Ask Dr. Amy: July 8

Dear Dr. Amy,
My orange male tabby, “Pumpkin”, had a 3 day hospitalization at our vet for a “blockage” where he couldn’t urinate in the litter box. He was very sick and seemed very uncomfortable. This was a scary emergency for us, what causes this and how can we prevent it from happening again?
Shannon in Wesley Chapel

Dear Shannon,
I’m so sorry Pumpkin and your family experienced what we call “urethral obstruction”. This is an unexpected emergency when a cat has a blockage in the urethra that communicates between the bladder and the penis- not allowing urination to happen. Often times, this is caused occasionally by stones, but usually by infection, inflammation, and often microscopic crystals that predispose to both.

The best way to prevent recurrence is to determine the cause at the time of the first obstruction. Vets do this by collecting a urine sample after passing a urinary catheter under sedation to re-open the urethra and flush out the bladder until the urine is as clear and dilute as possible from debris and inflammatory cells. The urine is spun down in the lab via a centrifuge, and examined microscopically for crystals, bacteria, red blood cells and white blood cells. If a severe infection is present, some of the urine can be submitted for a culture to determine which antibiotics would be sensitive and most effective. This isn’t always performed, but often is a great benefit in emergency cases to avoid recurrence.

In situations where crystals are present, my experience with dissolution diets such as the newer Royal Canin SO diet to eliminate their presence in the urine has been wonderful (I’ve even dissolved stones in the bladder in just weeks), or the Hill’s s/d. I also recommend owners to purchase circulating water bowls (i.e. Drinkwell or Pet Mate), to encourage increased water consumption. The SO diet also supersaturates and creates more dilute urine as well, thus reducing the amount of crystals and inflammatory cells passing at one time through the urethra.

If no pre-existing kidney disease is present, anti inflammatories such as Metacam may speed the recovery after a blockage, and pain medications such as Buprenex combined with anti-spasm drugs during urination such as Phenoxybenzamine usually help owners get their pets back to comfortable urination habits again within the first 3-5 days. Close follow-up with your vet for additional urinalysis in the future (I usually do one 2 weeks later, and perhaps 6 weeks) to monitor for recurrence or resolution of problems will help stay ahead of future emergencies. In rare cases when a patient has repetitive obstructions that do not respond appropriately to medical and dietary therapies, there are surgical options called a “P.U.” or perineal urethrostomy to reduce another crisis. This is a significant decision to undergo, and happens much less often now with the dietary advancements we have seen in this area over the last 10-15 years.

It is extremely important to watch Pumpkin for signs of straining to urinate, frequent urination, blood in the urine, or crying while urinating. If any of these occur, recheck with your regular veterinarian immediately. A patient who has been unable to urinate for an extended period of time runs the risk of bladder rupture, kidney damage, as well as cardiac arrest from the retention of potassium in the body that is normally released in urine. As these levels rise, patients become much more critical. With quick response and proper emergency therapy, these patients can have a great prognosis and recovery. Good luck!

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