Cat Care For Veterinarians

All You Need To Know About Feline Idiopathic Cystitis

May 1, 2018

Dear Readers,

For any of you whose cat has been diagnosed with FIC or any complication associated with it, you know how heartbreaking and oftentimes stressful this condition is for everyone involved. As much as we try to minimize recurrence, I tell owners that it can still return. So here are some tips I’ve compiled to help manage it and hopefully prevent a relapse.

FIC stands for Feline Idiopathic Cystitis. Feline (meaning ‘cats’) Idiopathic (meaning ‘unknown cause’ but we suspect it’s multifactorial in origin) Cystitis (meaning ‘inflammation of the bladder’) can be a frustratingly complex disease to manage, mainly because the exact cause and therefore treatment of this condition is unclear.

It’s a diagnosis of exclusion.  This means that your veterinarian has ruled out stones and a urinary tract infection as a cause of your cat’s lower urinary tract signs.  If you have seen your cat straining or howling while in the litter box, drops of red-tinged urine, urine droplets or spots outside of the litter box then your cat is exhibiting symptoms associated with the lower urinary tract, primarily the bladder.

The main complication of this is a urethral obstruction where the cat cannot urinate due to a large amount of inflammation, a plug or muscle spasms within the urethra. Young males are more prone to this than females due to their longer urethra. I’ve seen young cats euthanized because owners cannot afford the sometimes repetitive costs of urethral de-obstruction so it’s made its way to my list of least favorite diseases. That being said, I’ve seen a large amount of success managing this disease which means that maybe we are gaining some headway in controlling it and minimizing its recurrence. However, it does take a dedicated owner and a compliant cat.

How to manage FIC:

01  Diet:  Studies have shown that feeding a urinary specific diet such as Royal Canin Urinary S/O or Science Diet C/D can minimize recurrence in 80% of cats. These are prescription diets so you can only obtain this with authorization from your veterinarian.  I have seen cases where cats do well just on diet alone.  Then the owner thinks they can change it back to a commercial diet because their cat has been asymptomatic for a while. However, it’s not long after they’ve changed the diet that the FIC returns. This is why I’m pretty adamant about keeping these cats on this diet indefinitely. Complications associated with FIC can be very costly and stressful so if maintaining the disease on diet alone helps, that’s a win.

02 Water: We do know that increasing the amount of water in your pet’s diet is helpful, but a prescription dry food diet is better than a commercial wet food diet. In general, feeding a canned diet is recommended. Yes, it will be at the expense of maybe the teeth, but it’s worth it and you can do other things to help maintain dental hygiene. If your cat will not eat canned food, please try adding water, tuna juice or low sodium chicken broth to his dry food. You can also consider purchasing a water fountain at a local pet store as this encourages water consumption in many cats. Other options include adding a small amount of tuna juice or chicken broth to his water bowl, adding ice cubes to his water, etc. The idea is that the more water your cat consumes, the more like you can flush out their bladder.

03 Minimizing stress:  It’s believed that stress can play a role in the onset of FIC. Some owners will report that these urinary episodes are preceded by visitors, owners going out of town, a new addition to the home, etc. Therefore it’s important to decrease the amount of stress in your pet’s life and to make sure that your pet always has easy access to the litter box.  Also, Feliway is a feline calming pheromone that comes in an odorless plug-in diffuser.  If you anticipate a stressful event or you suspect stress playing a factor in your cat’s life, this might be a good option. I’ve heard variable results, but it would be worth a try.

I would also recommend behavior enrichment, which includes always having access to high surfaces, hiding spots, especially in cases where visitors or the introduction of a new dog in the home has preceded the onset of FIC. This will allow your cat to be able to have a safe place to escape to. I would also encourage vertical and horizontal scratching posts as well as spending portions of the day playing and interacting with your cat.

In some cases where the owner is high suspicious of stress being a component (i.e. new addition to the home) and the cat has recurrent bouts of FIC, I will consider starting them on an anti-anxiety medication (namely Prozac) to see if that will help. I’ve had a few cats who have responded well to anti-anxiety medication and they did not have another bout of FIC after being on the medication. However, it takes about 3 to 4 weeks for the medication to ramp up in their system and start taking effect.

04 Litter boxes:  It is recommended to have a litter box for each cat in the house plus one additional one. Therefore, if you have 1 cat, ideally you should have two litter boxes. Make sure that the litter box is in a quiet place away from high traffic areas and loud noises like washing machines. Also, some cats have shown improvement with a litter box that is uncovered with a shallow pan that is easy to get in and out of. I recommend cleaning the box daily to encourage clean boxes and promote healthy urinary habits. Nobody likes a dirty toilet; similarly, your cat doesn’t like a dirty litter box.

05 Weight loss:  Finally weight loss may help play a role in minimizing recurrence of FIC for those pets who are overweight or obese.

06 Medications:  Two medications that I often prescribe for cats with a flare-up of FIC are:

A) Prazosin:  This medication helps with urethral spasms and encourages urine flow.

B) Buprenorphine:  This is a pain medication that is administered under the tongue or in the cheek pouch is the best pain medication to help with cystitis in the meantime. Oftentimes, people don’t think that cystitis cats are uncomfortable. Let me tell you, if you have ever a urinary tract infection, you will know that it is a very uncomfortable feeling. Inflammation anywhere in the body can be uncomfortable, so if your cat is straining to urinate or is urinating blood, please believe me when I tell you that your cat is uncomfortable/painful. Be nice to your cat and give him/her some relief with pain medication.

Symptoms associated with FIC typically resolve in 5-14 days. During this time, please be sure that your cat is always producing urine, especially if he is a male cat. If he is not producing any urine at all for more than 12 hours, he needs to be taken to a veterinarian immediately to make sure his urethra is not blocked.

Let me know if there are other tips that have helped your cat with their struggle with FIC. I’d love to be able to add to this list if it can help other cat owners going through this struggle. For any owners dealing with this, please hang in there! It’s very frustrating, I know, but be patient and talk to your veterinarian. We are here to try to help you and your kitty!

Thanks for reading,

Dr. Theresa Loo

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