Feline Idiopathic Cystitis: The Most Common (and Frustrating) Cause of FLUTD

Feline idiopathic cystitis (FIC) is the most common diagnosis in cats with lower urinary tract signs. As discussed in my , FIC is a diagnosis of exclusion, meaning that the term FIC is used if all diagnostics fail to confirm the presence of another disease such as infection, urinary stones, urethral obstruction, tumor, or kidney disease. 

Interestingly, veterinarians and physicians have noted many similarities between FIC and a bladder disorder, called interstitial cystitis, which affects people. In people, a psychologically stressful event often precedes the onset of lower urinary tract signs, and stress also seems to be an important factor in the development of FIC in cats. Possible sources of stress in a cat’s life may include environmental changes, changes in food schedule, and changes in the number of animals in the household. Studies are ongoing to determine whether the human and the feline disorder are truly the same, and whether therapies helpful for people will be of benefit to cats as well.

Why do only some cats get FIC?

This syndrome has been described in cats for nearly 100 years and continues to be a common condition. Studies so far show that cats that get this syndrome have a unique imbalance in the way their brain controls hormones. In other words, these cats are unusually sensitive to environmental stress and, due to a complicated cascade of events in the body, these stresses manifest in the urinary tract.

As the struggle to understand this common but confusing syndrome continues, some features of FIC have been observed:

• Lower urinary tract signs tend to recur
• There is an association with environmental stress FIC seems to be a younger cat’s problem, with episodes decreasing in frequency as the cat gets older
• Urinary crystals, previously believed to be central to the syndrome, seem to be involved only peripherally
• Numerous therapies have been used to curtail the episode once it has started but because the episode seems to last a week or two regardless of treatment, it is hard to be sure what is working
• As difficult as it is to address an episode in progress, more success has been achieved in preventing future episodes

There are many theories as to why some cats become afflicted including a dietary/urinary pH theory, a theory that takes into consideration the lining of the bladder itself, as well as an environmental stress theory.

There are many approaches to treatment as well, and since no single therapy has emerged to treat an existing FIC episode, treatments are often selected to cover multiple theories and to prevent future recurrence. Treatments range from antibiotics and anti-anxiety medications to increased fluids and urine acidifiers.  

The major "management" strategy has been to focus on the prevention of future episodes and the following approaches have proved the most successful:

• Increasing the amount of water consumed by offering canned cat food, placing "drinking fountains" around the home, and filling water bowls while your kitty is watching to encourage a "social drink"
• Providing environmental enrichment to help reduce stress; also, allowing choices for your kitty in terms of where to play, rest, eat, and eliminate can help to minimize daily stress.

Many people are surprised to find that environmental enrichment has been effective in prevention since it does not involve medication or diets, and these are valuable interventions to try if you have an “emotional special needs” kitty.

I hope this has been helpful at shedding some light on this very frustrating syndrome. Next week I’ll discuss urinary crystals- —another highly common kitty issue.

Do you have a question for veterinarian Shea Cox, the Berkeley Patch pet expert? Let us know in the comments.