It's hard to imagine not being able to urinate. But that does happen in cats, and sadly, it is not uncommon. And tragically, it's a problem that can be completely reversible if caught in time.... but fatal if it's not.

What to Look For:
Major Symptoms

Straining and crying in the litter box (the most common symptom)

Excessive licking at the genitals (second most common symptom)

No urine produced

Small amounts of urine with or without blood in the box or around the house.

Other Symptoms

Blood or crystals in the fur at the back end where the urine comes out
Lethargy, hiding, inactivity, aggression, restlessness, crying, pacing
Vomiting
Swollen hard tummy
Loss of Appetite

If you suspect that your cat may be "blocked", meaning he cannot urinate, it is an emergency situation.

With the bladder as full as it can be, there is no place for any urine to go if it's produced by the kidneys, so the kidneys shut down. This causes a buildup of toxins in the body that can rapidly lead to death, in as short as 24 hours.

Kidney failure or burst bladder may occur as other complications. If you have not been checking the box daily, if your cat goes outdoors, or you have a multi-cat household, it may be tough to tell exactly when he last urinated, but do your best!

What Are The Causes of this "Blockage"?
There are many causes of urethra blockage, but the two most common are stones and plugs. Mucous, crystals, and tiny bits of urinary debris (cells and protein) can aggregate together to form a soft, compressible material that can lodge in the urethra and completely block the flow of urine. This is what plugs are. Stones, as the name implies, are mineral "stones" that are hard, and may or may not be round in shape.

Blockage is most common in male cats due to the fact that their urethra is longer and narrower than in the females. Female cats can become blocked though! Cats that are straining to urinate frequently and not producing urine may be blocked or just exhibiting these signs due to bladder discomfort associated with sterile interstitial cystitis, or bladder infection; other types of conditions we class as FLUTD complex.

How is This Blockage Diagnosed?
With simple palpation of the abdomen, the veterinarian can usually quickly determine whether blockage is the problem. A normal bladder will feel something like a water filled balloon. A "blocked" bladder will feel like a baseball. There is however, the entire gradation between the two, depending how long the bladder has been full and the urethra blocked.

How is the Blockage "Unblocked"?
Although on occasion, gentle pressure by the veterinarian on the bladder can expel the obstruction and relieve the blockage, usually a urinary catheter will be required. The passage of the catheter into the bladder requires sedation or light anesthesia. Although most catheters can be inserted, occasionally the stone or plug is so tightly lodged within the urethra that the urinary catheter cannot be passed. Flushing may be done to help move it out back into the bladder.

Can This Problem Recur?
Yes, it can. And if, at a certain point, after a certain number of blockages, the veterinarian realizes that this problem will continue to recur, a surgery called " perineal urethrostomy" will be performed to permanently change the size of the outflow tract to make it less likely a stone can become stuck. In this surgery, the urethra is shortened and widened making him more like a girl cat in the anatomy. The male cat will then urinate from an opening in the skin below the anus, and not out of the penis.

The surgery is the best bet to prevent subsequent bouts of blockage, but it may slightly predispose the cat to bladder infections. This is life saving surgery though, since repeated bouts or intractable blockage will lead to death of the cat.

If the bladder was very over-distended during blockage, some damage to the bladder wall may have occurred and only time will tell whether the muscles that produce normal emptying and squeezing down of the bladder will recover. Rarely, if extremely over-distended, tears can occur in the wall of the bladder, requiring surgical repair in another type of surgical procedure.

Once the obstruction has been relieved, cats will require at least a few days stay in the hospital. The urine is analyzed and cultured (to see if the urine contains bacteria) and antibiotics will be started if needed. Intravenous fluid therapy is provided as most blocked cats have dangerous levels of toxins in the blood and have bloodstream electrolyte imbalances that need to be corrected.

The veterinarian will leave the urinary catheter in place until it is less likely the cat will block again when it is removed. Spasms and pain will be attended to with medication, and sometimes tranquilizers are administered in order to relax an unhappy patient.

If you are not sure if your cat is able to express urine, assume that an emergency could be present and call your veterinarian's office at once!
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