Home  Health & Common Symptoms Difficult or Painful Urination
	By: Dr. Mary Anna Labato

•   Straining to urinate
•   Frequent attempts at urination
•   Blood in the urine (hematuria)
•   Excessive licking at the urogenital area
•   Passage of only small amounts of urine
•   Vocalization when attempting to urinate
•   Inappropriately urinating (in the house)
•   Unproductive urination (no urine passed)

Causes

Causes of dysuria include a number of different conditions including:

•   Urinary tract infection
•   A stone in the urethra
•   Bladder stones
•   Urethritis (inflammation of the urethra)
•   Masses (tumors) in the bladder or urethra
•   Stricture (narrowed area within the urogenital tract)
•   A neurologic problem resulting in increased urethral tone (dyssynergia) or decreased bladder tone (atony)

Treatment will depend upon the underlying cause of the problem. It may require:

•   Antibiotics to treat infections
•   Surgery to treat stones or a stricture
•   An anti-inflammatory dose of steroids to treat inflammation

Home Care

Administer as directed any medications prescribed by your veterinarian. Observe your cat’s urination patterns. Make sure urine is being passed in adequate amounts. Observe your cat’s general activity level, appetite and attitude. Make sure your cat has plenty of water and has frequent opportunities to urinate. Follow dietary recommendations of your veterinarian.

Causes

Dysuria may be the result of a number of different causes. These include:

•   Calculi. Bladder or urethral
•   Infection. Bacterial cystitis (infection of the bladder), urethritis, vaginitis, prostatitis (bacterial) or prostatic abscess
•   Bladder cancer. Transitional cell carcinoma, rhabdomyoma or sarcoma
•   Urethral cancer. Transitional cell carcinoma, transmissible venereal tumor
•   Prostate cancer. Adenocarcinoma, transitional cell carcinoma, squamous cell carcinoma
•   Vaginal or penile cancer. Transmissible venereal tumor, fibromas, sarcomas
•   Trauma. Ruptured bladder or urethra, urethral stricture
•   Inflammation. Feline lower urinary tract disorders (FLUTD) or granulomatous urethritis
•   Neurologic. Detrusor-urethral dyssynergia

Veterinary Care In-depth

Diagnosis In-depth

Diagnostic tests needed to determine the cause of dysuria include:

• Urinalysis to identify crystals, abnormal cells or evidence of inflammation
• Urine culture and sensitivity to identify the presence of infection
• Plain abdominal radiographs to assess for the presence of cystic (bladder) calculi (stones)
• Contrast cystourethrogram. A radiographic dye study to evaluate for the presence of calculi in either the bladder or urethra. This study will also establish the presence of filling defects that may be masses, areas of inflammation or strictures.
• Abdominal ultrasound to assess the kidneys, ureters, bladder and proximal urethra.
• A rectal exam will also be advantageous to assess the size and thickness of the pelvic urethra evaluating for masses, prostatic enlargement, or stones.
• Blood tests such as a complete blood count and serum chemistry profile may be needed to assess for changes suggesting infection or elevations in kidney values.

Treatment In-depth

The course of treatment will be dictated by the underlying cause of the problem.

• Dysuria caused by the presence of a stone in the urethra may require a technique referred to a retrograde urohydropropulsion. This is when a catheter is advanced to meet the stone and sterile water is flushed under pressure to dislodge the stone and either flush it out of the urethra or back into the bladder.
• The presence of stones in the bladder may require either surgery to remove them or in with some types a special diet to dissolve the stones.
  Antibiotics to treat for bacterial infection may be required for a short period of time (2 weeks) with a first infection or up to 3 months with recurrent infections.
• With granulomatous urethritis the use of steroids to decrease the inflammation and perhaps an antispasmotic agent/smooth muscle relaxant such as prazosin will be necessary.
• Some tumors of the bladder or urethra will require surgery to remove and those that are not amenable to surgery will require chemotherapy drugs or nonsteroidal anti-inflammatory drugs.

Follow-up

Follow-up may require long-term medical management. Also subsequent radiographs may need to be taken or repeat ultrasound examinations. Frequent examinations of the urine and repeat cultures will be required to monitor for infections and response to antibiotic management.

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