellow arrow points out numerous large bladder stones in
this cat which will require surgical removal

1. Take x-rays of the abdomen to determine if there are bladder stones that need to be surgically removed after dealing with the immediate problem of "unblocking" the cat. 
2. Perform bloodwork to assess kidney function, electrolyte balance, blood counts, and more. 
3. With the cat under sedation a urinary catheter is passed to relieve the pressure in the bladder.
4. A urine sample is obtained to check for infection, crystals, kidney function, etc. Medications and diet changes may be prescribed based on this information.
5. The kitty is hospitalized for one or more days while we flush the bladder, treat infection, rehydrate the patient, rest the kidneys and balance electrolytes. 
6. After the urinary catheter is removed the cat is closely monitored to make sure he does not re-block.

Most cats who have been treated for urethral blockage require special lifelong management at home. This often includes a prescription diet made to dissolve and prevent crystals from forming. Canned food is recommended to increase water consumption and flush the bladder of crystals and cellular debris. Unfortunately some cats with recurring obstructions require special surgery to open up their urethral opening so they "pee like a girl cat" and are less likely block again.

Cats are famously good actors. They hide discomfort and serious illness until the last possible moment. Routine veterinary care including periodic blood and urine tests is very important for keeping cats healthy especially as they age. Subtle changes in your cat's weight, appetite, thirst and litter box habits, socialization and behavior can signal important changes in health. Trust your instincts and get him to the veterinarian!