Feline Idiopathic Cystitis

Unfortunately, there is no definitive test for Feline idiopathic cystitis (FIC), it is a diagnosis of exclusion of the other causes of feline lower urinary tract disease. FIC is a sterile inflammation of the bladder by an unknown cause with stress thought to be a contributing factor. Most FIC episodes last 3 to 7 days. In cats with FIC, it appears that the protective mucus layer in the bladder is defective and deficient. This may allow damage to the underlying cells and inflammation to develop. Nerves in the bladder wall may also be stimulated either by local irritation to the bladder lining or from stimulation from the brain due to stress. Stimulation of these nerves can worsen inflammation and pain in the bladder. In some male cats with FIC, urethral blockage may also occur as a result of severe inflammation and spasm of the muscles surrounding the urethra, or if a urethral plug develops. Urethral blockage is a life-threatening complication of FIC and the cat should be seen by a veterinarian immediately.

Regardless of the underlying cause FLUTD is often characterised by

• Inappropriate urination – urination outside the litter tray
• Frequent urination
• Blood in urine
• Painful urination
• Straining to urinate/difficulty urinating

Causes of FLUTD

• Feline idiopathic cystitis (64%)
• Uroliths -stones (20%)
• Behavioral (9%)
• Urinary tract infection (3%)
• Neoplasia – cancer (1%)
• Other (2%)

Pain relief

Episodes of feline idiopathic cystitis are very painful as the bladder is very inflamed, although episodes are often self-limiting, lasting 3-7 days, pain relief during this time is important to help keep your cat comfortable. The vet will often prescribe an anti-inflammatory to help combat the bladder inflammation and pain.

Dietary management

Urinary diets enriched with omega 3 fatty acids and anti-oxidants, for their anti-inflammatory effects, are critical in the management of cats with feline idiopathic cystitis. There are a number of urinary diets available including Hills c/d and Royal canin S/O Feeding Hills c/d has been shown to reduce the incidence rate of feline idiopathic cystitis episodes by 89%, making it the most important aspect of treatment of FIC. In a year long study assessing the number of episodes of cystitis, cats fed Hills c/d had an average of 1.28 days with cystitis signs out of 1000 days, compared to cats fed a control, supermarket type food that had an average of 11.15 days with cystitis out of 1000 days. Success is seen with feeding either dry or wet c/d food. The diets also alter the pH of the urine in order to prevent urine crystal and stone formation and dissolve those that have already formed (urinary calculi). The urinary diets are fully balanced and are suitable for long-term feeding. It is very important that these diets are fed consistently as the exclusive food to minimise the long-term risk of recurrent episodes of clinical signs of idiopathic cystitis in male and female cats and the risk of urethral obstruction in male cats.

Additional therapeutic options:

Calmex- is a nutritional supplement which helps to promote a calm and relaxed demeanor in cats. Importantly it is a source of L-tryphtophan, a dietary amino acid precursor to serotonin. Increases in brain serotonin have been shown to increase happiness and decrease anxiety. Calmex may be an aid to reduce stress in cats.

Cystaid- is a nutritional supplement that can aid in feline urinary health. It contains:

• N-acetyl D-glucosamine which helps to maintain a healthy bladder lining
• L-Theanine, an amino acid, which has been shown to reduce stress behaviours in cats
• Quercetin, an antioxidant, which has been shown to regulate inflammation and support stress coping mechanisms.

Water – Encouraging cats to drink can be beneficial. Provide several water sources in different places where the cat is comfortable to spend time drinking, ideally in a quiet place away from the litter box. Metal or plastic bowls can leave an unpleasant taste in the water and so ceramic bowls are ideal. Cats prefer shallow bowls so that they can see what is happening around them as they drink and so that their whiskers do not brush against the sides of the bowls. Some cats prefer to drink from the base of the shower or from running water such as a dripping tap or a water fountain. Flavouring water with tuna or chicken can encourage some cats to drink.

Stress reduction – Behavioral management of feline idiopathic cystitis

Stress often plays a major role in the development of idiopathic cystitis. Cats with idiopathic cystitis have been shown to have higher circulating levels of stress hormones and environmental enrichment has been shown to reduce these stress hormones and help with bladder wall integrity.

Environmental stress management

1. Remove or reduce specific sources of stress
   • Avoid punishing your cat for inappropriate urination – inappropriate urination often puts a strain on the relationship between cat and owner however punishment is ineffective and can make an already stressed cat more nervous.
   • Instead engage in predictable friendly interactions with your cat
   • Maintain a routine including predictable play times and meal times in order to provide stability for your cat
   • Poor cat to cat relationships can contribute to stress. This can be seen as overt aggression, hissing, fighting, caterwauling etc or by avoidance and blocking of resources.
     • Provide lots of feline resources throughout your home – multiple litter trays, cat scratching posts, food and water sources and bed areas throughout the home so that one cat cannot block the use of resources by the other cat
     • Place a collar with a bell on the aggressor cat so that the victim cat can predict when the other cat is coming and learn to avoid it. Monitor this to ensure the new noise is not a new source of stress.
     • Partial or full segregation of the cats – providing feuding cats with just a few hours apart each day can help to significantly reduce the overall stress level.
2. Create a cat friendly home
   • Cat scratching posts – scratching is important for claw bed maintenance, muscle stretching and visual and scent marking. Scratching posts should be placed in prominent locations near resting spots as cats like to stretch when they wake up. Some cats prefer vertical posts whilst others prefer horizontal scratching pads.
   • 3D space – cats prefer an elevated perch to resting on the ground. They also prefer fabric perches. Putting a towel on a bookshelf can be an easy way to provide a comfy space
   • Opportunities for hunting
     • Food puzzle toys are commercially available or can be made by hiding food in empty egg cartons or boxes
     • Food treasure hunts – hide dry food around the house including on elevated perches
     • Play – cats prefer short bursts of activity that allow them to express predatory behavior such as chasing and pouncing. Cats are most active at dawn and dusk and so it is best to initiate play at these times. Rotating toys during play and short breaks of about 5 minutes between toys enhances the cats interest in play.
     • Leaving out boxes or bags for your cat to explore can also help to enrich your cat’s environment

Stress management – Pheromones

Feliway is a facial pheromone which has been shown to reduce stress in cats. Feliway may also be of benefit in reducing the number of episodes of idiopathic cystitis. Feliway is available as a plug in diffuser or a spray to spray around your home onto bedding or furniture.

Litter trays

Some cats with feline idiopathic cystitis can develop a classically conditioned aversion to a litter box. This can occur if a cat associates the discomfort of urinating during with cystitis with the litter tray.

• Try different litter tray styles – enclosed verses non enclosed, do not remove the original litter tray but put an additional one out
• Try a different litter type – cats can develop an aversion to the litter type
• Try a different litter tray location, ideally somewhere quiet, with multiple exit points
• Clean the litter tray at least once daily
• Ensure there is at least one litter tray per cat in the household plus a spare one

Most cats prefer a clean, large litter tray with clay clumping litter.

Weight management

Obesity is also linked to the development of idiopathic cystitis and so weight management plays an important part in the control of clinical signs.