Urinary Tract disease in dogs and cats

Keeping Your Pet’s Urinary Tract Healthy

Your dog or cat’s urinary tract can be the source of many minor and serious issues, ranging from bladder stones, bladder infections, and chronic inflammation. Therefore, it’s important to employ preventative techniques and therapies to keep your dog’s urinary tract in great shape!

About the Urinary Tract
Urine is created in the kidneys, then stored in the bladder before being expelled. Urine contains 95 percent water and its primary function is removing waste products from the body.  Those waste products make up for the other five percent of urine and normally composed of toxins, uric acid, mineral salts, and other forms of waste.

Urinary Tract Problems and Symptoms
First off, let’s talk about some of the issues that can arise in the urinary tract. Common symptoms include urination with greater frequency, straining, licking of the urethra, and changes in urine (presence of blood or severely concentrated urine). When viewing urinary health in a holistic sense, it’s essential to consider diet and environment. Stress can also be a major factor in cats. In cats the term FLUTD (Feline lower urinary tract disease) is often used to described various diseases symptoms presented.

Urinary crystals and stones are one of the most common complaints in dogs. Crystals and stones are formed when naturally-occurring minerals in the pet’s urine bond together. When enough crystals form, it can partially block the excretion of urine. Stones are an advanced form of crystals.  These are the types of stones that can be found in your pets: struvite, calcium oxalate, urate, cystine, calcium phosphate, and silicate. If you are interested in seeing what urinary crystals look like under a microscope click here to access the Cornell University website.

There are two more common types of crystals and stones: Struvite Crystals and Calcium Oxalate Crystals. Struvite crystals are made of magnesium ammonium phosphate, developing in urine ph that is highly alkalic, while Calcium Oxalate Crystals are formed in urine that is highly acidic.

Bladder stone I removed from a 55 lbs Boxer

Bladder stone I removed from a boxer

For many years, Struvite crystals were the most popular form of crystals to affect household pets. However, in an effort to hopefully dissolve and prevent crystals from occurring, many pet food manufacturers created high-acid diets. Unfortunately, as the pet food formulations changed to accommodate Struvite crystals, calcium oxalate crystals started to rise and become just as common as Struvite crystals. Your pet’s diet may be the reason for this.

When determining what type of crystal your dog or cat has, it is necessary to have your veterinarian perform a urine exam, known as a urinalysis. It is also important to know whether their urine is more concentrated or diluted. For pets with super-concentrated urine, your vet can give tips on how to dilute their urine.

Bladder Infections or Inflammation (Cystitis) are caused by bacteria and crystals that have led to inflammation in the lining of the bladder. Antibiotics for 2-3 weeks are typically the prescribed treatment for bladder infections. Pets treated with only 7-10 days of antibiotics will often have recurring infections because the duration of treatment is not long enough. Although as a holistic pet owner you may wish to avoid antibiotics, for many patients with bladder infections, it can be crucial in preventing formation of crystals as well as reducing the chance of developing scar tissue in the urinary tract. Scar tissue can create more health issues for your dog or cat long-term. Unless your cat is a diabetic, urine infections in cats are a lot less common than in dogs. Bacteria cystitis although rare in cats, is usually seen in cats over 10 years of age and it is more common in females. Bacterial urinary infections in cats accounts for only 1% of the cases of urinary problems and bladder stones/crystals are seen in 20-30% of the cases while stress related cystitis is seen in 75% of the cases. Antibiotics are seldom used in cats with urinary problems for that reason.

Environmental stresses, indoor overweight cats area also other factors contributing to FLUTD in cats. A dirty litter box is often a problem! Cleaning the litter box daily and providing at least one litter box per cat if part of the solution. Trying automatic litters, litters with a cover or without one can sometimes help. Trying different litter substrates may also be suggested if your pet is developing certain preferences. Feeding your pet the right amount (portion control) and avoiding obesity is very important with indoor cats. We need to keep these indoor cats active and their brains busy! For cats with stress related cystitis, the Ohio State University as a great website called College of Veterinary Medicine Indoor Pet Initiative. It contains loads of information that is recommended to every indoor cat owner. This is a great video that they have made available to help pet owners with indoor cats:

Treatment Options and Preventative Care

Diet and increasing water intake

Making your pet drink more water is the best natural treatment recommendation for urinary problems in cats and dogs. Urine dilution is the most important goal to achieve when treating urinary problems in pets. Here is a blog that shows you 10 ways to get a cat to drink more. 

As with almost all illnesses, diet is an important factor. It is essential to feed a quality, preferably homemade diet or raw diet that needs your pet’s nutritional requirements. If this is not possible, then feeding a good quality well-balance dry kibble may be the option for you. If your dog or cat’s diet is lacking in some area, this can cause many issues to arise.

** If your pet already has urinary issues, talk to a veterinary nutritionist for direction on home-cooked diets. Maintenance home-made diets are not ideal if your pet is already having issues and a special home-made diet for urinary problems will need to be fed. Visit our blog on Home-made diets to find more information on who to contact to get a urinary diet designed for you pet. **

Struvite crystals can usually be dissolved by dietary management, however oxalate crystals are generally more challenging to treat. Surgical removal is typically recommended for oxalate stones and if too many struvite stones accumulate or are not successfully dissolved.

The main stay of the prevention of calcium oxalate stones in pets that have had them in the past is using veterinary prescribed diets like Royal Canin/Medical S/O, Rayne Urinary Protection RSS, Science Diet K/D or Prescription diet U/D, etc. Struvites crystals and stones are most often associated with urinary infections in dogs. The Minnesota Urolith center at the University of Minnesota as this pdf list of recommendations for the prevention of calcium oxalate stones in dogs and minimizing their recurrence. 

In cats and dogs, suffering from struvite crystals/stones using veterinary prescribe diets can lead to their dissolution and are often recommended over pet store diets. These veterinary diets do work and I have seen evidence of struvite stones dissolution myself on xrays. I have also seen patients on pet store brand diets develop these types of urinary problems. Doing a urine test 4-6 weeks after your pet has been on any new food is a good preventive measure. This way you can make sure that the diet you are feeding your pet will not be leading to urinary problems down the road. It is important to consider that increasing the water intake is always the best way to prevent and treat these urinary issues.

  • VBMA veterinary discussions in regards to calcium oxalate stones and food.

Recently on the Veterinary Botanical Medical Association list server, holistic vets were discussing recommended diets for calcium oxalates stones and the subject of high protein low starch diets came up. The belief is that high protein low carbohydrate diets acidify the urine are not recommended for dogs and cats with oxalates. If a pet has an history of having urinary crystals/stone, any holistic vet that recommends a high protein low carbohydrate diet like those found in pet stores, is opening themselves up to malpractice suits because these diets may contribute to the development of new oxalate stones. Dr Susan Wynn, holistic vet and author, says that if diets with moderate protein and moderate carb are used in order to alkalinize the urine and dilute the urine, then potassium citrate and water need to be added and the urine target ph needs to be 7 and above for oxalate stone prevention with a urinary specific gravity of under 1,020 (very dilute urine). This means that a lot of urine sample need to be tested over 24 hours to make sure this is achieved and this option becomes costly for the clients. Also, the other problem with this option, potassium citrate is no longer readily available in Canada and it makes this option impossible to offer for some of us

Herbal Supplements and nutraceuticals

Antioxidants, such as Vitamin C and E, can help support your pet’s immune system while fighting bladder and urinary tract issues. For example a recommended daily dose of Vitamin C for cats would be about 125 mg to 500 mg depending on their size. In dogs, the dose of Vitamin C can range from 250 mg to 500 mg twice a day depending on their size. Please not that vitamin C is not indicated in patients with calcium oxalates because it can acidify urine which can lead to more oxalate stones. Vitamin C will modify the urine pH so consult a veterinarian before giving it to your pet. For Vitamin E the recommended dose for a cat would be around 100 I.U. daily. The dose of Vitamin E suggested in dog is about 10 I.U. per kg of body weight.

Cranberry for E.Coli infections

Cranberry has a wonderful reputation for enriching and healing the urinary tract. It is beneficial in preventing infections and problems for dogs who tend to have urinary tract problems, especially those with E. coli infections.(1) Cranberry prevents bacteria from latching to the wall of the bladder, as well as gently acidifying the urine. If you pet suffers from a bacterial infection that is not caused by E.Coli, then using cranberry will probably not help and relying on it without the use of proper antibiotics (herbal or synthetic) will put your pet at risk of an ascending kidney infection. Urine cultures are important in determining which type of bacteria is present. It is important to NOT give cranberry at the first sign of bladder troubles- have your veterinarian check for crystals in the urine first. There is some evidence that supplementation with cranberry can contribute to the excretion of oxalate and can promote Calcium Oxalate crystal formation due to its acidifying qualities.(1)

Keep in mind that simply giving your pet cranberry juice is not potent enough and is often high in glucose (sugar) so not at all recommended by holistic vets. You can find a cranberry extract, typically in capsule form, at your local health food store. I prefer to use the RX Vitaminsrx-vitamins-for-pets-cranberry-rx Cranberry supplement because I am sure of the safety and quality of this product. Cranberry is a helpful remedy, both as a treatment and as a preventative in pets with previous E.Coli infections. Talk to your veterinarian about dosing information. The Rx Vitamins product contains about 425 mg of cranberry juice extract per capsule.  Cats and small breed dogs would get 1/2 capsule to 1 capsule twice a day. Medium breed dogs would get about 1 capsule twice a day and large breed dogs would get 1-2 capsules twice a day.

Herbs for urinary tract problems

There are Chinese Veterinary Herbal formulas designed to help with DAMP HEAT, so bladder infections and in some cases bladder stones (Blood Stasis/Stone Lin) dissolution. The selection of a specific formula for your pet will depend on the Chinese traditional medicine exam and history in-take of your pet. Please consult a Chinese veterinary herbal vet prior to starting your pet on any herbal formula. other veterinarians like myself are certified by CIVT/IVAS in Chinese Veterinary Herbal Medicine or by Chi Institute. Examples of Chinese Herbal formulas: Polyporous Combination (Zhu Ling Tang), Herbsmith Bladder Care, Kan essentials Urinary Support, Kan Essentials Urinary Support Formula,  CrystaClair, etc.

Western herbs like uva ursi (Arctostaphylos uva-ursi) is commonly used in many herbal blends for bladder issues due to its antibacterial benefits. Uva ursi is best given for short periods of time as it can cause problems with diseased kidneys or if used long-term (2). There are other herbs that may assists with urinary problems (marshmallow, dandelion, corn silk, nettle, cough grass, gravelroot, stoneroot, fenugreek, cough grass, astragalus, crataeva, withania, passion flower, chamomile, milk thistle, etc), but consult a veterinary herbalist before using these herbs. A formula can be designed by a trained veterinary herbalist. Buying on-line herbal formulas without assistance from a vet is not recommended. A lot of natural products that are not quality and safety controlled are available for the average consumer. These products may be detrimental for your pets and a lot of them may be contaminated by other things like antibiotics. A recent study published in Canada showed that over 60% of the natural products they tested were contaminated by either the wrong herbs or other drugs. Make sure you buy herbal supplements from a vet or a trusted supplier that has GMP procedures in place. For more information of natural supplements safety in Canada, visit our blog on the subject.

As a certified veterinary herbalist, I do not list recommended herbal formulas on this blog, because I practice holistically. This means that I evaluate each patient before recommending or designing appropriate herbal formulas for each. Herbal formulas can be modified based on the patient and their physical exam including history. There should not be a one formula fits all attitude when it comes to treating pets holistically.

Omegas

Supplementation with Omegas (30mg/kg DHA) can also help manage bladder health. Omega fatty acids have anti-inflammatory properties and can help decrease inflammation if your pet is currently being treated.(1) You can visit our previous blog on omega supplements for pets! Many veterinarians recommend long-term supplementation even after the bladder infection has resolved.

Glucosamine

Cosequin (glucosamine) for cats is sometimes recommended by some veterinarians to help with urinary problems, but it is contra-indicated if your pet is a diabetic. Glucosamine is more often recommended for pets with arthritis but some vets have seen pets on it have improvement of their urinary conditions. It seems that glucosamine may help support the protective wall of the bladder from irritation and can also be used in dogs with recurrent bladder problems.

It is important to discuss using supplements with your veterinarian or veterinary herbalist before starting, as some may interact with other medications or not be appropriate for your dog’s particular case.

Feliwayfeliway_refill

Using products like Feliway or herbal formulas designed with herbs to reduce anxiety and calm cats suffering from stress related cystitis is also suggested. Feliway can be dispensed in a spray form or plug-in dispenser and it is a feline facial pheromone that is used to help cats feel safe and secure, reducing their anxiety which is the major factor leading to urinary problems in cats.

Acupuncture

Acupuncture can help pets deal with the pain associated with urinary problems and it can help reduce their stress. It can help tonify the immune system to help them fight off infection but it is not known to be able to dissolve bladder stones themselves. It can reduce inflammation in the bladder wall and in the urethra to help dogs and cats urinate with less discomfort. Acupuncture can also speed up healing and recovery after bladder surgery in patients.

Maintaining urinary tract health is important, as the urinary tract is an essential part of your dog’s overall health and immune system strength. Feeding a healthy, well-balanced diet, supplementing with omega fatty acids if you feel your pet is at-risk for urinary problems, and keeping a watchful eye out for any urinary tract issues that may arise is the best way to keep your dog in tiptop health!

Written by Dr Cindy Lizotte, DVM, MBA, CVFT (CHI institute), CVA (IVAS), Grad Dip Vet Western Herb Med (CIVT) Grad Dip Vet Chinese Herb Med CVHM (IVAS/CIVT)

References

(1)   Bowles, Mary. Alternative Options for Managing Urinary Tract Disease in the Dog and Cat. ACVIM Proceedings. 2012
(2) Tilford, Greg L. Toxicology of Herbal Medicines. Western Veterinary Conference Proceedings. 2004.

 

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