Lauren Baker, DVM
There are many causes of urinary tract issues in cats including urinary tract infections (UTIs), sterile or idiopathic cystitis, urinary tract stones, cancer, anatomical or congenital problems, and problems with other organs or body systems. Feline idiopathic cystitis (FIC) is a urinary condition in cats that has been described at least since the 1970s. The terms feline urologic syndrome (FUS) and feline lower urinary tract disease (FLUTD) are sometimes used to refer to feline idiopathic cystitis (FIC), but FUS and FLUTD are umbrella terms that include a variety of urinary tract conditions, including FIC. Feline sterile (non-bacterial) cystitis and feline interstitial cystitis are sometimes used as well, but feline idiopathic cystitis (FIC) is the most correct term. One of the most important things to remember is that feline idiopathic cystitis is NOT the same thing as a bacterial urinary tract infection.
The term “idiopathic” means that we do not currently understand exactly why this condition occurs. “Cystitis” refers to inflammation of the bladder. There are many causes of cystitis. Urinary tract infections, urinary tract cancer and bladder stones can all cause cystitis. FIC is somewhat different than these other condition in that there is no readily identifiable source of the inflammation. FIC is the subject of intensive research. Humans suffer from a similar condition called interstitial cystitis, and many of the same disease symptoms are found in feline patients. New research indicates that cats and people that suffer from this condition have an exaggerated stress response. Genetics likely plays a role, but environment and diet all seem to contribute.
The following clinical signs can be seen with FIC: straining unproductively to urinate, straining while passing urine, vocalizing while urinating, sitting in the litter box, blood in the urine, urinating smaller volumes than normal and urinating in unusual places. You may also notice vague symptoms such as lethargy, hiding or vomiting. If your cat is exhibiting any of these symptoms they need to be evaluated as soon as possible by a veterinarian.
FIC is a diagnosis of exclusion. In humans, the diagnosis is reached by excluding other causes of the symptoms (like a urinary tract infection), and then by finding characteristic pinpoint spots of hemorrhage on the bladder wall via cystoscopy (inserting a camera into the bladder). These same spots of hemorrhage have been found in research settings in cats, but cystoscopy is not something that is really feasible in a routine clinical setting. Your veterinarian likely will want to rule out other conditions such as a urinary tract infection and bladder stones before arriving at FIC as a possible diagnosis. Some studies have shown that in young, neutered, otherwise healthy, indoor male cats, over 95% of patients presenting with lower urinary tract signs will turn out to have FIC, not a bacterial urinary tract infection or other condition.
One of the most serious symptoms seen with FIC is urethral obstruction. This happens almost exclusively in male cats (though female cats can have urethral obstructions from stones or cancer). This is because the male urethra is longer and narrower than the female urethra. Urethral obstruction (“block”) can happen when crystals, mucous or cells form clumps and get stuck in urethra, preventing the pet from emptying the bladder. It is very important to try to identify those times when the cat has blocked as this is a life threatening medical emergency. It can be difficult for you to tell at home if your cat has blocked, as blocked and not blocked cats can exhibit similar symptoms, but some symptoms of “block” include no urinations in 12+ hours, vomiting, collapse/extreme lethargy, straining unproductively to urinate and abdominal pain. Sometimes the cat will not experience these severe and obvious symptoms and will simply be found straining in the litter box. Your veterinarian will assess your cat for blockage by palpating the bladder.
FIC is not currently a curable disease, but it can be managed. Most cats will not suffer symptoms continuously, but will have occasional “flare-ups” of their symptoms that often are precipitated by stress. Some cats will go long periods of time between having flare ups. Some cats will have flare-ups but never block; other cats will block. If your cat is having a flare-up, but is not blocked, he may be treated as an outpatient. If your cat is blocked, he will need to have a urinary catheter passed under sedation and likely will need to be hospitalized for fluids, pain medication and medications to decrease urethral spasms. Relieving a urethral obstruction will not prevent future urethral obstructions. Many cats will experience more than one urethral obstruction over the course of a lifetime. The rate of recurrent urethral obstructions (blocks) is reported in various studies to be anywhere from 11 – 40%. If your cat is having a flare-up of symptoms but is not obstructed, fluids, pain medication and anti-spasm medications can help, but will not cure, the flare-up. Some veterinarians will use anti-depressants and glucosamine supplements; no studies have shown these definitely help, but there are some anecdotal reports of benefit. Some veterinarians have started using a medication (Elmiron) designed for human interstitial cystitis, but there are no studies yet in cats.
If your cat is suspected to have FIC by your veterinarian, there are some things you can do at home to help prevent symptoms.
- Increase water intake: Increased water intake will help dilute the urine and also helps release inflammatory molecules from the bladder wall into the urine and can result in faster symptom resolution. The most important way to increase water intake is to only feed canned food, not dry food. Always provide fresh, cool water on every level of the house and clean water bowls often. Some cats like a circulating cat fountain, but do not take away regular watering dishes because some cats are afraid of the fountain. You can also occasionally feed treats of low-sodium clam or tuna juice (water-packed tuna).
- Stress Reduction and Environmental Enrichment: Because flare-ups of symptoms are thought to be precipitated by stressful events, it is very important to try to reduce stress in pets. The things that can be stressful to cats are not necessarily the things people would consider stressful. Potentially stressful events for cats may include: erratic feeding times, stray cats outside the house, boredom, construction on the house, house guests, a new baby, a change in routine, feeding dishes or litter pans near noisy appliances or busy areas of the house, getting chased by the dog, other cats in the house hold that are bullies, a source of pain from another health condition, absence of one or more owners, change in food, etc. Some of these things are unavoidable, but do your best to establish and stick to a peaceful house-hold routine. There is evidence that providing environmental enrichment can lower stress levels in indoor cats. However, with sensitive cats you have to make sure that the enrichment is not stressful! Simple ideas include providing a cat climbing gym with lots of comfy perches near a window, playing with or brushing your cat more or teaching your cat simple tricks.
- Litter Boxes: Litter box hygiene is very important in keeping your cat symptom-free. If your cat dislikes urinating in the litter box, this can be a potential source of stress for your cat. The American Association of Feline Practitioners recommends n+1 litter boxes where n is the number of cats in the house. For example, if you have 3 cats, ideally you would keep 4 litter boxes available. Even if you can’t provide an optimum number of litter boxes, try to get as close to the optimum number as possible. You might try placing these new litter boxes in a different location from the other boxes, but keep at least one box in your cat’s preferred location. Litter boxes should be large, uncovered and generously filled with an unscented, low-dust, clumping litter and placed in a quiet, safe space away from busy areas. Covering litter boxes, while great for human noses, traps odors and creates a stuffy “port-a-potty” environment that discourages your cat from using the box. If you have changed litters recently, you should change back to your old litter. Clean litter boxes daily and wash them out once a week with mild dish soap. Some cats dislike plastic litter box liners and mechanical litter scoopers because of the sounds they make.
- Regular Veterinary Preventative Care: Routine veterinary care can help keep your cat generally healthy and can help prevent flare-ups of FIC by minimizing and treating illnesses that can stress your cat. If your cat has not been seen by a veterinarian this year, contact your local veterinary clinic to set up an appointment. Angell West is here for you 24/7, 365 days a year for any emergency illness needs.
For more information about Angell’s Emergency service, please visit www.angell.org/emergency. Dr. Baker can be reached at 781-902-8400, or by e-mailing firstname.lastname@example.org.