Cat Bleeding When Urinating: Understanding Hematuria in Cats

Discovering blood in your cat’s urine, known as hematuria, can be alarming for any pet owner. The sight of red or pink urine in the litter box often raises immediate concerns. It’s important to understand that hematuria in cats is not normal and can be a sign of various underlying health issues, ranging from minor infections to more serious conditions. This guide will help you understand what blood in your cat’s urine might mean, what steps to take, and how veterinarians diagnose and treat this condition.

Recognizing Blood in Cat Urine

Normal cat urine should be pale yellow and have a mild ammonia-like smell. Changes in color or consistency can indicate a problem. Blood in cat urine can manifest in several ways:

Bright red blood: This is the most obvious sign and indicates fresh blood.
Pink tinge: Urine may appear diluted pink.
Orange discoloration: While less directly indicative of blood, it can sometimes be related to urinary issues.
Brown discoloration: This can suggest older blood or other pigments in the urine.
Foamy urine: While not always related to blood, it can sometimes accompany urinary issues.
Blood clots: Visible clots in the urine are a clear indication of bleeding.

It’s crucial to pay close attention to your cat’s litter box habits. Sometimes, bloody urine is the only symptom you might notice initially.

Alongside blood in the urine, be alert for other accompanying signs that may suggest a urinary problem:

Straining to urinate (dysuria): Your cat may spend excessive time in the litter box, pushing and posturing without producing much urine, or vocalizing in pain.
Frequent urination (pollakiuria): Increased trips to the litter box, often with small amounts of urine each time.
Urinary accidents outside the litter box (periuria): Cats may start urinating in inappropriate places due to urgency or discomfort.
Increased thirst (polydipsia): Some underlying conditions causing hematuria can also lead to increased water consumption.
Lethargy: A general decrease in energy and activity.
Loss of appetite: Reduced interest in food.
Vomiting: Although less directly related, vomiting can sometimes occur with urinary issues.

Alt text: A ginger cat is using a clean litter box, highlighting the importance of monitoring feline urination habits for signs of blood.

Immediate Actions if You See Blood in Your Cat’s Urine

If you observe blood in your cat’s urine or any of the symptoms mentioned above, it is essential to contact your veterinarian promptly. Do not wait to see if it resolves on its own. Urinary problems can quickly become serious and require veterinary intervention.

Emergency Situation for Male Cats: Male cats, in particular, are prone to urinary blockages, which are life-threatening emergencies. If you have a male cat exhibiting signs of straining to urinate, frequent litter box visits with minimal or no urine production, or excessive licking of the penis, seek immediate veterinary care. A urinary blockage can be fatal within hours if left untreated.

Common Causes of Blood in Cat Urine (Hematuria)

Hematuria in cats can stem from various conditions affecting different parts of the urinary tract. These causes can be broadly categorized based on location:

Upper Urinary Tract (Kidneys and Ureters):

Polycystic Kidney Disease and Renal Dysplasia: These are genetic conditions where the kidneys don’t develop properly, impairing their function.
Kidney Stones (Nephrolithiasis): Mineral deposits that form in the kidneys, causing irritation and potential blockage.
Trauma: Injury to the kidneys or ureters can result in bleeding.
Kidney Cancer (Renal Neoplasia), especially Renal Lymphoma: Cancerous growths in the kidneys can lead to hematuria. Renal lymphoma is a common kidney cancer in cats.
Kidney Infection (Pyelonephritis): Bacterial infections of the kidneys. Certain viruses, such as feline leukemia virus (FeLV), can also increase the risk of kidney cancer and infections.
Chronic Kidney Disease (CKD): A progressive decline in kidney function, which can sometimes manifest as hematuria.
Idiopathic Renal Hematuria: Inflammation or bleeding in the kidneys or ureters with no identifiable cause (not bacterial, viral, cancerous, or traumatic).

Lower Urinary Tract (Bladder and Urethra):

Trauma: Injury to the bladder or urethra.
Bladder or Urethral Cancer (Neoplasia): Tumors in the bladder or urethra.
Bladder Stones and Urethral Stones (Urolithiasis): Mineral stones in the bladder or urethra.
Bladder Polyps: Non-cancerous growths in the bladder lining.
Urinary Tract Infections (UTIs): Bacterial infections are the most common type of UTI in cats affecting the lower urinary tract.
Feline Idiopathic Cystitis (FIC): Inflammation of the bladder with no known underlying cause. Stress is a significant contributing factor to FIC.
Congenital Abnormalities: Rare genetic defects in the bladder or urethra.

Other Potential Causes of Hematuria:

Chemotherapy: Certain chemotherapy drugs can cause bladder inflammation and bleeding.
Estrus (Heat Cycle): Unspayed female cats in heat may have blood in their urine, which is physiologically normal during this period.
Clotting Disorders: Conditions that impair blood clotting, such as rat poison ingestion, immune-mediated thrombocytopenia, or inherited clotting deficiencies, can lead to hematuria.
Vasculitis: Inflammation of blood vessels, causing leakage and potential bleeding into the urine.

Alt text: A veterinarian gently examines a cat, emphasizing the importance of professional veterinary care for diagnosing the cause of feline hematuria.

Diagnosing the Cause of Blood in Cat Urine

Veterinary diagnosis of hematuria involves a systematic approach to identify the underlying cause. Your veterinarian will typically start with:

Detailed History: They will ask about your cat’s symptoms, duration of the problem, previous health issues, current medications, diet, and any potential stress factors. Providing a thorough history is crucial.
Physical Examination: A complete physical exam helps assess your cat’s overall health and identify any abnormalities.

Based on the initial assessment, further diagnostic tests are usually necessary:

Urinalysis: A urine sample is essential to confirm the presence of blood, check for infection (bacteria, white blood cells), crystals, and assess urine concentration and pH.
Bloodwork (Complete Blood Count and Serum Biochemistry): Blood tests evaluate overall organ function, check for signs of infection, inflammation, and assess kidney values.
Abdominal Radiographs (X-rays): X-rays can help visualize the urinary tract and detect radiopaque bladder or kidney stones.
Abdominal Ultrasound: Ultrasound provides a more detailed image of the kidneys, bladder, and surrounding structures, allowing for the detection of stones, tumors, polyps, and other abnormalities not visible on X-rays.

In some cases, more advanced diagnostics may be recommended:

Urine Culture and Sensitivity: If a UTI is suspected, a urine culture identifies the specific bacteria present and determines the most effective antibiotics.
Cystoscopy: A minimally invasive procedure where a small camera and biopsy instrument are inserted into the urethra and bladder to visualize the lining and obtain biopsies if needed. This is helpful for diagnosing tumors or other bladder abnormalities.

Treatment Options for Cats Peeing Blood

Treatment for hematuria is always directed at addressing the underlying cause. The specific treatment will vary depending on the diagnosis:

Urinary Blockage (Male Cats): Requires emergency unblocking of the urethra under sedation or anesthesia, followed by hospitalization for monitoring and supportive care.
Urinary Tract Infections (UTIs): Treated with antibiotics, typically based on urine culture results. Hospitalization is usually not required for uncomplicated UTIs.
Bladder or Kidney Stones: Some stones can be dissolved with prescription diets, while others require surgical removal. Surgery often necessitates hospitalization for pain management and monitoring.
Kidney Infections (Pyelonephritis): Severe kidney infections may require hospitalization for intravenous fluids and antibiotics.
Cancer (Neoplasia): Treatment options for urinary tract cancers may include surgery, radiation therapy, or chemotherapy, depending on the type and extent of the cancer.
Chronic Kidney Disease (CKD): Managed with supportive care, including fluid therapy (subcutaneous or intravenous), prescription kidney diets, and medications to manage complications.
Feline Idiopathic Cystitis (FIC): Treatment focuses on stress reduction, pain management, increasing water intake, and sometimes medications to relax the urethra or modify behavior. Environmental enrichment and stress reduction are key components of managing FIC.

Even with appropriate treatment, hematuria can sometimes persist or recur. In such cases, long-term management strategies may be necessary and should be discussed with your veterinarian.

Preventing Blood in Cat Urine

Preventing hematuria often involves addressing underlying risk factors and promoting overall urinary tract health. General preventive measures and specific strategies depending on the underlying condition include:

Creating a Low-Stress Environment

For cats prone to FIC or stress-related urinary issues, minimizing stress is paramount. Provide:

Quiet and Safe Spaces: Offer secluded resting areas where your cat can feel secure.
Individual Resources: Ensure each cat in a multi-cat household has their own food and water bowls, litter boxes, and resting areas to reduce competition and stress.
Adequate Litter Boxes: The general rule is one litter box per cat plus one extra. Place litter boxes in quiet, accessible locations and keep them clean.

Encouraging Play and Enrichment

Interactive Play: Regular playtime with stimulating toys helps reduce stress and provides mental and physical stimulation.
Vertical Space: Cat trees and perches allow cats to climb, explore, and feel more secure in their environment.

Nutritional Management

Balanced Diet: Feed a high-quality, balanced cat food appropriate for your cat’s age and health status.
Prescription Diets: For cats with a history of urinary issues, especially crystal or stone formation, or FIC, your veterinarian may recommend a prescription urinary diet to help maintain optimal urine pH and mineral balance.
Canned Food: Canned food has a higher moisture content than dry kibble, which can be beneficial for urinary tract health by promoting dilution of urine.

Increasing Water Intake

Adequate hydration is crucial for urinary tract health. Encourage your cat to drink more water by:

Multiple Water Sources: Provide fresh water in multiple bowls around the house.
Water Fountain: Many cats prefer drinking from moving water sources like fountains.
Adding Water to Food: Mix a little water into your cat’s wet or dry food.

Urinary Supplements

Probiotics for Urinary Health: Certain probiotic supplements may help support urinary tract health, particularly in cats with recurrent infections or FIC.
Silica Gel Litter (e.g., Pretty Litter®): These litters can change color to indicate changes in urine pH or the presence of blood, providing early warning signs of potential problems.

If you ever notice blood in your cat’s urine, remember that it’s almost always a sign of an underlying issue that needs veterinary attention. Early diagnosis and treatment are crucial for ensuring your cat’s comfort and long-term health. Don’t hesitate to contact your veterinarian if you have any concerns about your cat’s urinary health.

WRITTEN BY:

Katie Grzyb, DVM
Veterinarian

Dr. Katie Grzyb received her Doctorate of Veterinary Medicine from Ross University in 2009. She continued her clinical training…