Understanding Feline Idiopathic Cystitis

feline-cystitis

Feline Idiopathic Cystitis (FIC) is an inflammatory condition of the bladder. And, as the term “idiopathic” implies, it isn’t exactly known what causes the disease. FIC is one of many medical issues that fall under the banner of feline lower urinary tract disease (FLUTD) and some veterinarians may use the two terms interchangeably. Generally speaking, cats between the ages of 2 – 6 years are at risk and both genders can be affected. Cats suffering with FIC commonly display problems with urination or with pain and irritation around the genital region.

Causes:

  • Disturbed bladder lining: in cats with FIC the bladder lining gets damaged thus allowing ulceration and inflammation to develop.
  • Neurogenic causes: due to irritation and inflammation of bladder wall, nerves get stimulated and release neurotransmitters causing further damage, extending to deeper layers of the bladder. Also, neurogenic stimulus of the bladder wall may increase the micturition reflex (the need to contract the bladder and urinate). An increased micturition reflex may lead to urinating in small amounts or to sudden, strong urges to urinate, which sometimes means the cat cannot make it to the litter box in time, and can result in your pet inexplicably urinating in inappropriate places.
  • Imbalanced adrenal gland hormones: underlying stress factors causes increased noradrenaline and decreased cortisol in blood resulting in the weakening of urinary retention. The factors contributing to stress include traveling, weather changes, dirty litter boxes, decreased water uptake and aggression among cats. In multiple cat households, you should always have at least one additional litter box per total number of cats to reduce stress and competition between pets for litter box use.

cat-FIC-FLUTD

Clinical Signs:

  • Difficulty with urination (dysuria)
  • Urinating often (pollakiuria) and in inappropriate places (periuria) but not in their litter boxes due to an increased urge to urinate.
  • Blood in urine (hematuria)
  • Pain and discomfort during urination (stranguria); cats will squat for  prolonged periods which can be misinterpreted as constipation.
  • Increased grooming of the genital area and plucking or removing hairs from inner thighs and caudal abdomen to decrease the irritation and pain response.

Diagnosis:

There is no specific test to diagnose FIC so diagnosis is performed by excluding other factors that show similar signs. These can be urinary tract diseases, bladder stones, neoplasia (cancer) and anatomical defects. Your vet will perform the following tests to reach his or her conclusion:

  1. Complete blood count and biochemical tests are performed to check the function of the liver and kidneys.
  2. Urinalysis: performed to detect urine pH (acidity of urine), specific gravity and abnormal substances in urine including blood, crystals or proteins and culturing of microorganisms if detected.
  3. Diagnostic imaging, including radiography or contrast radiography and ultrasound of the bladder helps in excluding neoplasia, stones or any anatomical defects.

Treatment and Management of FIC:

Particular emphasis should focus on dietary changes, reducing environmental stress, providing analgesics and other therapeutic drugs (if required).

Clinical signs resolve in over 85% of cats within 2-3 days but out of these, 50% will show recurrence – mostly those who are given dry food.

Dietary Changes:

  1. Replace dry food with wet (canned) food.
  2. Specific diets (per your vet’s recommendations) can help in managing recurrent FIC.
  3. Diet changes should always be gradual – be sure to mix old food with new food (slowly increasing the amount of the new each day) to increase palatability.

Environmental Modification or Multimodal Environmental Modification (MEMO) Therapy:

MEMO therapy proves useful in reducing environmental stress factors and can help alleviate FIC. These include:

  1. Regular cleaning of litter boxes, at least once per week.
  2. Follow the 1+1 rule – if you own multiple cats, each feline should have one litter box, with one additional box present too (2 cats = 3 litter boxes, 3 cats = 4 litter boxes and so on).
  3. Litter boxes should be large enough for the animal and be kept in a private, quiet space so that the cat can use it comfortably, without disturbance.
  4. Make sure fresh and clean water is available round the clock with multiple watering bowls placed in various locations throughout your home.
  5. Adding flavors to water (chicken or tuna) may encourage more frequent drinking (and thus urination) decreasing the risk of FIC.
  6. Avoid overcrowding and unhealthy interaction if you have two or more cats – this may trigger stress factors and ultimately increase the risk of FIC.
  7. Take some quality time for grooming your cats and give them plenty of interactive toys so that they can express their natural predatory behavior.

feline-FIC-urination

Drug Therapy:

FIC is not a drug-responsive disease. However, if dietary modifications and environmental changes don’t help, drug therapy can be taken into consideration:

  1. Glycosaminoglycan (GAG) replacers: these help in replacing the defective and damaged wall of the bladder. GAG replacers are given in oral or injectible forms as prescribed by your vet.
  2. Tricyclic antidepressants: these are given in severe non-responsive FIC and include drugs like amitriptyline and clomipramine.
  3. Some veterinarians may prescribe medications, such as prazosin, to relax the constriction/spasm of urethral sphincters.

Analgesics:

Cats showing signs of discomfort and pain may be prescribed non-steroidal anti-inflammatory medications (NSAIDs) or opioids (buprenorphine or butorphanol).

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