Feline Idiopathic Cystitis
Signs that your cat may have FIC:
Blood in urine or blood-tinged urine
Straining to urinate
Frequently going to the litter tray
Vocalising when trying to urinate
NOTE: A lot of people think that their cat is constipated when they are often straining to urine.
Cats position themselves differently for urination and defecation. It is helpful for you to watch how your cat goes to the toilet so that you can tell the difference between the two. See below:
Words you should know:
Idiopathic = A disease or medical condition for which the underlying cause is not known. We will see that this is sort of true, but also sort of not true for feline idiopathic cystitis. I.e. Researchers kind of understand why cats get it, but we still have a lot to learn.
Cystitis = Inflammation of the urinary bladder
What is Feline Idiopathic Cystitis (FIC)?
FIC is a condition where a cat’s urinary bladder becomes inflamed, usually due to stress.
To understand FIC, we are going to look at:
1. What is happening to a cat’s body when it has FIC?
2. What sorts of things make a cat feel stressed enough to get FIC and what we can do about it?
1. What is happening to a cat’s body when it has FIC?
All cats experience stress from time to time. Cats that get FIC, however, have some differences in their bodies from non-FIC prone cats.
This is a combination of:
Damage to the bladder wall
Differences in the nervous system
Differences in hormones
1. Damage to the bladder wall
FIC cats have defects in the lining of the bladder that allows the inner bladder wall to become damaged. This lining is important as it protects the nerves in the bladder from the “ouchy” effects of contact with urine. Urine contains the waste products that the body is trying to expel, including ammonia. Remember ammonia? It is used in cleaning agents to help with stain removal and degreasing. Imagine that contacting the sensitive nerves in the bladder? Therefore, a strong healthy bladder wall is important. When the bladder wall is damaged, the harsh urine causes it to become inflamed and bleed. Hence why cats with FIC produce blood-tinged urine and why the act of urination appears painful! Poor things!
2. Differences in the nervous System
Cats prone to FIC have been found to have increased tyrosine hydroxylase immunoreactivity in the brain. Don’t worry. I will explain.
Tyrosine hydroxylase is an enzyme that is needed to produce the hormones and neurotransmitters called adrenaline and noradrenaline. You have probably heard of these. These hormones/neurotransmitters are responsible for the “fight or flight” response. We all need a certain level of adrenaline and noradrenaline so that we get our butts into action when we are being chased by a lion (or whatever the modern urban equivalent is).
Cats that get FIC tend to have higher-than-average presence of tyrosine hydroxylase in the brain, indicating that they are likely going to have a greater stress response. For instance, if there is a loud noise, a cat with normal tyrosine hydroxylase levels will likely get a fright, quickly realise that there is no danger, and happily go back to grooming, eating or sleeping. A cat with higher levels of tyrosine hydroxylase will also get a fright, but then probably hide in the closet all day in fear that the danger is yet to pass. Make sense?
3. Differences in hormones
Cats with FIC have smaller adrenal glands with decreased response to hormones from the brain.
Adrenal glands are two organs in the abdomen that are responsible for producing a bunch of different hormones. One of these hormones is cortisol. You have probably heard of cortisol. Cortisol is a stress hormone. It is responsible for making the body use its energy reserves in times of danger. When you need to quickly run away from danger, it will increase blood sugar levels to provide a short burst of much needed energy.
Although this is the most well-known role of cortisol in the body, it is also anti-inflammatory, it is involved in the process of repairing damaged tissue, and it is needed for proper function of certain proteins that provide tight junction formation in the wall of the bladder.
FIC cats have been found to have smaller adrenal glands that also have a reduced response to the hormones that are released from the brain that tell the adrenal glands to produce and release cortisol. Hence, overall cortisol levels are lower in these cats.
As cortisol is needed to reduce inflammation and provide tight junctions in the wall of the bladder, these poor cats tend to be more prone to damage of the bladder wall, and less able to reduce the resulting inflammation.
In summary, FIC cats tend to have poor integrity of the bladder wall, are more prone to stress, and thus tend to manifest this stress as damage and inflammation to the bladder wall. Basically, FIC cats are nervous stressed cats for whom urination can become difficult or painful.
What sorts of things make a cat feel stressed enough to get FIC and what we can do about it?
Management of FIC cats can be considered short-term and long-term.
1. Short term management
Cats with active urinary issues need to be treated for pain.
The signs you may notice include blood in urine, straining to urinate and not producing much (if any) urine, frequently going to the litter tray and vocalising while urinating.
When the bladder wall is inflamed and bleeding, the most important immediate treatment is to ensure these cats are not in pain so that they can continue urinating.
Your vet will provide the necessary medication which is often a combination of an opiate (buprenorphine) and gabapentin (treats nerve pain and produces mild sedation).
Note: Some male cats with FIC may be unable to urinate. URINARY OBSTRUCTION IS AN EMERGENCY. These cats need to be taken to a vet immediately, where a urinary catheter will be placed to facilitate urination. If your cat is spending a long time in the litter tray, but producing little or no urine, then they are experiencing a blockage in their urethra and they will not be able to pass urine. This is life-threatening and needs to be treated immediately. If this happens in the evening, do not wait until your regular day vet is open. You must take your cat to the nearest afterhours vet. DO NOT WASTE ANY TIME.
2. Long Term Management
Long term management of FIC cats is to manage their stress. This involves a combination of managing your cat’s environment to reduce stress, as well as potentially administering diets and medications that treat stress.
1. Moving house or major renovations / New people (i.e. new partner or baby)
2. No access to outdoors with limited indoor activity
3. Ensure close contact with your cats if they want it
4. Other house-hold cats and inter-cat aggression
5. Litter tray set-up
Moving house or major renovations / New people
Here we are looking at changes triggered by the humans in the household.
Cats with a nervous disposition can become stressed enough to trigger FIC if there are major changes in their physical environment or with the humans in the household.
If you know that there will be such changes coming up, you can plan ahead to prepare your cat:
Talk to your vet about medications that will help your cat through the change. This could be short-term medication to reduce stress just for the transition period, or longer-term anti-anxiety medication if the changes are likely to be dramatic or drawn out.
Ensure your cat always has quiet places in which it can hide out. You might have a cupboard or a bedroom where there is not a lot of foot traffic or noise. Ensure your cat’s water bowl and litter trays are nearby so that it doesn’t have to venture out into “dangerous” territory to perform normal functions.
Place a Feliway diffuser in your cat’s living area. Feliway is a synthetic feline facial pheromone. Cats use their natural facial pheromone to mark territory. When the cat smells the pheromone, it sends a signal to the brain that the environment is secure.
No access to outdoors with limited indoor activity
This is not to advocate letting indoor cats go outdoors, but rather to ensure indoor environmental enrichment and activity.
If your cat is permanently indoors, ensure that they have easy access to windows so that they can see the outdoor environment. You can use perches and raised bedding (cat towers). Note that raised windows are better than ground level screen doors. Doors and low windows allow communication with outdoors cats in the neighbourhood which can worsen the stress of the indoor cat.
Ensure you play with your cat. Even older cats like to play.
You can give them toys filled with catnip, or get them to play with toys on the end of a string.
Do not, however, use laser pointers for play. As the cat can never “catch” the laser, it will feel frustrated, and this may worsen stress. Remember that cat play mimics catching prey, so they need the opportunity to actually “catch the prey.”
Ensure close contact with your cat if they want it.
For instance, I live in an apartment with two cats. I have set up two cat tower beds on either side of my work desk that are level with my desk. Whenever I sit at my computer, as I am doing now while I write this information, my two cats are sitting on either side of me, and they are level with me. This makes them extremely happy. We are close together and “hanging out” even if we are not in immediate physical contact with each other.
My cats also sleep in bed with me at night and sit on my lap when I watch TV.
They are two indoor apartment cats who display no stress 😊.
Other household cats and inter-cat aggression
If you have a multi-cat household, ensure the following:
All cats have separate feeding areas
Cats should never be fed together. Always feed them in separate locations. Even though there would be no actual food insecurity with your cats, they will have a perception that their food source is under threat if the other cat(s) can see them eating.
Ensure separate resting areas
Make sure each cat has somewhere they can go where they have “quiet time” away from the other cat(s). If you have one cat that bullies another cat, ensure that the cat being bullied can have their own separate space. One of the best ways of doing this is to purchase a microchip-operated cat flap which you can install in a door or kennel. These flaps that will only open when it reads the designated microchip.
Ensure that cats who do not like being together do not have to toilet together. Therefore, have separate litter tray areas.
Ensure all cats get their own time with the humans in the house
If you have multiple cats and cannot control the bullying and spraying behaviour, you may need to consider finding friends or family members to take one of the cats. Although this can be hard, as we all love our cats, sometimes you need to consider the happiness of your cat. If they are permanently stressed in your house, then maybe it is not the best house for them.
Litter tray set-up
How you set up your cat’s litter trays can have a big impact on their stress levels.
Always have at least one more tray than the number of cats you have.
One cat, have two trays. Two cats, have three trays.
You can always have more trays, but this is considered the minimum.
Ensure the litter trays are in a quiet area of the house or apartment, with little foot traffic.
You would not like to go to the toilet in the middle of a busy room with lots of people around, so neither would your cat.
Ensure you use a litter that is pleasing to your cat.
Most cats do not like crystal litter. The texture is unpleasant, and it is usually scented with a fragrance designed to please humans, which is off-putting for a cat.
Most cats will be happy with the recycled paper pellet litter or clumping/clay litter.
If you are unsure, set up a litter “buffet” for your cat and allow your cat to let you know what they prefer.
Ensure the litter trays are cleaned daily, if not more frequently.
Cats do not like urinating over urine, defecating on faeces, urinating on faeces or defecating on urine. Did you follow that? As such, you must ensure that your cat always has fresh clean litter.
Note that you do not have to fill the whole base of each litter tray with litter. Often a scoop or two of litter will do. Cats just want something to dig around to deposit their urine or faeces.
Other things you can do to help your stressed cat:
You can place Feliway Diffusers in the main areas where your cat likes to be.
Feliway is a synthetic pheromone that mimics the skin secretions in the queen (feline mother cat) after she gives birth. The pheromone is supposed to make the kittens stay with the queen by giving the perception of safety.
When an adult cat “smells” the pheromones, it affects certain sensory neurons which produce changes in the parts of the brain that affect the emotional state of the cat. As the cat was already exposed to such a pheromone as a young kitten with its mother, its perception of the safe environment in response to the pheromone does not require any learning, but rather the cat has an innate sense of safety.
Feliway has no effect on humans or dogs.
2. Drug Therapy
Certain medications may help your cat if you have implemented the environmental changes suggested and have a Feliway Diffuser set up.
Earlier we discussed the differences in FIC cats compared with non-FIC cats in terms of the health of the bladder wall, and their nervous system and hormonal responses to stress. We know the FIC cats are just generally more nervous cats. While implementing appropriate environmental changes is still the priority for management of these cats, some cats will continue to display stress.
For these cats we advised adjunctive medical management.
There are certain medications that can significantly reduce your cat’s anxiety, and thus not only help to prevent the painful urination that comes with FIC, but will also give your cat a better quality of life. Many of these medications are very safe and they can be used long term. There is no point in allowing your cat to live a life of uncontrolled anxiety when they don’t have to.
Note that most of these medications are prescription drugs, and hence will require an appointment with your veterinarian.
Wet food diets have a heavy water content. This helps to dilute your cat’s urine, and thus makes it less noxious to the nerves in a damaged bladder wall.
It will also make your cat urinate more, therefore expelling blood and inflammatory cells that aggravate the urethra out of which your cat urinates.
Royal Canin Calm
This is a great maintenance diet for a nervous cat.
Roya Canin Calm contains L-tryptophan and alpha-casozepine.
L-tryptophan is a serotonin precursor. Serotonin is a neurotransmitter and hormone that helps to regulate mood by improving feelings of calmness.
Alpha-casozepine is also a peptide that potentiates the activity of GABA (gammaaminobutyric acid). GABA is a neurotransmitter that decreases the stimulation of nerves cells in the brain that are associated with stress and fear. Hence, alpha-casozepine can make a cat feel less stressed and fearful.
Prescription urinary diets
These diets have controlled amounts of certain minerals designed to limit the formation of certain urinary stones and crystals that can form in the urine of some FIC cats. These diets should only be commenced if advised by your veterinarian.
Written by Dr Kirsty Fridemanis BVSc