Feline Idiopathic Cystitis

By Tammy Hunter, DVM; Malcolm Weir, DVM, MSc, MPH; Ernest Ward, DVM

What is feline idiopathic cystitis?

Feline lower urinary tract disease (FLUTD) is an older term used to describe a set of clinical signs associated with abnormal urination in cats. Some causes of FLUTD are: urinary tract infections (UTIs), bladder stones, or bladder crystals. When the condition has no identifiable cause, it is called feline idiopathic cystitis (inflammation of the bladder) indicating that this is an exclusionary diagnosis (i.e., no other causes for it can be identified). Feline idiopathic cystitis (FIC) is the exclusionary diagnosis made once all of the common or known causes of the clinical signs have been eliminated. This condition was previously called Idiopathic feline lower urinary tract disease or iFLUTD. Some studies suggest this condition is very similar to interstitial cystitis in human females. It is most common in young to middle aged cats.

"Feline idiopathic cystitis (FIC) is the exclusionary diagnosis made once all of the common or known causes of the clinical signs have been eliminated."

This condition is also called Pandora Syndrome, as the underlying causes for the condition may reflect abnormalities in many organ systems (including the nervous system), and takes into account the effects of environmental stressors that contribute to its development. Cats will often suffer waxing and waning of clinical signs in response to stresses affecting the central stress response system.

What are the clinical signs of feline idiopathic cystitis?

The most common clinical signs are similar to those seen in other urinary diseases:

  • straining to urinate
  • bloody or discolored urine
  • frequent urination
  • urinating in unusual locations
  • the inability to urinate (this is a critical emergency and your cat must be seen by a veterinarian immediately)

What causes feline idiopathic cystitis?

By definition, in cases of feline idiopathic cystitis there are no known causes. The conditions that must be ruled out first include:

  • bladder stones and urethral plugs
  • bladder infections
  • trauma
  • neurologic disorders that alter normal urination by affecting the nerves and muscles of the bladder
  • anatomic abnormalities such as urethral strictures
  • neoplasia (cancer or benign tumors of the urinary tract)

Once all of the common causes of abnormal urination have been eliminated, a diagnosis of feline idiopathic cystitis may be made.

How is FIC diagnosed?urine_jar_updated2017-01

FIC is diagnosed by performing tests to eliminate the known causes of abnormal urination. These tests include any or all of the following:

  • thorough medical history and physical examination - especially paying attention to any changes in environment, feeding, stress, etc.
  • blood tests - complete blood cell count (CBC) and serum chemistries
  • complete urinalysis
  • urine culture and antibiotic sensitivity tests
  • abdominal radiographs, which may include contrast radiographic studies to see if the bladder appears abnormal or contains bladder stones
  • abdominal ultrasound to look at the structure of the bladder and presence of bladder crystals or bladder stones
  • cystoscopy or endoscopic examination (video examination) of the urethra and bladder
  • bladder biopsy

Your veterinarian will formulate a diagnostic plan based on your cat's specific clinical symptoms.

What is the treatment of FIC?

The most effective approach for treating FIC is to address the stressors that triggered the clinical signs in the first place. This often involves the use of anxiety-relieving medications. As well, improving the cat's environment to reduce or eliminate potential stressors is important. A combination of strategies can be tried to eliminate stressors including:

  • keep water dishes clean and filled with fresh water.
  • keep a regular daily schedule including times for feeding, play, affection, and rest.
  • be consistent with 'rules' for your cat: do not allow your cat to climb on the counter one day and scold it the next.
  • if your cat eats dry food, use a puzzle feeder occasionally instead of a regular food bowl.
  • make any required changes to your cat’s schedule slowly over time.
  • add scratching posts, cat condos, and toys for your cat to play with.
  • try to eliminate foreign cats from entering your property as they can be a source of stress to your cat, even if your cat does not go outdoors.
  • reduce competition between cats in your home by ensuring that there are enough litterboxes (one more litterbox than the number of cats in the home), resting places, and ensure that all cats have easy access to food and water.

In addition, this condition is considered to be painful, so pain medications are used in order to alleviate discomfort during flare-ups. Anti-spasmodic medication to prevent urethral spasms may also be prescribed.

A change in diet may also be recommended by your veterinarian. Certain diet formulations, as well as increasing canned food consumption, may be needed.


What is the prognosis for FIC?

Recurrence of the condition can be common. Medical treatment may help reduce the frequency or improve clinical signs, thus relieving your cat's discomfort. The main thing to be aware of is to watch for the development of clinical signs, and, more importantly, be aware of changes in the environment that may trigger a recurrence due to stress. FIC cats can be very sensitive to these changes; thankfully, most cat owners are aware that the cat in question has an anxious or sensitive personality and are mindful of watching for flare-ups.

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