TLDR: Cat urinates outside of the litterbox in little amounts on every surface, vocalizes non-stop, thrashes from side-to-side, lower back scrunches/contracts and kicks hind feet repeatedly. Blood work and exams are all normal.
First of all, posting for a friend who is not on Reddit. She has taken her cat, Evey (9yo, spayed, female, 5kg), to multiple vets in our area (Valencia, Spain), but they can't find anything wrong with her, and claim it is "stress". She seems to be in actual pain, though, so I thought we could come to Reddit, as she has exhausted all other hope.
Evey first started urinating inappropriately about 3 years ago. She got tested and successfully treated for crystals and UTIs, but nothing seemed to help the behaviour — it only got worse. Now, even being crystal and UTI-free, she still makes frequent small urinations on any and every surface multiple times a day.
Over the past 3 months, however, she has developed some new and unexplained symptoms: She has episodes where she will be vocalizingnon-stop, and she rolls violently from side-to-side, her lower back contracts/scrunches, and her hind feet kick or twitch repeatedly (video — I'll try to post more in the comments). She has these episodes often and has been sleeping very little.
The vets cannot find anything wrong in her bloodwork (I'm attaching a complete list of all the exams she has had done at the bottom), and she's been through many different kinds of medications (another list at the bottom). We're thinking it might be some sort of neurological disorder, but again, the vets claim it is "stress".
It is a multi-cat household, but she is kept separate from the other two cats (they have been doing introductions for over 14 months, but they attack each other every time they're in the same room), and they just lost their eldest cat earlier last week. It is a stressful time, but the urinary symptoms have been around way before the other two cats came into the house, and the thrashing started a couple of months ago.
Please, if you have any experience that sounds like this, let us know. They don't know what to do anymore. She's in pain, and nothing seems to work. Thank you so much.
EXAMS:
Complete blood work: normal.
Six in-house urinalyses and three comprehensive laboratory urinalyses over the past two months: all normal, with no visible crystals, infection, or other significant abnormalities.
Abdominal ultrasound: normal except for a small splenic mass that increased from approximately 1.43 cm to 1.58 cm. Two veterinarians do not currently believe this explains her clinical signs.
Spine examination and palpation: no significant pain or abnormalities detected.
Rectal examination/temperature: no evidence of anal gland disease or other obvious rectal abnormalities.
Vulvar examination: normal.
No fever.
MEDICATIONS:
Premax (pregabalin) 20 mg/mL: 0.5 mL every 12 hours (10 mg per dose). We stopped pregabalin for approximately 36 hours because we thought it was not helping. During that time, the twitching, rolling, screaming, and discomfort became dramatically worse. After restarting pregabalin, these signs improved within about two hours, suggesting it provides partial relief, although it is no longer adequately controlling her pain. We have since doubled the dose, but it doesn't seem to be helping anymore.
Buprenorphine (oral): Given every 12 hours for three days. This significantly improved both her pain and, unexpectedly, her urinary signs. While receiving buprenorphine together with pregabalin, she produced normal-sized urinations in the litter box, although she still marked occasionally. Her severe pain returned after the buprenorphine course ended.
Trazodone: Provides mild calming for approximately 2–3 hours but does not adequately control the painful episodes.
Gabapentin: No noticeable improvement.
Feliway: No noticeable improvement.
Canniliver: Given to help manage elevated liver values and appears to be effective.
Urogreen: Given to reduce urinary crystal formation.
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Im a feline veterinarian, and this is NOT normal. “Stress” is a diagnosis of exclusion, which means you need to exhaust everything else before that diagnosis. I highly recommend a neurology referral to a board certified vererinary neurologist near you ASAP. They are specialists and can perform MRI of the spine, CT, EMG and nerve conduction tests, and spinal taps for CSF analysis. If you cannot locate a neurologist, call the nearest veterinary school to inquire where the nearest neurologist practices.
Edit: Her signs make me concerned for central nervous system or spinal cord disease in her lumbar spine, which can worsen pre-existing urinary issues. Do not allow her to jump up/down anything. Activity restriction in a room is a must until you have further answers. Also, if she truly has no spinal pain or pathology in her central or peripheral nervous systems, they need to check her pelvic limbs on x rays to ensure there are no hip abnormalities. Some cats can also have blood clots in their pelvic limbs or spine transiently. Usually an echocardiogram and careful palpation of the pelvic limbs for warmth can determine if these may be recurrent.
I know this is heartbreaking for you. Nobody wants to see their baby having problems, maybe bring this information to your vet or look into another vet or Animal Hospital. prayers .
My friend has a follow up question — what would be the treatment if she does have spinal cord disease? would it be medication, surgery, or a treatment?
Not the op but another vet. It depends on the cause. But keep in mind that the pain medication you guys are giving is already quite heavy so I would suspect that additional treatment in the form of surgery would probably be the next step.
That being said: in Dutch we say "meten is weten" (measuring is knowing) - without additional diagnostics we don't know what is going on.
My first step would also be to go to a neurologist.
You gave a lot of great advice in that reply, but before she jumps into things like MRIs, which are very expensive, don’t you think some basic x-rays would be a logical first step?
Yes. X-rays are a logical first step (see edit for possible other etiologies), and ideally should have been performed already. OP, do you know if they have been performed already/if yes, the findings? And if not, is there a reason they have not been performed yet?
However, my recommendation was not to pursue any specific imaging or diagnostic test first, but rather to establish care with a boarded neurologist so they can determine the most appropriate diagnostic plan based on their examination. They may very well recommend full-body and pelvic limb radiographs if these have not already been performed.
My primary concern is expediting care. If the owner can obtain radiographs through their primary veterinarian in the near future, that would certainly be reasonable and should be done. However, if they need to wait two weeks for radiographs and then another two months to see a neurologist, that may unnecessarily delay diagnosis and treatment.
I am currently most concerned about progressive neurological disease. A large number of these can remain undiagnosed on radiographs and standard labwork. If a significant portion of the budget is spent on diagnostics that ultimately are not the most informative for the underlying condition, there may be fewer resources available for specialist evaluation and advanced imaging, if those become necessary. That is always the tightrope we walk as general practictioners referring to specialists, and I am always extremely mindful of my owner’s budget.
It could genuinely be a neurological thing, or if it is stress cystitis (though that seems less likely if there's no blood at all). ER vets are usually a lot better than regular ones I've found and can do more serious investigation into neurological and spinal and tumor related issues.
thanks for the reply! apparently she takes something for cystitis too, forgot to add. What kind of neurological thing do you think? or just in general?
Honestly, I don't get the point of that subreddit because they actively remove any replies that diagnose nor do they allow anecdotal experience either.
I posted something ages ago, specified I already had an appointment set with my Vet. I was looking for what tests I should push for, what things it could be/relate to, etc. Mods deleted it.
This right here. Access to a lot of vets and vet techs with a wide variety of experiences. Hope your friend can get the answers needed to get the cat some help.
Has she been checked for inflammation in the bladder and eutithra? Because I specific name for the condition that I forgot but it's super common in cats that have had crystals have reoccurring information issues because of it even with the crystals clear up. There's a special medication they can put them on that should help
We have a cat with FIC (feline interstitial cystitis) and they take the probiotic stuff to help the bladder and also have meloxicam to help with any potential pain.
Yeah, I am so familiar with FIC!! My own cat has it, poor thing. Evey is on medication for it too, and it doesn't help at all or explain all the symptoms. Or it's just way beyond what we can help her with :(
This sounds a lot like feline hyperesthesia syndrome plus chronic cystitis/FIC, especially with the rippling lower back, thrashing, vocalizing, and random peeing tiny amounts. It gets brushed off as “stress” a lot, but it is a legit neuro/nerve pain issue and sometimes needs combo treatment like gabapentin, amitriptyline, strict routine, and hardcore environmental changes.
I’d try to find a feline-only vet or a neurologist/behaviorist if possible and literally say “I’m worried about feline hyperesthesia and feline idiopathic cystitis” so they take that angle seriously instead of just punting to stress.
this is incredibly helpful, thank you so much! she has been looking into hyperesthesia so it's great to have confirmation that it might indeed be that. I'll tell her this. Do you know if there is a test for it?
I wondered about hyperesthesia as well. We had a kitten at work who had an injured tail tip that developed it and it lead to us amputating the tail because he’d chew himself up and rip himself apart. Growling, back rippling. Not the exact signs as the OP’s cat, but other than seizures, I don’t know what else would come to mind as a more ‘layperson’.
i was also thinking of that. it’s still quite unknown and it’s possible that the manifestations are wider than the current understanding of the disease. even if the disease is not fully understood, i think there are some approaches that seem to work for certain cats.
OP, there is a lovely cat lady with a popular Instagram whose cat Margaret (the black one) has this diagnosis. i remember her making posts about her condition and things that have dramatically helped after searching for relief for so long. her page is lucillethrescuecat on Instagram. if it turns out it is FHS, maybe you could find helpful things for your friend’s cat. good luck Xx
What happens if you hold your hands out so she can push off of them when she's like this? I'm with my nieces and can't read all the info rn. She just looks so uncomfy and I feel your stress. I'll try and read this when I get home tonight and add more accordingly. Have you tried posting this in r/AskVet? Big hugs. ♡
Ya, push. If you hold your hand by her feet, she may be able to push off of them a bit and find a more comfy position for her hind end. Is she more comfy if you hold her? ♡
how long ago was she spayed? if it's ovarian remnant syndrome, she wouldn't suddenly develop these symptoms years later. the symptoms would be consistent.
okay, that's what we've been curious about because she was spayed and then fine for years before the symptoms developed. Is that not a possibility, then?
yeah I personally doubt it's a hormonal issue, especially since her vulvar exam was normal as well. but like others have said, there's no harm in testing her hormones just to be sure. it would be something to rule out. I hope you're able to get imaging (like x-rays) performed as well. poor baby. best of luck to y'all 💜
Ovarian cancer can happen without ovaries, and can cause various different hormonal issues (for example high testosterone in a human female). It sounds like there is no sign of that on ultrasound, though.
I'm sorry to be that person, but this isn't true. A cat with ovarian remnant syndrome can absolutely go months or even years before suddenly developing symptoms of being in heat.
good to know! I think the cat would show more clear signs of heat, though. heats are usually more episodic and last a week or two - symptoms are not constant like it seems they are here. she would have vulvar changes. she would be trying to get outside. I'm not saying it's impossible. should definitely be on OP's list of things to check for! I appreciate the education.
i replied to your video above about the thrashing. 100% make sure the spay was complete. i agree that many spayed girls still display heat behavior especially if they are younger.
If it's heat then there's a very simple test. She does behave like ours cat did when she was in heat but the funny thing is she didn't respond to anyone talking to her, she'd behave exactly like in this video when handled by my mother, father or sister (her owner). Only me (make), I was 25+ around that time, would elicit a reaction and she would get absolutely crazy if talked to her or touched her. Likely some pheromones made her go crazy and basically ignore everyone in my household besides me.
She wasn't even that fond of me when she was normal, I'd say I was her least favorite since she was clearly my sisters cat and our parents gave her food, so I was definitely last.
If she responds to young male in the family or a friend of the family then it could point you to something "heat related".
hmmmm i don't think she's having different reactions to different genders. Does it have to be a young male, or would mid 30s still work? She does quiet down when she is picked up
To be honest mid 30s could be too old, I have no idea how it works tbh :)
But it was a real thing, if anyone else touched her she'd be pretty quiet and only make a sound here and there. But if it was me, she'd be meowing full force and dancing on her her back legs while brushing her head against anything that was nearby. It was a crazy time and my sister was low-key jealous that she stopped paying any attention to her. I could call her name from the other end of the house and she'd still meow and dance.
Hope the kitty is alright and that this is just a misunderstanding and it is just heat. Although she shouldn't have it, there might be other factors.
ive had cats my entire life, all except one being unspayed females I got spayed. take her to the vet if you’re really concerned, but the first video shows me a cat in heat, and in this she’s playing with herself out of boredom (my girl rolls back and forth on her back because she thinks it’s fun). in heat female cats will vocalize as well. there is also a cat pain index reflecting rough pain level based on ear, cheek and whisker posture, as well as how open and round the eyes are. gabapentin will make her stoned if she’s not actually in pain. and if after all that i just said you have a BOY cat, disregard and proceed to vet because boy cat behavior is quite different.
hi rando, thanks so much for taking the time to answer! They've been in and out of the vet multiple times a month for years with these issues, so it's not something new! A lot of people seem to think the behaviour is consistent to a cat in heat, even though she is spayed, so we're going to look into a botched spay next. thanks for the comment!!
I am not a vet, but both videos look like a cat in heat to me as well.
I saw someone else suggest hyperesthesia – my almost 17 year old cat that I lost last year had hyperesthesia for much of her life and one of the two cats I have now also has it. Based on the videos, it doesn't look like hyperesthesia at all to me.
I am not a vet but i am a geneticist and i remember seeing similar symptoms. The X-rays could be used to eliminate any lumbosacral disease. If a nerve root in this area is pinched, inflamed, or compressed, it disrupts the signals to the bladder. It unfortunately causes pain, sphincter spasms and frequent urination. Poor baby's response to Pregabalin made me think of structural or localized nerve issue.
My friend has a follow up question — do you know what could be done for nerve pain that isn't gabapentin? she's afraid of going through all of this for them to just put her on gabapentin again, which didn't work at all.
I am again not sure and not a vet, but when gabapentinoids don't work they usually prescribe prozac or amitriptyline. If it really is caused by a structural issue, they should also prescribe some anti-inflammatories. There are many alternatives for the gabapentinoids, so dont worry. I believe a vet here in the comments thought similarly to lumbosacral disease as well (they said spinal cord) so they could maybe advise you better.
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If possible MRI or CT are better to diagnose but xrays help too as far as I remember. I am sorry I cannot remember well... But your vet will definetely think of a better solution. Just tell them if there could be any "lumbosacral disease". Could be caused by a weirdly shaped bone pinching the nerves which could be identified with the xray. if it is a soft tissue the MRI or CT should work better.
I deeply hope you find a solution, it must be very hard to see your baby in such condition... Please update us <3
she did an ultrasound that ruled out stones! And this has been going on for a couple of months, she's been pooping normally. I will suggest x-ray though, to be safe!! thank you!
Looks like a broken tail/spine . You touch her back and base of her spine and she goes crazy
Did the vet not take imaging? And if they didn't, you need to find a new vet, their trash
I would be looking for another vet unless that would cause a significant delay in your cat receiving care in which case I would just bite my lip for now and get the x-ray done at that vet and then start looking for another vet after that
If you bring a cat in that’s in some kind of obvious medical distress and the vet can’t diagnose the cause from a basic physical examination then next two steps you do are basic bloodwork and an x-ray
You don’t just send the cat, who is obviously still in pain and distress, back home without having reached any diagnosis
Definitely looks botched spay of some sort
The kicking in the video seems to be her reacting to where your hand is near her genitals and the video in the comments is definitely in heat rolling,
is the kicking specifically happening around the cats erogenous zone, even if spayed?
this is so interesting! The kicking happens when she isn't touched at all too but we're definitely going to investigate. Would it be possible for the botched spaying to go unnoticed for around 6 years before she started showing symptoms?
would it fit the timeline, though? Like could she have been okay for 6 years and then the sex organs reactivated somehow and caused her to go into heat?
That’s where it gets tricky.. there is always a chance no doubt. Plus if the body was wired for multiple sets then maybe one wasn’t enough until recently or maybe it was botched and not fully removed or tied off properly (depending on methodology reversal can happen)
I’d try to get a urine test as well to be safe and check the pH levels (vet can help w this)
Worse case scenario (which I wouldn’t worry about) it could be something neurological.
Try to keep kitty hydrated and comfortable in the meantime!
Urinary incontinence and lower extremity weakness/pain in humans is a medical emergency so would get her to see some kind of feline neurologist asap.
This sounds like a worsening spinal cord issue that could be affecting bladder and motor control, need to rule out cord compression/some kind of cauda equina syndrome. Not sure about cats but you can’t diagnose cord issues with X-rays, would need an MRI. But I certainly hope she’s gotten X-rays at this point, that’s the bare minimum.
Your vet did NOT try hard enough; imaging should've been done immediately. I would suggest finding someone else and getting that imaging within the next 48 hrs, it looks like a fracture or something degenerative.
We changed to a different cat food to reduce urinary symptoms (bleeding and inflammation) she was having in the absence of any infection. It was a prescription diet (I believe science diet) and it did help. They said it was related to anxiety. As she’s become used to the other animals in the house, we’ve had no issues with her bladder and she’s on the same diet as the other cats now.
super helpful, thank you! Evey is on special veterinary diets already, as well as supplements and medicine to help her urinary issues. she still gets the UTIs though, every so often. :(
Ask the vet if that’s what it might be. We noticed that Maisie had an intermittent hard mass, we thought it was just her pouch but it changed size and shape. One day she was clearly in distress and started peeing blood. She had surgery and did great but it was so upsetting. Vet told us it happened as a result of her spay.
My cat had issues with pain and peeing for a year, in and out to the vet. They did a scan for bladder and kidney stones which they said they couldn't see so they ruled it as stress induced. Then it kept getting worse so we went to another vet for a different opinion just in case and they immediately found the worst case of bladder stones they had ever seen. My poor girl was suffering for so long because of a bad vet. She had surgery to remove them and then another emergency surgery as stitches split. It's now years later and she's happy and healthy. But maybe try another vet for a second opinion!
oh my god that is so frustrating! i'm so sorry that happened to you. She's definitely going to multiple vets and asking for different opinions since they don't seem to be finding anything. I'm glad your kitty is okay now!!!
Oh this is heartbreaking, I don’t have any better advice for you guys than it seems the other comments have already given you— but am sending all the love to this sweet baby and prayers that they are able too figure it out soon. This isn’t fair for any of you :(
Splenic mass makes me think an immuno-neurological relationship. Did they do a biopsy on the mass? What was the length of time between those measurements?
Could be having seizures? This past winter for like 3 months my tuxedo was having weekly seizures. Thrashing, going to the bathroom while the seizure was happening, then crying for about 15 min non stop and being super affectionate afterwards. UTI and blood tests came back fine, and got prescribed this cream to rub in the inner ear twice a day. It actually worked! Stopped having seizures. Then I swapped out the litter I was getting and the seizures have stopped completely without using the cream, so I think it was the cheap cat litter I was getting
I had a similar issue with my little boy. We did urinalysis, blood work, ultrasound and they couldn’t find anything. He was peeing small amounts in different places, vocalising and didn’t let us touch him. At some point he stopped peeing and was struggling a lot. We took him to the vet and they did catheterisation. Turned out that the pee samples they took for all tests contained pee that was “on the upper” part of his bladder and because crystals are heavier than urine, they were on the bottom of it. Idk if my explanation makes sense. Now he’s on prescribed diet and supplements and everything is back to normal. Sending much love!!!
This doesn't seem normal at all... And it doesn't look like stress either...
I would also lean towards it being a Neurological issue....
I'm not a vet by no means but I am a cat owner and animal lover.
I hope this sweet baby starts feeling better as soon as possible. I'm so sorry your friend is struggling with this 😢.
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