Feline Idiopathic Cystitis

By Courtney Barnes, BSc, DVM; Tammy Hunter, DVM; Malcolm Weir, DVM, MSc, MPH; Ernest Ward, DVM

What is feline idiopathic cystitis (FIC)?

Feline lower urinary tract disease (FLUTD) is an older term that describes a set of clinical signs associated with abnormal urination in cats. Some causes of FLUTD are urinary tract infections (UTIs), bladder stones, or bladder crystals. When the condition has no identifiable cause, it is called feline idiopathic cystitis (inflammation of the bladder).

Feline idiopathic cystitis (FIC) is the exclusionary diagnosis made once all the common or known causes of the clinical signs of abnormal urination have been eliminated. FIC was previously called Idiopathic feline lower urinary tract disease or iFLUTD. Some studies suggest this condition is very similar to interstitial cystitis in human females. It is most common in young to middle-aged cats.

This condition is also called Pandora Syndrome, as the underlying causes for the condition may reflect abnormalities in many organ systems (including the nervous system) and the effects of environmental stressors. Cats often suffer waxing and waning of clinical signs in response to things that effect the central stress response system.

What are the clinical signs of FIC?

The most common clinical signs are like those seen in other urinary diseases:

  • straining to urinate
  • bloody or discolored urine
  • frequent urination
  • urinating in unusual locations
  • the inability to urinate, especially in male cats (this is a critical emergency, and your cat must be seen by a veterinarian immediately)

What causes FIC?

There are no known causes of idiopathic cystitis. The conditions that must be ruled out first include:

  • bladder stones, crystals, and urethral plugs
  • bladder infections
  • trauma
  • neurologic disorders that alter normal urination by affecting the nerves and muscles of the bladder
  • anatomic abnormalities such as urethral strictures
  • neoplasia (cancer or benign tumors of the urinary tract)

Once the common causes of abnormal urination have been eliminated, a diagnosis of feline idiopathic cystitis may be made. Some predisposing factors have been identified, such as overweight body condition, restricted access to the outdoors, decreased activity level, lack of perches or hiding spaces, multi-cat households, inter-cat aggression, eating a diet of mostly dry food, and having a nervous disposition. It typically occurs in young to middle-aged adults and male cats are over-represented.

How is FIC diagnosed?

FIC is diagnosed by performing tests to eliminate the known causes of abnormal urination. These tests may include:

  • thorough medical history and physical examination – with special attention to any changes in environment, feeding, stress, etc.
  • blood tests - complete blood cell count (CBC) and serum chemistries
  • complete urinalysis
  • urine culture and antibiotic sensitivity tests
  • abdominal radiographs, which may include contrast radiographic studies, to see if the bladder appears abnormal or contains bladder stones
  • abdominal ultrasound to see the structure of the bladder and presence of bladder sediment or stones
  • cystoscopy or endoscopic examination (video examination) of the urethra and bladder
  • bladder biopsy

Your veterinarian will formulate a diagnostic plan based on your cat's specific clinical symptoms.

What is the treatment of FIC?

Treatment includes medical management and environmental modification to reduce stressors that triggered the clinical signs. If a urinary obstruction is suspected or diagnosed, your cat will need emergency treatment.

Environmental modification: It is important to change your cat’s environment to reduce or eliminate potential. You can try a combination of strategies, including the following:

  • Keep water dishes clean and filled with fresh water.
  • Keep a regular daily schedule, including times for feeding, play, affection, and rest.
  • Be consistent with “rules” for your cat: do not allow them to climb on the counter one day and scold them the next.
  • If your cat eats dry food, use a puzzle feeder occasionally instead of a regular food bowl.
  • Make any required changes to your cat’s schedule slowly, over time.
  • Add scratching posts, cat condos, and toys for your cat to play with.
  • Try to eliminate foreign cats from entering your property, as they can be a source of stress to your cat, even if your cat does not go outdoors.
  • Reduce competition between cats in your home by ensuring that there are enough resting places and litter boxes (one more litter box than the number of cats in the home), and ensure that all cats have easy access to food and water.
  • Ensure litter boxes are large and have a deep layer of litter. Scoop boxes daily and fully empty them regularly.

Pain medication: This condition is known to be painful. Anti-inflammatories, medications for nerve pain, and narcotics may be tried. Anti-spasmodic medication to prevent urethral spasms may also be prescribed.

Anti-anxiety medication: Medications such as selective serotonin reuptake inhibitors (SSRIs), or tricyclic antidepressants (TCAs) can be tried to reduce anxiety. These medications may need to be given long term to prevent or reduce flare-ups. If a stressful event is expected, such as home construction or travel, sedatives may be prescribed on a temporary basis.

Diet: Your veterinarian may also recommend a change in diet. Prescription urinary diets may be needed, as well as increased canned food consumption. Increasing fluid intake via canned food and encouraging more water consumption can form a more diluted urine, which is less irritating to an inflamed bladder wall.

Glycosaminoglycans (GAGs): GAGs are a normal component of the bladder wall. Cats with FIC may be deficient in these substances, so in theory, supplementing them may improve the integrity of the bladder wall. Studies have not shown much benefit, but anecdotally some have seen positive response.

Adjunctive therapies: Other non-pharmaceutical therapies include Feliway® (a synthetic pheromone with anti-anxiety effects in some cats), acupuncture, and natural supplements to relieve stress. Some prescription urinary diets contain these natural, stress-relieving supplements.

What is the prognosis for FIC?

Recurrence of the condition can be common. Medical treatment may help reduce the frequency or improve clinical signs, thus relieving your cat's discomfort. It is important to watch for clinical signs and to be aware of changes in the environment that may trigger a recurrence due to stress. FIC cats can be very sensitive to these changes; thankfully, most cat owners are aware that the cat in question has an anxious or sensitive personality and are attentive to flare-ups.

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