Cat Straining in the Litter Box? When It's a True Emergency

Most litter-box problems can wait for a regular vet appointment. This one can’t. A cat that strains to pee and produces little or nothing may have a urethral obstruction, which means its bladder can’t empty. According to the Cornell Feline Health Center, it is “an absolute emergency.”

Know the signs

Cornell lists these as the most common signs of lower urinary tract disease (LUTD) in cats:

• Difficult or painful urination
• Going more often than usual
• Crying out while urinating
• Blood in the urine
• Urinating outside the litter box
• Licking the genital area a lot

Red flags that mean “go now”

A blocked cat usually shows the signs above, but passes little or no urine and gets more and more distressed, often crying out in pain. You may see the cat squatting in the box over and over with nothing coming out. (People sometimes mistake this for constipation.)

Why the rush? When the urethra is completely blocked, the kidneys can’t clear toxins, and dangerous electrolyte imbalances build up. Cornell notes that death can occur in less than 24–48 hours after a complete obstruction.

Which cats are most at risk?

Cats of any age can have urinary signs, but Cornell says they show up most often in:

• Middle-aged, overweight cats that get little exercise
• Cats that use an indoor litter box or have limited outdoor access
• Cats that drink less water
• Male cats, which are more likely to become blocked because their urethra is longer and narrower
• Cats dealing with stress, such as a multi-cat household, a move, or a change in routine

What’s usually behind it

• Feline idiopathic cystitis (FIC) is the most common diagnosis. It’s painful bladder inflammation with no single identifiable cause, and stress seems to play a big part.
• Urinary stones (struvite or calcium oxalate) can irritate the bladder or block the urethra.
• Urethral plugs, soft mixtures of minerals, cells and protein, are another common cause of blockage.

What the vet will do

Expect a physical exam and urinalysis, and possibly bloodwork, X-rays, ultrasound or a urine culture. If the cat is blocked, treatment usually means sedation or anesthesia and a catheter to clear the urethra, followed by IV fluids to fix dehydration and electrolyte problems. Cornell says hospital stays can run from a few days to several weeks.

Emergency care is expensive, which is one reason some owners look into pet insurance before they need it.

How to lower the risk at home

Cornell’s prevention steps:

1. Fresh, clean water at all times.
2. Small, frequent meals, and keeping your cat at a healthy weight.
3. One more litter box than the number of cats in the house.
4. Boxes in quiet, safe spots, cleaned often.
5. Keep routines steady, and give cats ways to climb and “hunt” with toys to burn off stress.
6. If your cat has had struvite stones, ask your vet about diet. Don’t add urinary acidifiers on your own, because too much acidification can cause other problems.

Most cats that have one episode rarely have another, or only occasionally. But if you see straining with little urine, don’t wait it out.