"Moley" was a lovely, petite, Chocolate Burmese cat. She had been brought into the clinic frequently recently with recurring cystitis symptoms, which were quite stressful for her.
A full investigation revealed that wee Moley had recurring condition: Feline Idiopathic Cystitis, FIC.
Feline lower urinary tract disease, or FLUTD, is a term describing conditions that can affect the urinary tract, ... the bladder, and the lower urinary tract of cats.
Although many different diseases can affect the lower urinary tract, frustratingly, some cats develop disease without any diagnosed underlying cause. This condition is termed ‘feline idiopathic cystitis ‘or FIC. These cases exhibit all the symptoms and signs of cystitis.
FIC has similarities to a disease in humans called ‘interstitial cystitis’. In both cats and humans, it can be frustratingly difficult to manage long term, and recurrent episodes are likely.
The common clinical signs of FIC are difficulty in passing, or painful urination; increased frequency of urination; blood noted within the urine; urinating outside the litterbox or in other areas within in the home; Overgrooming around the groin area and straining to urinate but being unable to. A urinary blockage is always a real concern. Male cats, as their urethras are longer and narrower than in female cats, are more likely to become blocked. If evidence of a blockage occurs, then this should be treated as an emergency.
With FIC, affected cats often develop recurrent episodes. Typically, these may develop rapidly, and then naturally subside and resolve over 5-10 days, only to recur. In severe cases, the signs can recur rapidly and frequently, and in some cats, the signs may persist for longer periods. Recurrent FIC can ultimately lead to severe bladder inflammation and a thickened bladder wall.
A diagnosis of FIC is made by excluding all other recognised causes of lower urinary tract disease. Cats with recurrent symptoms should be investigated thoroughly by: Analysis and bacterial culture of urine samples, and by imaging the bladder using X-rays and Ultrasound. Only when other recognised causes of FLUTD are excluded, can a diagnosis of FIC be reached.
In cats with FIC, an analysis of a urine sample may show the presence of blood and inflammatory cells, but there is no recognisable underlying cause e.g., no excess urine crystals, or infection.
Although FIC is a disease of unknown cause, some abnormalities appear to be common in affected cats. In cats with FIC, it appears that there is a defective Bladder lining in these cases. The mucus layer of the bladder, composed of glycosaminoglycans, GAGs, that helps protect the underlying Bladder walls cells, appears to be defective and deficient. This deficiency may allow damage to the underlying cells of the bladder wall and cause areas of inflammation to develop.
Nerves within the bladder wall may be stimulated either by local irritation to the bladder lining, or from stimulation via the brain, for example in response to any stress. Over stimulation of these nerves causes the release of chemicals that can exacerbate a local inflammation. There is evidence to suggest that stress plays an important role in FIC.
Cats kept solely indoors, who share their environment with one or more other cats, are examples of where stress can occur, even if no other obvious outward signs of stress are present.
Although drug therapy may be helpful in some situations, FIC can be refractory and is often poorly responsive to drugs. It is important therefore to concentrate on the diet and the environment, recognising that these aspects do have a crucial role to play.
Encouraging a more frequent urination, and the production of a urine that is more dilute and less irritant to the bladder lining appears to be helpful. This can be achieved by modifying the cat’s diet by changing to a mainly wet diet, rather than dry, along with other measures to increase their daily water intake. Prescription Urinary diets include added polyunsaturated fatty acids, which potentially may help reduce bladder inflammation, these diets also cleverly adjust the urine pH, and promote a more dilute urine. Increasing the cats water intake is also important. Make sure a good supply of fresh water is always available. Offer water from shallow, ceramic bowls located in several, quiet areas of the house. You can flavour water with some chicken or tuna, use water fountains with running fresh water to encourage drinking, and add some water to their food, if tolerated.
Modifying their environment to help reduce stress is key and necessary in the management of FIC. It is important that cats feel in control of the environment they live in. Make sure your cat has every opportunity to urinate frequently and in peace. Avoid putting the litter trays in noisy or busy areas and provide one litter tray for every cat in the household, plus one more. Try putting litter boxes in different locations and try different types of cat litter. Try to identify any specific stress triggers. This could be the addition of another pet, or person, within the house, abrupt changes in routine or diet, overcrowding, owner stress, or other changes within the home. The single most common cause of stress is conflict with other cats within the household. This should always be suspected in a cat with FIC where there are other cats within the same home.
Lack of ‘environmental enrichment’ can also cause cat stress. Some simple measures may help, such as spending more time gently playing with the cat on a regular basis. Provide some new interests and stimulation, and modify their environment with plenty of toys, scratching posts, and hiding and elevated resting places.
Synthetic feline facial pheromone products, either as a spray or as a plug-in diffuser, can also help to reduce stress and anxiety.
FIC is not primarily a drug-responsive disease, however, in some cases, drug therapy may have some additional benefits, alongside dietary and environmental changes and increasing their water intake. Glycosaminoglycans, GAG, supplements may be of benefit. Anti-inflammatory and pain relief treatments will assist episodes, and some antidepressant drugs, such as amitriptyline, may be of help. Recurrent FIC cases are frustrating and difficult to manage.
Wee Moley's condition was managed fairly well, ... although she did still have occasional cystitis episodes.
If you are concerned about any symptoms in your cat, please do contact your Vet practice.
Alison Laurie-Chalmers,
Senior Consultant,
Crown Vets.