Creature Comforts

So if you are just tuning in from three weeks ago, you’ll recall I asked you to drink a large glass of ice water and hold on until now. How’d it go? Not so good, huh? Had to give in and “use the facilities” didn’t you? Uh huh, just as I expected. Okay then, pour yourself a fresh cup of coffee and try to get through this without stopping to use the facilities.

If you have no idea what I’m talking about, I’ll sum up. We continue our discussion of urethral obstructions: being able to make urine, and store it in the bladder, but being unable to urinate or pass the urine outside the body.

Receptionist: “Mrs. Smith is on the phone. She says Tiger has been going in and out of the litterbox a lot for the past few days, and he’s crying a lot. He won’t eat today, and she said that he doesn’t seem to be doing anything in the litterbox, even though he seems to be straining to go. She says he may be constipated.”

Veterinarian: “How soon until they get here?”

This conversation is a classic. It is repeated many times over in veterinary hospitals everywhere throughout history. The “blocked” cat: a true emergency. Why would we assume this case to be a potential urethral obstruction rather than constipation (unable to have a bowel movement) as the owner opined? Actually, it’s just a hunch. An educated hunch backed by the law of averages. You see, most of the cats with a history like this have urinary issues, not bowel issues. One is a serious emergency. Which hunch do you want to play? We generally don’t play hunches, and get them in ASAP. Better safe than sorry, right?

When Tiger comes in, and the diagnosis of urethral obstruction is made, he may be alert and normal-looking, excepting his painful, blocked bladder. Or he may be flat-out, nearly comatose. It all depends on how long he has had the blockage.

Tiger needs some assistance to relieve his blockage. This usually requires heavy sedation or anesthesia, so that a small, rubber or plastic catheter tube can be introduced into the urethra and advanced into the bladder. Anesthesia, because cats don’t much appreciate our efforts to help them, especially when helping involves sticking a tube someplace objectionable to the cat. And cats are equipped with various effective weapons to make even simple restraint rather difficult.

The process of urinary catheterization may take multiple attempts, copious flushing with sterile fluid, and a great deal of patience – another reason anesthesia usually is a must.

Once the blockage is relieved, the catheter usually is left in place for at least 24 hours to maintain an assured free flow of urine, and to keep the bladder empty. Anybody who has ever had the pleasure of experiencing a urinary catheter themselves will attest – it makes one a bit cranky. A lot of cats don’t take much prompting to reach “cranky” moods. Cats with indwelling urinary catheters can be downright ornery, making them more demanding patients in general.

Kidney function may be affected after a blockage, which may result in permanent damage.

Blood tests always are recommended after a blockage has occurred to evaluate organ function. Fluids may be administered to any animal that has experienced a blockage, to support the kidneys and help correct electrolyte and fluid imbalances. If the bladder has been overstretched (like a big, floppy, balloon) it also may be permanently damaged.

X-ray pictures of the abdomen are necessary to assess organ size, shape, position and consistency. We look for uroliths (urinary stones) that may be present in the bladder, urethra or even in the kidneys. Kidney stones are not part of this discussion – they occur with much less frequency as compared to bladder stones. But not all blockages are caused by stones.

Urethral obstructions can be caused by a variety of problems, all of which are basically plumbing problems (a mechanical plug of sorts in the drain). The most common cause in cats is a matrix of mucus and sandy material that lodges typically in the farthest portion of the urethra. Urinary stones may also cause blockages, of course, if they are small enough to lodge in the urethra. On some occasions, urinary blockages can be caused by tumors or trauma to the pelvis. A swollen prostate gland also may be responsible for slowing or even stopping the flow of urine.

Blockages happen most often in males, both dogs and cats, because the urethra is longer and narrower than in females. Urethral obstructions in females are almost uniformly surgical emergencies, as it is notoriously difficult to catheterize the bladder of female animals. Fortunately, this type of scenario doesn’t happen very often in females. That is not to say female animals aren’t afflicted with the same urinary tract diseases as males – they are. However, they don’t tend to suffer urethral obstructions with the same frequency, thank goodness.

Treatment and diagnostic tests are pretty much the same for all species, provided a urinary catheter can be passed to relieve the obstruction. Male dogs are a bit more difficult to unblock because of the os penis. Totally not being rude here – that is the name of the bone that is part of the male dog’s “boy parts.” This bone is long and narrow and the urethra passes through it. Many of the blockages seen in dogs occur at the os penis, which makes unblocking them a big challenge if the catheter being introduced will not pass. A temporary but lifesaving surgery may need to be performed in some of these more difficult cases, sometimes followed by more permanent surgical solutions.

The outcome of any of these cases is dependent on a few key factors: the length of time the animal has been blocked, the location and nature of the obstruction and the ease and effectiveness with which the obstruction is relieved. In many cases, particularly with bladder stones or feline urinary tract syndrome (the mucousy-sandy plug in cats), a repeat performance is expected. If or when this will occur is anybody’s guess.

Sometimes we can suggest dietary changes that will help prevent these problems from recurring, especially in the case of bladder stones.

While this topic is discussed in entire chapters of veterinary medical and surgical textbooks, and is given hours of lecture time in continuing education meetings, space and time here are limited. Besides, I’m sure you’ve drained your coffee cup by now, and need to take a break. You can stop holding it now – time to go.

Creature Comforts

Thanks to my parents, it was hardwired into my brain from a very early age to (as I now tell my children) “start on empty” before going anyplace. Now that I am a parent, I can fully appreciate the wisdom of enforcing this rule, EVEN IF YOU DON’T HAVE TO GO.

It may delay departure by a solid 15 minutes, and may involve some yelling or dishing out ultimatums, but it sure beats dragging a whiny, urgent 6-year-old around in a store the size of a city block frantically searching for a public rest room. It also is preferable to finding oneself on the interstate with 35 miles to the nearest exit or rest area – with a suddenly full bladder.

As a consequence of this habit, I generally don’t allow my bladder to become any larger than the size of a walnut – or so it seems. So, when I arrived for my appointment for the ultrasound, I was very uncomfortable. Although this was years ago, I can remember it very clearly. Trauma does that to a person.

The receptionist checking me in asked in a sweet voice, “You remembered to arrive with a full bladder?” I smiled as nicely as I could while I answered in the affirmative. To my great dismay, she directed me to a seat in the waiting area.

When I was finally called (it seemed like an eternity, but it was likely to have been less than 10 minutes) I was practically dancing with urgency. It took a great deal of strength not to wail in angst when the ultrasound technician announced firmly that my bladder wasn’t at all full enough, and that I’d have to wait a bit longer. I believe I did emit a little yelp as the helpful nurse handed me a very large Styrofoam cup full of ice water to drink to speed things along.

The actual ultrasound was a cosmically painful event. I say “cosmically” because I actually saw stars as the technician pressed on and around my seeming full-to-bursting bladder with the ultrasound probe – all part of the normal scan, she assured me. The imprints where my hands gripped the table are probably still there today, but I got through it without an accident, I am proud to say. What we ladies won’t endure for a safe, healthy pregnancy and baby!

My patients are not nearly as cooperative as I was that day. If they have to go, they go. We do a lot of cleaning up in my line of work. That is, unless they can’t go.

My painful experience pales in comparison to those poor animals I see that can’t urinate. Just imagine feeling like you urgently have to urinate, but being unable to go, no matter how hard you try. Now, imagine this going on for hours – or days – with no end in sight.

This situation can happen to any animal that has a urinary bladder. I have seen urinary blockages in cats, dogs, ferrets, guinea pigs and even a pet raccoon. In most cases, the animals are in great distress – although some are better at hiding it than others.

The typical scenario for cats is that the owners have seen them acting strangely for a few days prior to the day they are brought to see us at the veterinary hospital. They may be hiding a lot, or may be walking around crying, or may be seen visiting their litterboxes frequently. Some urinate (or try to urinate) right in front of their owners. Some lose their appetites, some vomit.

Dogs usually don’t give much warning – they suddenly just start straining to urinate, with little or no urine passing.

Frequent, urgent attempts to urinate, often in inappropriate places like indoors is the hallmark sign of a urinary blockage in an animal. That being said, it is entirely possible for the animal to be experiencing cystitis (bladder infection) and be exhibiting the same symptoms. Cystitis usually is very painful but not immediately life-threatening. A urinary blockage, however, can cause death in sometimes less than a day.

How does one tell the difference? By palpation of the abdomen, usually. As most people who are not trained in veterinary medicine are unsure of what an obstructed bladder feels like, it is best to bring the animal to your veterinarian’s office for this determination.

What we’re looking for is a firm or hard, enlarged urinary bladder that will not empty with firm, steady pressure applied. Yes, it is possible for a bladder to burst when pressure is applied in this way, so care must be used when using this technique – another reason to seek professional help. If the animal strains to urinate while the bladder is found to be full and does not empty, the animal is determined to be “blocked.”

Bear with me here while I give a mini anatomy lesson. The kidneys are paired organs that lie on either side of the spine around the lower back (lumbar area) and are responsible for manufacturing the urine. The ureters are tubes that carry the urine from each kidney to the urinary bladder.

The urinary bladder stores the urine for a time, and the urethra is the single tube that exits the bladder and carries the urine to the outside of the body. If the animal is normal, he has conscious control over the urinary sphincters, which when released, signal the bladder to contract and empty.

The type of urinary obstruction we are discussing here is a distal blockage, or urethral obstruction. In plain terms: you’re making urine, it’s getting into the bladder, but you just can’t pee. How’s that?

Super painful, that’s how. So what do we do about it? Well, attempt to remove the obstruction, silly. But this is sometimes easier said than done. Mechanically, it is simple: the urethra has a plug of some sort that must be relieved. But it is not always in a convenient spot, and is not always something that is easily removed or even moved in some instances.

Anxious to know more about urinary blockages, causes and treatments? Well, you’ll have to hold on ’til next time! Why don’t you sit in a comfortable chair and drink a big cup of ice water while you wait? ‘Kay, see you in two weeks

Daverio is a veterinarian at Williamsport West Veterinary Hospital