The successful management of feline idiopathic cystitis

November 22, 2022

Feline idiopathic cystitis is a common and frustrating condition to treat. Now thought of as more than just a disease affecting the bladder, it is generally considered to be an ‘anxiopathy’ resulting from chronic activation of the central threat response system (CTRS).

What is feline idiopathic cystitis?

Feline idiopathic cystitis (FIC) is one of a number of conditions affecting the feline bladder and urethra that may be collectively termed, feline lower urinary tract disease (FLUTD). FLUTD also includes conditions such as urolithiasis, feline urinary tract infections and neoplasia. As the name implies FIC is of unknown cause and therefore it is a diagnosis of exclusion. However some clinicians suggest that FIC can be thought of as systemic disease rather than a lower urinary tract disorder, similar to interstitial cystitis in humans.

Predisposing factors for feline idiopathic cystitis

  • Multi-cat household
  • Indoor lifestyle
  • Obesity
  • Stress
  • Young to middle aged cats

Stress in FIC cats can be due to a whole host of factors, such as a house move, a new cat moving into the household or the neighbourhood, or seasonal stressful events such as bonfire night, Christmas and New Year’s Eve.

Moreover, the association with an indoor lifestyle means that feline idiopathic cystitis may be more common in the autumn and winter months when inclement weather and darker nights means cats will tend to spend more time at home.

When it comes to cat idiopathic cystitis, age has a significant bearing on disease prevalence. In cats under ten years of age, FIC is responsible for the majority of cases of FLUTD. This is in contrast to older cats where up to 55% of cases of FLUTD may be due to bacterial urinary tract infection (UTI) and only about 5% due to FIC.

Clinical signs of feline idiopathic cystitis

The clinical signs of feline idiopathic cystitis are:

  • Dysuria (difficulty passing urine)
  • Stranguria (painful urination)
  • Haematuria
  • Pollakiuria (increased frequency of urination)
  • Periuria (urinating in inappropriate places)
  • Excessive licking of the perineum and ventrum

Feline idiopathic cystitis is very often a non-obstructive disease. However obstruction can occur, and urethral spasm often plays a key role here. In other words the obstruction is functional rather than mechanical. Where there is obstructive disease, systemic signs may be seen, including lethargy, anorexia and vomiting, together with a palpably enlarged painful bladder.

Clinical signs of FLUTD are similar whatever the underlying cause so further investigations are needed to reach a diagnosis and to formulate an appropriate treatment plan.

Approach to the diagnosis of FIC

Symptomatic treatment of a single episode of FLUTD in an otherwise healthy cat is often appropriate. Antibiotics should be avoided, and treatment should focus on pain relief, with opioids and / or a short course of non-steroidal anti-inflammatories (NSAIDs) as long as there is no contra-indication.

However further investigation is warranted in many cases, including:

  • All cats over ten years old
  • Cats with recurrent episodes
  • All cases where there is feline urinary obstruction

Diagnosis should focus on blood samples, urinalysis and imaging. Blood tests, including routine haematology and biochemistry form part of a thorough clinical investigation and are good practice but are often normal, especially in non-obstructive FIC. As well as screening for any systemic or underlying disease, blood tests are useful for general health screening prior to sedation or general anaesthesia, as well as prior to the use of NSAIDs.

Urinalysis

Feline urinalysis is an essential part of the investigation of feline idiopathic cystitis. Comprehensive urinalysis should include measurement of urine specific gravity, urine dipstick, microscopy for sediment analysis and bacterial culture and sensitivity. 

Litter tray or free catch samples are best for determining the presence or absence of haematuria, as iatrogenic haematuria may result from procedures such as cystocentesis. However cystocentesis is far superior for bacterial culture. Samples obtained by urinary catherisation may also be used for culture, but the results should be interpreted with caution as complete sterility is not possible.

It is important to bear in mind that crystals can start to precipitate within two hours of collection, especially if the sample is refrigerated, so samples must be examined without delay to improve diagnostic accuracy.

Imaging

Diagnostic imaging should include plain and contrast radiography and ultrasonography. Imaging is important to assess for abnormalities including uroliths and neoplasia, and to evaluate the wall of the bladder and urethra.

Managing idiopathic cystitis in cats

The pathogenesis of FIC is complex and multi-factorial. Interactions between the nerve supply to the bladder, the glycosaminoglycan layer and compounds in the urine result in bladder inflammation and the clinical signs of FIC. However it is now widely accepted that stress plays a major role in this process1 and identifying and managing stressors in the environment are key to management of feline idiopathic cystitis. Stressors will vary, but the following should always be considered:

  • Insufficient resources, including litter trays, beds, scratch posts, food and water bowls

Ample resources are essential to help avoid conflict. The ‘one plus one rule’ is a good place to start, in other words one litter tray for each cat in the house, plus an extra one. The same rule can be applied to other resources.

  • Multi-cat households

Cats are often solitary through choice, and multi-cat households can be inherently stressful. This stress can be reduced through adequate allocation of resources and reducing the likelihood of conflict, through such measures as feeding cats at a distance from each other and careful placement of litter trays.

  • Routine changes

Any change to the normal routine can be a source of stress. This could be a trip to the cattery or a house move, or social stress such as a new cat in the neighbourhood. Seasonal events like firework night can also be challenging for anxious felines.

In addition, cats with feline idiopathic cystitis are thought to have an abnormal response to these stressful events, which increases the risk of bladder inflammation. For those cats that need some extra help, commercially available facial pheromone products, to help provide reassurance and reduce stress can be useful.

Owner communication

Feline idiopathic cystitis can be a challenging condition to manage, both for owners and veterinary surgeons. Communication is of the utmost importance to adequately manage client expectations and ensure a successful clinical outcome.

  • Owners of male cats should be warned about the risk of urinary obstruction and the importance of seeking urgent veterinary attention.
  • Owners should be advised that FIC is likely to be a recurrent condition requiring ongoing management (over 50% of cats with FIC will have a recurrence within the first year).

Feline idiopathic cystitis will often resolve within a few days without treatment, but despite this, the consequences of FIC should not be underestimated. Extreme outcomes including euthanasia or re-homing are not uncommon, largely due to the difficulties of coping with inappropriate feline urination.

So with much still to learn about this multi-factorial condition, client communication is of the utmost importance.  Use VisioCare Consult in your consulting room, to support communication and help your clients understand complex diagnoses and treatment plans.

References

  1. Buffington, C. A. (2011) Idiopathic cystitis in domestic cats-beyond the lower urinary tract. Journal of Veterinary Internal Medicine25, 784– 796