Journal of Feline Medicine and Surgery (2010) 12, 431e434

doi:10.1016/j.jfms.2009.10.008

Effect of water source on intake and urine

concentration in healthy cats*
David C Grant DVM, MS, Diplomate ACVIM

Department of Small Animal
Clinical Sciences, Virginia-
Maryland Regional College of
Veterinary Medicine, Virginia Tech,
Blacksburg, VA 24061-0442, USA
Date accepted: 28 October 2009
Increasing water intake and decreasing urine concentration are recommended
for cats with urolithiasis and with idiopathic cystitis. Fountains are advocated to
encourage drinking; however, effects on drinking of fountains have not been
reported in cats living in pet owners homes. Thirteen healthy cats were assigned
to have 24-h water intake and urine osmolality and specific gravity measured
when water was offered from a bowl or fountain. One cat developed excessive
barbering, vomiting, and refusal to drink water offered from the fountain. For
the remaining 12 cats, intake was slightly greater from the fountain. However,
urine osmolality was not significantly different. In this study, a fountain failed to
substantially increase water intake and dilute urine in cats. A similar study
including a greater period of time and additional cats may clarify the results of
this study.
Ó 2009 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

D
isorders leading to lower urinary tract signs
and hematuria are diagnosed at 1.5% of cat
visits to primary care veterinarians.1 The
most common lower urinary tract disorders of cats
are idiopathic conditions, urethral plugs, and uro-
liths.2 There is evidence, though minimal, that increas-
ing dietary moisture and urine dilution, in addition to
other treatment factors, may reduce the recurrence of
calcium oxalate uroliths and idiopathic cystitis in
cats.3,4 Maintaining dilute urine is promoted as part
of strategies to prevent recurrence of numerous uro-
lith types in cats.5 Presumably urine dilution reduces
the concentration of irritating and lithogenic
substances and increased urine volume leads to
more frequent voiding.
Dietary changes used or recommended to increase
water intake and promote urine dilution have in-
cluded feeding canned food, high sodium diets, and
addition of water to diets.4e7 Additions of flavoring
to water and water fountains have also been sug-
gested to increase water intake.6,8 Numerous commer-
cial water fountains are being advertised to provide
flowing drinking water for cats. One such product
(Drinkwell The Original Pet Fountain, Veterinary Ven-
tures, Reno, NV) claims it is ‘the best way to entice
your pet to drink more water’. No studies have
*
Presented in part at the 2009 American College of Veterinary
Internal Medicine Forum, Montreal, Canada.
E-mail: dgrant@vt.edu
prospectively evaluated the efficacy of water foun-
tains to increase intake in cats. The hypotheses of
this study were that cats would consume more water
and have more dilute urine when water was offered
from a fountain versus a bowl.
Materials and methods
All portions of this study were approved by the
VirginiaeMaryland Regional College of Veterinary
Medicine Veterinary Teaching Hospital (VTH) Board
and the Institutional Animal Care and Use Committee
of Virginia Tech.
Animals
Thirteen client-owned cats housed indoors only with
no other pets were determined to be healthy based
on a physical examination and results of a complete
blood count, biochemistry profile and urinalysis
(dipstick tests, microscopic analysis, urine specific
gravity, and osmolality (Advanced Microosmometer
Model 3300, Advanced Instruments, Norwood,
MA)). Cat owners verified their cat was not experienc-
ing any health problem at the time of the study and
had no history of the following diseases; diabetes
mellitus or insipidus, chronic kidney disease, pyelone-
phritis, hyperthyroidism, urolithiasis, or cystitis. They
were specifically queried to be sure their cat did not
have polyuria, polydipsia, or pollakiuria.

1098-612X/09/060431+04 $36.00/0 Ó 2009 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.
432 DC Grant
Procedures
Cats were randomized in a 2  2 cross-over design to
have 24-h water intake and urine specific gravity and
osmolality measured when water was offered from
a bowl or a fountain; access to water elsewhere in
the house was prohibited. Cats were given 7 days to
acclimate to the fountain prior to measurement of wa-
ter intake and 14 days passed between measurements
using the bowl or fountain (Drinkwell). The cats were
kept in their home environment and water intake and
evaporation were measured by the cat owners. For the
duration of the study cats were fed their usual food.
24-h water intake was measured on two consecutive
days (48 h) and the mean value used for statistical
analysis. The bowl and fountain were never allowed
to become empty. At the end of the 48 h, water was re-
moved and the cats were brought to the VTH for col-
lection of urine by cystocentesis within 4 h for
urinalysis and measurement of urine osmolality and
specific gravity.
To determine and correct for the volume of water
that may have been spilled by cats playing with their
water during all water intake measurements, an ab-
sorbent pad was placed under the bowl or fountain.
The absorbent pads were sealed in an air-tight plastic
storage bag and weighed prior to and after each 24 h
period. The difference in weight of the pad was con-
verted to milliliters of water and the volume sub-
tracted from the amount of water offered during
that period. To determine and correct for the volume
of water that could evaporate, or in the case of the
fountain could have been retained within the filtra-
tion/pump system or displaced by splashing, a control
bowl and fountain were placed in a room in the cat
owner’s house with no motion, people, or animals
for 24 h following the respective water intake mea-
surement. The volume missing from the fountain or
bowl was subtracted from the amount placed in the
bowl or fountain during each 24 h period.
Cat owners were then queried to determine the fol-
lowing: (1) Did their cat play with its standard water
bowl or the water in it? (2) Did their cat play with the
fountain or the water in it? (3) Did they feel their cat
liked the fountain?
Statistical analysis
Data were summarized as means  standard devia-
tion. Subsequently, both volume of water intake and
urine osmolality were compared between the two
treatments (water offered from a bowl or fountain) us-
ing mixed model analysis of variance with sequence,
period, and treatment as fixed effects and cat within
sequence as a random effect. For each analysis,
a norm plot of the raw data and the residual plots
were inspected to assess model adequacy. Statistical
significance was set to a ¼ 0.05. All analyses were per-
formed using the Statistical Analysis System (version
9.2: SAS Institute Inc, Cary, NC).
Results
One cat, whose first assignment was the fountain, devel-
oped excessive barbering, and vomiting and aggression
directed at the fountain, and refusal to drink water
when the fountain was offered. These behaviors resolved
upon removal of the fountain, therefore, the cat was re-
moved from the study. Individual results for the remain-
ing 12 cats can be found in Table 1. Water intake from the
fountain was statistically significantly greater than intake
from the bowl (31.6  13.5 versus 22.9  10.2 ml/kg/day,
P ¼ 0.0381). However, no difference was observed in
urine osmolality after intake from the fountain versus
the bowl (2537.7  440.8 versus 2468.9  367.3 mOsm/l,
P ¼ 0.6579). The lowest urine osmolality and specific
gravity obtained from a cat drinking from the fountain
were 1901 mOsm/l and 1.044, respectively. The data
were also analyzed after excluding cat 2 because its diet
did not remain consistent between these two treatments
(canned food was added to the dry diet when the bowl
was used). After exclusion of cat 2, no significant differ-
ence in urine osmolality or water intake from the
fountain versus the bowl could be identified. The 24 h
mean volumes of water that disappeared from the control
bowls and fountains were 25.3  19.7 ml/day and
108.0  56.0 ml/day, respectively.
Three of 12 (25%) cat owners reported their cat
played with its water bowl or the water in it and 5/12
(42%) reported their cat played with the fountain or
water in it. Ten of 12 (83%) cat owners concluded their
cat liked the fountain, one was unsure, and one con-
cluded their cat did not like the fountain.
Discussion
Offering water from a fountain led to greater water intake
in cats when compared with water offered from a stan-
dard bowl. However, when urine osmolalities following
these treatments were assessed, there was no significant
difference, suggesting the accuracy of the intake volume
from the fountain was falsely elevated. The difference in
water intake became insignificant after exclusion of cat
2. One explanation for this discord in intake and urine os-
molality could be that while eating dry food only, more
water was ingested from the fountain and more water ex-
creted in the feces rather than in the urine of this cat com-
pared with when it was eating dry and moist food while
drinking from the bowl.9 Another possible explanation
for the apparent increase in water intake from the fountain
but lack of reduction in urine osmolality for the group as
a whole could be that cats played with water in the foun-
tain, more so than the bowl, and thus displaced water cre-
ating a falsely inflated water intake. In an attempt to
account for this confounding factor absorbent pads
were placed under the bowls and fountains the cats drank
from and weighed before and after. It is possible that with
the fountain some cats splashed water beyond the edges
of the pads or that the fountain on its own splashes or
that water evaporated from the absorbent pads prior to
being weighed at the end of the intake period. The
much greater amount of water that disappeared from or
 Effect of water source on intake and urine concentration in healthy cats 433

Table 1. Signalment, water intake, and urine specific gravity and osmolality of cats offered water from
a bowl and a fountain.
Cat Signalment Bowl, mean Bowl, Bowl, urine Fountain, mean Fountain, Fountain,
number (age in years, water intake urine osmolality water intake urine urine
gender, breed) (ml/kg/day) specific (mOsm/l) (ml/kg/day) specific osmolality
gravity gravity (mOsm/l)
1 5, MC, DSH 20.9 1.051 2044 18.1 1.044 1901
2 7, FS, DSH 14.7 >1.060 2636 52.3y 1.054 1961
3 5, MC, DSH 21.3 1.056 2504 31.5 >1.060 2500
4 7, MC, DSH 11.3 >1.060 3040 25.4 >1.060 2819
5 0.5, F, DLH 41.6 1.058 2442 41.6 >1.060 3141
6 8, MC, DLH 15.8 1.053 2260 37.0 1.054 2229
7 4, MC, DSH 9.5y 1.060 2825 16.2y >1.060 2901
8 6, FS, DSH 23.7 1.051 2206 44.1 1.051 2097
9 10, MC, DSH 18.8y 1.046 1977 14.8y 1.057 2432
10 0.5, F, DSH 38.0 1.054 2286 50.8 >1.06 3231
11 0.5, F, DSH 32.3 >1.060 3105 28.7 >1.06 2738
12 8, FS, Siamese 26.9 1.052 2302 18.2 >1.060 2502
Mean 22.9  10.2 2468.9  367.3 31.6  13.5* 2537.7  440.8
(n ¼ 12) (n ¼ 12)
23.3  10.6 33.1  13.1*
(n ¼ 11) (n ¼ 11)
All remaining cats received dry commercial diets. MC ¼ male, castrated; FS ¼ female, spayed; F ¼ female;
DSH ¼ domestic shorthair; DLH ¼ domestic longhair.
*Indicates statistically significant difference in mean water intake, P < 0.05.
y
Fed dry commercial feline diet with canned diet added.

was retained within the control fountain (108 ml/day)
compared with the bowl supports the latter two possibil-
ities. Increased environmental temperature or exercise
would increase water intake and result in more concen-
trated urine but this possibility seems unlikely in this pop-
ulation of cats as they were strictly indoors, the study was
randomized and crossed-over, and this study was done at
the same time of year in all cats. Similarly, because of the
randomized cross-over design, water volume measure-
ment errors by cat owners seem very unlikely. Regardless,
the mean urine osmolality of 2537.7 mOsm/l obtained
following the water fountain treatment is evidence the
fountain did not induce enough water intake to cause sub-
stantial urine dilution. Individual variation did occur but
even the lowest osmolality and specific gravity was only
1901 mOsm/l and 1.044, respectively. Urine specific grav-
ity <1.020 is a commonly quoted therapeutic target for di-
luting urine for prevention of urolithiasis and clearly this
was not met.5 The fountain was not uniformly tolerated,
as one cat developed aggression and vomiting directed
at the fountain and refused to use it. Results of this study
do not support replacing a cat’s water bowl with a foun-
tain to increase water intake and produce dilute urine. It
would be interesting to determine the effect of providing
a fountain in addition to a cat’s usual bowl but currently
this is unknown. While it seems plausible that some cats
will drink more from a fountain, not a single cat in this
study achieved the desired effect on urine concentration.
It is important to note that there is only a single study
which has shown that urine dilution, produced by feed-
ing a canned diet, has been associated with reduced recur-
rence of a feline lower urinary tract disease, that being
idiopathic cystitis.4 In that study, other causes of lower
urinary tract signs were not excluded as causes of recur-
rence for all cats. Additionally, after removal of a cat
with urinary tract infection from the analysis, the recur-
rence rate was not significantly different for the canned
versus dry food.
However, the results of this study suggest water
fountains may provide a source of enjoyment for
some cats. Most cat owners thought their cat liked
the fountain and 42% observed them playing with
the fountains. It has been proposed that stress and
a sedentary lifestyle may play a role in the recurrence
of idiopathic cystitis in cats.10 Provision of activities
for indoor cats as part of an uncontrolled multimodal
approach to managing idiopathic cystitis resulted in
resolution of stranguria, pollakiuria, and periuria.10
Whether water fountains represent an adequate
source of activity for cats is unknown.
The small population size is a limitation of this
study. The power of the study to detect small but sig-
nificant differences in water intake or urine dilution is
likely low. However, the main goal of the treatments
applied was to produce dilute urine, preferably a urine
specific gravity 1.020, and this was not met in any
cat under any treatment. Repetition of the study using
more cats would be optimal to verify or nullify the
434 DC Grant
results of this study. Additionally, similar studies uti-
lizing various flavorings added to water would be
interesting.
In summary, water fountains are unlikely to lead to
substantial increase in water intake or dilution of
urine in cats. However, this does not exclude the pos-
sibility of individual variation in preferences of cats
for fountains or flavoring.
Acknowledgements
The author thanks Dr Stephen R. Were, PhD for statis-
tical assistance. The author also thanks Mrs Stephanie
Milburn, Ms Dana Calicott, and Ms Barbara Kafka for
technical and organizational assistance. The author
also thanks Veterinary Ventures for donation of the
fountains used. Neither Veterinary Ventures nor any
other party had any influence on the results of this
study or were aware of the results of the study until
after such time that it was accepted for publication.
This study was funded by an Internal Research Com-
petition Grant for the VirginiaeMaryland Regional
College of Veterinary Medicine.
References
1. Lund EM, Armstrong PJ, Kirk CA, Kolar LM, Klausner
JS. Health status and population characteristics of
dogs and cats examined at private veterinary practices
in the United States. J Am Vet Med Assoc 1999; 214:
1336e41.
Available online at www.sciencedirect.com
2. Kruger JM, Osborne CA, Goyal SM, et al. Clinical evalu-
ation of cats with lower urinary tract disease. J Am Vet
Med Assoc 1991; 199: 211e6.
3. Lekcharoensuk C, Osborne CA, Lulich JP, et al. Associa-
tion between dietary factors and calcium oxalate and
magnesium ammonium phosphate urolithiasis in cats.
J Am Vet Med Assoc 2001; 219: 1228e37.
4. Markwell PJ, Buffington CA, Chew DJ, Kendall MS, Harte
JG, DiBartola SP. Clinical evaluation of commercially
available urinary acidification diets in the management
of idiopathic cystitis in cats. J Am Vet Med Assoc 1999;
214: 361e5.
5. Lulich JP, Osborne CA. Management of urolithiasis.
Manual of canine and feline nephrology and urology.
Gloucester: British Small Animal Veterinary Association,
2007: 252e63.
6. Buffington CA, Chew DJ. Management of non-obstruc-
tive idiopathic/interstitial cystitis in cats. In: Elliott J,
Grauer GF, eds. Manual of Canine and Feline Nephrology
and Urology. Gloucester: British Small Animal Veterinary
Association, 2007: 264e81.
7. Hawthorne AJ, Markwell PJ. Dietary sodium promotes
increased water intake and urine volume in cats. J Nutr
2004; 134(suppl 8): 2128Se9S.
8. Forrester SD, Roudebush P. Evidence-based manage-
ment of feline lower urinary tract disease. Vet Clin North
Am Small Anim Pract 2007; 37: 533e58.
9. Burger IH, Smith PM. Effects of diet on the urine charac-
teristics of the cat. Nutrition, malnutrition and dietetics
in the dog and cat. Proceedings of an International Sym-
posium, 1987: 71e3.
10. Buffington CA, Westropp JL, Chew DJ, Bolus RR. Clini-
cal evaluation of multimodal environmental modifica-
tion (MEMO) in the management of cats with
idiopathic cystitis. J Feline Med Surg 2006; 8: 261e8.