Information

Feline Idiopathic Cystitis (FIC)


Feline idiopathic cystitis (FIC) is also referred to as feline interstitial cystitis. It is one of several medical issues that fall under the umbrella term of feline lower urinary tract disease (FLUTD). FIC is a sterile inflammatory condition affecting the urinary bladder. This feline disease, in some ways, resembles the disorder referred to as interstitial cystitis in humans.

Cause of feline idiopathic cystitis
The exact cause(s) of FIC remain uncertain. One theory suggests that the combination of decreased water intake, along with increased permeability of the bladder wall (which allows irritants to penetrate the lining of the bladder) set the stage for FIC to develop. Some examples of FIC triggers include:

  • Introduction of a new cat into the household
  • Inter-cat aggression in a multi-cat household
  • Dirty litter boxes
  • Too few litter boxes in household
  • Introduction of a new caretaker (pet sitter in the home or boarding outside of the home)
  • Decreased activity because of obesity, arthritis or illness
  • Sudden diet change
  • Substantial illness

Symptoms of feline idiopathic cystitis
Many cats with FIC have recurrent, or waxing and waning symptoms. The most common symptom observed is increased frequency of urination (pollakiuria). The most common symptom observed is increased frequency of urination (pollakiuria). The inflammatory process causes affected cats to repeatedly hop in and out of the litter box, while producing only a small amount of urine.

If the frequent attempts to void are producing no urine, it is important to consult with a veterinarian immediately. Some cats with inflammatory bladder disease produce crystals and other debris capable of forming an obstructive plug within the urethra (the narrow tube that leads from the bladder to the outside world). Other cats seems to display only functional obstruction, with pain and spasm, but no crystals or debris. A urethral obstruction causes an inability to pass urine and represents a true medical emergency. The longer and narrower urethral plumbing in male cats renders them more susceptible than females to an obstruction.

In addition to increased frequency of urination, symptoms associated with FIC often include:

  • Restlessness
  • Straining to urinate
  • Blood in the urine
  • Excessive licking at the penis or vulva
  • Urination in inappropriate places (outside of the litter box)
  • Vocalizing while urinating

Diagnosis of feline idiopathic cystitis
FIC is considered a “rule out diagnosis,” made after ruling out other diseases (infection, stones or tumor within the bladder) capable of causing similar symptoms. Doing so typically involves the following testing:

  • Urinalysis
  • Urine culture
  • Abdominal ultrasound or x-rays (ultrasound is the preferred test if available)

Treatment and prevention of feline idiopathic cystitis
The symptoms of FIC will resolve spontaneously (without any treatment) in most cats within five to seven days. However, given an affected cat’s level of discomfort, it can be very difficult to simply wait and watch. There are several treatment options to choose from when managing a kitty with FIC. Most experts agree that addressing environmental stressors and getting the cat to produce a dilute urine provide the most benefit. Note that antibiotics are not mentioned because FIC is a sterile (bacteria-free) inflammatory process. Listed below are the more commonly recommended treatments:

Diet change— There are several prescription diets on the market that have been developed for management of FIC. Most produce alteration of the urine pH. They may contain antioxidants and supplemental, omega-3 fatty acids. The diet change should be made gradually, and your veterinarian notified right away if the cat is unwilling to eat the new food.

Supplemental fluids added to the diet— The goal is to create a more dilute urine. This can be accomplished by feeding canned rather than dry food, adding liquids (water, broth, tuna water) to the food, and feeding multiple meals per day.

Analgesics (pain relief) medication— Opioids or nonsteroidal anti-inflammatory medications.

Anti-inflammatory medication— Nonsteroidal anti-inflammatory medications or corticosteroids.

Amitriptyline— This is an antidepressant that benefits some cats with FIC.

Pheromones— Feline pheromones may reduce stress by impacting the limbic system and hypothalamus. These are available as sprays and diffusers.

Environmental modification— Changes that enrich the environment and reduce psychological stress for the affected kitty may provide benefit. Examples include:

  • Increasing the number of litter boxes in the home
  • Cleaning the litter boxes more frequently
  • Maintaining a daily routine/schedule, particularly in terms of mealtime
  • Setting up multiple drinking stations with fresh, clean water
  • Isolating a nervous cat from new people or animals entering the home
  • Increasing one-on-one affection/play/grooming time with a favorite human

Prognosis of feline idiopathic cystitis
FIC is considered a very treatable disease in most cats. It only becomes life threatening if urethral obstruction and the inability to urinate develop. Some cats experience only one FIC episode and never look back. For other cats with FIC, long-term, if not life-long, management is necessary.

Questions for your veterinarian

  • Have lower urinary tract disorders other than FIC been ruled out?
  • What are all of the treatment options for my cat?
  • How should I amend my cat’s diet?
  • How should I change my cat’s environment?
  • What symptoms should I be watching for?

Contents

  • 1 Signs and symptoms
    • 1.1 Non-obstructive FIC
    • 1.2 Obstructive FIC (“the blocked cat”)
    • 1.3 Differential diagnosis of obstructive and non-obstructive cases
  • 2 Pathophysiology
  • 3 Non-obstructive episodes of FIC
    • 3.1 Causes
    • 3.2 Treatment of an acute episode
  • 4 Obstructive episodes of FIC (“the blocked cat”)
    • 4.1 Causes
      • 4.1.1 Functional blockage
      • 4.1.2 Mechanical blockage
      • 4.1.3 Interaction between functional and mechanical blockage in FIC
      • 4.1.4 The role of crystals in obstructive FIC
    • 4.2 Treatment of an acute episode
    • 4.3 Secondary bacterial infection (UTI) after an obstructive episode
  • 5 Ongoing management of FIC
    • 5.1 Importance of hydration
    • 5.2 Environmental modification
    • 5.3 Surgical intervention for refractory cases
  • 6 References

Feline idiopathic cystitis begins as an acute non-obstructive episode and is self-limiting in about 85% of cases, resolving itself in a week. In approximately 15% of cases, it can escalate into an obstructive episode (“blocked cat”) which can be life-threatening for a male cat. [5] The symptoms for both a non-obstructive and an obstructive episode are usually very similar and a careful § differential diagnosis is necessary to distinguish between the two.

Non-obstructive FIC Edit

The vast majority of FIC cases (85%) are non-obstructive. In the case of non-obstructive FIC, the underlying inflammatory process has begun but the disease has not progressed to the extent that it prevents urination (ie there is no obstruction of the urethra). The cat's lower urinary tract is inflamed and the urethral passage may have narrowed due to swelling but it remains open and he can urinate to varying degrees, albeit in discomfort. Clinical signs apparent during an acute episode may include:

  • Frequent trips to the litter box, coupled with straining due to an involuntary urge to void because of the irritated and inflamed bladder.
  • Sensation of incomplete voiding.
  • Production of small volumes of urine.
  • Possible presence of blood in the urine [7] due to glomerulation or Hunner's ulcers. [8]
  • Odorous urine.
  • Irritability.
  • Lack of interest in normal activities.
  • Hiding in a dark, quiet location (hiding is part of the cat's stress coping mechanism and should not be interfered with unnecessarily).
  • Experiencing pain during the act of urination, characterized by vocalisation. However, since cats are evolutionarily adept at hiding their pain, vocalising, crying, or any other audible cue may not always be observed.
  • Reluctance or refusal to urinate due to the pain of excretion. This causes urine to collect in the bladder, similar to that in an obstructive episode. Stagnant urine can become concentrated which promotes § crystal formation, aggravating the risk of § mechanical obstruction (see below).
  • Urine leakage if the bladder is not emptied due to overflow incontinence and/or detrusor malfunction (also seen in obstructive episodes). Leaking of urine can also occur due to inflammation of the urinary musculature.
  • Loss of appetite and/or refusal to drink due to pain.
  • Adopting unusual postures to cope with the pain.
  • Urinating in places other than the litter box as the cat associates the pain of urination with the litter box.
  • Licking/over-grooming the genital area.
  • Lying on cold surfaces, such as tile floors or in showers, in an attempt to relieve pain.

Obstructive FIC (“the blocked cat”) Edit

If the acute flare-up of non-obstructive FIC has not resolved itself, it can progress to an obstructive episode (15% of FIC cases), where the male urethra can become partially or fully blocked. Female cats have a larger urethra and rarely become blocked. The following clinical signs may be observed:

  • In the case of full obstruction, unproductive and painful straining with either no urine passed at all or isolated drops produced ("spotting"), despite frequent trips to the litter box.
  • Urinary retention due to incomplete voiding as a result of the obstruction. This means the bladder fills but cannot empty, causing bladder distension (the bladder will feel large and tense). [9]
  • Involuntary leaking of urine due to paradoxical incontinence (when drops of urine leak past the obstruction due to pressure building up in the distended bladder). [10]
  • Increased pain caused by stagnant urine collecting in the bladder, aggravating underlying inflammation, as well as the increasing distension of the bladder.
  • Increased agitation and restlessness.
  • Possible vomiting.
  • Eventual lethargy and listlessness if a fully obstructive episode progresses, causing risk to life.

A full obstruction is a medical emergency and must be relieved by a vet immediately. Partial obstructions should also be investigated as soon as possible as they are unlikely to resolve themselves and can escalate to full obstruction. Early intervention leads to better prognoses.

Differential diagnosis of obstructive and non-obstructive cases Edit

A vet will often distinguish between obstructive and non-obstructive cases by checking the cat's bladder. [4] [9] A normal, healthy bladder will be semi-full of urine and soft to the touch, like a partially filled balloon. However an inflamed bladder (suggestive of cystitis) will have thickened walls. A small or empty bladder is indicative of an inability to retain urine, as the urine is irritating to the bladder muscles. Provided the cat is able to urinate, it suggests non-obstructive cystitis. However, if the bladder remains distended (ie full of urine) then the cat is either unwilling or unable to void. The vet will palpate the bladder in an attempt to produce a free-flowing, continuous stream of urine. If this does not occur, a potential obstruction will be suspected and further diagnostics like urinalysis, ultrasound and x-rays [11] may be warranted. However even an inability to express a distended bladder is not definitive for blockage as the cat may simply actively resist the vet's intervention by "pushing back," due to anxiety or a desire to avoid a painful urination.

A less frequently seen intermediate case is where the bladder presents as normal but is accompanied by straining and frequent attempts at urination. This suggests a possible intermittent spasming of the urethra (ie an "on-off" § functional block) which allows voiding at times when the cat is able to relax himself, but prevents it when the urethral muscles tense involuntarily again. In these instances, the vet may sedate the cat, which relaxes the entire urinary musculature, causing spontaneous urination.

Feline idiopathic cystitis is above all an inflammatory process. Whilst the specific cause is unknown, it appears to be associated with complex interactions among the nervous system, adrenal glands, and urinary bladder. [11] Environment also appears to play a role in the pathophysiology and, in some cases, is associated with clinical signs related to the gastrointestinal, cardiovascular, respiratory, nervous, integumentary, and immune systems. [11]

Flare-ups of FIC generally begin as non-obstructive incidents involving acute inflammation of the lower urinary tract but where the cat is still able to urinate. The majority of cases (85%) remain non-obstructive without escalation into blockage and usually resolve themselves within 7 days with or without treatment.

Causes Edit

The direct cause of feline idiopathic cystitis is unknown. It is a diagnosis of exclusion which means other possible urinary diseases which could cause bladder inflammation (e.g. feline urinary tract infections or urolithiasis) are ruled out. [5] Research is still being pursued regarding the causes of cystitis in cats, though the following principal risk factors have been identified. [12]

  • Cats predisposed to anxiety or who have a low tolerance to stressors are particularly vulnerable since stress is now considered to be a key factor in triggering acute attacks of FIC [13]
  • Cats who are neutered or spayed too early
  • Cats who are younger/middle-aged (ie those less than 10 years old)
  • Indoor cats and/or cats who are unable express natural feline behaviour (eg hunting)
  • Cats fed a dry food diet who may be inadequately hydrated [14][15]
  • Increased body weight [16]

Treatment of an acute episode Edit

First and foremost, the cat must be kept well hydrated with wet food/soups/broth/increased water intake. This keeps the urine dilute, reducing pain and inflammation, as well as encouraging urination to keep the bladder clear of debris thereby reducing the risk of a § mechanical blockage (dry food must therefore be avoided). [17] Since the underlying process is inflammation of the bladder, one of the most frequent pharmacological treatments is to administer anti-inflammatory medication. NSAIDs such as meloxicam or robenacoxib are commonly prescribed to control this (provided there are no renal or gastric contraindications). [18] The condition is intensely painful and analgesia (via NSAID or opiates such as buprenorphine) is essential to reduce discomfort and control further stress (which could in turn trigger further inflammation). In the case of a male cat, spasmolytics such as prazosin in combination with dantrolene may also be prescribed to control painful urethral spasms and prevent the risk of a § functional blockage. [18]

Since stress is considered to be a key aggravator in triggering cases of FIC, the most important non-pharmacological/non-dietary intervention is to modify the cat's environment to minimise stressors and improve general well-being (see § environmental modification below). In addition, calming supplements such as tryptophan or alpha-casozepine can also be added to food to improve mood and relaxation. [18] [19]

Oral supplements to reinstate the protective glycosaminoglycan (GAG) layer of the bladder (often deficient in cats suffering from FIC) may also be considered. Supplementation with antioxidants and essential fatty acids such as high quality fish oil have also been shown to reduce the severity of the episode. [20] The veterinarian may also use a urine sample from the cat to carry out urinalysis to test for the § presence of crystals which could aggravate the condition (see below). [21]

Within a week most cats should improve spontaneously as the inflammation subsides. However, it is essential to monitor urine output (and compare it to moisture intake) throughout the day, every day, to watch for incipient signs of blocking until the inflammation subsides and the cat returns to good health. Any presumed non-obstructive case which does not resolve itself with 7 days should be suspect for obstruction and investigated further.

Causes Edit

Obstructive episodes occur in the rarer instances (approximately 15% of FIC cases) when the initial, § non-obstructive attack (see above) is not self-limiting and escalates into partial or full block of the urethra so that voiding of urine is impeded or altogether impossible. Obstruction occurs almost exclusively in male cats due to their long, narrow urethra. There are two reasons why a cat may obstruct ("block"):

Functional blockage Edit

The block can be functional. This occurs when a severe muscle spasm of the urethra occurs to close it shut and the cat is unable to relax himself again to regain normal function. It is intensely painful and is triggered by the underlying inflammation, itself suspected to be caused by the stress of the condition. Effectively the cat involuntarily "blocks himself". [22]

Mechanical blockage Edit

A mechanical block occurs when actual physical particles obstruct the urethra. In 80% of such cases, a urethral plug composed of material generated from the underlying bladder inflammation (eg blood cells, mucus), called matrix, combines with struvite crystals in the bladder to form a hardened obstruction. In a small number of cases, the plug will be composed of matrix alone if no crystals are present.

Interaction between functional and mechanical blockage in FIC Edit

Both functional and mechanical blocks can negatively interact to fully obstruct the cat rapidly. In a multifactorial example, the underlying inflammation can narrow the urethral opening as well as provoking spasming to cause the walls of the urethra to close shut around a urethral plug forming in it.

The role of crystals in obstructive FIC Edit

Crystalluria is the presence of microscopic crystals in feline urine. These are most often struvite precipitates but other minerals such as calcium oxalate crystals are also found, albeit less frequently. Urinary crystals are not necessarily an abnormal finding and can be seen both in cats who are healthy and those who are suffering from a urinary tract illness. However a cat suffering from FIC may struggle with urinary retention and incomplete voiding, causing stagnant, concentrated urine to collect in the bladder which encourages crystal formation. Whilst crystals (as opposed to uroliths) do not alone cause a urethral obstruction, [23] they aggravate the risk of it since they are usually one of the components of a urethral plug which is responsible for § mechanical blockage in obstructive episodes.

As struvite crystals tend to form in concentrated, alkaline urine, they are unlikely to accumulate to a problematic degree in the healthy, well hydrated cat which is fed a high quality meat or white fish diet.

The nature and extent of crystal formation, together with urine pH, can be ascertained with a urinalysis to determine if there are any areas of possible concern.

Treatment of an acute episode Edit

Veterinary attention is essential if urine does not pass at all as the bladder could rupture and there is risk of death within 72 hours. The vet will usually attempt to relieve the blockage with a catheter, to drain the backed-up urine and flush the bladder out of any sediment and/or crystals. This is an invasive, delicate procedure which will require either heavy sedation or general anaesthetic. The cat may then be hospitalised with the catheter in place and hydration administered intravenously to encourage healthy urination and good kidney function for up to 3 days. While the catheter is in place, intravesical instillation (which is also used to treat human interstitial cystitis [24] [25] [26] [27] ) may also be administered to repair the compromised bladder lining. [28] [29] When the catheter is removed, the cat must be able to show he can urinate with good function before he can be discharged. With this proviso, he can return home and the anti-inflammatory and anti-spasm medication indicated for non-obstructive cases will be prescribed, as well as oral supplements to calm the cat and replenish the protective bladder lining (see above).

Even after the cat is unblocked, the underlying inflammatory syndrome will continue for some days at home (particularly since the catheter itself will have irritated the urethra). Therefore, some of the clinical signs for non-obstructive FIC may still be apparent post-discharge until the inflammation subsides and cat has fully recovered (e.g. frequent voiding, blood in urine, possible leaking due to tenderness). However medication should alleviate the severity and discomfort as well as assisting recovery. The owner must focus above all on good hydration (from a wet food diet only) and frequent urination to keep the bladder clear. Wet prescription diets may be recommended but if the cat refuses this (cats often avoid eating unfamiliar food when stressed [30] ), any high quality, high moisture, high animal protein wet food which the cat finds appealing may be administered. A urinary acidifier (e.g. DL-Methionine or Vitamin C) may be added to the latter to prevent struvite crystal formation but as animal protein is already acidic, it is not strictly necessary. In any case, excessive acidification should be balanced against the risk that it could irritate the inflamed bladder wall (possibly triggering recrudescence ie a further acute attack), as well as encouraging calcium oxalate crystal formation. An acidifier should never be added to prescription urinary food as this has already been acidified. Acidification or prescription foods are always secondary to the first priority of overall, general hydration from any wet food the cat finds palatable. Dry food of any sort (including prescription dry food) must be avoided.

Environmental modification to reduce stress, itself suspected to be one of the principal causes of FIC, must also be considered (see below) as the risk of re-blocking is highest within the first week after catheterisation.

Secondary bacterial infection (UTI) after an obstructive episode Edit

Whereas primary feline urinary tract infections are very rare in younger male cats, when a cat suffers an obstructive episode of FIC which has involved catheterisation and/or the symptomatic presence of crystals, then a secondary urinary tract infection becomes more likely as a follow-on complication. [31] The symptoms of bacterial infection in the lower urinary tract are very similar to those for non-obstructive FIC (ie straining, blood in urine etc) and a urine test with cultures will be needed to detect if an infection is present. Treatment is usually effective with antibiotics once the result of the urine culture identifies the precise bacteria involved in the infection. D-mannose is also used by some pet owners as a natural alternative to antibiotic treatment although this may be less targeted and specific than prescribed antibiotics following a urine culture.

Since feline idiopathic cystitis is commonly known to reoccur, ongoing precautions need to be taken to avoid relapse.

Importance of hydration Edit

As domestic cats are descended from their desert-inhabiting ancestors, they instinctively seek moisture from their prey. High quality wet food is the most natural way therefore to hydrate a cat as drinking water from a bowl is arguably species-inappropriate since anatomical limitations in the cat's tongue restrict the amount of water they can ingest this way. [32] Drinking still water from a bowl (particularly tap as opposed to rain water) is often a last resort for many cats and some may avoid it altogether. A quality wet food diet will therefore be most effective in ensuring sufficient moisture intake and will always be more effective than dry food in hydrating a cat, even when any additional moisture intake from drinking water is taken into account. [15]

Supplementing wet food with antioxidants and essential fatty acids such as high quality fish oil have also been shown to reduce the severity and recurrence of FIC episodes. [20]

Environmental modification Edit

Together with hydration, improvements to the cat's environment have been shown to prevent relapses. [33] Reducing stress and encouraging natural feline behaviour (particularly for indoor cats) is essential. Suggested methods include:

  • No sudden disruption to routine or changes in a cat’s environment. [34]
  • Olfactory enrichment with indoor cat-safe plants (e.g. cat grass, catnip, silver vine or cat thyme) [35] can again replicate a pleasing, natural environment indoors.
  • Outdoor visits (supervised in the case of indoor cats) will encourage sensory stimulation and defeat boredom which could lead to stress.
  • Window sill perches (particularly if they look out onto a natural landscape with wildlife and birds) provide important visual stimulation, particularly for cats who have no outdoor access. [36] Ideally the perches should be affixed to windows which provide good visibility of the surrounding outdoor space (windows on lower floors of a building work better therefore than those on floors which are too high up). Perches should be affixed at a variety of locations to offer diverse vantage points.
  • Maintaining close contact with owners and avoiding extended periods of isolation to prevent separation anxiety. This is particularly important for rescued strays or abandoned cats who have since been re-homed in an environment they perceive as safe..
  • Play with owners in short bursts de-stresses a cat and stimulates positive neural activity.
  • Regular rotation and replacement of cat toys. [37]
  • Safe, enclosed, quiet sleeping areas such as igloo beds. [38]
  • Avoidance of sudden or loud noises which could adversely trigger the startle response (classical music in the background can be used to mitigate this).
  • Litter tray hygiene and availability.

Surgical intervention for refractory cases Edit

For recurrent cases of FIC in male cats where blockage is a risk, and dietary and environmental modifications have not prevented relapse, a last line of treatment to prevent future obstruction is surgery to widen the male urethra. This is called Perineal Urethrostomy (PU) [39] but brings with it other risks and should therefore only be considered once all other options have been exhausted.


Help! My Cat’s Been Diagnosed With FIC!

No pet parent wants their beloved cat to receive a chronic diagnosis. And when it comes to a chronic urinary issue, it feels overwhelming, especially if you’re faced with bloody urine or outside-the-box elimination.

For cat parents who discover their cat has feline idiopathic cystitis (FIC), it can feel even more daunting since environmental stress appears to be a contributing factor to the disease. But there are lots of things you can do to help a cat who has been diagnosed with FIC, says Erin Connolly, DVM, who practices in Washington, DC.

First, What Is FIC?

Dr. Connolly says, “Feline idiopathic cystitis is a urinary problem that typically affects younger cats and is thought to be caused by stress due to changes in the environment or household routine. FIC is one major cause of feline lower urinary tract disease. FLUTD can also be caused by a urinary/urethral blockage–almost exclusively a male cat problem–bladder stones, urinary tract infection, trauma, or urinary tract cancer.”

Frustratingly, there isn’t a test to diagnose FIC, but certain signs can help your veterinarian make the call. They may include bloody urine, straining to urinate, which may look like straining to defecate, frequent trips to the litter box, vocalizing while urinating, urinating outside the litter box, or licking the urinary opening, typically because of pain.

If your cat starts showing any of these signs, call your vet as soon as possible. “These signs can indicate a urinary blockage, especially in male cats,” Dr. Connolly says.

Lauren Bowling, DVM, who practices in Kentucky, expands on signs to watch for, including some that are hard to spot. “Usually you will see small, frequent attempts to urinate. Sometimes it will be in the box, sometimes it will be outside of it, or both. Basically, these cats feel like they always have to pee, so they are either constantly in the litter box or squatting to go where they are if they can’t make it to the box. Some cats will also display more subtle signs like a decrease in appetite or restlessness, but those can be really hard to pick up.”

When to Call Your Vet

“This can be a life-threatening problem, especially in male cats, so the sooner we see them, the better,” says Dr. Bowling. “As soon as you notice these symptoms, or it seems like your cat is acting off, a visit to the vet is in order. I try not to let these symptoms go unaddressed for more than 24 hours if possible, so sometimes a visit to the ER on the weekends or holidays will be necessary. My general rule for any illness in cats is if you think something is off, it doesn’t hurt to call if you definitely know something’s wrong, see us ASAP.”

Cat parent Teri Thorsteinson experienced this first-hand with her male Cornish Rex, Brighton. “It was my last day of vacation, and the pet sitter said the night before he didn’t greet her at the door. He seemed okay, though,” she says. “I got home at one a.m. He was wobbling. Staggering. He went to jump up and fell. The force of hitting the floor forced some bloody clotted urine out.”

Luckily for Brighton, Thorsteinson worked at a feline animal hospital and knew exactly what to do. She took him to the emergency veterinary clinic. Brighton spent three days in the hospital, but Thorsteinson says it took him six weeks to return to his normal self.

How to Help Your FIC Cat

Since FIC is linked to stress, and since it’s usually chronic with flare-ups after the initial diagnosis, home management is critical.

Work with your veterinarian to find the right diet. Erin Buck, cat mom to a male named Lionel, discovered his urinary problems when her family had to replace the carpeting in their living room because of his outside-the-box urination. At first, they focused on cleaning, assuming it was a marking issue–they have a second cat in the family. However, when it didn’t stop, they checked in with their vet. Once Lionel was diagnosed with FIC, they implemented a special urinary diet that has kept him healthy for six years. There are a few different brands so you may need to try several before finding one that is best for your cat.

Eliminate Stress

“Cats are sophisticated creatures, and they can potentially become stressed by any change in their environment or routine,” Dr. Connolly says. “Potential stressors include disruptions or loud noises around litter boxes, new litter type, the introduction of new pets or people into the household, the absence of regular pets or people in the household, schedule changes, furniture rearrangement, visible outdoor cats/other outdoor animals, or moving.”

Another stressor? Litter box shortages! Especially in multi-cat households, Dr. Connolly recommends one more litter box than the total number of cats. “For example, if you have two cats, you should try to have three total litter boxes located in different places in your house. Cats feel less stressed when they have more litter box options,” she says.

Another way to tackle stress is with environmental enrichment. Dr. Bowling recommends providing vertical areas where your cat can jump and perch and puzzle toys that allow him to “hunt” for his food. Catios are an option for safe outdoor exploration. Feliway diffusers, which emit synthetic feline pheromones that may have a calming effect, can help, as can treats that contain natural calming ingredients

“Using things like Feliway diffusers and Composure treats can help,” she says. “It’s going to be a little bit different for each cat, but these are some of the things that can be tried.”

Permission to Relax!

Don’t overlook your own effect on your cat’s wellbeing. If you’re stressed, your cat senses that, Dr. Bowling says.

The final piece of your cat’s FIC plan? Relax! Dr. Bowling says, “If you’ve wanted to take up yoga or meditation, or maybe increase your massage and spa days, do it. Cats are not as independent as we think and our state of mind has a huge impact on theirs.”

While the initial diagnosis might feel scary, rest assured: With the right diet and environmental tweaks, your FIC cat can live a long, happy, healthy life.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.


Unmasking the prevalence of feline idiopathic cystitis (FIC)

Diagnosing the underlying cause of lower urinary tract signs (LUTS) in cats is often a lengthy process for veterinarians, and a costly source of frustration for pet parents. Multiple studies show that FIC is the most common cause. 1

The Prevalence of FIC

A compilation of data reveals the following:

Managing FIC with the right nutrition can lead to significant reduction of recurrent episodes.

Cats with FIC often need a long-term, multimodal management plan, including nutrition and environmental enrichment. A year-long, prospective, randomized, double-masked study reveals that the right nutrition can reduce the recurrence of FIC signs by 89%. 2 That may mean better, long-term quality of life for the pet and reduced frustration for the pet parent.

The purpose of this clinical study was to evaluate the efficacy and safety of a therapeutic urinary food, enriched with omega-3 fatty acids (EPA & DHA) and antioxidants, for preventing recurrent

episodes of FIC. Participating cats were offered dry or wet product depending on preference, which was then fed exclusively.

The cats which were fed the nutrition of Hill’s Prescription Diet ® c/d ® Multicare feline (test food) consistently had a significantly lower proportion of total days with episodes of FIC signs compared with cats fed a control food. This is the first study with grade one evidence to definitively show that foods of different nutritional profiles impact the expression of acute episodes of FIC signs in cats 2 .

Recurrence of FIC signs has been defined as cats exhibiting two or more LUTS per day. Sixty-four percent of cats exhibited greater than two clinical signs when fed the control food, compared with only 36% of cats fed the test food. Translated into days with at least two clinical LUTS signs, the cats fed the test food experienced only 13 days with recurrence of LUTS vs. 152 days in cats fed the control food. This represents an 89% lower rate of recurrent episodes of FIC signs over 12 months. No significant difference had been found in this study between wet and dry groups.

To find out more about Hill’s® Prescription Diet® c/d® Multicare products – the #1 feline urinary foods recommended by veterinarians 3 – and about FIC, visit Hillsvet.com/FIC.

1 These data are combined from the following 4 studies:

•Kruger JM, Osborne CA, Goyal SM, et al. Clinical evaluation of cats with lower urinary tract disease. J Am Vet Med Assoc 1991199:211-216.

•Buffington CA, Chew DJ, Kendall MS, et al. Clinical evaluation of cats with nonobstructive urinary tract diseases. J Am Vet Med Assoc 1997210:46-50.

•Lekcharosensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract diseases in cats. J Am Vet Med Assoc 2001218:1429-1435.

•Gerber B, Boretti FS, Kley S, et al. Evaluation of clinical signs and causes of lower urinary tract disease in European cats. J Small Anim Pract 200546:571-577.

2 Kruger, JM, Lulich, JP, Merrils, J, etal., Comparison of foods with differing nutritional profiles for long-term management of acute non-obstructive idiopathic cystitis in cats. J Am Vet Met Assoc., 2015: 247(5): 508-517.

3 2017 Veterinary endorsement study, data on file.

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