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Quick Overview: Incontinence in Cats
A cat leaking urine around your home is sure to cause some complicated emotions. While you’re concerned for your sweet pet’s health, you’re also frustrated with cleaning it all up and finding a solution. Meanwhile, it’s so important to remember that your cat doesn’t like this either and needs your help and patience at this time.
In this article, you’ll learn what true urinary incontinence is in cats, how you can recognize it, and how to differentiate it from other inappropriate urinary behaviors.
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Healthy Urination in Cats
Incontinence in cats is caused by one or more dysfunctions of the urinary bladder. SciePro / Shutterstock.com
Understanding incontinence requires some basic knowledge about how the normal urination process actually works. Your veterinarian uses this knowledge to try to determine what type of incontinence is happening.
Urination is a very complex coordination between muscles and nerves. The bladder and the urethra must work together to properly store urine and release it at the appropriate time. There are two phases to this process: storage and voiding.
During storage, the bladder is relaxed, allowing it to expand and fill with urine. Muscles in the neck of the bladder and the early urethra remain tightened to keep urine from leaking out. As urine fills the bladder, pressure increases until your cat feels a nerve signal that says it’s time to urinate.
When your cat arrives at the litter box, the bladder and urethra must shift gears simultaneously. The bladder contracts as the urethra relaxes. This allows urine to leave the body through the urethra. Once empty, the bladder relaxes and the urethra tightens back up.
Causes of Urinary Incontinence in Cats
So what happens when the bladder and urethra do not work so seamlessly together? Urinary incontinence in cats generally falls into two categories: problems with the bladder and problems further down in the urethra. Each type can have several causes.[1]
1. Bladder
Urge incontinence: This type of incontinence occurs when the detrusor muscles in the bladder wall contract uncontrollably and intermittently. The bladder typically does not have an opportunity to fill. This form can occur with inflammation in the bladder wall or urinary tract and when there is a space-occupying condition within the bladder (i.e. bladder stones, a mass, or severe swelling).
More specific causes include:
Urinary bladder stones
Some types of urinary tract infections
Bladder mass or tumor
Chronic bladder inflammation leading to scar tissue formation (fibrosis)
Inflammation from feline idiopathic cystitis (FIC)
Bladder surgery where a part of the bladder wall was removed (partial cystectomy)
Overflow incontinence: This is a condition where the bladder is much too full but is unable to empty itself normally due to impaired function of the detrusor muscles in the bladder wall. The pressure in the bladder body eventually exceeds the resistance of the bladder neck and urethra—so urine dribbles out.
Causes of this type are usually related to nerves that connect to the bladder. Spinal cord injury or disease is usually responsible.
2. Urethra
Urethral sphincter incompetence: This relates to the muscle tone in the urethra that is supposed to remain tight during urine storage and then relax during urination. The “incompetence” refers to when the muscle lacks tone or is “weak” allowing leakage of urine during the storage phase. Here are some causes:
Weakening over time (especially in older pets)
Low levels of hormones like estrogen and testosterone
Trauma that affects the nerves connecting to the muscle
Other spinal cord disease (inflammation, infection, immune disease, cancer)
Paradoxical incontinence: This type of incontinence results from a blockage in the urethra. This is often a urinary stone or mucus plug but can also be from a functional or congenital (birth defect) problem with the urethra.[2] When pressure above the obstruction increases enough, urine will leak around the obstruction. The paradox is that there is actually a blockage present. Nearly 70% of cats with non-neurologic incontinence exhibit this type.[3]
Causes include:
A urinary bladder stone that lodges in the urethra
A mucus plug that lodges in the urethra (inflammation contributes to mucus accumulation and mixes with mineral sediment or grit to form a plug)
Severe urethral inflammation
Urethral stricture
A condition causing a malfunction of the urethral muscle (such as reflex dyssynergia) that prevents urine flow.
Symptoms of Urinary Incontinence in Cats
There can be some overlap between signs of urinary incontinence and other causes of inappropriate urination. This is what we see most commonly:
Urine leaks out while a cat is resting or sleeping
A cat’s hindquarters is constantly wet or soaked with urine
Urine dribbles out constantly, even while a cat is awake and engaged in normal activity
Some cats will show other signs of inappropriate urination as well, such as:
Straining to urinate
Urgency to urinate
Excessive licking or grooming of the hindquarters
Frequent trips to the litter box
Extended periods in the litter box with very little urine produced
These other signs can be seen especially in cases of urge incontinence as well as paradoxical incontinence.
Similar Conditions
Some animals come to our clinic for urinary incontinence but the exam reveals there’s something else going on. Other causes of inappropriate urination may include:
Diagnosis of Urinary Incontinence in Cats
Evaluating a urine sample is one of the first tests needed to diagnose urinary incontinence in cats. Yaya Photos / Shutterstock.com
When there is concern about urinary incontinence in a cat, a veterinarian will first get some detailed historical information from you. This is a crucial first step to what type of urinary disorder may be present.
True urinary incontinence commonly involves the involuntary voiding of urine. Your vet will ask about urination while sleeping or resting, dribbling, and how your cat behaves when urinating.
A physical exam is also performed. Sometimes, there are clues a vet will come across. This includes whether the bladder feels full, empty, or painful.
A diagnosis of urinary incontinence often requires a very full assortment of tests to arrive at. Other urinary disorders must be ruled out. Common tests include:
Some advanced testing may be needed, especially for some disorders involving urethral obstruction, birth defects contributing to incontinence, or spinal and nerve disease.
MRI
This is the preferred imaging method for spinal cord disease.
CT (cat) Scan
This test may be used to look for structural abnormalities or trauma
Contrast urethrocystogram (or cystourethrogram)
This is a special x-ray test that uses a contrast material to highlight the urinary tract. It can be used to highlight obstructions in the urinary tract or abnormalities in urine flow.
Treatments for Urinary Incontinence in Cats
The medication used to treat incontinence in cats depends on the type of incontinence they’re experiencing.
Urge incontinence may be treated at the source of what is causing bladder inflammation (cystitis). This may include a urinary tract infection, bladder stones, stress cystitis, or a bladder mass. Bladder stones and bladder masses usually require surgery.
Feline idiopathic cystitis (FIC) is a urinary disease that vets struggle to treat effectively. Researchers recently finished a study involving low-dose radiation therapy to see its benefits for chronic recurrent bladder inflammation.[4]
Dr. Michael Nolan, a professor of radiation oncology and lead researcher, said, “You can actually treat arthritis and other inflammatory conditions with low-dose radiotherapy and it works really well…” He and Dr. Allison Kendall enrolled 15 client-owned cats with FIC in their trial to significant success.
Every cat in the study showed some improvement, with many not having repeat cystitis episodes, and Dr. Kendall sees a lot of promise in this therapy. “I feel confident enough in the study to start recommending it.”
Overflow incontinence caused by a nerve injury or disease may be difficult to treat. Some spinal cord disorders may be addressed with surgery, but many cats may still retain some degree of incontinence.
If the urinary bladder is stubbornly full and can’t empty, treatment with a combination of bethanechol and phenoxybenzamine may be tried. Bethanechol increases the contraction of the bladder detrusor muscles, while phenoxybenzamine helps the urethral sphincter muscle to relax and allow for urination.
Urethral sphincter incompetence can be treated medically. There are no products approved for use in cats. But one product, phenylpropanolamine (PPA), may be used off-label. PPA works by increasing muscle tone of the urinary sphincter muscle, keeping the urethra squeezed shut and preventing urine leakage. The main side effect of PPA is that it can increase blood pressure. Blood pressure is usually monitored in pets on this medication.[5]
Hormone therapy is sometimes used to treat urethral sphincter incompetence in pets. Medications include estriol and diethylstilbestrol (DES), which are both very similar to estrogen. But estrogens are not advised for cats because they can cause bone marrow suppression and blood disorders. DES has fallen out of favor as a treatment option due to a high risk of adverse effects.
Paradoxical incontinence, where some kind of obstruction is present, may be addressed surgically. In a case where a physical obstruction, like a urinary stone lodged in the urethra, can’t be relieved, a surgery called a perineal urethrostomy may be performed. This surgery creates a new opening earlier on in the urethra where it’s wider. This creates a new exit for urine, leaving the obstruction behind.
Other interventional procedures have been used, including the placement of an artificial sphincter called an occluder to help keep the urethra closed to prevent leaking.[6]
Cat Care Tips
If you’re concerned your cat has urinary incontinence, here are some helpful things to consider:
Reaching a diagnosis of a particular type of urinary incontinence is extremely important to determine the correct treatment.
When discussing with your vet, it’s helpful to share any observations about your cat’s urination. This can give your vet important clues about what urinary disease process is occurring.
If your cat is incontinent, regular daily inspection and cleaning of the hindquarters is important. Urine residue can be irritating to the skin and lead to infections.
Having an incontinent cat means you will have to adapt your world to fit theirs. Set up a home that is easy to clean. Try washable rugs, towels, and puppy pee pads. Keep furniture protected with washable coverings.
For clean-up of urine, use enzymatic cleaners. Having a vacuum with deep cleaning and steam cleaning capabilities could be a good investment.
Some causes of urinary incontinence can’t be avoided, such as congenital birth defects, cancer of the spinal cord, and old age. However, some incontinent cats may have an undiagnosed obstruction. Early recognition, diagnosis, and treatment is crucial to prevent long-term consequences in these cases. Spaying or neutering a kitten too young may also lead to incontinence due to poor hormonal exposure during growth. If possible, wait several months to have kittens spayed or neutered.
Frequently Asked Questions
What causes sudden incontinence in cats?
Sudden causes of urge incontinence can include a flare-up of feline idiopathic cystitis (FIC) or a urinary tract infection. Sudden trauma to muscles and/or nerves that connect to the bladder can lead to other forms of incontinence like overflow incontinence.
What can you do for a senior incontinent cat?
A very old cat may or may not have true urinary incontinence. Old cats can have arthritis which makes it difficult to get in and out of the litter box or up and down stairs to reach a litter box on another floor.
Cognitive dysfunction may affect a cat’s ability to remember to use the litter box or where it is.
Old cats may also be more likely to suffer from conditions like chronic urinary tract infections, kidney disease, and diabetes.
It’s important not to assume an old cat is incontinent and nothing can be done. Make sure to pursue a diagnosis with your vet.
What medication is used for incontinence in cats?
Phenylpropanolamine (PPA) is the most commonly used medication for incontinence in cats. Specifically, this is for urinary sphincter mechanism incompetence where the muscle keeping the urethra closed is too weak and allows urine leakage. PPA increases muscle tone in the urinary sphincter, preventing leaking.
This medication will not work if urinary incontinence is caused by a disorder of the bladder.
For a bladder that can’t express properly, leading to overflow incontinence, a combination of the medications bethanechol and phenoxybenzamine may be used. Bethanechol enhances contraction of the bladder detrusor muscles and phenoxybenzamine helps to relax the muscle of the urethra to allow urination.
Why is my cat leaving small pee spots?
If your cat is leaving small pee spots, there may be several causes. Small frequent urination may be caused by urinary tract infections, stress-related bladder inflammation or feline idiopathic cystitis (FIC), bladder stones or crystals, and bladder tumors. If your cat leaves small drops of urine while walking around, a form of urinary incontinence may be present.
Cats may also urinate inappropriately for behavioral reasons including cognitive dysfunction, marking behavior, and stress-related behavior.
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Fournet, A., Maurey, C., Decambron, A., Viateau, V., & Manassero, M. (2020). Treatment of urinary incontinence in a cat with genitourinary dysplasia using an urethral sphincter occluder. Journal of Small Animal Practice, 62(5), 391–396.
