Cat with UTI symptoms, but no bacteria or crystals found?

Hello!

Yesterday morning, my 2 year old cat  "Butler" started exhibiting signs of a UTI, so I called the Vet the moment I noticed.  He was trying to urinate a lot (not straining) and after a few hours of waiting for his appointment he started to have bloody urine.  They took a urine sample from him, which was difficult as his bladder was empty when he got there, and sent it off to a lab.  While we waited for the results, they went ahead and gave him the antibiotic injection.  The lab said he had a lot of white blood cells, red blood cells, a normal ph, and no crystals in his urine.  But they also said they found no bacteria.  The vet said that we'll give the injection a few days to see if he improves before trying any more treatment.  She has mentioned an xray to make sure there aren't any stones, but she doesn't seem to feel it's absolutely necessary right now, or that they would even find anything.

Today he's still trying to urinate a lot (not as often as yesterday) and seems to be straining more (but this may be due to the pain).  He only pees a drop here and there, but then may pee a good 2-3 tablespoons -- he's done this a couple of times today.  It doesn't seem like he isn't able to pee, just feels like he needs to frequently, even when he doesn't actually have to.  I haven't seen any more blood in his urine, but I haven't had to clean it off the floor to get a good look at it.  But what I scoop out of the litter doesn't have any red tint.

I've increased his water intake by mixing him some dehydrated food with a lot of water (he laps it all down).  He's already been on a very high protein diet (Orijen Cat & Kitten) due to his digestive issues.  He's not licking himself as much as he was yesterday, but he doesn't seem to be as peppy as he was, but that may be due to discomfort, the injection, or being restricted to my office to keep him from urinating around the house.  He was completely healthy, happy, and normal up until yesterday morning, so I was pretty surprised to find he wasn't feeling well.  I had another cat for 16 years who would get a UTI every couple of years and after the antibiotic injection, he'd perk up in 24 hours and be back to his old self.  I've never had  a cat with UTI symptoms that didn't actually have a bacterial infection.

I don't really know what else could be causing him this discomfort.  I worry about a blockage or stones because a friend of mine just lost her 3 year old cat a couple of months ago from a sudden blockage that had developed over the night.  But her cat was always prone to UTIs and also always had a lot of crystals in his urine, but Butler hasn't had any urinary problems like UTIs.  It's entirely possible that he may have fallen in the night and injured himself due to his clumsiness, but I highly doubt that.

I'm really protective of my furry kids, so I'm worry that something else more serious may be going on.  Any advice is greatly appreciated.

I would try and increase his water intake even more. If he likes tuna get some salt free tuna drain the juice into a bowl and add filtered water to that to encourage him to drink more. I would also switch him to wet food ASAP. Ideally 100% wet food but as much as possible.

EDIT - I just saw you're giving him dehydrated with water, good! Is it dehydrated raw food? Orijen is decent kibble, but it's still very carby which can trigger urinary issues, on top of being very dry. It does sound like he has some kind of UTI going on. It seems strange they didn't' detect anything, but maybe it has to do with the fact it was hard for them to obtain a sample. Kibble has been linked to UTIs and kidney issues, and with cats that have a history of urinary issues wet or raw food makes a huge, huge difference it keeping them hydrated, and he needs all the water he can get while he's recovering. 

Sorry about your cat Did they provide pain killers for him at the vet?

If there are no physical issues like infection or crystals found it sounds like it might be a case of feline idiopathic cystitis. The symptoms are basically what you just described but with no obvious underlying cause. Nobody really knows exactly what it is caused by but it is thought that things like stress (which cats are highly sensitive to) can contribute to this popping up. In fact a vet has also told us before that aside from cats being sensitive to stress in general, some cats are genetically prone to an abnormal or higher intensity response to stress, which increases the risk of something like this happening. Can you think of anything that might have caused stress to your cat around the time this started? A move, new people coming around, something new happening that he wasn't used to?

Apparently for cats that are prone to this there is no set treatment since...well, there is no known concrete cause. Managing stress is an important thing to try (maybe put in some Feliway plugs around the house?), making sure they have a quiet place to retreat. It is thought that in general increasing water intake long term can help manage the symptoms when they come up. During an episode, if the cat is in pain from the bladder irritation some vets recommend pain killers (since pain can make them even more stressed, exacerbating the whole problem into a vicious cycle). There has also been some evidence that glucosamine supplementation can help improve condition of the bladder lining (our cat gets daily glucosamine supplements). Some "cystitis" supplements sold at our vet hospital also largely feature glucosamine in the ingredients.

Of course all of the above is just a guess based on what you have described. Maybe it's worth just asking your vet about the possibility that it might be FIC? It's not such an uncommon issue and it's likely they've already considered this (and maybe ruled it out for some other reason).

Hello!

Just an update on Butler.  Turns out his urine was "too concentrated" and the vet suggested getting a water fountain to entice him to drink more water.  I got the Catit water fountain and my cats love it!  They're drinking loads of water now and his bladder problems seem to have cleared up!

Thank you for the response, lazer!

So, we're back on this road again. Three weeks ago Butler started peeing blood outside of the litterbox again, despite having a cat fountain and now being switched to a grain-free wet food. I also give him Animal Essentials Tinkle Tonic twice a day and he's getting Adaquen injections once a week. I've added another litterbox and using Dr. Elsey's Cat Attract litter. He's even wearing a Feliway Cat Calming Collar in case of any stress (thought honestly, the only stress he has in a day is not being able to reach a moth on the ceiling). I also clean all the spots he urinates with Nature's Miracle Advanced Cat Formula.

I'm really upset right now about this. I've done everything right and he's still not getting any better. I hate seeing him in pain, and I'd really hate to shut him up in a room just to keep him from peeing around the house. But after he jumped up on our guest bed and peed on a brand new comforter set right in front of me, I nearly had an emotional breakdown. The vet just keeps saying he needs to drink more water, but aside from giving him an IV 24/7, I just don't know how that could be possible.

This has been going on for months and there was only a 3-4 week window where it wasn't a problem. I don't know what else I can do.

bombshellbonny said:

So, we're back on this road again. Three weeks ago Butler started peeing blood outside of the litterbox again, despite having a cat fountain and now being switched to a grain-free wet food. I also give him Animal Essentials Tinkle Tonic twice a day and he's getting Adaquen injections once a week. I've added another litterbox and using Dr. Elsey's Cat Attract litter. He's even wearing a Feliway Cat Calming Collar in case of any stress (thought honestly, the only stress he has in a day is not being able to reach a moth on the ceiling). I also clean all the spots he urinates with Nature's Miracle Advanced Cat Formula.

I'm really upset right now about this. I've done everything right and he's still not getting any better. I hate seeing him in pain, and I'd really hate to shut him up in a room just to keep him from peeing around the house. But after he jumped up on our guest bed and peed on a brand new comforter set right in front of me, I nearly had an emotional breakdown. The vet just keeps saying he needs to drink more water, but aside from giving him an IV 24/7, I just don't know how that could be possible.

This has been going on for months and there was only a 3-4 week window where it wasn't a problem. I don't know what else I can do.

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What's his urine pH? What grain free food are you feeding? Are you adding extra water to it? What kind of litter box are you using? Are you sure it's not too hard for him to get in and out of?

missmimz said:

What's his urine pH? What grain free food are you feeding? Are you adding extra water to it? What kind of litter box are you using? Are you sure it's not too hard for him to get in and out of?

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I don't remember what his pH was, but I can call the vet to ask them tomorrow.

The grain free food is "BFF Chicken & Tuna", and yes I add extra water to it. I also have dry food down for my other cat who prefers it, it's "Instinct: Rabbit". He nibbles on it a bit here and there, but he mainly only eats the wet food.

His litter box has very low sides -- the lowest I could buy from the pet store, but it's also quite wide. I also have a covered box in case he would prefer it, but he isn't interested.

I can definitely tell it's a psychological aspect that's causing him to pee outside of the box. I think it's so painful for him that he's associating urinating in the litter box with the pain. So when he's on something soft, squishy, and comfortable, he must think he could go there and it wouldn't hurt him. I've gotten to the point where about every 30 minutes I go track him down and if he's awake, I call him over to the litter box where he'll use it.

bombshellbonny said:

I don't remember what his pH was, but I can call the vet to ask them tomorrow.

The grain free food is "BFF Chicken & Tuna", and yes I add extra water to it. I also have dry food down for my other cat who prefers it, it's "Instinct: Rabbit". He nibbles on it a bit here and there, but he mainly only eats the wet food.

His litter box has very low sides -- the lowest I could buy from the pet store, but it's also quite wide. I also have a covered box in case he would prefer it, but he isn't interested.

I can definitely tell it's a psychological aspect that's causing him to pee outside of the box. I think it's so painful for him that he's associating urinating in the litter box with the pain. So when he's on something soft, squishy, and comfortable, he must think he could go there and it wouldn't hurt him. I've gotten to the point where about every 30 minutes I go track him down and if he's awake, I call him over to the litter box where he'll use it.

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I would try and get him off that tuna wet food. There are connections between UTIs and fish foods. Those BFF foods are very fishy.

missmimz said:

I would try and get him off that tuna wet food. There are connections between UTIs and fish foods. Those BFF foods are very fishy.

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Okay, what about this food? Is turkey okay?

Eh. I'm not a fan of BB. Turkey would be fine, though. What about Weruva's cats in the kitchen line? Funk in the Trunk might be a good one to try. It does have tuna in it, but it's not tuna based like the BFF line. There's also Fowl Ball, which is turkey and that one is popular as well.

An update: Butler is at the emergency vet clinic tonight where they're going to be putting in a catheter to help drain his bladder as he's now completely blocked. I took him to the vet at 4pm for his 4th Adaquen injection and after bringing him home, he went to the litter box and proceeded to squat for 5 minutes without being able to urinate. By 9pm, he still wasn't able to pass urine so I took him to the 24/7 Vet ER where they determined he was blocked.

Another update: Despite having a negative urinalysis, and a negative x-ray, the emergency vet who put in the catheter said she is 90% positive she saw a bladder stone with ultrasound. He's now at my vet where they will assess him and decide his treatment from there.

Butler is home now. He had the catheter in for 48 hours where they gave him fluids and monitored him. Despite having a clean x-ray two months ago, they did a new x-ray to confirm the stone from the ultrasound and found a large one about the width of my pinkie finger. They said it's too big to have caused the blockage, but suspected the inflammation and red blood cells from bloody urine might have caused it. They did a urinalysis to try to find out what kind of stone it is, but it came back negative for crystals (wtf?). He has an appointment with a local veterinary surgeon to see if he needs to have surgery for the stone. But since we can't tell what kind of stone it is, then I'd prefer to try the diet option of putting him on c/d to see if we can't dissolve the stone naturally, rather than putting him under the knife.

He's on pain medication, and anti-spasm medication for right now. The vet also gave him an injection of antibiotics to prevent him from getting an infection from the catheter. He keeps going to the litterbox and squatting for long periods of time, but is able to produce about a tablespoon of urine here and there. I suspect the inflammation of the catheter will make him feel like he needs to urinate more until it's had time to heal. But I'll ask the vet this afternoon at his consultation.

Personality wise, despite going to the litterbox numerous times, he is drinking, eating, and affectionate. He's doing a lot of licking himself, but I'm sure that's due to the discomfort of having had the catheter in.

Photos of my boy:

bombshellbonny , how is Butler doing? I found this thread in researching pH and cat foods, and thought I would check up on you to see how things are going.

PushPurrCatPaws said:

bombshellbonny , how is Butler doing? I found this thread in researching pH and cat foods, and thought I would check up on you to see how things are going.

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Butler is going great! The appointment with the surgeon uncovered that the stone was too big to try to dissolve with food and would probably result in another blockage, so he had to have surgery to remove the stone. After opening him up they found a second, much smaller stone that probably caused the blockage. He did great with the surgery and recovered fairly quickly.

He ended up having an allergic reaction to the dissolving stitches which resulted in a large welt over his abdomen, but the swelling went away after two weeks.

Now he's on Royal Canin Urinary SO formula and really enjoys it (especially the canned version), and pees like a racehorse. I'm glad he's doing so much better.

Thank you for asking!

I am so glad to hear this!!

Is Butler still doing well?

Catmomm1 said:

Is Butler still doing well?

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Yes he is! His urine has been tested three times since surgery and everything has come back clean. He's also had a few x-rays to confirm and they see no signs of stones in his bladder.

We've got some behavior struggles in terms of him marking around our front door, but that's due to the mass amount of strays that convalesce on our welcome mat when they're not at our neighbor's eating the food she puts out. But we're working on it.

Thank you for asking!