If you’re caring for an incontinent cat, you may need to manually express your cat’s bladder. While it takes a bit of practice to get the hang of it, it’s a simple, straightforward procedure that anyone can learn.
A healthy bladder is meant to fill and empty, expand and release. When we express a cat’s bladder, the expresser's hand acts as a muscle squeezing the urine out of the bladder through the urethra, and out of the body through the urethral opening. A degree of mechanical irritation cannot be avoided and increases with the amount of time the bladder needs expressing. The goal is to be as gentle as possible to avoid damaging the bladder walls while moving out as much urine as advisable.
Learning to express is a two-fold process. The first step is the physical action of squeezing the urine out of the bladder. The factors involved are knowing the locations to comfortably express the cat, ways of holding the cat, precisely where to place your hand and how to move it to encourage the bladder to release.
As you learn the mechanical aspects, you also will learn the “art” of bladder expression, which includes ways to balance the stress level of both you and your cat, how to gauge when the bladder is adequately empty and whether the cat is up to his or her normal level of urinary tract health. This includes knowing what is normal for each individual cat. As with any skill, the more you practice, the more adept you will become.
Choosing a location for expressing a cat’s bladder
The location where you express the cat varies with the temperament of the cat and your situation. You can express:
- Onto a towel, piddle pad or litter box on the floor
- From a counter into a sink or toilet, or onto a towel or piddle pad
It is important to find the position most comfortable for both you and the cat. If you are stressed or worried, the cat will sense it and may react by tensing up, blocking the internal flow of urine or by squirming so much that handling the cat is impossible.
Don’t worry about urine getting on your surroundings. It happens. Better to get the urine out of the cat than to worry about the environment, which you can easily clean and sanitize afterward. (Be aware that you may get urine on yourself or your clothing.) Focus on the cat and keep your intentions positive and confident.
It is normal for some cats to vocalize during the process. Try not to let the cat’s voice unnerve you. If the volume and intensity escalate enough to indicate pain or a high stress level, stop and set the cat down. You can approach and refresh your friendship with the cat later in the day and try again.
This process is one that the cat needs to get used to as well. The cat will learn to identify you as the person who helps her empty her bladder. The cat may never “enjoy” it, but if you can visualize that you are working with rather than working against each other, the process will go much more smoothly. Consider it teamwork, even if the cat doesn’t seem to agree with the idea.
It is natural to worry about hurting the cat. If you have questions about how to determine this, talk to your vet. If you are attentive to the levels of comfort for both you and the cat, in time you will easily see when to give yourself and the cat a break. Gentleness is an important key.
Positioning the cat to express the bladder
The cat will feel any tension in your body, so use your body and sense of calm to communicate comfort and assurance to the cat. This will help the cat relax and give you more time to work before the cat becomes restless. Here are some tips:
- It helps if you can keep the cat's front legs on the counter, floor or your thigh (depending on your location and position). The hind end should be at the edge of or slightly over the target (sink, toilet, litter box, towel or piddle pad). If the cat can feel better supported by having contact on some surface, the cat will be more relaxed, confident and less likely to squirm around.
- Sometimes the cat will stay in a good position with all four legs on the counter or floor surface, allowing you to more comfortably (and gently) brace the animal with one arm or hand, while squeezing with the other.
- Sometimes it is helpful to hold the cat's hind legs together and positioned toward the belly with your nonsqueezing hand. This can allow the bladder to fall into a position and shape that can be manipulated more easily. This restraint also prevents the cat from rabbit-kicking your wrist as you express the bladder.
- Sometimes gentle scruffing helps, although this allows you just one hand on the bladder and rear area of the cat. If the cat is very wriggly, and just one or two good squeezes is the best you can do, scruffing can help ensure that even if the results aren’t optimum, you’ve expressed at least some of the urine. Later in the day, you can revisit the cat and, if needed, call in a colleague.
- If you do need to scruff, maintaining a sense of calm will help the cat release the urine.
Finding the cat’s bladder
Slip your dominant (squeezing) hand under the cat’s belly and slightly closer to the rear than right below the ribs. Place your other hand along the animal’s side so you can gently hold and/or lift the cat. When the animal has settled into position, feel the abdomen, slightly higher than the leg sockets. Beneath the spine is the colon and then beneath that is the bladder.
The bladder has a distinct shape and feeling. It feels smooth and self-contained, much like a water balloon. So, what you are feeling for is a water balloon inside a warm, furry skin sack. You do not have to squeeze immediately. Give yourself a moment to move your fingers around the bladder. Become familiar with its size and shape.
Hand movement when expressing a cat’s bladder
The goal is to steady/cradle the bladder in your hand, applying the least amount of pressure needed to force out the urine. Sometimes with a very full bladder, you can release some urine just by rolling your fingers along the sides of it. But as the bladder empties and diminishes in size, you will likely need to shift your hand to squeeze more out.
Use the flat pads of your fingers (not your fingertips and never your fingernails) with the thumb on the opposite side. Provide a firm even pressure. As you squeeze and the urine comes out, aim to maintain the position for as long as the stream of urine continues.
Pause for a moment and squeeze again when the urine stops. If the stream continues and you feel the bladder shifting and shrinking, it's OK to subtly move your fingers to encourage a continuing stream. It's also OK to pull your hand completely away from the cat and reposition it for the next squeeze.
How to tell if the bladder has sufficiently emptied
You can stop and rest a little or let the cat have a minute to walk around at any point in the process. This gives the bladder time to shrink around the remaining urine, and it also gives the cat a break. If the bladder has become smaller and you can still get some urine out (but not solely by finger pressure), you can let the bladder fall into the palm of your hand and gently squeeze, as if you were making a slow fist. The urine may be released and you may feel the bladder walls touching. At this point, the bladder is usually empty.
It is OK to leave a very small amount of urine if the bladder is about grape-sized and the urine is coming out in drips (no need to continue expressing).
Different cats have different “normals” when it comes to the size of a full bladder or a bladder that needs expressing, or a bladder that’s empty enough. This will become easier to recognize as you gain more experience.
Tips and other pertinent information
- If you can’t express any urine or you are unsure whether the bladder has sufficiently emptied, always check with your vet.
- Not all bladders are of equal size or behave the same. Some cats naturally produce more or less urine than others; however, an underlying condition such as kidney disease or diabetes can also cause an increase or decrease in urine volume. If a cat receives regular subcutaneous fluids, the bladder will be typically large. For a healthy continent cat, a full bladder is somewhere between the size of a handball and a golf ball, while the bladder of an incontinent cat can sometimes be as large as a large grapefruit. Some incontinent cats can have larger bladders because over time the bladder walls have stretched to accommodate the retained urine.
- Some bladders are wiggly. Using your thumb to brace the bladder while holding contact with your fingers opposite can help keep it steady enough to squeeze.
- Sometimes gently stimulating the penis or vulva while squeezing the bladder helps relax the opening and release the urine without a forceful squeeze. This technique is preferred over continual squeezes with little output and helps reduce the irritation of the bladder walls caused over time by manual expressing. Stimulate means rubbing your finger briefly but continually until you feel the urine come. Your finger will get wet so wearing gloves is recommended.
- As you express on a regular basis, you will get to know what is normal for your cat. This knowledge will help you gauge whether the bladder is adequately emptied. You may also note differences — times when the bladder is more resistant to being compressed. This often indicates that the colon has some stool in it and there is less room for the bladder to be manipulated. It’s OK to palpate and evacuate some of the stool to allow for better bladder expression.
- As you become more practiced, you may occasionally feel other changes in the consistency of the bladder, such as a spongy feeling that could indicate infection or (if your squeezing is not moving the urine out at what you think is a normal rate) abdominal gas.
- With an infection, the urine may have a strong, fishy odor to it. It also could be tinged with blood. Call your vet if you notice any of these symptoms.
- With gas, palpating the colon a bit can help. If you postpone expressing for 30 minutes or so, there may be less gas and the expressing may be more productive.
- If the bladder is large and hard and you cannot express any urine (or only drops), the cat may be blocked. This is a medical emergency and you should immediately contact your vet.