Feline Idiopathic Cystitis
Straining to urinate, blood in the urine and urinating outside the litter box—to the untrained eye, it might seem obvious that a cat who exhibits these signs has a bladder infection. In reality, the majority of cats that exhibit these signs do not have a urinary tract infectionan infection in any part of the urinary system, the kidneys, bladder, or urethra (UTI). If it’s not a UTI, what is it?
The Role of Stress in Cystitis
Feline idiopathic cystitis (FIC, formerly known as Feline Lower Urinary Tract Disorder) is a commonly diagnosed, painful and frustrating disorder for cats who experience it and those who love them. The root cause of cystitis signs is stress. While humans with chronic stress may suffer from gastrointestinal symptoms, headaches or irritability, the cat’s main “stress organ” is its bladder. The bladder is lined with a layer of polysulfated glycosaminoglycans, which are specialized proteins that protect the delicate tissue of the bladder from the urine, much like how the stomach lining protects the tissue of the stomach from the acid it contains. During periods of stress, this layer thins.
Unfortunately, one of the things that most endears cats to people—their inscrutable nature—also makes it difficult to determine the cause of the cat’s stress. In some cases, it’s obvious. A change in the household dynamic (such as a new pet or baby), a vacation, houseguests or a move can precipitate FIC. In other cases, the cause isn’t so clear.
Some cats are picky about where they eliminate, so litter box hygiene is important. The current recommendation is to have one litter box per cat plus one and to include a litter box on every level of the home. Clean the litter boxes regularly, and keep them in places that are not subject to high traffic. Litter type also is important for some cats, so if you have recently changed the litter type, and the cat is showing signs of FIC, consider returning to your previous litter type. Other stressors include displaced aggression (i.e., aggravation from animals outside, such as outdoor cats, and interact aggression [friction between cats in the same household is a common reason for this, newly adopted cats, etc.]), severe weather changes, strife in the household between humans or new items in the house such as furniture or carpeting. It is important to consider underlying medical diseases as a cause of house soiling. In a smaller subset of cats, bladder stones, tumors or true urinary tract infections are the cause of these symptoms. Your veterinarian should rule these out before a cat is diagnosed with FIC.
Cats require relief from pain and inflammation to heal. Treatment includes anti-inflammatory medications, analgesics and antispasmodics to keep the muscles of the urethra from spasming. Occasionally, other medications are added, including anti-anxiety medications. Anxiolytics are most often prescribed in chronic cases to help curtail further episodes of disease. It is vital to identify the stressor or stressors in order to prevent recurrence.
Guidelines for a Healthy Lifestyle
Because many of these cats will have recurrent episodes of FIC, especially in times of stress, it is helpful to enrich the cat’s environment and lower the incidence of stressors. The American Association of Feline Practitioners (AAFP) released guidelines for a healthy feline lifestyle: https://www.catvets.com/guidelines/practice-guidelines/environmental-needs-guidelines.
Cats need the ability to play, climb and interact with owners and other cats as desired but also require solitary spaces. Litter box hygiene, as outlined above, is very important. Clean food and water dishes that are not shared and out of visual sight of other cats competing for resources are also important. Most veterinarians recommend feeding primarily a canned diet because water and hydration are key to bladder health. If cats experience crystal formation or high pH, special diets may be required. Feliway or other synthetic feline pheromones also may help lower stress when used in commonly shared areas. Many cat owners find that a diffuser in the same room as the litter box helps too.
Though FIC episodes tend to become more sporadic as cats age, they can be prevented or minimized with careful monitoring, medications and environmental awareness.
Note of Caution
Male cats who exhibit signs of FIC are at high risk for urinary blockage, which is a medical emergency. Sometimes the blockage is due to swelling and spasm of the urethra. Sometimes it is secondary to crystals or stone formation. If your male cat is straining and not producing urine, please visit the closest veterinarian immediately.
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Hillary Olin Smith, DVM is a graduate of Texas A&M College of Veterinary Medicine and lives in Navasota, Texas. She works for three different practices: Hempstead Veterinary Clinic in Hempstead, Texas; Waller Veterinary Clinic in Waller, Texas; and Beard-Navasota Veterinary Hospital.