Blood in urine, UTI meds didn't help

I'm writing this on behalf of a friend whose young kitty has been having some litter box issues. Now I don't know every little thing about this cat, but from what I do know, she's relatively young (no older than 3 years, I'd say) and spayed with no prior history of health issues. A couple months ago, my buddy talked about Kitty having bloody urine, so he took her to the vet where she was diagnosed with a UTI and medicated. Kitty continues to pee outside her box and on the furniture and floors, and her urine is still tinged with blood. She doesn't seem to be in pain. Does this mean she doesn't have a UTI, or maybe she has a particularly resistant infection? I think she's been treated for a UTI at least twice already. I know "go to the vet" is the best advice to give and he knows that, but I'd like to ask what folks here might suggest for other possible tests or causes of this ongoing bloody urine? Is it normal for urinary tract infections to be so resistant to treatment? Kitty also has a clean litter box and everything and is indoor-only, if that helps.

Has an x ray been done to check for stones, and a urine culture to check for resistant bacteria and certain types of crystals? If these things have not been done I would advise your friend to find another vet. They should have been done after the first repeat.

Tell him to make sure he feeds his little girl a wet low carb high in meat protein canned diet, no fish.

I would also recommend blood work, to see how the kidneys are doing.

Is there anything stressful going on in her world?

If all the labs come back normal, idiopathic cystitis is most likely her problem, and the best way to manage that is with a wet low carb diet (no fish) and an anti-inflammatory such as krill oil, a few times a week.

A little bit of info

http://www.petwave.com/Cats/Health/Kidney-Urinary/UTI/Diagnosis.aspx

My cat Thompson was recently diagnosed with bladder issues, he did not have an infection but the Dr. found crystals in his urine.  He was in extreme pain and I was distressed at the thought of having to put him down. I was told that some cats never get better.  The Dr. seemed to think that the cause was stress (we moved recently).  They gave me an antibiotic (although there was no infection) and pain medication and a prescription for Hills CD cat food.  I have stopped all dry food and Thompson is on a strictly canned diet.  I add warm water to the canned food and he loves it.!  It has been a couple of months since the diagnosis and he is urinating like a race horse! 

I would think that more extensive testing would be in order. Thus, another trip to the vet, sadly.
 

I'm not sure what all was done during previous visits - unfortunately, my friend does not live in the same area as me, so I only have his word to go by. Whatever was done cost about $300 at the last visit, so I assume that could be an X-ray or ultrasound or something to rule out stones. If it weren't for the bloody urine, I might consider the possibility of behavior issues since Kitty likes to pee square in the middle of his bed, and not even things like Feliway keep her from using the bed as her toilet. Also, if there were stones, would the cat not be in pain? My Rolly had bladder stones and was all blocked up many years ago and he just laid on the floor and howled day and night. This kitty's not in pain.

I don't think anything stressful is happening. My friend doesn't have anyone new living in the house, no children, no new pets, didn't move recently, the cat hasn't been in any fights. I have no clue what kind of food the cat eats, but I'm not totally sure if my friend could afford a strictly canned food diet for Kitty. Not that he doesn't want to, but he's unemployed and has quite a bit of debt. I don't know how much more canned food would set him back, especially if it had to be a high-quality brand.

But thank you all for the suggestions!

$300 may cover an X-ray and blood work, etc, but not an ultrasound.

Please be sure to forward this information to your friend because it's very necessary for guidance on further diagnostics

http://www.petwave.com/Cats/Health/Kidney-Urinary/UTI/Diagnosis.aspx

It would be very helpful for us to have info regarding what kind of food the kitty is eating.  Regular diet, snacks, everything.   Could you possibly help with that?

A little update: My friend went to a new vet with Kitty and she was diagnosed with an ear infection and not a UTI, but bladder inflammation. And she's on ear drops and some kind of pill that relaxes the bladder, I guess so she doesn't wet all over the bed anymore. I didn't know it was possible for a cat to have an inflamed - but not infected - bladder. Here's hoping kitty gets better. No clue why her bladder is inflamed to begin with either. It seems to be a common occurrence in cats, from what I'm hearing.

Glad he went to a new vet and hope the cat is on her way to feeling better!

Just a little update, I believe Kitty completed her round of meds, but my friend says there seems to be no pattern to her urinating habits, which have not changed even with medication. She still like to pee on the bed and in other places outside the box, but her desire to do so seems to come and go. Sometimes she'll be wetting on everything for a while, then she behaves, then goes back to being a bed wetter.

My buddy is a saint and obviously a cat lover. I can't say I know of anyone else (I mean personally know) who would keep their cat if it kept peeing on everything. I know more than one person who has gotten rid of their cats because they were wetting outside the box without even going to the vet to see if there was a health issue. No idea why Kitty continues to wet outside the box after being medicated. I guess it's just something she's going to do for the rest of her life.

Your friend's cat may have Feline Interstitial Cystitis (FIC), also known as Feline Idiopathic Cystitis, which is an inflammation of the bladder and can often be mistaken for UTIs, mostly because it can also cause frequent UTIs.  (Humans suffer from this condition as well, though of course it doesn't have Feline in the name ).  The problem with this is if they are treated too frequently for a UTI and they don't have one it can make them become resistant to medications for it in the future, and the medications that treat for a UTI can actually make the Interstitial Cystitis worse for a time. 

This disease affects a cat's lower urinary tract.  It can cause pain, frequent urination (or attempts to do so), urinating in inappropriate places, crying out during attempts to urinate, blood-tinged urine.  Like most conditions, not all symptoms have to be present.  It is unfortunately a chronic disease.  For humans with this disease there are more and more treatment options available to them like medications, implanting a device that regulates the bladder (like a pacemaker for the bladder), and there are even I.C. diets. 

Unfortunately there doesn't seem to be as much understanding with the Feline variety, though research is ongoing to see if similar treatments can be used on cats as on humans.  It looks like right now the recommended course of action is to try to minimize stress (using the Feilway is often recommended, so I'm sorry that it's not working for your friend ), make sure they're getting enough water, and put them on a special diet if your vet recommends it and give medications for pain (if present) and for relaxing the bladder like your friend was already given.  The human version of the one that relaxes the bladder is usually Pyridium (Phenazopyridine).  It relaxes the bladder making it easier to urinate without straining which then makes it so that you're in less pain.  It also helps to make it so that you don't constantly feel that urge to go when you don't really need to go.  It also appears that in some instances that they will put a cat on an anti-depressant to help alleviate any unknown stressors.

How many litter boxes does your friend have for his cat?  He may need 2 or 3 of them located throughout his house to help with the inappropriate peeing.  (I'll bet you've already suggested that, though, haven't you? )

To diagnose it a vet would have to blood tests, urinalysis, have an abdominal xray done, the vet may even want to preform a biopsy or endoscopic exam of the bladder wall (Article Source: http://EzineArticles.com/3332353)

None of this seems to be very helpful, I'm afraid  And unfortunately, (well, I guess, fortunately actually ) I only have human experience and not feline.  I do know that from a human standpoint that it is manageable/treatable though it is still life-long, it's all about managing and minimizing symptoms/flare ups.   Good luck!

RuneKeeper said:

Just a little update, I believe Kitty completed her round of meds, but my friend says there seems to be no pattern to her urinating habits, which have not changed even with medication. She still like to pee on the bed and in other places outside the box, but her desire to do so seems to come and go. Sometimes she'll be wetting on everything for a while, then she behaves, then goes back to being a bed wetter.

My buddy is a saint and obviously a cat lover. I can't say I know of anyone else (I mean personally know) who would keep their cat if it kept peeing on everything. I know more than one person who has gotten rid of their cats because they were wetting outside the box without even going to the vet to see if there was a health issue. No idea why Kitty continues to wet outside the box after being medicated. I guess it's just something she's going to do for the rest of her life.

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What kind of diet is the cat on? She needs to be on an all wet low carbohydrate diet, no fish.

Krill oil at least every other day as anti-inflammatory. Cosequin for cats can also be helpful.

Feliway plug in diffusers can reduce stress.

Blood in urine and no other issues are mostly caused from stress and it considered FIC. Idiopathic Cystitis (no none cause). My Pip has blood in urine but has never, ever gone outside of the box and the blood was never visual to the eye. Stress causes the cat's bladder lining to inflame allowing the cells to expand and urine to seep in where it should not. There is an antidepressant called Elavil which Pip has been on and off and it helps calm the bladder and helps the cat retain his urine.

I think this kitty needs more of a workup though. Visually seeing blood is not good at all. Have they done a urine sensitivity culture? Very important to see if and what kind of bacteria (if any) so the correct antibiotic can be used.

I would also suggest that your friend consider looking into a raw or species appropriate diet. This has helped Pip tremendously with keeping his body and bladder healthy. At the very least, this cat should only be eating a high quality grain free canned food. Our nutrition forum is the place for her to check out. All my best to this cat

RuneKeeper said:

I'm not sure what all was done during previous visits - unfortunately, my friend does not live in the same area as me, so I only have his word to go by. Whatever was done cost about $300 at the last visit, so I assume that could be an X-ray or ultrasound or something to rule out stones. If it weren't for the bloody urine, I might consider the possibility of behavior issues since Kitty likes to pee square in the middle of his bed, and not even things like Feliway keep her from using the bed as her toilet. Also, if there were stones, would the cat not be in pain? My Rolly had bladder stones and was all blocked up many years ago and he just laid on the floor and howled day and night. This kitty's not in pain.

I don't think anything stressful is happening. My friend doesn't have anyone new living in the house, no children, no new pets, didn't move recently, the cat hasn't been in any fights. I have no clue what kind of food the cat eats, but I'm not totally sure if my friend could afford a strictly canned food diet for Kitty. Not that he doesn't want to, but he's unemployed and has quite a bit of debt. I don't know how much more canned food would set him back, especially if it had to be a high-quality brand.

But thank you all for the suggestions!

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Calvin did not howl or cry. He was not blocked but did have stones. He did have blood in his urine and did go outside of the box right in front of me. I only observed this once though he may have done it elsewhere in hiding that went unnoticed. He was still playing with the other cats and eating normally. Some cats just don't show the sames signs of discomfort. 

Bladder inflammation can be caused by multiple reasons; glad he took kitty back to the vet. X-rays would need to be done to know for sure if it is idiopathic or not. 

I don't know if a raw diet would be doable since my buddy is broke. His cats get the care they need at the vet's, but if he doesn't have to spend a small fortune on kitty food, I don't think he's going to. I also haven't a clue what exactly they're eating right now, and I imagine there's at least two litter boxes in the house since he's got another kitty. But I will definitely mention FIC to him if he decides to try the vet again. Is that something that can actually be treated, or is it just manageable with medication?