Meghane,

Thanks for your reply. How can a partial blockage be diagnosed? I am still waiting on a call back from my vet. Any tests I should request. I really feel something is wrong. I sometimes hear him meow when he is in his litter box. The vet assured me last week everything is OK.

Sounds like he is straining or at least painful to urinate, which is a BIG problem. Don't wait for the vet to call back- he needs to be seen now. You're absolutely right to be worried. This can be a very serious problem. Has he been eating and drinking normally? Is his activity level normal?

They could tell the bladder is distended by palpation on physical exam, and they may try to express his bladder. A blockage would be relieved by passing a urinary catheter. They would also take some crystals or stones for analysis because different crystals or stones are treated in the exact opposite manner. Many cats have to be hospitalized to make sure the obstruction is relieved- often inflammation keeps them blocked after the obstruction is gone.

Please take him in tonight- you're right that he's not doing well, and he needs to be seen. Good luck, and please keep us posted.

I took my cat back to the vet today. The vet took a x-ray but nothing showed up. He doesn't think that there is any blockage. He prescribed amitryptoline once a day for 10 days to help with bladder spasms. If he doesn't get any better he said that he will do further testing. Any thoughts on this treatment? Thanks

If the vet didn't run blood tests, find another vet. I get the feeling this vet doesn't want to go beyond his initial diagnosis.
A cat meowing in the litterbox sounds like something is wrong!

The new vet can request the x-ray and urinalysis from the current vet.

Amitriptyline is a tricyclic antidepressant that MAY provide pain relief for neurogenic inflammation- it does NOT control bladder spasms. The 10 day course makes no sense to me because it may take weeks before the drug has any effect. There is no benefit in the short term, and it may cause faster relapse of lower urinary tract disease. Therefore it is only used for severe unrelenting or recurrent cases of FLUTD. Since your cat had signs of pain- meowing in the litter box- he should be on some sort of pain control (amitriptylline doesn't count since it takes so long to work).

Radiographs are good at ruling out large stones, but male cats can be blocked by crystals or very small stones because of the tiny diameter of the urethra. Radiographs can only detect stones >3mm. So while helpful in ruling out larger stones, plain rads cannot rule out smaller stones or crystals. That said, if no crystals were found on UA, and if the bladder can be emptied by your cat on his own, then it is very believable that he is not blocked.

It seems that your vet believes your cat has feline lower urinary tract disease (FLUTD) aka interstitial cystitis, aka feline urologic syndrome... However this is a diagnosis of exclusion, and there hasn't been enough done to rule out other causes of urinary incontinence. At the bare minimum, he needs a urine culture to rule out a UTI. Cats are great at hiding diseases, and UTIs are no exception. You may not see bacteria or WBCs in a urine sediment exam, but the cat could still have an infection. Amoxicillin is a good starting choice for UTI but not all infections are susceptible to it. I would definitely do a urine culture and sensitivity, just to rule out UTI better.

You don't want your cat to be diagnosed with FLUTD. It is a very difficult disease to manage, since we don't know what causes it and don't really have a good way to control the clinical signs. If there is any possibility of finding another cause for his urine dribbling and pain, go for it- it will probably be easier to treat than FLUTD. The bare minimum diagnostics for a cat with his clinical signs are UA and urine culture. FLUTD cats will often have resolution of their clinical signs no matter what you do- even if you do nothing- after some time (usually several days to a couple of weeks). But the signs tend to recur and of course the cat is miserable when flare ups are happening. Sometimes the best you can do is control the pain, put up with the dribbling, change to a canned diet, encourage drinking, and wait it out.

If you wanted to go whole-hog, then the workup includes CBC, chem, UA, urine culture and sensitivity, and abdominal imaging (may include ultrasound, double-contrast cystography). For an 8 year old cat, if you haven't had a CBC and chem done in the last year, it may be a good time to do that anyway (I recommend at least annual cbc, chem, UA on all dogs and cats >7y). Also if it does turn out that your cat has FLUTD and you decide to go on long-term amitriptyline, it would be a good idea to know the liver values because this medication can cause liver problems. I'd still at least get a urine culture done, just to be sure there is no UTI.

It's really hard to think of reasons your cat could be dribbling urine because there are literally hundreds of possibilities and without a lot more information, it's just silly to guess. Obviously your cat is not feeling well and he needs relief. I hope he gets it soon.

Meghane,

Thanks for your reply. I'm on my way back to the vet. I am requesting the test you suggested.

The vet said he will have the results of the blook test tomorrow and the urine culture will take about 4 days.

That should say "blood". Sorry

Blood test are back and the only thing that showed up was his glucose was 215. Urine culture will be back next week.

That's not too bad for a stressed cat glucose. Diabetes is usually a concern when the glucose is >400, or if there is glucose in the urine, which probably wasn't since the UA was normal. Cultures do take a while.

How's your cat doing now?

The 48 hour urine culture report showed nothing. The final report will be back after 72 hours.

My cat is still dribbling but maybe not as much. He is not crying on the litter box anymore. He is eating and drinking normally. I am still giving him the amitriptyline. I read a article on CFA that talked about this.

http://www.cfa.org/articles/health/urinary-tract.html

I'm not sure what to do at this point. My vet is telling me to be patient.

Glad that he's not crying any more. Looks more and more like FLUTD, so being patient is a good plan. Like I mentioned before the flareups usually go away with or without treatment, so doing whatever it takes to make him comfortable is all you can do. The use of amitriptyline is a hot debate topic among vets- some swear by it, others think it's useless or even harmful (considering that it may cause faster relapse when used continuously).

Decreasing stress in a cat's life is easier said than done in most cases. Unless there was an obvious life-altering change such as moving, new person or pet in house, absence of person or pet, etc. it is hard to control. Amitriptyline may help control stress (it is after all an antidepressant), so some vets use it long term for that.

The unfortunate fact of the matter is that we don't know what causes FLUTD and we don't really know how to fix it. Any time a single disease has a ton of treatment options, you can guess that we are really just shooting in the dark. Amitriptyline is just a good an option as any as long as the cat is comfortable.

A UTI would have been easier, but that looks less likely given the culture is still negative, and it's rare in otherwise healthy male cats anyway (certain diseases such as renal disease and diabetes make UTIs more likely).

I hope he continues to improve.

Meghane,

Thank you for all of the information. We have recently added a dog to the family. My cat doesn't care for him very much but they do not have much interaction. I can tell that this does stress him.

I have made an appointment with a new vet for tomorrow. I'm not sure it will help much in this case. My current vet has given me several signs that it may be time to look for a new vet. He didn't remember sending out for some test. I had to have him call the lab again to get the results. I also have another cat that has been on tapazole for hyperthyroidism for about six months. The last time he saw her he said it was time to start giving her tapazole. I'm not sure if he is not taking notes or not reading them.

It is a hard decision to try a new vet.

A new dog could certainly be the culprit, even though they don't interact much. Hopefully kitty will get over it and not have more problems.

Sorry about the vet. It isn't easy finding someone else to trust- been through that myself. Good luck with the search.

mate im having exac same problem with my cat vet said theres no blockage hes took xrays and tested hes urine hes a week through antibiotics and hes still the same what happened with your cat