Feline Idiopathic Cystitis –
by Kim Halford BVetMed MSc MRCVS
Feline Idiopathic Cystitis (FIC) is a cat bladder disorder. Broken down, the name means Inflammation of the Bladder (“Cystitis”) in the cat and no-one knows the cause (“Idiopathic”).
FIC is one of the main causes of Feline Lower Urinary Tract Disease (FLUTD) a group of disorders of the bladder or urethra (the pipe going from the bladder to the outside world).
Approximately two thirds of cats with FLUTD have FIC so it’s a very common disorder which is both poorly understood and treated.
What Is FIC?
FIC is like an excruciating painful, recurring bladder condition in women called Interstial Cystitis and the condition is not fully understood in either species.
FIC causes the bladder wall becomes inflamed every so often with each bout lasting around 5 to 10 days.
One potential cause of FIC is problems with the inside of the bladder.
On the inside of a healthy bladder wall, a layer of mucous separates the acidic urine from the cells to protect them. Damage to this layer means the cells and nerve endings within the wall become in contact with urine and become incredibly sensitive and swollen due to irritation from the urine.
Another cause of FIC is stress.
Stress signals from the brain interfere with the sensory nerves in the bladder wall leading to them becoming more sensitive and firing pain signals. This results in the cat constantly feeling the urge to go to the toilet even if their bladder is empty.
A third theory is that affected cats have less of the stress hormone Cortisol going around their body.
This hormone should be released whenever cats are stressed. If it isn’t properly released the hormone levels within a cat becomes unbalanced during times of stress which potentially may lead to inflammation developing and cystitis setting in.
What are the signs of FIC?
- Urinating small amounts frequently.
- Blood in Urine.
- Pain when urinating which may lead to crying in some cases.
- Squatting for longer periods of time.
- Urinating, and potentially defecating, outside of the litter tray.
- Over grooming, especially around the genitals.
- A developing fear of the litter tray.
- Increased Sleep.
- Aggression, especially when stroked or lifted around the tummy.
- A reduced appetite.
- Possibly drinking more.
FIC is diagnosed by exclusion. Vets diagnose it when they do tests for other possible causes of their symptoms and those tests are all normal.
Usually when you take your cat to the vets with a urinary problem they will want to take a urine sample to check for both infection, crystals in the urine and kidney disease. Crystals are commonly present in cat urine and do not always cause problems or form stones. As a result, the presence of crystals in the urine does not necessarily mean your cat has a physical abnormality other than FIC.
To ensure there are no bladder tumours or stones, your vet may advise doing an x-ray or ultrasound of your cats bladder. Some cats will allow an ultrasound to be done fully conscious however, many will require a sedation as they may not tolerate it otherwise.
Most xrays are done under sedation or general anaesthetic so cats lie completely still. During bladder xrays a vet may want to inject air or other liquids into the bladder to help stones, tumours or thickenings of the bladder lining.
How to Manage Cats with FIC
A main cause of FIC is stress so the best way of improving it is through reducing their stress.
Cats are solitary animals; they like to be by themselves. A common cause of stress leading to FIC is them living with other cats (known as a multi-cat household) or conflicting with neighbourhood cat.
To reduce stress, cats need their own space. It may even be necessary to separate them from each other. One possible way of helping is by having areas both areas that are raised and low-down within the home to give your cats space to stay away from each other.
Letting your cat outdoors often helps by giving them more space away from each other. It must be remembered that cats in the wild spend all their time outside so is where they are often least stressed.
If you have multiple cats in your household you need to be aware that they need enough resources to keep them happy. This ideally means having one each of everything plus a spare. So, if you own two cats you should have at least three water bowls, three food bowls, three litter trays etc. Adding extra items means your cats can stay away from each other if need be with the spare reducing the risk of fights and confrontations.
Cats drinking more water can be very beneficial. This extra water dilutes their urine, stopping it irritating the bladder as much. There are several ways of doing this.
- Ensuring the cat has plenty of access to water near where your cat likes to hang out.
- Leaving a tap dripping may help as some cats prefer drinking dripping water. This should be somewhere your cat likes such as the bath tap.
- Keeping the food and water bowls out of sight of each other. Wild cats evolved not to drink water near their food as their prey’s bodies quickly decomposed potentially contaminating nearby water sources and making cats unwell if they drank it. Domesticated cats still carry out this behaviour meaning most cats prefer drinking out of sight of their food.
- Keep their food and water bowls away from their litter trays. Just like you or I cats don’t want to eat or drink near their litter tray. Keeping water bowls in numerous places and, out of the rooms where their food or the litter trays are may be helpful.
- Some cats prefer to drink flavoured water such as that in cans of fish.
- Giving your cat a choice of fresh water or that that has been left to stand for a day or two may be useful at first. Many cats don’t drink fresh water so offer them a choice and then stick with that.
- Leave water outside. Many outdoor cats prefer drinking from puddles. If this is a preference make sure you allow this by potentially leaving a garden tap running for short periods when it’s not been raining. However, you should still provide water in the house.
- Providing water in a water fountain is preferred by cats who like running water. Some products are specifically marketed for cats and often they drink more.
- Feeding wet food ensures they take in more water making the urine more dilute so it irritates the bladder lining less.
Vets can prescribe a specialist diet for lower urinary tract diseases. These are higher in sodium which reduce the sensitivity of the nerve endings in the bladder wall, lessening the pain. However, FLUTD diets can harm those with Kidney Disease so you must make sure your cat does not suffer from this.
Many proprietary brands of cat food are quite acidic. To reduce bladder sensitivity you could look at buying less acidic food.
Wild cats roam long distances every day which keeps themselves active and busy. To emulate this it is imperative you take steps to keep your cats mentally and physically challenged. Activities may simply include playing with your cat using laser pens and toys. Make sure your cats have plenty of toys that are frequently switched round to prevent them getting bored.
Try to deal with the root cause of your cat’s stress.
- Sudden changes can stress cats. With their sight, smell and hearing being different to humans it can be difficult to work out what has changed; they may become extremely stressed by something humans cannot detect eg. high frequency noises.
- The main sources of stress, apart from the presence of other cats, are building works, house moves, a new baby and changes in the neighbourhood.
- A new cat in the neighbourhood may lead to conflict with your cat whilst resolving their territories which is incredibly stressful.
Litter trays can hugely influence FIC as these may become a source of stress due to the potential for your cat to associate them with FIC-induced bladder pain.
Cats prefer using clean litter trays so they should be very regularly cleaned. Many cats also prefer the privacy offered by covered litter trays, but, these may be too small for large cats.
With FIC, cats experience pain whenever they use the litter tray often leading to them fearing it and, instead, opting to soil outside of it. This often won’t improve whilst your cat is suffering from a relapse of FIC however, in the long-term and with litter that they like, it will likely resolve. Punishment won’t help, in fact this could only lead to your cat fearing the act of urinating instead, causing more problems.
Medical treatments for FIC?
Medical treatments are most effective when used in conjunction with environmental changes. These are short-term solutions and won’t help long term.
FIC is not a bacterial infection and therefore antibiotics will not help. However, sometimes these are prescribed for early bouts if the vet hasn’t ruled out a bacterial cause.
Pain killers are often used.
These are usually anti-inflammatories such as steroids as a long acting injection or, non-steroidal anti-inflammatory drugs (NSAIDs) like Meloxicam. Meloxicam is a liquid medication cats often don’t mind and is usually easily administered.
A stronger painkiller called Butorphanol may be given in severe cases. This liquid is similar to Morphine to be squirted on the gums and helps to dull the pain but can cause cats to become sleepy.
Some cats are trialled with Cartrophen. Cartrophen contains the proteins potentially damaged within the mucus coating the bladder lining. These injected proteins may replace the defective ones to help protect the lining and prevent relapses.
Amitriptyline is an antidepressant which may reduce nerve pain from the bladder lining. Amitriptyline may also reduce your cat’s stress levels meaning it works in two ways.
Purely Antidepressant medications such as Fluoxetine and Clomipramine may also be used. These are not licenced for cats and need to be given every day, often for long time periods for them to work. These medications should be avoided. They are only there if all else fails and should only be combined with environmental changes. If you’re thinking about trying these medications it’s worth considering if moving to a different household may be the best thing for your cat if they aren’t the only at there.
Cats pass messages between each other by rubbing certain areas of their body, such as their cheeks, on things within their territories. These areas release a pheromone (chemical message without a scent) called Feline Facial Pheromone. This pheromone also helps to calm cat’s.
A synthetic version of Feline Facial Phermone is called Feliway which is available in plug-in diffusers or sprays. Spraying Feliway in areas where the cat spends much of their time may help to keep them calm. First off, it’s best to use the spray as this can reach high levels in a room over a short time span. However, the diffuser is worthwhile over time as that leads to constant pheromone levels.
Feline Idiopathic Cystitis is a very common condition in cats often triggered by stress. Though it recurs, many cats with FIC are well managed with changes to the diet, environment, and sometimes, medications.
In severe cases, in multi-cat households it may be necessary to rehome an FIC prone cat to live alone cat with outside access where their stress should be lower.
If your vet suspects your cat to have FIC they will usually perform tests to ensure nothing else going on. It is important to remember that as a bladder infection is not present, antibiotics will not help FIC.
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