“Does she use the litter box?” – expressing a cat bladder

Over the past five years I have been asked this question at least a hundred times.  Because Zoey is quite the spectacle to watch – a line-backer of a little kitty dragging her back legs behind her and wearing a diaper – people are usually first surprised/shocked by the sight and then, as their brains begin to process what they are witnessing, the flood gate of questions starting with “how,” “why,” and “when” opens and I am left to give my elevator speech.

“Zoey was attacked by a dog when she was very young…she does not feel any pain in her rear legs…as a result of her injuries, she has permanent paralysis in her rear legs…meaning she is paraplegic…she wears the diaper to protect her delicate areas as well as the floor…she can use the litter box but, instead, I help her out by expressing her bladder at least twice each day…while I am doing that, I also stimulate a bowel movement to keep things clean and organized…”

When you choose to care for a paraplegic (or any potentially incontinent or special needs) pet, you open yourself up to questions that, while you’re glad someone has asked, you’re initially surprised and weirdly embarrassed by the fact that you do these things for your pet.  It takes patience and a little bit of pride to accept that, yes in fact, you are one of the chosen ones – magical and mystical – and able to do things that many other human beings might not ever consider doing for their cat or dog.  Suddenly you’re equally a pariah and a saint.  I choose to believe that I am a sensible, compassionate individual who has chosen to adopt an animal, in my case: Zoey, with special needs and I just don’t mind the “dirty work” that accompanies that decision.  And, in fact, it’s one of the best decisions I have made in my nearly 33 years.

So, with that, I take you to my explanation of bladder expression.

I have always used what Handicapped Pets refers to as the “ragdoll” method of bladder expression.  I hold Zoey above a small litter box on the changing table; her rear legs dangle down while I support her weight and body with my right hand and arm.  I use the four fingers of my left hand to locate and stimulate her bladder while balancing, and almost holding, her bladder in place from the left side with my thumb so that I can gently squeeze it to begin the process of emptying it of urine.  Zoey weighs in at about 9 lbs. and her bladder is about the size of an oblong golf ball.  The organ is smooth with an almost rubbery quality to it – but be careful and don’t squeeze too hard.  It really doesn’t take much pressure to express a bladder and an incontinent pet will have a full, ready bladder!

Zoey’s bladder is almost always distinctly on the right side of her body (some pets will be a little more to the center or left of the lower abdomen) and I am able to find it quickly.  When you’re first looking for the bladder on your pet, you might want to hold them like I have described, or if they are larger, have them lie on their side and palpate the abdomen/belly and give gentle pushes.  You’ll know you’ve hit pay dirt when you get a little trickle of urine.  You can also search for feline or canine anatomy online to get some great visual aides.

Once you’ve located the bladder, you’re ready to begin.  Gather your equipment (wipes, towel, litter box, etc.) and get comfortable.  Prepare to be patient while you learn and consider doing more frequent expressions to ensure that you are emptying the bladder completely.  Now that I have been doing this awhile, we’ve found our ideal balance of two good expressions each day and Zoey has virtually no leakage.

I hold Zoey snugly to support her weight and simultaneously give a gentle but consistent squeeze to the bladder, focusing my squeeze in a slightly downward motion to ensure that the pressure is pushing the urine out of the body rather than up.  As I feel her bladder empty beneath my fingers, I lighten the pressure and massage around the organ to ensure that it’s relatively empty.  Remember – be gentle, you’re trying to empty it, not pop it.

When I am done, I give Zoey’s external urethra/vulva area a quick wipe with a baby wipe and move on to stimulating a bowel movement.

I recommend doing lots of research when preparing to embark upon the bladder expression journey so that you build up your confidence with knowledge.  There’s a lot more info on the web today than there was five and a half years ago when I was first looking.  A great place to start is on the Handicapped Pets website.  Also, fellow blogger, Abby, mom of Sophie, a paraplegic dog shares her experiences dealing with incontinence as well as bladder and bowel expression in one of my favorite blogs: Our Dachshund Sophie.

I’d love to know how you’re taking care of “business” for your pet and welcome your comments and questions.


13 thoughts on ““Does she use the litter box?” – expressing a cat bladder

  1. Great article. I love this pictures. I was really interested as I was reading because we do things differently, but I am always changing my methods as I learn new techniques. I love how you describe peoples questions regarding this. So true, and beautifully stated. Sophie’s bladder doesn’t hold onto urine anymore, so it will flow out between expressions. But what I have found is if her stool is the perfect consistency, firm, it blocks the flow of urine. So I always focus on expressing her stool, and when I release it, her urine empties. Thank you so much for mentioning me. I am honored. And you are one of my favorite blogs too. I love the look on Zoey’s face in the pictures. She is so cute.

    • It’s so interesting how differently paralysis can affect individual pets (and people for that matter.) For a long time, I used a dried cranberry extract powder on Zoey’s food and, I think, that really helped her bladder. Now that she’s eating Hills C/D, I rarely (fingers crossed!) have any bladder issues. I am curious – do you have anymore issues with Sophie’s stool? Or have you found the right diet to ensure a pretty consistent movement? Have you tried probiotics? Thanks for the compliments, I think Zoey is pretty darn cute! And, you’re right, the look on her face is like “oh, here we go again.” LOL

      • As long as I can keep Sophie strictly on dog food, her stools are perfect. We have been using Rachael Ray’s Just 6. I can buy it at the grocery store, and it works wonderfully for her and she really likes it. The problem is she doesn’t like it as much as she likes other things, so she is always trying to steal food from my kids and they always like to try to sneak her treats behind my back. Sometimes it is just to heartbreaking to deny her a treat, because she becomes so enthusiastically excited over some things it is very difficult to say no. I haven’t tried probiotics, but I should definitely look into that. Thanks for the suggestion. I tried researching the “best” dog foods for her condition and nothing was working, but then I tried the Just 6 because i was away from home and ran out of her other food and things became better almost immediately. So as long as it works for her and she continues to like it, I am going to stick with it. I do let her have access to it all day, so she munches whenever she feels like it. So she has little stools throughout the day that need to come out, but like I said before, it has the effect that it holds the urine in, so I don’t mind at all that I have to express her more frequently, because it seems to work well for getting her urine out that way. I know I’m rambling, it’s hard to explain, but it is working.

  2. Pingback: Rescuing a paraplegic pet: the next steps « The life and times of Zoey.

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  4. Hi… two weeks ago, STRIPE, my big fluffy lovely-bug 2 year old calico cat was rendered paraplegic after being hit by a car. I am giving her the best care, lots of love, acupuncture, laser therapy and am slowly getting used to maintaining her. They wired her broken jaw together and she’s eating on her own now. She has been home since Wednesday, April 15, 2014 and she’s been grooming herself, and purrs as loud as ever when she and papi have anything to talk about. Her other two sibling sisters are puzzled by her sudden reappearance after a week’s absence and I’m slowly dealing with their reluctance to come into the house to eat.
    I tried a diaper (small dog) but it lasted about thirty seconds before it came off as she pulled herself across the carpet, I noticed you have some sort of retaining belt or extra gear on that diaper that looks like it would hold the diaper in place better. Could you explain exactly what diapers you use and the apparatus that has kept them on?
    Thank you and know that you are soooo appreciated for what you are doing.

    • Hi William, I am sorry to hear about Stripe’s injury but it sounds like you’re doing everything you can for her. The first few weeks of figuring it all out are the toughest! I use Pooch Pants washable diapers. They have a good swatch of velcro that has definitely stood the test of time. I’ve only been able to find them online and usually order them from Revival Animal Health. Zoey wears a size small and they typically last me a year+ with regular washing. Over the years I’ve built up my inventory and keep 7-9 on hand at all times so I can do her laundry every week or so. I hope that info is helpful. Please feel free to ask all the questions you think of. I remember what the first few weeks/months were like so please don’t feel alone! You can also email me at aimee275@hotmail.com. keep in touch. I want to hear how Stripes and you are doing!

  5. Sorry about the delayed response but I filled out the form expecting to receive an email whenever a new post was made on your site… so when I didn’t receive anything I decided to check your site directly. I’ve been pretty busy rushing Stripe to her laser and acupuncture appointments and checkups. Thank you for the diaper tip… I knew you had something there that looked like it would stay on.

    You are so right about the first few weeks. I was very anxious and the scary part was not being able to take home a pre-packaged kit to take care of her, so figuring out a work flow of how I was going to maintain her was agonizing and time consuming. The specialty hospital only reviewed meds when they discharged her and not much else but my local Vet/s have been very helpful. So I went to two pet stores that were clueless, twice to Bed and Bath looking for stuff I could use to bathe her and keep her comfortable. Today was the fifteenth day after she got hit and it’s been a whirlwind of making decisions, waiting to get the right information, checking it out, surgery (to fix her jaw and tail) and multiple visits everyday. I’m learning to express her bladder but I’m still squeamish about putting too much pressure on it… if I can even find it. Fortunately, the Vets are very patient in helping out and one Doctor even provided two of her dogs for me to try it out.

    Thank you again and I will write directly and keep you up on the progress.


  6. Amazing story. Thank you for sharing. It is inspiring to know that there are people out there who will regard and care for our pet companions just as family.

    I have read somewhere the risk of stones when feeding a cat a special diet such as Hill’s c/d. I wouldn’t want to spread misinformation, but have you read anything similar?

    • Hi Pablo, thanks for reading Zoey’s story and for saying hello! In regards to your question about special diets, like c/d, causing stones – it’s actually the other way around. Urinary diets like c/d or Royal Canin’s s/o are designed to help prevent the development of crystals which can cause bladder stones. One of my other cats, Lucy, had small bladder stones several years ago that dissolved as a result of being on c/d and s/o. Every prescription diet is unique and requires veterinary oversight and maintenance. If you’ve heard of stones developing, I would tend to think that it’s likely on a case-by-case basis. Here’s some general info about Hill’s c/d.

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