Please reach out to your veterinarian before beginning any treatments for your cat’s incontinence, including bladder or bowel expression. While it can be challenging to learn to express a cat via written instructions, we hope this information will help supplement your training with a veterinarian or other experienced expresser.
Inappropriate expression can be harmful and even dangerous, so it’s necessary to have proper hands-on instruction in technique and in how to avoid complications. Please do not attempt expression without consulting a veterinarian and without receiving proper training.
If you are caring for an incontinent cat, you may need to manually express your cat’s bladder. While it takes a bit of practice, it is a simple, straightforward procedure that anyone can learn.
You will note that we stress the importance of maintaining a calm energy when expressing. The effect of your mood on the cat cannot be overstated. Of course, when you start learning, you may be nervous. Just do your best to relax. The more you and your cat work together, the easier it will be for you (and your cat) to remain calm during the process.
We recommend that you always wear disposable gloves when expressing. And if you are working with a cat who may bite or scratch you, please talk to your vet about whether personal protective equipment (PPE) is needed.
About the process
A healthy bladder is meant to fill and empty, expand and release. When a cat’s bladder is expressed, the expresser’s hand acts to squeeze 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 length 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 possible each time.
Learning to express is a two-part process. The first part is learning the physical action of squeezing the urine out of the bladder. The factors involved are the location, the position of the cat, how you hold the cat, where you place your hand, and how you move your hand to encourage the bladder to release and express the urine.
The second part is learning the “art” of bladder expression, which includes how to balance the stress level of both you and your cat, how to gauge when the bladder is adequately empty and how to tell when there is a problem. As with any skill, the more you practice, the more adept you become.
Before getting started
Be sure to keep your nails short. This will make the experience much more comfortable for the cat and easier for you.
The cat will feel any tension in your body, so take the time to calm yourself before you start. Use your body language 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. A relaxed cat also means a relaxed bladder, which is much easier to express than a tense one.
This process is one that both you and your cat will need to get used to. Even if the cat has been expressed for years, his experience with you will be different. The cat will learn to identify you as the person who helps him empty his bladder. The cat may never enjoy it, but if you can visualize that you are working with rather than against each other, the process will go much more smoothly. Consider it teamwork, even if your cat doesn’t seem to agree with the idea. This is important because the cat will sense and mirror your attitude.
It’s natural to worry about hurting the cat. If you have questions or concerns about how to determine when your cat is in pain or getting too stressed, talk to your veterinarian. If you are concerned, a good rule of thumb is to stop, take a break and then start again. With time and support from your vet, you will develop a sense of when your cat is OK and when you need to stop.
Choosing a location
The location you choose to express your cat will depend on your physical needs and preferences as well as those of your cat. For example, if it is difficult or painful for you to bend down, you should select a location where you can be standing.
You can express:
- Onto a towel, pee pad or litter box on the floor
- From a counter into a sink, or onto a towel or pee pad
- Into a toilet
It may take some trial and error to find a location that works for both of you. Keep in mind that urine will likely go astray and end up in places you don’t intend, including on the surrounding objects and you. This will lessen with time, although even the most experienced expressers still have “accidents.” You will want to keep this aspect in mind when selecting the location.
Whatever location you choose, be sure to clean and sanitize it after each session. If you decide to use a sink, be sure to rinse the drainpipe thoroughly with clear water every time to avoid damage.
Positioning the cat
It is important to find a position that’s comfortable for both you and the cat. If you are stressed or uncomfortable, the cat will sense it and may react by tensing up, blocking the flow of urine, or by squirming so much that handling him becomes impossible. It may take some trial and error to find a position that works for both of you.
Some recommendations and tips:
- For some cats, it is helpful to hold the hind legs together and pull them in toward the belly with your non-squeezing hand. This puts the bladder in a good position for expressing. This restraint also prevents the cat from “rabbit-kicking” you as you express him.
- If you are holding the cat’s back legs, it helps if you can keep the cat’s front legs on the counter, floor or your thigh (depending on your location). The cat’s hind end should be at the edge of or slightly over the target (sink, toilet, litter box, towel or pee pad). If the cat feels grounded, he will be more relaxed, confident and less likely to squirm around.
- All four legs on the counter or floor is often an ideal position, allowing you to comfortably (and gently) brace the cat with one arm or hand, while squeezing with the other.
- Sometimes, a gentle hold on the cat’s neck helps, although overt “scruffing” should generally be avoided. Keep in mind that if you are restraining the cat to prevent him from turning and biting you, your hand should be up higher on the neck, toward the head. If you are placing a gentle hold on the cat for relaxation only, your hand should be farther down, near the shoulder blades.
- Don’t forget that maintaining a sense of calm will help the cat and his bladder relax and release urine more easily.
Finding the cat’s bladder
Slip your dominant (squeezing) hand under the cat’s belly slightly closer to the rear than right below the ribs. Place your other hand along the cat’s side opposite from you so you can gently hold and/or lift the cat. When he has settled into position, feel the abdomen, slightly higher than the leg sockets. Beneath the spine is the colon and beneath that is the bladder.
The bladder has a distinct shape and feel. It feels smooth and self-contained, much like a water balloon. 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.
The goal is to cradle the bladder in your hand, applying the least amount of pressure needed to release 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 urine 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, try to maintain the position for as long as the stream of urine continues.
When the urine stops, pause for a moment and then squeeze again. If the stream continues and you feel the bladder shifting and shrinking, it’s OK to move your fingers to encourage a continuing stream or to pulse slowly. It’s also OK to pull your hand completely away from the cat and reposition your hand for the next squeeze.
As the bladder becomes smaller, let it settle into the palm of your hand and slowly make a fist, while still not using your fingertips. Once the bladder is about the size of a grape or you feel the bladder walls touching, it is empty. You can stop.
At any point in the process, you can stop and rest a little or let the cat have a minute to walk around.
Different cats have different “normals” when it comes to the size of a full bladder or an empty bladder. Also, each cat’s normal will likely change over time. This will become easier to recognize as you gain more experience.
Additional tips and other information
- If the bladder is large and hard and you cannot express any urine (or only drops), the urethra may be blocked. This is a medical emergency, so contact your veterinarian immediately.
- Do not use excessive force when expressing because too much force can result in bladder rupture. If you are having difficulty, contact your veterinarian.
- It is normal for some cats to vocalize during the process. Try not to let the cat’s cries 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 try again later once the cat and you are both calm.
- If you are unsure whether the bladder has been sufficiently emptied, check with your vet.
- As mentioned above, not all bladders are equal in 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 typically be 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 grapefruit. Some incontinent cats can have larger bladders because over time the bladder walls have stretched to accommodate retained urine.
- Some bladders are wiggly. Using your thumb to brace the bladder while moving your fingers can help steady it. Using your non-expressing hand to press down gently on the cat’s back above the bladder can also help.
- Sometimes, gently stimulating the cat’s 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 gently rubbing your finger on the area in short bursts until you feel the urine coming. Your finger will get wet, so we recommend wearing gloves.
- If you notice that the cat’s bladder is more difficult to express than usual, this can indicate that the colon has stool in it, so there is less room for the bladder to be manipulated. Talk to your veterinarian to see if evacuating your cat’s colon is advisable in these situations.
- You may occasionally feel 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. Contact your vet if you notice any of these symptoms.
- With gas, it can help to gently squeeze the colon a bit, but please check with your vet before trying this. Another option is to delay expressing for 30 minutes or so, with the hope that there may be less gas at that time and expressing will be more productive.