You are doing your normal scooping of the litter box and you notice drops of blood in your cat's urine, what does this mean?  Blood in your cat's urine is always a concern and can be due to a variety of issues from stress to lower urinary tract disease.

Hematuria is the medical term used to describe blood in the urine. When this happens, you may notice orange or red-tinged urine or blood clots. In some cases, urine may appear normal and the bleeding can be on a microscopic level. In these cases, blood will be detected by diagnostics and laboratory analysis.

Causes of Blood in Cat Urine 

Blood in the urine is a symptom of an underlying issue and not a diagnosis. This symptom can be seen with a variety of health conditions and if noticed, your cat should see a veterinarian.

Pandora Syndrome

Bacterial UTIs occur much less frequently in cats than in dogs, with only one to two percent of cats suffering from UTIs in their lifetime. More commonly what cats have is Pandora Syndrome which does not in most cases have a bacterial component and treatment consists of more than just an antibiotic.

A disease of the lower urinary tract is one of the most common problems in cats. It involves inflammation and discomfort in the bladder and the urethra which is the tube leading from the bladder to the outside of the body. This goes by various names, FLUTD (Feline Lower Urinary Tract Disease) or FIC (Feline Idiopathic Cystitis, Idiopathic means the cause is unknown) as well as Pandora Syndrome.

Pandora syndrome, like the name implies, has no single cause. The underlying causes are likely due to multiple factors: among these include bladder and hormone abnormalities, obesity, environmental stressors, history of early adverse experience or severely stressful events, living with other cats, infections, urinary stones, and/or rock-hard collections of minerals formed in the urinary tract of cats which obstructs the normal flow.

Cats with Pandora syndrome most often show signs of bladder inflammation, difficulty and pain when urinating, increased frequency of urination, urinating outside of the box, and blood in the urine. Often cats who have Pandora Syndrome will have chronic urinary issues that wax and wane.

Urethral Obstruction

Urethral obstruction is a medical emergency that can cause a can to urinate blood. This condition is most common in male cats but can be seen in female cats as well. This is because the urethra of a male cat is much longer and much narrower than that of a female cat, and so is more susceptible to becoming blocked.

A urethral obstruction occurs when the urethra (the tube that carries urine from the bladder to the outside of the body) is blocked and the cat is unable to pee. The obstruction can be due to several causes including mucous plugs, urinary stones, urinary crystals, strictures, or tumors. An obstruction can occur develop from urethral spasms or swelling secondary to inflammation in the lower urinary tract. When this happens, it is difficult or impossible for a cat to empty the bladder, making it a life-threatening emergency. If your cat is having trouble urinating, it should be seen by a veterinarian immediately. Left untreated, the urethral obstruction can lead to kidney failure and death within 24 to 48 hours.

Other Causes 

Although they are less common causes, hematuria can also be caused by constipation, tumors of the urinary tract, congenital abnormalities (birth defects), or injury to the urinary tract or spinal cord.

What to Do if There Is Blood in Your Cat's Urine

If you notice blood in your cat’s urine, it's best to contact your veterinarian immediately. At your veterinary visit, your vet will perform an exam and diagnostics to rule out the known causes of blood in urine and form a diagnosis.

These include:

• History: Your veterinarian with the help of the veterinary technician will obtain a history on your cat. This will include your cat's behavior, including any changes to the environment, the cat’s routine and schedule, and any other symptoms you have observed at home.
• Physical Exam: Your veterinarian will perform a physical exam of your pet.
• Bloodwork and Urinalysis: By obtaining and running bloodwork and a urinalysis, your vet will be able to see how your cat’s internal organs are functioning as well as check for dehydration, bladder inflammation, and infection.
• Urine Culture and Susceptibility: A urinalysis sample should ideally be obtained via a cystocentesis which is a procedure where a needle is placed into the urinary bladder through the abdominal wall and a sample of urine is removed. A urine culture test is a method of identifying the specific bacteria that may be causing a urinary tract infection. It involves placing a urine sample on a special medium, incubating the sample so the bacteria can grow, and then identifying the bacteria. A second test (a sensitivity test) is usually conducted to determine the most effective antibiotics to use against the bacteria involved.
• X-Rays and Ultrasound: These are done to assess if the bladder appears abnormal or contains bladder stones.

Treatment for Blood in Your Cat's Urine

Treatment for hematuria is based on the underlying cause and is tailored to the individual cat. Treatment may include pain medications, diet changes, increasing water intake, fluid therapy, anti-spasmodic medication to help the bladder relax, and stress reduction.

If your cat has a urethral obstruction, your vet will need to relieve the obstruction quickly. Your vet will need to sedate or anesthetize your cat to place a urinary catheter along with providing supportive care to address pain, nausea, and metabolic changes.

Infections are treated with antibiotics and pain medication. A prescription diet may be used to try to dissolve bladder stone over a few weeks. If the prescription diet doesn't work the stones need to be surgically removed. Diet and increased water intake can be used to address urinary crystals.

How to Prevent Blood in Your Cat's Urine

You cant always prevent blood in your cat's urine but there are factors that are known to increase the chances of your cat having blood in their urine which includes obesity, decreased water intake, and one of the most common causes, stress. Read below to find out you can help prevent hematuria.

• Monitor your cat's behavior and elimination patterns and be sure to alert your veterinarian to any changes or concerns.
• Keep your cats active with play and food puzzle toys to help prevent obesity.
• Increase water intake: Increasing water intake helps prevent urinary issues in cats. You can encourage your cat to drink by providing various resources for water including water fountains, wide and shallow bowls, and having water available on each floor in your home. Feeding wet food, a canned urinary prescription diet, and adding water to their food easily provides your cats with more water.
• Enriched environment: It is important to provide multiple and separated key environmental resources which include litter boxes, water, food, hiding spaces, places to perch, resting/sleeping areas, play areas, scratching areas, and toys. This helps to decrease social tension and competition, decreases territorial motivations, decreases stress and fear, and provides choices that all help to prevent stress and create a safe environment.
• Stress reduction: There are a variety of ways to help decrease stress for your cat. Pheromones, such as Feliway and classical music such as Through a Cat's Ear can help create a relaxed, cat-friendly environment. Do your best to provide your cat with a routine and consistent schedule and be aware of the stress caused by changes such as construction in the home, vacation, etc.
• Appropriate litter box setup: In many cases, a cat's litter box is not set up properly, which can lead to stress and urinary issues. When it comes to litter boxes, there should be one litter box per cat in the home, plus one extra. If there is more than one floor in the home, there should be at least one litter box per floor. The larger the box, the better, boxes should be 1.5 times the length of your cat, and boxes should be located in open, well-ventilated areas and should be kept clean.

Overall, blood in your cat’s urine can be caused by a variety of issues stemming from the bladder and urethra in cats. If you ever feel as though your cat is experiencing a urinary tract problem, especially if they are straining to urinate and seem uncomfortable, please seek veterinary attention.