You need a new vet. Get a second opinion. She could easily also have a
chronic infection or interstitial cystitis.

Karen

I would have this re-checked by another vet: a second opinion.  It strikes
me as more likely to be a medical problem rather than a behavioral one.

Cathy

I have yet to hear of a cat who strains to urinate having a behavioral
problem.

I'd get a second opinion.

Could be:
interstitial cystitis
infection (UTI)
stones (kidney or bladder)
feline urologic syndrome (may include stones/crystals)

It sounds to me like your cat may have a condition called Interstitial
Cystitis. This is a chronic inflammation of the bladder that happens
because there are flaws in the protective lining of the bladder and the
urine irrtates the bladder wall casing inflammation, blood and symptoms
of a urinary tract infection.  
I have two cats with this condition and have been able to control it,
and I suggest you try my approach for a few months and see if you see
improvement.

1) The first thing you'll need to do is eliminate dry food.

Dry food diets have been shown to exacerbate or cause urinary tract
issues. Cats have evolved to derive most of their moisture intake from
what they eat. As a result the cat does not get enough water from dry
food and usually doesn't drink enough to make up for the losses, thereby
not allowing the bladder to be properly flushed and keeping the cat in a
constant state of dehydration, which puts a lot of stress on other
organs as well. The fact is dry food is not a species appropriate diet
and is now suspected to cause diabetes, inflammatory bowel disease,
kidney problems, etc.

A good website that addresses a lot of this is
http://www.catnutrition.org

When choosing a canned food, it is also important to only feed *high
quality* foods, which generally use a fixed formula and are more
digestable as they contain quality ingredients (no by-products), where
grocery store foods generally are made with whatever is cheapest. Some
foods I would recommend, and use myself, are Wellness, Felidae, and
Innova, all which can be purchased at the smaller specialty type pet
stores. To find a supplier of Wellness near you you can go to
http://www.oldmotherhubbard.com/locator/locator_form.asp

It's likely you'll find Innova and Felidae at the stores that carry
Wellness.

2) The next thing you'll need to do is put your cat on a 12 hour feeding
schedule. Free feeding is not a good idea, and can't be done with canned
food anyway. I also recommend that you give your cat a variety of
flavors (something different each day), so you don't risk the cat
getting fixated on one particular food to the exclusion of all others,
and also to alleviate boredom with a food where the cat gets sick of it
and stops eating it altogether.

3) Supplement your cat with Glucosamine. While it is generally used for
joints and arthritis, it also works to rebuild the protective layer of
the bladder, which in turns stops the pain and irritation that causes
the cat to exhibit symptoms of a UTI. For this purpose your best bet is
to buy Cosequin for Cats, which can be given by capsule or mixed in with
the canned food. It is available through your vet, or can be purchased
online without a prescription. The dose is 1 capsule for every 10
pounds. If your cat is larger, say 12-13 pounds. I would suggest you use
a capsule and a half rather than try to get away with using one capsule
as it would be better to do a little extra than not enough. If your cat
is smaller than 10 pounds, just use one whole capsule.

4) Try to determine, then eliminate, what any stressors might be in
household. Stress can exacerbate or cause flare-ups in cats with IC. You
can also buy Feliway plugins and use those as they have a calming effect
on cats and can help reduce stress. http://www.valleyvet.com is a good
source for buying these at a reasonable price. The refills last longer
than the packaging says, and the ones I have last close to two months,
so the long term expense is minimal.

5) Keep the litterbox immaculately clean. Generally, as a rule, using a
clumping litter (natural litters such as World's Best Cat Litter or an
*unscented* clay litter such as Everclean are good) and scooping a
minimum of twice a day will keep the litterbox clean and to the cat's
liking. It is also important to regularly disinfect the box (every 2-3
weeks) and completely change the litter *at least* once a month. Having
a dirty litterbox can be really stressful for cats, and the routine I
have described to keep the litterbox clean takes no more than a few
minutes a day for scooping and maybe 10 minutes every few weeks for the
disinfecting and litter change.

If, after a few months (it probably won't take that long to notice a
difference,) you aren't seeing improvement, then it would be wise to
investigate other possibilities such as bladder stones. HTH.

Megan