Feline Idiopathic Cystitis (FIC) in layman’s terms is inflammation of the bladder without a known cause. In the past, this syndrome has also been known as Feline Lower Urinary tract disease (FLUTD) or Feline Urologic Syndrome (FUS).
This has caused confusion among pet owners – so lets dispel the myths and focus on what we know. This is a recurrent condition commonly found in younger cats, less than four years of age, and is manifested as one or more of the following signs: urinating outside the litter pan, voiding small volumes (pollakiuria), and often bloody urine (hematuria) accompanied by straining (strangiuria).
Humans, who have experienced a urinary tract infection accompanied by cystitis can appreciate what the cat is feeling. FIC is not the only condition manifesting these signs, which only adds to bladder stones, tumors, infection, and partial or complete urethral obstruction (in males). Due to strictures, urethral plugs or stones may also have one or more of these signs.
In reality less that 5% of young cats will have infections and less than 20% will have a urethral blockage or stones. This is where a physical exam by your veterinarian, diagnostic testing and a good history can help differentiate the cause.
For many years, antibiotic therapy (usually penicillin-based) seemed effective and would placate clients convinced that their pet had a urinary tract infection. The apparent effectiveness was most likely in synch with the waxing and waning signs of the episode, convincing pet owners that their cat got better in response to the antibiotic, whereas it was probably due to the natural course of the disease.
In reality, a young cat with healthy kidney function should be producing supersaturated, concentrated urine (similar to sugar crystals), which in itself is a natural barrier to infection. On the down side, this urine has the potential to cause irritation to the bladder wall through extremes in pH and formation of crystals.
It has been postulated that a healthy bladder will produce a protective layer of a carbohydrate and protein complex (amino-glycans) against the effects of this potentially irritating urine. Early approaches to treatment involved dietary modification to pH and crystals, but this didn’t seem to help all cases. This is where the stress factor came into play and became another mainstay of therapy.
Why? Because in times of stress (in the case of a cat – anytime!), the protective bladder lining breaks down and allows exposure of the bladder wall to the irritating effects of the urine; thereby, causing, in some cases, a bloody urine voided in small amounts in response a natural reflex of the bladder to expel the irritant.
So how do we treat this? Since we know the cause can be multi-factorial, treatment involves the prevention of causative factors and addressing the discomfort that our feline patients are experiencing:
- Anti-anxiety medications such as Buspirone, amitryptylline, sertraline, fluoxetine to reduce stress hormone formation.
- Anti-spasmodics or muscle relaxants to relieve the painful bladder and urethral muscle spasms.
- Analgesics (usually opiods) for pain.
- Dilution of the urine through fluid therapy and increasing dietary water as well as switching to a canned diet promoting direct consumption via a pet water fountain.
- Reducing environmental stressors that include creating an “environment of plenty” – important in overcrowded housing situations and providing environmental enrichment.
- Nutriceuticals such as supplementation of aminoglycans and other holistic or alternative therapies are also out there, and may have merit, but we do not have strong evidence-based data to support these as yet.
Some argue that antibiotics are warranted as the bladder wall (mucosa) is no longer patent and a potential portal of infection. This may be true but continual empirical treatment with antibiotics in the absence of infection can also lead to bigger problems like antibiotic resistant infection.
While FIC is not life threatening, it is important to keep in mind that it is extremely uncomfortable for your kitty and it can mimic a potentially life-threatening urethral obstruction in male cats. Please make an appointment to see your vet if your kitty has any of these signs.
Reference: Veterinary Clinics – Small animal Practice: 34 (2004) 1043-1055:Feline Idiopathic Cystitis: Current understanding of Pathophysiology and Management. Jodi L. Westropp DVM; C.A. Tony Buffington DVM and PhD.