Fluid and Urinary-Related Issues
Regulation of Fluid Levels in the Body
Dehydration is a common problem in CKD cats. If CKD cats "crash" and are in crisis, they are
usually severely dehydrated and
intravenous fluids (IV) at the vet's may
be required for several days - Thomas had these twice and they were very
Of course, ideally you do not want things ever to progress to
this stage, so to avoid dehydration occurring in the first place, fluids may be
given under the skin at home (subcutaneous fluids).
Therapy is so essential in the treatment of
CKD that it has its own page.
This can be a sign of dehydration, but should improve once your cat's
hydration is under control.
bark is often used to help with gastrointestinal issues
mouth ulcers, but as a side effect it often improves the cat's coat.
Essential fatty acids may also help.
Dehydration can lead to problems with constipation in
CKD cats. There is a separate page about constipation
Overhydration and Fluid Retention
It is possible for cats to be overhydrated, i.e. given
too much fluid, either via IV or sub-Qs.
Some vets say it is not possible to
overhydrate a cat using sub-Qs, but believe me, I've heard of plenty. Overhydration may also cause
Cats with heart problems can also develop problems with
body fluid build up. If your cat is receiving sub-Qs and has undiagnosed
heart problems, it may be that the amount of fluid would be fine for most
cats but is too much for your cat. It is also possible for cats with heart
disease to develop fluid retention even if they are not receiving sub-Qs.
in the lungs (pulmonary oedema)
around the lungs (pleural
in the abdomen
If your cat:
feels "squishy" when you stroke him or her
has loss of appetite (which may be caused by the fluid pressing on the
stomach causing a feeling of fullness)
appears to be gaining weight rapidly or suddenly.
Most people are delighted when their CKD cat gains weight, and certainly
if weight gain is slow and steady, this is good news. However, if your cat
gains weight very quickly (I have heard of people who are delighted
because their cat has gained 2 lbs in a week, a phenomenal rate of weight
gain as a percentage of the average cat's size), this may be a sign of
fluid build up.
starts coughing and/or develops a nasal discharge
you need to see a vet quickly.
If your cat starts breathing with the mouth open or develops a limp, this
is a medical emergency and you need to get to a vet as quickly as
Do not give sub-Qs to a cat exhibiting any of
the above symptoms until you have spoken to your vet. You should also
never give a cat sub-Qs until the fluids from the previous session have
Heart Problems page has more information about fluid build up and
congestive heart failure, including symptoms, causes, what happens, and
how to treat.
If your cat does exhibit these problems and you can afford it, I would
recommend a visit to a feline cardiologist to discuss future treatment
options for your cat. It may still be possible to give sub-Qs in the
future if your cat needs them, but it is a careful balancing act between
the needs of the kidneys and the needs of the heart.
If the problem was caused by giving too much fluid, you may find that reducing the amount or frequency of sub-Qs
given in the future prevents this problem arising again; so speak to your vet about this. The
Subcutaneous Fluids page has information on amounts and frequency of fluids.
If your cat is prone to overhydration and/or fluid retention, you may wish to monitor your cat's
weight with baby scales. I actually recommend that everybody weighs their
Digital Baby Scales 1584, which weigh in one ounce (20g)
increments, are popular on Tanya's Support Group. They are available for
around US$140. You might also be able to buy a set of
scales secondhand from eBay or similar.
I have a Redmon
baby scale which I like (it can be stored
on its side when not in use, saving space), but it no longer seems to be
Amazon sells other Redmon scales for US$47.63.
Drs Foster and Smith
sell Redmon scales for US$59.99.
Amazon sells Salter scales for US$48.93.
Amazon sells Beurer scales for US$52.36.
In many cases, diarrhoea will only last for a day. However, if it goes on
any longer, or stops and then starts again, I'd recommend a trip to the
vet because the cat may quickly become dehydrated
(which does not only mean water loss,
the cat may also be losing electrolytes such as
Waste Product Treatments for more information on how to treat
Urinary Tract Issues
Here are treatments for urinary tract problems which
you may sometimes see in CKD cats.
Blood in Urine (Haematuria)
If your vet
obtains a urine sample from your cat via
(a needle into the bladder), this may sometimes cause blood in the
urine, which should resolve fairly quickly.
Other common causes include
a urinary tract infection,
bladder or kidney stones
If you can find the cause, you may be able to treat
is the leaking of excessive amounts of protein into the urine. It may
cause foamy urine, weight loss and swollen legs, face and abdomen. Its presence may
make the CKD progress faster.
Please see the Proteinuria
page for more information.
Urinary Tract Infections and Kidney Infections (Pyelonephritis)
Please see the new
and Urinary Tract Infections page for more information.
This means that the cat has limited control of where s/he urinates or
defecates. This section only addresses urinary incontinence.
Pet Place has some information about
Urinary Tract and Kidney
Incontinence may sometimes be caused by either a urinary tract infection
or by a kidney infection. A urine culture and sensitivity test should show
the presence of a urinary tract infection, but will not detect kidney
One of our cats, Harpsie, was prone to kidney infections, partly because
polycystic kidney disease (PKD). In PKD cats, the bacteria can enter
the cysts in the kidneys and cause a deep-rooted infection. We always knew
when Harpsie had a kidney infection because he became incontinent, but the
incontinence would go away within a couple of days of starting treatment
with antibiotics (although the treatment would continue for 4-6 weeks to
ensure the infection was completely eradicated).
Please see the
and Urinary Tract Infections page for more information.
If there is no infection present, you might want to try using
in the form of methylcobalamin in case that helps - some
Tanya's CKD Support Group
members have found it helpful.
Please also read the
Elimination section below in case some of it applies to your
cat's situation, and for tips on dealing with the problem from a practical
While you are trying to resolve the problem, using incontinence supplies
can help keep your home clean and make this stressful experience a little
less stressful for you.
Supplies (Puppy Pads Etc.)
incontinent cat is a lot less stressful if you take the time to protect
stores sometimes sell plastic sheeting to protect your furnishings when
decorating. It is really thin, like those bags used for fresh fruit and
vegetables in supermarkets. It comes on a roll about 18ft long and 6 ft
wide, and costs about £3 ($5). I used this to
cover the bed for Ollie, it was wide enough for my superking size bed and I
just cut it to the right length. It's so fine that you can't feel it on
the bed, but it helps protect the bed, although urine
can pool in it to a degree, plus it is so fine that it might slip
off the bed. Therefore I used mine in conjunction
a washable throw on top. I got mine from Wilkinsons.
Joybies sells piddle pants for cats in several sizes.
Handicapped Pets sells pet diapers in a
number of sizes.
Pet Edge sells puppy pads.
sells human incontinence supplies, which can be cheaper, although you do
have to buy in bulk.
Amazon sells rubber-backed waterproof
Amazon sells another type of waterproof
Amazon also sells waterproof picnic
Bed Wetting Store
sells a variety of products which might be helpful.
Chewy sells 150 pads for $25 but you can
get 50% off your first order only.
Boots sells incontinence supplies, including protective
covers for beds and chairs. You might wish to place these where your cat
spends time, with a
blanket on top which can be easily washed.
Pets at Home
sells puppy pads - I use
these ones to protect my sofas from cat vomit.
This means that
the cat is urinating (and sometimes defecating) in the
wrong place. There can be a number of possible reasons for this, but it is
definitely not done out of spite. Your cat is trying to tell you something
and you need to try to work out what it is.
Fortunately inappropriate elimination is usually manageable.
is a behavioural problem, but there may be some other reason for it in a
It can be helpful to video your cats around the litter tray, especially if
you are not sure who is the culprit.
Quantification of urine elimination behaviors in
cats with a video recording system (2017) Dulaney R,
Hopfensperger M, Malinowski R, Hauptman J & Kruger JM Journal of
Veterinary Internal Medicine 31(2) pp486-491 found that cats
recorded on video urinated more frequently than their caregivers thought
they did, and healthy cats spent longer covering their performances than
cats with issues. There are links to webcams
Infections or Constipation
Firstly and most importantly, inappropriate elimination
can be caused by a
urinary tract infection (UTI)
whereby the cat associates the litter box with the pain of the condition, so starts urinating and/or defecating elsewhere. You should
also consider the possibility of a
- our cat was prone to them and used to leak urine uncontrollably when he
had one (incontinence), which could have been mistaken for inappropriate
Infections and constipation can be very painful, and UTIs and kidney
infections may also damage your cat's kidneys further, so if your cat
urinates or defecates in the wrong place more than once, you should go to
the vet as soon as possible in order to have tests done and treatment
begun if necessary.
Inappropriate elimination can be associated with the general weakness and
weight loss of a CKD cat. If your litter box has a high edge, it might
simply be too hard for your cat to clamber in to the tray. Try to provide a lower
litter box and see if this makes a difference.
weight loss of CKD can make your cat's paw pads rather tender, which makes
standing on litter uncomfortable. This can be remedied by providing softer
litter, or by placing a few layers of newspaper on top of the litter which
can easily be thrown away with the litter.
In view of their increased need to urinate, many CKD cats simply get
"caught short" and cannot make it to the litter box in time. This is
easily remedied by placing several litter boxes in various locations,
including on every level if your home has more than one floor, and/or by
using larger litter trays. You may also need to clean the litter
boxes more often or provide more to offset the increased urination, so the
cat always has a clean place in which to go.
If you have recently had new carpets laid, it is possible that the carpet
actually has a urine-type aroma to the cat, which leads the cat to
associate the carpets with the litter tray and urinate on them.
with the above possible causes does not seem to help, you need to consider the possibility of
a behavioural problem not necessarily related to the CKD. Reviewing your
litter tray arrangements is an important part of this.
As a rule of
thumb, in a multi-cat household you need one litter tray per cat, plus
Almost all cats prefer a tray out of the way of household
traffic which offers some degree of privacy.
Some cats prefer one litter tray to urinate in and a separate one to
defecate in, and some cats like a covered litter tray, while others prefer
Litter box preference in domestic cats:
covered versus uncovered (2013) Grigg EK, Pick N & Nibblett B
Journal of Feline Medicine and Surgery 15(4) pp280-284
looked at whether cats prefer covered or uncovered litter boxes. The study
found "Overall, there was no significant difference between use of the two
box styles. Eight individual cats did exhibit a preference (four for
covered, four for uncovered), but individual preference results are not
evenly distributed, with more cats than expected showing no preference
between litter box types. We postulate that, if boxes are kept
sufficiently clean (ie, once daily minimum cleaning), most cats will not
show a preference for either box type. The observation that a minority of
cats in the study exhibited a preference supports the recommendation of
providing individual cats with a 'cafeteria' of litter box styles,
including a covered box, to determine whether such a preference exists."
For most cats, the bigger the
litter tray, the better.
Litterbox size preference in domestic cats (Felis
catus) (2014) Guy NC, Hopson M & Vanderstichel R
Journal of Veterinary Behavior 9(2)
pp78-82 looked into this and concludes "Results indicate that most cats
show a definite preference for a larger litterbox than is typically
available to them in homes and that other factors such as box cleanliness
and location may have a compounding influence on this choice." The litter
box favoured by the cats in the study was 85cm (33.5 inches) in length.
Therefore some people get large (100 gallon) Rubbermaid tubs and cut an
entrance for their cats.
Try to keep the trays as clean as possible (although be careful not to
clean them too much; they need to retain toileting associations for the
Experiment with the type of litter you use, because this can also be important to cats.
is designed to appeal to cats and some people have had good results
with it, and also with the Senior Cat version. It is available from
Amazon, among other retailers.
Automatic self-cleaning litter trays which clean the litter tray to a
degree after use appeal to some cats, though they can be expensive.
Dr Elsey's litterbox solutions (2017) has
more litter box tips.
If your cat has been urinating in one particular spot, you need to clean
it very thoroughly to remove all traces of the smell - even if you can no
longer smell it, your cat, with his/her better sense of smell, probably
Many cleaners contain ammonia which is a component of cat urine, so it
attracts them back to the spot. Try to get a cleaner without ammonia in
it. Ideally you need an enzymatic cleaner which really removes the smell,
though of course you must make sure you do not use a product which is
harmful to cats.
After the area is completely dry, try putting a litter box in the cat's
chosen spot, or if that is not possible try a food bowl (cats usually do
not urinate where they eat), a pot plant or aluminium foil (cats do not
like the texture).
The following products have been used successfully by members of Tanya's
CKD Support Group.
is an enzymatic cleaner and is the product I use for those little
accidents. It works really well, and without too much effort.
Amazon also sells a three pack.
Faeries also sell Anti-Icky-Poo.
This is another enzymatic cleaner for which I have heard good reports.
Needs sells Mystical.
Ashleys Green Products sell Mystical.
Inappropriate Elimination: Medication
Occasionally cats benefit from medication to help with inappropriate
elimination. Feliway and
Zylkène are worth considering. There is more information about these
treatments on the
Subcutaneous Fluids Tips page.
In some cases anti-anxiety medications may be used, such as clomipramine
or .fluoxetine (Prozac).
Mar Vista Vet has some information on
If All Else Fails
Unfortunately, for some CKD cats, urinating and/or defecating
inappropriately continues regardless of any measures you might take, and
you may have to grit your teeth, minimise access to favoured zones and try
to focus on the fact that this is related to the illness in some way and
your cat probably can't help his or her behaviour. We had to do this
with Tanya, who seemed to get caught short despite being provided with
multiple litter trays, but we figured twelve years of
her love more than compensated us for her behaviour.
You may derive some
comfort from knowing that, since CKD cats have dilute urine, most of their
accidents only have a mild smell, if any. For cats who urinate on beds or
sofas, try limiting their access to such areas by closing doors, or if you
are reluctant to do this, cover the bed or sofa with incontinence pads or a plastic sheet
supplies), and put a machine-washable blanket on top for the cat to
lie on: this will protect the bed and so reduce your stress levels, whilst
allowing the cat to lie on a comfortable but easily washed blanket.
Please, do NOT rub your cat's nose in the accident, it is extremely cruel
and achieves nothing, cats do not associate the punishment with their
Links to Further Information
Treating feline elimination disorders
Overall KL is an excellent article from a veterinary
Hilltop Animal Hospital has a series of
articles with advice on dealing with such problems.
International Cat Care
discusses soiling indoors.
Best Friends has an overview of litter
Litter box aversion: is it medical or behavioral?
Johnson-Bennett P helps you
consider possible medical causes for the problem.
AAFP and ISFM guidelines for diagnosing and solving
house-soiling behavior in cats
Carney HC, Sadek TP, Curtis TM, Halls V, Heath S, Hutchison P, Mundschenk
K & Westropp JL Journal of Feline Medicine and Surgery 16
pp579–598 has tips on managing, treating and hopefully resolving feline
has helpful information about housesoiling.
discusses our experiences of inappropriate elimination with a number of
different cats which we resolved.
Cornell University College of Veterinary Medicine
has tips on resolving this problem.
Why does my cat pee on the bed?
Johnson-Bennett P considers
Pet Place has some information from Dr
Nicholas Dodman on inappropriate elimination.
Common mistakes people make when trying to solve a
cat's litter box problem (2012) Johnson-Bennett P aims to help you deal with litter box problems.
Curing the litter box blues
(2011) Krebsbach S Humane Society Veterinary Medical
Association is a helpful presentation on this topic.
Cats Come Clean Animal Behavior
Associates is a book from animal behavioursts costing US$5.75.
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This page last updated: 12 May 2018
Links on this page last checked: 12 May