What’s New (and Old) in the Management of Feline Urinary Disorders

What is FIC?

Feline Idiopathic Cystitis just means inflammation of the urinary bladder due to an unknown cause. Years ago this was often called FLUTD ( Feline Lower Urinary Tract Disease). FLUTD is now reserved for the set of symptoms including inappropriate urination, straining to urinate, painful urination, etc. This can include urinary stones or infection. FIC is actually sterile, meaning no bacteria can be found in the urine sample. This often perplexes cat owners because we would love to be able to make our feline family members feel better with a course of antibiotics. Unfortunately, only about 2 % of cats will actually have an infection. 

 

What about crystals in the urine?

Many cats will be diagnosed with crystals or less often, stones in their urine. These crystals have not been found to predict FIC or urinary tract infection. This could just be an incidental finding. However,  preventing crystalluria is a worthy goal for most patients with crystals in their urine. These crystals do have the propensity to coalesce together and form stones which can be difficult to remove and may require surgery.

 

Old Standby Treatments for FIC:

Increase water intake

It has been long understood that if we can decrease the concentration of the urine through dilution in cats with FIC, their symptoms will likely improve.  Highly concentrated urine is irritative to the lining of the bladder wall and can lead to more pain in our patients – never a good thing.  Enticing cats to drink water is a little like herding them. Some common strategies include leaving a faucet to drip and using water fountains or bubblers. The most efficient way is to feed canned food. Canned food has a very high moisture content, especially when compared to dry. It is often recommended to feed canned food exclusively while a cat is having a flare up of cystitis.

Pain control

We know that this condition is painful. Many cats cry and yowl when urinating. We also have the comparison to a similar condition in humans. Women with interstitial cystitis which is very similar to FIC , report that the condition is very painful . Often patients are given topical or oral pain medications. This also will help these patients to relax and hopefully decrease spasms of the urethra. 

Diet Change

The hallmark of treating cats with FIC has been to change their diet. Luckily, research has shown that by decreasing minerals in the food and adding additives to encourage thirst and calmness have really decreased the episodes of FIC.  It is imperative that cats with FIC symptoms be on an appropriate diet whether that is canned food or a prescription dry food in order to prevent further episodes which may lead to life threatening obstruction. 

Anti-anxiety medications

Indoor, multicat households are not natural to cats. We know that they experience stress just by the situations we put them in. However, we also know that one key to longevity in cats is the protection of being indoors. Therefore anti – anxiety medications, like Fluoxetine and Amitriptyline became popular as a treatment for FIC. Daily “pilling” a kitty can be stressful in itself. However, some cats improve and have less episodes on maintenance levels of anti- anxiety medications. These medications take several weeks to be effective and should not be stopped without tapering. Note, Gabapentin and Trazadone may be prescribed short term with generally good results.

Steroids

The use of steroids has not been shown to be effective in FIC.  We also avoid steroids due to their common side effects. 

Antibiotics

Antibiotics are not usually indicated in typical FIC cats. Only 2 % of the cases actually have infection. Therefore, don’t be surprised if your kitty does not receive antibiotics in their treatment of FIC. If we are concerned that a true infection is occurring, we would likely recommend a urine culture and sensitivity in order to ensure the use of a proper and effective antibiotic. 

Anti- spasmotics

Prazosin was once used to decrease the tone of the urethra to prevent obstruction. However, this too has not been proven through research studies to be beneficial. 

 

New Discoveries about FIC

Some things that we thought in the past have been reinforced by recent research. FIC is a disease of the bladder wall.  This causes symptoms call dysuria. This becomes very frustrating for owners and the veterinarian because it is not really cured but hopefully controlled. The other component confirmed with recent recearch is the role stress plays. It is believed that this certain group of cats do not respond to stressors normally. This involves a complicated pathway involving the response to cortisol and the tampering or “putting on the brakes” of a stress response. When the stress response is overwhelming, this leads to increased pain perception as well as the chemical make up of the bladder wall lining. This increases inflammation in the bladder wall, increased pain and eventually urine which contains many inflammatory chemicals. 

Clinical signs of true Feline Inflammatory Cystitis include straining to urinate, blood in urine, and urinating outside of the box. Many cats will excessively groom their abdomen due to chronic pain in the bladder. Many kitties with FIC act off in other ways such as; decreased appetite, weight loss, lethargy. 

Urinalysis and radiographs or ultrasound help rule out stones, crystalluria or true infection. This is important so that we can properly treat.

 

Multimodal Environmental Modification ( MEMO) 

Certain cats need environmental enrichment to help them adapt to living in enclosed places like a house. This occurs in all species of cats including lions and tigers as zoos struggle to keep their environmental stressors to a minimum. The same is true of most of our domesticated cats. The following is a list of some important steps to make your house a home for your cats. In the long run, this can really benefit your cat’s mental and physical health.

• Hiding places. Cats need plenty of places to feel safe; elevated positions are optimal because they give cats the chance to hide and provide a good view of the environment. Think about how in nature, they would love to have a vantage point to see any approaching danger. As you look around the house – think like a cat! Cages with blanket covers or other hiding spots that aren’t high are good for those cats which don’t want to or can’t jump up high. 
• Decrease litter stress. Litter boxes are a source of stress for owners and their cats. Some cats are fastidious and demand a very clean box. Some do not want to share. We recommend one litter box more than the number of cats in your household. Some like high edges others want covers.  We recommend putting litter boxes in various areas around the house, especially if you have a multilevel household. Keep them in quiet, out-of-the-way places. Once you find something you think everyone can agree on – leave them alone! Don’t change litter brands often as this alone can upset your cat population. 
• Increase water.  As mentioned earlier, you may enrich your environment with bubblers, fountains and multiple watering stations. 
• Play and hunting. Some cats are wired to need to hunt. They really do get quite stressed without a job to do. Some are the “border collies” of cats. You may add enrichment with toys, games, puzzle feeders. Predatory games and toys on a schedule will relieve much of the stress and boredom of indoor living. 
• Feline hormones.  Feliway and other feline hormone tools have been around a long time and still do help us acclimate kitties to indoor living. They come in diffusers, sprays, etc. 
• Scratching posts and cat trees. These tools around the house do allow the cat to have a place to call their own. This mimics life outside which is very important for your indoor cat. If placed by a window these can be especially stress reducing for the cat. 
• Resolve cat conflicts. 
  •  Never require your cats to interact with each other
  • Create spaces for each cat to be able to eat and drink and use litter in their own space.
  • Do not punish cats for poor interactions with other cats.
  • Neuter or spay all cats in the house.
  • Reward cats with treats for good interactions.
• Human interaction. Make time for human interactions. Don’t force a cat to sit with you but if they enjoy the interaction, make time with your pet. Combing and petting your cat will strengthen the human animal bond. 

 

Calming foods 

Over the last few years, ingredients have been added to cat food and treats to calm cats and decrease stressors. Various studies have shown mixed results. Tryptophan had the greatest effect. Our philosophy is it does not hurt and if we are recommending a prescription diet, we usually recommend the stress or calming formula. Some choices we recommend are Hill C/D Stress and Royal Canin SO/ Calm.

 

Bottom line on FIC.

Knowledge is power! This condition is very prevalent in our young cats. The more you know about FIC, the quicker you can respond. Hallmarks of treatment and prevention are increased water intake and decreased stressors. I hope the above article can give you some insight on how to avoid these episodes. If your cat is straining to urinate and not producing urine, it is a medical emergency. Please contact Somerset Veterinary Hospital or your local emergency clinic so your patient can receive the care he needs.