I have two cats that blocked with urinary crystals, and one of those two (points at Jack) is so sensitive that we have had recurring issues.. it has been a nightmare. Because of this I have done a lot of reading and research on the matter, looking at not only conventional treatments but alternatives.
What I have learned..
Science has never explained why some cats get struvite crystals and others do not, but they do know that once you have them and there is a problem, there are a few things that are really important to treat them. A cat who has problems with struvite crystals are at risk of being blocked, which is a very deadly issue. If you find your cat going in and out of the litter box you need to get your cat to the vet. If the cat is peeing, you might have a day; if your cat is not peeing, it is an emergency. A cat generally has 36-48 hours after being blocked before long term damage occurs including death.
Both male and female cats suffer from crystals in their urine, but you see it more often in males because of their longer urethra which are more easily irritated. I have heard some people say they do not need to worry about females, that is not true. Vets often prescribe a perineal urethrostomy, a surgery that removes the cat's penis and reconstructs the 'plumbing'. I have been told we should do this to Jack, but this does nothing to remove the crystals from his bladder which would still be very irritated if we weren't able to understand when he was having an issue and if left too long it is still possible for him to block, just as it is possible for female cats to block.
Please note that not all cats that have urinary crystals have a problem with them. If your cat is discovered to have urinary crystals but has no clinical symptoms with it, do not feel the need to treat them, but it is not a bad idea to keep these kitty well hydrated and their urinary PH in the proper range for a cat.
Keeping the cat well hydrated will keep the urine from becoming concentrated allowing the crystals to bunch up and keeping the cat's urinary PH in the 'ideal' acidic range of 6.0-6.5 (with neutral being 7) will also keep things flowing properly. When my cat is showing he is having issues, his urinary PH is usually 8.0
Long term treatments:
Wet foods will keep your kitty better hydrated than dry. Cats have a very low thirst drive since they were originally desert creatures. That is why water fountains work to help keep cats better hydrated, as desert creatures they recognize running water as fresh faster than stagnant water sitting in a bowl. When you think about it, it makes sense; if you come upon two sources of water, one a running brook, the other a stagnant pool, which one are you going to drink out of first? One maker of Rx urinary food thinks hydration is the most important issue and addresses it by adding all kinds of extra salt into their food to encourage the cats to drink more. I haven't come across a study yet that says extra salt is bad for a cat, but I have a feeling it just hasn't been studied yet.
The other issue is keeping the PH in the right range. Science shows us that plants are *generally* alkalizing.. (driving urinary ph up to the 8 range) and meat is *generally* acidifying (bringing it back down to the 6.5 range) So you want to find a canned food that has as few plants as possible. Low glycemic greens are better than other fruits and veg and grain. I'm not opposed to some parsley and what not, but apples and squash.. I tend to forgo those. Spinach is right out for me because it's high oxalate content - which can risk oxalate stones which are harder to get rid of. It is very hard to find a food that says it uses good quality meat that isn't full of fruits and vegetables. The foods that don't tout their high quality meats - like your supermarket brands - tend not to use as many plants in their foods. Be wary of health claims Big Pet Food makes regarding fruit and veg. Cats are obligate carnivores and their systems are completely different from omnivores that are able to properly digest plants and extract the nutrients out of them. Plant based proteins are sources of protein which makes protein counts look good on labels, but since cats lack the digestive enzymes to break them down, they can not extract out of them and utilize what they need... not to mention they generally are alkalizing..
While on the whole any canned food is far superior to dry food, be aware that certain types of canned food NEED plant based binders in order to form the chunks or shreds, etc. There are very few brands that don't use them. There are some manufactures that are working on high animal protein kibble with very little carbs, but these foods still have the problem of being dehydrating.
All this being said, the best food for your kitty is the one it will eat. Do not stress over switching your cat's food... because if you bring that stress to the cat it will sense it and be less hesitant to try to eat it. Remember, the resistance to trying new foods is biological, so your cat isn't being stubborn or pig headed in not eating the good food you just got them. Cats learn from their mom which foods are foods, if mom didn't bring it home it obviously wasn't edible because she needed to hunt a lot of food to provide for a family. You can overcome this instinct, but it takes a lot of patience, it is in your cat's best interest to not be willing to just eat any ol thing in front of it, so be glad for it (says the woman who has cats who grew up in the foster system eating anything and everything and are now so food motivated it can be a problem)
But my cat was just diagnosed, what do I need to know?
Please note that most times when a cat is suffering from urinary crystals, there is no infection. Too many people continue to call any and all urinary issues with a cat a UTI, which is misleading and can be harmful to cats. A lot of vets default to prescribing antibiotics to a cat with urinary crystals despite not finding any bacteria upon examination. This is as bad for our cats as it is for us. Overuse of antibiotics is rampant in our society and should be avoided *if you can*. If there is a known infection, or they had to do any sort of invasive procedures to get your cat unblocked, by all means get antibiotics. If you can, try not to get a broad spectrum one, but do a culture and sensitivity to find which antibiotic is necessary to kill the particular infection. When giving antibiotics, you should also be giving probiotics to keep the gut flora happy. Many cats have diarrhea while on antibiotics and it is because the antibiotics are broad spectrum and kill any bacteria they come in contact with, good or bad. Yes, this is more expensive, but it will be less stress on you and your cat in the long run because you won't need to do trial and error with expensive drugs.
If your cat has blocked, please talk to your vet about bringing home pain management medication as well as an antispasmodic to keep the bladder from spasming and causing more problems for your kitty. This is usually a pill and will make a huge difference in your cat's recovery. I would also recommend talking to your vet about doing at home subq fluids which will help your kitty stay well hydrated especially if it is not feeling well enough to eat properly or it is addicted to dry food.
There are herbs and supplements you can use to help keep your kitty's bladder happy. L-methionine is an amino acid that helps acidify the urine. You can buy it at most health food stores and supplement stores. Most pet food companies use a lower quality DL-methionine in their pet foods to help keep urinary PH lowered because they use a lot of plant matter. You need to be cautious when supplementing with L-methionine because if you make the cat's urine too acidic you can cause additional problems. I use it with my cats short term when I see they are uncomfortable. Slippery Elm Bark, Marshmallow Root and Corn Silk are three herbs that help soothe the mucous membranes of the irritated bladder and help the kitty recover from a bout of inflammation. Cosequin will also help keep the bladder in good health. For long term use with Jack I used UT support from Pet Naturals of Vermont, the tablets not the chews.
Keep in mind, I am not a vet, and this is for informational purposes only. There is lots of information out there on the web regarding dosing a kitty.. If you want to know what I do with my cat, I'll tell you but I won't tell you what to do with your cat.
Jack has seen a multitude of vets for his inappropriate elimination. Each and every one of them stressed how incredibly important it was to start their Rx foods. Since Jack is incredibly sensitive to plant based ingredients, I will not feed them. You can do better. As I touched on above, one Rx is to acidify which you can do better at home with high animal based protein diets.. the other on hydration. Know you do not need to buy or feed these diets. You can if you choose. They are easy and a lot of cats do okay on them, but to me they are a lot like giving a diabetic pile of cookies and then more insulin to cover the additional sugar.
Sometimes when Jack had issues he had crystals, sometimes he did not. Stress was a major factor for him when he started peeing in his designated 'I feel bad so I'm going to pee here' places. Stress can take many different forms, the addition or subtraction of a household pet or household members, a change in routine, a change in food, a change in your pet's food's normal formula, even your own state of mind.. i.e. if you are stressed. Jack's latest issues were because he was stressed because he was hyperthyroid.
Know you are not alone in this diagnosis. Because of the lack of a nutritional foundation in the veterinary education, vets have been recommending dry food for decades. I have been told many times that there is no difference between wet and dry food but the water - and who wants to pay for water (this was also the attitude of one president of a Big Pet Food Company I went to visit a few years ago). The list of ingredients will tell you that is completely not true. Even in Rx diets that come in wet and dry varieties, you can see the ingredient list is vastly different.
I know that a diagnosis of urinary issues is overwhelming, especially if your kitty was blocked. Following the vet's recommendations, including the Rx food, until the cat is back on their feet can make things less stressful for you and there is nothing wrong with that. If you want alternatives, know they are out there. Talk to the vet about antispasmodics for the short term while your cat's bladder recovers, and if you are up for it subq fluids that can help too. A lot of cats are transitioned off of the Rx food and onto a high protein diet food and never have issue with crystals again.
Additional reading on the subject: