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Dr. B.
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 21419
Experience:  General practice veterinary surgeon with extensive experience in a wide range of species.
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We have a 17 year old female moggy who is suffering from incontinence.

Customer Question

We have a 17 year old female moggy who is suffering from incontinence. She uses the litter tray when she's awake but her bladder leaks when she's asleep. We have started to use Puppy Pads on our sofa, which we cover with towels, so that she doesn't scratch the pads to pieces. We tend to cover our laps now as well, when she wants to sit on us - as she falls asleep & then accidents happen. She was treated for a UTI about 2 months ago and we had hoped that would be the end of her incontinence but unfortunately it wasn't. Is there any treatment we could give her? Her kidney function isn't brilliant & so we have her on a kidney diet and therefore a diuretic is, I imagine, out of the question. She's always been a fussy eater but recently she's turning her nose up at everything, even her favourite; tuna. I'm not sure if it's because she's slowing down, or if it's just the heat getting to her. This time last year, my 18 year old tabby cat stopped eating when it got hot & lost half of his body weight. We had to have him put to sleep in the end. I'm worried that this will happen again to my moggy this year. She's always been slightly overweight and so had weight to lose but now she's as light as a feather & I'm concerned she will lose more weight over the summer. So as well as the incontinence is there anything we can do to keep her weight up & to encourage her to eat? I was going to phone my vet tomorrow, but if you had any suggestions maybe I can then discuss them further with my husband & the vet. Thank you, ***** ***** for your help. Mrs Antonia Boyton.
Submitted: 3 years ago.
Category: Vet
Expert:  Dr. B. replied 3 years ago.

Hello & welcome, Antonia. I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.

First, just to clarify, you mentioned diuretics which would only be used if Opal had a heart issue (not a kidney issue). Does Opal have a heart issue you didn't mention?

Has she been on any medical treatment for her kidneys besides her diet?

Have you noticed her drinking more since the accidents started?

What does the urine look like? More watery then before?

Is she passing increased volumes of urine when awake?

In regards ***** ***** appetite, does she seem keen to eat but then turn away?

Or does she have no interest?

Any vomiting or retching?

Customer: replied 3 years ago.
Hello Dr B,
In response to your questions I think Opal's heart is fine, it's just her kidney function which is something the vet is worried about.
She was recently on antibiotics for a UTI but although the UTI has cleared up, the incontinence hasn't improved.
She doesn't seem to be drinking that much more, now that she no longer has a UTI.
Not sure what colour her urine is - as she tends to pee in the litter tray. We've tried using the plastic litter to collect urine samples in the past but she won't go near the litter box!
We do seem to be emptying the litter tray a lot more frequently, but I think that's because she no longer goes outside to urinate.
With regards ***** ***** appetite, she's just not interested in eating. She may lick the jelly off the wet food but then leaves it & walks away. She eats her biscuits, but again only a few mouthfuls before leaving it. She's really not at all interested in any of her usual favourites. Not even the treats!
She's occasionally sick but that's usually after she's eaten some grass & it tends to be fur ball related.
Expert:  Dr. B. replied 3 years ago.

Thank you Antonia,

First, I appreciate your clarification of Opal's heart situation since it was quite unclear why a diuretic would even be a concern here. Since there is no underlying heart issues in her history, the use of diuretics is not something we'd need to worry about here at all. Instead, we can focus on the health issues at hand.

Now to start, we have to consider that we are likely looking at a range of interrelated issues relating to her kidneys. As kidney disease progresses, we will see a depression in kidney filtration. This translates to increased urinary dilution and thus volume -- which leads to an older cat suddenly having to go more often and accidents often result (since they aren’t used to having to go so frequently and old joints often aren’t keen to get up to do so more frequently). So, while we can see urinary accidents of the elderly cat for a range of reasons (ie arthritis, other organ or metabolic issues, bladder stones, bladder tumors, urinary sphincter troubles, etc), in Opal's case it is most likely to be related to those struggling kidneys.

Furthermore, as these kidneys struggle to filter, we will not just see more fluid loss

but also see an increase in the levels of toxins/metabolic wastes (ie urea, creatnine, phosphorus, etc) in her blood stream. As this happens, we will see these cats develop nausea, vomiting, and most commonly appetite loss related to uremic gastritis of the stomach and uremic oral ulcers. So, while dental disease and other health issues could play a role in her appetite decline, again in this situation this is highly likely to be a side effect of her kidney disease progressing.

Therefore, in this situation, we can see each of these signs related to the above issues. Still in Opal's situation, it is very likely that these signs are linked to her kidneys struggling. Therefore, it would be ideal to have a discussion with her vet about potentially starting further kidney support measures here. At the same time, they can examine her and just make sure that none of those other above mentioned concerns are also affecting her (and address them if they are). If those are clear, then her vet can dispense kidney supportive treatment like Semintra (More Info) or Fortekor. Both will help the kidneys filter better to reduce toxin build up in her blood (and thus address the trigger for her appetite loss) and aid fluid reuptake to normalize her urine output (to prevent dehydration but also likely settle her accidents). As well, depending on their exam findings and whether they recheck her blood values, phosphate bingers (ie Renalzin) may also be a good step for her. And if we are seeing appetite decline due to high urea levels affecting her stomach, then you may want your vet to trial her on an antacid or anti-nausea therapy (ie Cimedtidine, Pepcid (LINK) or Zantac (LINK)) to settle her stomach +/- kidney relief pain relief (ie Bupenorphine) if uremic ulcers are found.

Overall, feline urinary accidents at rest and appetite decline in the elderly cat can be triggered by a range of issues. Still with Opal's combination of signs, her age, and her known kidney struggles; we do have to be very suspicious that these signs are all related to this organ. Therefore, it would be best to have a wee check up with her vet (to rule out other concerns since there is no rule to say they can have one thing wrong at a time) and confirm if those kidneys are our culprit. And if they are as we suspect, then it would be worth considering kidney support medication to see if you can settle this for her to get her eating better and halting these accidents.


I hope this information is helpful.

If you need any additional information, do not hesitate to ask!

All the best,

Dr. B.

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Customer: replied 3 years ago.
Thank you for your help. I will phone the vet tomorrow and get Opal checked over. It's reassuring to know that we can help her & hopefully get her appetite going again.
All the very best
Antonia B
Expert:  Dr. B. replied 3 years ago.
You are very welcome, Antonia.

That is the best course of action for wee Opal. Hopefully, if we intervene at this stage to help support those kidneys, we can stop this progression, stop her accidents, and get her back to eating properly for you again.

All the best,
Dr. B.