🩺 Equine Cystitis (Bladder Inflammation): A Vet’s 2025 Guide | Dr Duncan Houston BVSc

Meta description: Understand cystitis in horses: painful/difficult urination, bladder infection, stones or nerve damage—symptoms, diagnostics, treatments and Ask A Vet support.

1. 💧 What is Cystitis?

Cystitis refers to inflammation of the bladder lining. Though uncommon in horses, when present it causes significant discomfort—markedly affecting urination patterns. Often, it is secondary to urinary tract issues like uroliths, nerve paralysis or trauma from foaling or catheterization :contentReference[oaicite:2]{index=2}.

2. ⚠️ Why Early Recognition Matters

Left untreated, cystitis can lead to ascending infections (pyelonephritis), fibrosis of the bladder wall, incontinence, scalding of the perineum and long-term urinary dysfunction :contentReference[oaicite:3]{index=3}.

3. 🔍 Clinical Signs to Watch

• Frequent urination (pollakiuria)
• Straining to urinate (stranguria), dribbling—often with scant urine
• Blood, pus, sediment or clots in urine :contentReference[oaicite:4]{index=4}
• Cloudy or thick urine with sediment/loss of clarity :contentReference[oaicite:5]{index=5}
• Discomfort during urination, frequent posturing
• Mild systemic signs: fever, lethargy possible if ascending infection :contentReference[oaicite:6]{index=6}
• Urine scalding on hind limbs från chronic dribble :contentReference[oaicite:7]{index=7}

4. 🧪 Diagnostic Approach

• History & physical exam: palpation for bladder distension/tract abnormalities :contentReference[oaicite:8]{index=8}
• Urinalysis & culture: >10⁴ cfu/mL diagnostic; sediment analysis for blood, neutrophils :contentReference[oaicite:9]{index=9}
• Bloodwork: Check renal values, inflammatory markers :contentReference[oaicite:10]{index=10}
• Ultrasound: Bladder wall thickness, sludge, uroliths or masses :contentReference[oaicite:11]{index=11}
• Cystoscopy: Direct visualization of inflammation, stones, hemorrhage :contentReference[oaicite:12]{index=12}
• Rule out underlying causes: trauma, neurological injury, uroliths, tumors :contentReference[oaicite:13]{index=13}

5. 🛠️ Treatment Strategies

5.1 Eliminate Underlying Causes

Treat uroliths surgically, repair trauma, address bladder paralysis or neurological injury :contentReference[oaicite:14]{index=14}.

5.2 Antibiotic Therapy

Base choice on culture/sensitivity. Common empiric options: trimethoprim–sulfa, penicillin+gentamicin, ceftiofur :contentReference[oaicite:15]{index=15}.

5.3 Bladder Lavage & Catheterization

Flushing with sterile saline via catheter or cystoscope removes sediment or “sabulous” material :contentReference[oaicite:16]{index=16}. Repeat sessions may be needed.

5.4 Anti-Inflammatory Support

Use NSAIDs sparingly to control discomfort. In hemorrhagic cystitis: consider phenazopyridine and mucosal protectants :contentReference[oaicite:17]{index=17}.

5.5 Supportive Care & Monitoring

Treat skin scalding, ensure hydration, repeat urinalyses and cultures every 1–2 weeks, monitor bladder function.

6. 🛡️ Long-Term Management & Prognosis

With early, targeted therapy, many horses make full recoveries :contentReference[oaicite:18]{index=18}. Chronic or neurological cases require ongoing management and are guarded due to incontinence and recurrent infections :contentReference[oaicite:19]{index=19}.

7. 🛡️ Prevention Strategies

• Promptly treat urinary tract infections and stones.
• Prevent bladder trauma during foaling or catheter use; maintain aseptic technique :contentReference[oaicite:20]{index=20}.
• Monitor neurologic cases for bladder paralysis; manage to avoid sabulous sediment buildup :contentReference[oaicite:21]{index=21}.
• Maintain hydration and reduce stress.
• Educate handlers to notice subtle changes in urination frequency, straining, color.

8. 🤝 Ask A Vet Support Services

• 📋 Guidance interpreting urine tests and culture results.
• 📸 Remote photo/video review of urine color, behavior, skin scalding.
• 📆 Treatment plan support: antibiotic schedule, flush reminders.
• 🔁 Regular follow-up and recheck prompts for vets and owners.
• 🎓 Webinars: "Urinary Health in Performance Horses," "Bladder Flushing & Catheter Care."

9. ❓ FAQs

Q: Are mares more prone than stallions?

Yes—mares show higher incidence due to anatomy and potential reproductive tract trauma :contentReference[oaicite:22]{index=22}.

Q: Can cystitis lead to kidney disease?

Yes—if untreated, ascending infection (pyelonephritis) may compromise renal function :contentReference[oaicite:23]{index=23}.

Q: How long do antibiotics run?

Typically 4–6 weeks guided by culture/cytology and ultrasound/cystoscopy findings :contentReference[oaicite:24]{index=24}.

Q: What is sabulous cystitis?

A secondary condition due to bladder paralysis, where sand/grit accumulates, worsens inflammation—managed with regular flushing :contentReference[oaicite:25]{index=25}.

10. ✅ Final Takeaway

Cystitis in horses, while uncommon, causes significant urinary discomfort and may lead to serious complications if untreated. Early diagnosis through urinalysis, culture, and imaging—paired with targeted antibiotics, bladder flushing, and supportive care—can restore urinary health. Preventive strategies and prompt management of contributing factors reduce recurrence. With Ask A Vet support, owners can monitor subtle urinary changes, follow treatment plans, and receive timely follow-up. As Dr Duncan Houston, I’m here to help ensure your horse’s bladder stays healthy in 2025 and beyond. 🐴💧