Urinary incontinence in cats can easily be confused with inappropriate urination (urination that occurs anywhere other than outdoors or in the litter box). Inappropriate urination is more common, but it is a voluntary (purposeful) action. Urinary incontinence will happen involuntarily, without the cat’s knowledge.

Symptoms of involuntary leakage of urine (urinary incontinence) include:

Not squatting or in position to urinate

Cat unaware of urination

Urine found in bed during sleep or rest

Urine staining or smell near the urethral opening (under the tail). This can be seen as a skin infection.

These symptoms can be seen in both urinary incontinence and inappropriate urination:

chronic urinary tract infection

hematuria (blood in the urine)

Excessive grooming in urethral area

Symptoms of inappropriate urination that are not seen with urinary incontinence include:

Posturing to urinate

Straining to urinate

Pain during urination

Reoccurring urination in certain areas of the house

Urination on vertical surfaces (behavioral)

Causes of Urinary Incontinence in Cats

Congenital

Congenital causes are seen when the anatomy of the bladder or urethra was not correctly developed when the kitten was growing in the womb. These causes are present from birth:

• Ectopic ureter is when the ureter (the tube between the kidney and bladder) is attached in the wrong location. It is usually seen attached to the urethra, the tube through which urine is eliminated from the bladder to outside the body. This causes the urine to leak directly out instead of pooling in the bladder.
• The urethral sphincter (the muscle that controls the flow of urine from the bladder) may not form correctly, which allows the urine to flow out once any pressure is applied to the sphincter. It is usually associated with other congenital abnormalities such as being born with one kidney, a small vagina or renal aplasia.

• Spinal/vertebral abnormalities can cause damage to the nerves in either the bladder wall or sphincter.

Acquired

Acquired urinary incontinence is when the inability to urinate begins after birth and is not associated with a birth defect. It is most commonly due to trauma.

• Injury to the spine or vertebrae can affect the nerves in the bladder or sphincter.
  • Decrease in nerves to the bladder wall allows the bladder to overfill or not empty completely.
  • Decrease in nerves to the urethral sphincter causes the sphincter to not close properly.
• Urethral blockage is the most common cause seen in cats. This occurs when an object obstructs the flow of urine in the urethra, causing overflow of the bladder so that urine leaks out around the obstruction.

• The feline leukemia virus has been suspected to cause acquired urinary incontinence, resulting in occasional dribbling during times of relaxation.

Mimics of Urinary Incontinence

Several metabolic diseases can be mistaken for urinary incontinence. They do this by increasing the amount of urine that is produced, thereby increasing urinary accidents. Some examples are diabetes, liver disease, hyperthyroid, and renal disease.

Treatment of Urinary Incontinence in Cats

Treatment of urinary incontinence in cats is based on the underlying cause. Medications, supportive care, and symptomatic treatment may be tried until the best combination is found. Treatment may be needed for a couple of weeks, months or life long support.

Medications

• Antibiotics may be necessary if an infection is found.

• Several medications can allow the bladder to empty easily. They are needed when the urethra is swollen, overly stimulated, or a blockage is possible. Medications can accomplish this by:
  • Decreasing urethral spasms. Prazosin is a commonly prescribed medication in cats.
  • Increasing relaxation of the urethra
  • Decreasing bladder wall spasms
  • Decreasing stress, allowing the cat to relax more
  • Stimulating the bladder wall to contract
• IV fluids may be needed to correct renal imbalances and remove toxins from the body after urethral blockage. Toxins, electrolyte imbalances, and kidney malfunction can lead to death if not corrected completely. IV fluids are usually only temporary.

SupplementsAt HCCF we encourage the use of urinary system supplements and holistic therapies to support the long term management of urinary incontinence.

Surgical Repair

Depending on the cause of the urinary incontinence, surgery could be an option. A bladder stone must be removed if it is causing bladder or urethral irritation. A urethral catheter can be placed temporarily to remove urethral blockage and allow urination until the swelling has resolved. Periurethral surgery (commonly referred to as a PU surgery) is used when male cats have several episodes of blockage. A PU surgery widens and shortens the urethra permanently in male cats. This surgery cannot be performed in female cats. If a back injury is the underlying cause, surgery can be used to correct the pressure on the spine. Some congenital causes (depending on their severity) can be corrected with surgery as well.

Your veterinarian will evaluate the cause of the urinary incontinence to help decide if surgery is an option.

There are also pioneering options for surgery to correct severe internal deformities which may be the only option for a quality of life for some special needs cats that have been born with major congenital abnormalities.