Feline Idiopathic Cystitis

Feline idiopathic cystitis (FIC) is a bladder disease that is frequently seen in young and middle-aged cats. Historically named feline lower urinary tract disease (FLUTD), this is a painful and sometimes fatal disease if left untreated. FIC is caused by bladder inflammation but can result in life-threatening obstructions of the urethra that can lead to death if not treated promptly. Over 50% of cats with lower urinary tract problems that went to the veterinarian were diagnosed with FIC, and 40-50% of cats have a recurrence of the disease within one year of diagnosis.^1,2 Feline idiopathic cystitis is more commonly observed in overweight male cats that live indoors, use an indoor litterbox, get a little exercise, and eat a dry diet.^2,3 Unfortunately, it is also responsible for millions of cats being relinquished to shelters or euthanized due to behavioral problems such as urination outside of the litterbox.⁴

The symptoms of FIC can range from bloody urine, vocalizing while urinating, excessive licking of the genital area, and painful, frequent, or inappropriate urination to the complete inability to urinate.⁵ Unfortunately, these non-specific signs make FIC difficult to diagnose, as many other urinary tract diseases display the same symptoms, and there are no specific diagnostics for this disease. To properly diagnose the disease, a veterinarian must rule out urinary tract infection (which can occur concurrently), urinary neoplasia, metabolic or neurologic disease, anatomical malformation, behavioral, and bladder stones or crystals.⁶

This disease is poorly understood and is believed to be primarily caused by stress and environmental factors that lead to reduced water intake, litter box avoidance, and reduced urination.^7-10 Due to the lack of identification of the etiopathogenesis of FIC, there is no specific and successful treatment. Instead, the treatment aims at the prevention of the reoccurrence of FIC. Treatment is focused on immediate management by a veterinarian, then reducing stress, increasing water intake, and using the litter box by changing or controlling the environment, food, water, play, litter box, and conflict.¹¹

The following changes may aid in the management of FIC, in addition to veterinary supervision and treatment:

• Environment – cats like to feel safe in their environment; one way to accomplish this is to ensure there is plenty of space for them to have quiet, comfortable locations away from other cats or household chaos. When doing this, remember cats can enjoy vertical space as well. Consider window perches or wall shelves to increase vertical territory. Keep changes in the environment to a minimum. Cats typically don’t like change, so keep things consistent.
• Food – breaking up feeding into small frequent meals helps to mimic the natural dietary cycle of a cat and can increase enrichment for them. Particularly in the case of cats with FIC, it is important to make sure they are getting enough water intake. To help achieve this, it is often recommended to switch to a diet that is high in moisture, like canned, raw, or gently cooked food. Rotate the location of the feeding for even more activity and enrichment for cats.
• Water – have clean, fresh water available in multiple locations. Some cats are very particular about their whiskers touching bowls when they eat or drink, so consider having wide, shallow, or differently shaped bowls for water. Another great option is a water fountain, as some cats prefer running or moving water. A water additive, or attractant, is sometimes suggested to increase water intake for cats and may be a good option, but always make sure to have a source of plain fresh water available as well.
• Play – exercise is vital to reduce stress and improve the emotional well-being of cats. Sometimes they seem reluctant to play, so experiment with multiple types of toys to find the kind they like. Consider what type of “prey” a toy might mimic and be sure to try several different “prey” types. Some examples are ribbon-like toys that mimic snakes, stuffed tubes that provide a good kicking surface mimicking a small rabbit, or a ball that could represent a mouse. Picking the time of day is essential to get some more reluctant cats to participate. Cats typically will play right after a nap and right before a meal, so arrange play time around these activities for the greatest success.
• Litter boxes – a required item for an indoor cat. Cats like plenty of options, so be sure to provide one litterbox for each cat plus one, (for one cat, there would be at least two litterboxes). These should be placed in quiet, safe areas of the house. The litter box must be inviting for FIC cats, so make the litter box is cleaned at least daily.
• Conflict – in multi-pet households, it is crucial to observe each pet, and if an FIC cat conflicts with another pet, take steps to reduce this conflict. These steps are highly variable depending on the pet’s personality, species, and environment, so it may be best to get professional help from a trainer or behaviorist if this is an issue.

References

1. Kruger, JM, Osborne, CA, Goyal, SM, Wickstrom, SL, Johnston, GR, Fletcher, TF, et al. 1991. Clinical evaluation of cats with lower urinary tract disease. J. Am. Vet. Med. Assoc. 199:211–216.
2. Feline lower urinary tract disease. American Veterinary Medical Association. (n.d.). Retrieved January 5, 2023, from https://www.avma.org/resources/pet-owners/petcare/feline-lower-urinary-tract-disease
3. Cameron, ME, Casey, RA, Bradshaw, JWS, Waran, NK, Gunn‐Moore, DA. 2204. A study of environmental and behavioral factors that may be associated with feline idiopathic cystitis. J. Small Anim. Pract. 3:144-147. doi:10.1111/j.1748-5827.2004.tb00216.x
4. Patronek, GJ, Glickman, LT, Beck, AM, McCabe, GP, Ecker, C. 1996. Risk factors for relinquishment of cats to an animal shelter. J. Am. Vet. Med. Assoc. 209:582–588.
5. He, C, Fan, K, Hao, Z, Tang, N, Li, G, Wang, S. 2022. Prevalence, risk factors, pathophysiology, potential biomarkers and management of feline idiopathic cystitis: An update review. Front. Vet. Sci. doi:10.3389/fvets.2022.900847
6. Kay N. Feline Idiopathic Cystitis (FIC). Pet Health Network. Accessed January 5, 2023. https://www.pethealthnetwork.com/cat-health/cat-diseases-conditions-a-z/feline-idiopathic-cystitis-fic
7. Buffington, CAT. External and internal influences on disease risk in cats. 2002. J. Am. Vet. Med. Assoc. 220:994–1002. doi:10.2460/javma.2002.220.994
8. Defauw, PAM, Van de Maele, I, Duchateau, L, Polis, IE, Saunders, JH, Daminet, S. 2011. Risk factors and clinical presentation of cats with feline idiopathic cystitis. J. Feline Med. Surg. 13:967–75. doi:10.1016/j.jfms.2011.08.001
9. Lund, HS, Saevik, BK, Finstad, OW, Grontvedt, ET, Vatne, T, Eggertsdottir, AV. 2016. Risk factors for idiopathic cystitis in Norwegian cats: A matched case-control study. J Feline Med. Surg. 18:483–91. doi:10.1177/1098612X15587955
10. Buffington, CAT, Westropp, JL, Chew, DJ, Bolus, RR. 2006. Risk factors associated with clinical signs of lower urinary tract disease in indoor-housed cats. J. Am. Vet. Med. Assoc. 228:722–725. doi:10.2460/javma.228.5.722
11. Westropp, JL, Delgado, M, Buffington, CAT. 2019. Chronic lower urinary tract signs in cats. Vet. Clinics N. Am.: Small Anim. Pract. 2:187-209. doi:10.1016/j.cvsm.2018.11.001

 

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About the Author

Dr. Katy Miller works as the Director of Veterinary Services at BSM Partners. She earned her veterinary degree at Ross University and completed her clinical year at Louisiana State University. She previously served for 11 years as the Director of Dog and Cat Health and Nutrition for Mud Bay where she earned multiple certifications and specialized in pet food nutriton, prior to which she practiced general and emergency medicine for seven years. She is also a competitive three-day eventer, licensed falconer, and claims only two (Golden and Mini Doxie) of their nine dogs.