Cats develop cystitis for many reasons including infections, bladder stones and tumours. Feline Idiopathic Cystitis (FIC) is the most common cause of cystitis in cats under 10 years. Idiopathic means that no cause is found or known. However, there is much that we can do to help manage this frustrating condition.
Cats with cystitis (also known as “FLUTD”) show the following signs: frequent urination or attempts to urinate, urinating in inappropriate places, painful urination and blood in the urine. In severe cases, the urethra can become obstructed and the cat cannot pass urine. This can be fatal. Veterinary investigation and treatment is essential if a cat is showing these signs. Analysis and culture of a urine sample and an ultrasound scan are usually necessary to determine the cause of cystitis.
FIC is a painful condition as the bladder and urethra become inflamed. It will usually resolve in 3-7 days with or without treatment. However, as it is a painful and potentially serious condition, investigation and treatment are vital. FIC is usually recurrent with repeated bouts causing damage and thickening of the bladder wall.
Traditional treatments for Feline Cystitis
Traditionally, treatment involves increasing water intake, which has been shown to improve the outcome. Various medicines have also been used including nutraceuticals, antidepressant and anti-spasm drugs. None of the medicines are curative and it is hard to prove a clear benefit associated with their use.
In the last 15 years, studies have shown that FIC is similar to interstitial cystitis in people. Both syndromes are caused by an abnormal stress hormone response in susceptible cats and people(1,2). So, the urinary signs are only part of a disease that affects the whole body. The disease is sometimes called ‘Pandora Syndrome’ in the cat. These cats often have gastrointestinal symptoms and altered grooming behaviour. Cats with FIC were shown to have smaller adrenal glands and reduced cortisol (stress hormone) production. This leads to an inability to manage stressful situations. This abnormal stress response is believed to be associated with adverse early life experiences.
This research led vets at Ohio State University to study stress reduction as a treatment for FIC, alongside increasing water intake. Early studies suggest that stress reduction works (3). The method is called Multimodal Environmental MOdification or MEMO.
MEMO involves taking a detailed history to assess stressors, triggers, the cat’s behaviour and the home environment, then undertaking measures to modify the environment and reduce stress.
What makes cats stressed?
The most common stressor in cats in the UK is inter-cat conflict. This is common in multi-cat households. Cats show subtle signs when they are stressed, some find it difficult to live with other cats. Their ancestor, the African wild cat, had large territories with limited inter-cat interactions. In a healthy cat relationship, they will groom each other, have moments of nose to nose contact and sleep together. Giving each cat their own space to eat, drink, toilet and rest can be helpful. In some sad cases, cats cannot live together.
New pets or family members can also be stressors. Some are stressed or bored as indoor cats. An outdoor run can enrich their environment. Play sessions with an owner and various toys can also help to relieve boredom. Puzzle feeders can help to make feeding time more stimulating,
Cats sometimes take exception to certain litter or dislike the position of their litter trays. Many cats will only use clean litter trays and are unhappy using the same tray as other cats. A multi-cat household should have a litter tray per cat plus one extra in quiet, private spots. A sandy clumping litter is often preferred with a 3cm litter depth. Trays should be emptied and cleaned regularly.
Any stress which the cat cannot control or escape from can lead to a bout of FIC in a susceptible cat.
There are other risk factors for FIC
These include obesity, neutering, lazy cats, cats that won’t go out in the rain to toilet. These cats tend to empty their bladders less often, so the inflammatory chemicals are not flushed out.
Synthetic cat pheromones are available as environmental sprays or plug ins. Pheromones are reported to have a positive effect on owner-reported stress levels.
Increasing water intake
Greater fluid intake results in the production of more dilute urine and encourages urination. This flushes the inflammatory chemicals out of the bladder speeding recovery. Wet food is usually recommended to increase water intake. Some prescription dry foods have also been found to be effective in reducing FIC recurrence. If you need to change a cat’s food, do not mix old and new foods. Provide small amounts of new food in a separate bowl and slowly increase the proportion of new food in the ration. Changing food should take 4-7 days. Do not attempt to change your cat’s diet when they are unwell, wait until they are feeling better. Food aversion and refusal to eat can occur if they associate with the new food with feeling unwell.
Providing multiple water sources encourages drinking. Ceramic or glass bowls are preferred as plastic or metal bowls can affect the taste of the water. Water fountains or dripping taps provide fresh water and encourage some cats to drink more. Water sources should be in quiet areas of the house. Ideally shallow, wide bowls allow drinking without compromising a cat’s ability to look around and stay safe.
Reducing your cat’s calorie intake and increasing exercise will reduce their bodyweight. This will reduce the risk of FIC recurrence.
FIC will resolve in 3-7 days, but it is a painful condition and can lead to obstruction. Veterinary prescribed pain relief will help your cat to feel better safely. Never give any medication to your cat without speaking to your vet for advice first. Many human painkillers such as paracetamol are lethally toxic to cats.
No drugs are curative. Medications may be used to try and reduce the frequency or severity of a bout of FIC. These include:
A milk protein alphacasozepine was found to reduce anxiety in one study(4). Tryptophan is an important precursor of serotonin. Serotonin is a transmitter in the brain which improves mood and well-being. Tryptophan and alphacasozepine are both included in some veterinary prescription diets used to treat FIC, with positive effects (5).
Glycosaminoglycans are added to some nutraceutical products to aid healing of the mucoid layer of the bladder. There is no conclusive evidence that they are beneficial although some cats appear to have more frequent bouts when they are withdrawn (6).
These can be used to reduce the spasm in the urethra. Some owners recognise triggers or changed behaviour such as obsessive over-grooming prior to FIC occurring. In these cases, anti-inflammatory analgesics and an anti-spasmodic drugs can be used, with veterinary direction, to pre-empt FIC.
Tricyclic antidepressants have been used to treat FIC in some cats.
So what’s the answer for cats with cystitis?
MEMO (i.e. stress reduction), increasing water intake and feeding wet or prescription diets provide a successful treatment strategy. Careful assessment of a cat’s environment and stress reduction have proved effective adjuncts to traditional treatments. Non-responsive cases are rare, but in some cases long term medication is necessary.
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References and further reading:
- Westropp JL, Welk KA, Buffington CAT. Small adrenal glands in cats with feline interstitial cystitis. (2003) Journal of Urology 170:2494-2497
- Buffington CAT. Comorbidity of interstitial cystitis with other unexplained clinical conditions. (2004) Journal of Urology. 172 :124201248
- Buffington CAT, Westropp JL, Chew DJ, Bolus RR, Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. (2006) J Feline Med Surg 8(4) :261-8
- Beata C, Beaumont-Graff E, Coll V et al (2007). Effect of alpha-casozepine (Zylkene) on anxiety in cats, J Vet Behav 2(2): 40-46.
- Meyer HP and Becvárová I (2016). Effects of a urinary food supplemented with milk protein hydrolysate and L-tryptophan on feline idiopathic cystitis – results of a case series in 10 cats, Intern J Appl Res Vet Med 14(1): 59-65
- Gunn-Moore DA and Shenoy CM. Oral glucosamine and the management of feline idiopathic cystitis. (2004) J Feline Med Surg 6(4):219-25