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Feline Idiopathic Cystitis, or FIC, is the most common cause of lower urinary tract symptoms in cats under 10 years of age. Idiopathic is a term used to describe a condition that has no known cause identified. It is currently thought that FIC is caused by multiple factors including genetics, environment and an altered, inappropriate response to stress by the cat’s nervous system.

Symptoms of FIC

FIC can be classified as either “non-obstructive” or “obstructive”. Cats with non-obstructive FIC have a patent urethra and are therefore able to void urine, although often only in small, frequent amounts.

Non-obstructive FIC is often self-limiting with the symptoms resolving over one to two weeks.

With obstructive FIC, the cat’s urethra becomes obstructed with a stone or a mucus plug which subsequently prevents urine flow. Males are at greater risk of obstructive FIC due to their narrower urethra. Unsuccessful attempts by the cat to urinate will progressively lead to distress, lethargy, inappetance and vomiting. Without prompt veterinary attention, the condition will progress to acute kidney failure and death.

The majority of cats with FIC will have at least one recurrence with variable frequency and severity of signs.

Signs of FIC in cats can include one or more of the following symptoms:

• Increased frequency of urination
• Blood in the urine
• Straining or difficulty urinating sometimes accompanied by distressed cries
• Inappropriate urination in unusual sites (such as the bath or sink)
• Loss of litter tray training
• Increased grooming, especially in the area around the genitals
• Behavioural changes including aggression

Risk factors for FIC

• Male cats, neutered cats and overweight cats
• Cats that eat a predominately dry food diet (due in part to inadequate water intake)
• Cats that do little or no exercise, or have limited/no access outdoors
• Cats that use litter trays
• Cats in households with more than one cat
• Cats in a stressful environment e.g. new baby or pet, moving house, change in household routines

Diagnostic investigation of FIC

FIC can only be diagnosed by excluding other causes of lower urinary tract disease. Your vet will start by performing a thorough physical examination of your cat in addition to a urinalysis test. Depending on your cat’s age and symptoms, your vet may also recommend blood testing to assess a complete blood count, serum biochemistry and thyroid hormone levels.

Cats with recurrent symptoms or those who fail to respond to treatment will require further investigations. This will usually include abdominal x-rays and ultrasound, and sometimes also advanced contrast studies (pneumocystogram).

Treatment of FIC

Initial treatment recommendations for FIC will depend on whether it is non-obstructive or obstructive. Obstructive cases must be admitted to hospital to be treated as an emergency to relieve the obstruction. Obstructive cats will often have serious electrolyte imbalances which will need urgent treatment and most cases will remain in hospital for a few days with an indwelling urinary catheter in place.

Once obstructive FIC cats are able to urinate on their own without the need for a urinary catheter they will be discharged from hospital. Homecare management strategies are a crucial part of FIC treatment and are the same for both obstructive and non-obstructive cases.

Home-care Management of FIC

Successful management of FIC requires a “multi-modal” approach which needs to include addressing your cat’s environment to reduce stress, increasing their water intake, optimizing their litter trays and in some cases use of medications.

1.      Environmental enrichment and reduction of stress

The ISFM and AAFP are two of the largest feline veterinary organisations in the world who share the vision of helping improve the lives of cats and collaborate together to publish specific Feline Guidelines on a variety of cat-specific topics. Their guidelines are formed by a panel of feline experts and help provide recommendations to both vets and cat owners on the optimum standard for feline care.

The 2013 Environmental Needs Guidelines identified five primary concepts needed to provide a healthy environment for your cat. Incorporating these “Five Pillars” into your cat’s environment is an essential part of FIC treatment. Please refer to our “Environmental Needs” information page for more detail.

Pillar 1: Provide a safe place:

Each cat needs a safe, secure place to retreat to and feel protected, this space needs an exit and entry from at least two sides, should have sides around it, ideally be sized for a single cat and raised off the ground. E.g. cardboard boxes, cat carriers, open wardrobes, etc.

Try to increase available “vertical space” around the home by adding cat perches, shelves and cat trees with built in hiding spots. Aim for your cat to be able to walk across a room using this vertical space without having to touch the floor. Needs to be at least one safe place per cat located away from each other so that cats can choose to be on their own.

Pillar 2: Provide multiple and separated key environmental resources

A cat’s key resources include food, water, toileting areas, scratching areas, play areas and resting or sleeping areas. These resources should be separated from each other so that cats can have free access without being challenged by other cats or threats. Separation of resources reduces risk of competition, stress and stress associated diseases.

Cats in the wild will eat 10-20 small meals a day. By making food available in one location in a single bowl, foraging time for indoor cats is reduced to a few minutes per day, as compared with the hours needed for natural foraging.

Encourage hunting and foraging by feeding using food puzzles, interactive food toys, food/treat balls and hiding food in multiple locations around the house so the cat “hunts” for food. In multi-cat households, ensure to have multiple options of each resource for each cat.

Remember scratching is normal cat behaviour. Provide acceptable scratching materials (e.g. scratching posts). To train your cat to use the post, reward with treats and praise. Also put catnip, treats and toys on or near the post. Scratching posts should be sturdy and made of materials that cats prefer such as wood, sisal rope or rough fabric including carpet.

In a multiple cat households, set up several areas with litter trays available at more than one site, a cat can choose which path to take and which cat to greet or avoid.

Outdoor enclosures or runs for cats protect them from injury and infectious diseases while still allowing outdoor exposure. There are a number of specialised companies that can build these such as Catmax or Secureakat.

Pillar 3: Provide opportunity for play and predatory behaviour

Play and predatory behaviour allow cats to fulfil their natural need to hunt. Stimulate play with interactive toys that mimic prey such as toy mice or feathers on a wand.

Let your cat capture the “prey” at least intermittently to prevent frustration. Rotate or replace toys regularly to maintain interest.

Pillar 4: Provide positive, consistent and predictable human-cat interaction

Cats are social animals. They need companionship & mental stimulation which can be in the form of gentle patting, stroking, feeding, grooming & play.

Each cat will have their individual preference on how much human interaction they like such as petting, grooming, playing, being picked up and sitting on your lap. This is largely determined by their genetics and exposure to humans during their socialisation period (2-7 weeks of age).

Pillar 5: Provide an environment that respects the importance of the cat’s sense of smell

Cats use their sense of smell to evaluate and communicate in their surroundings, using facial pheromones, foot pad (scratching) pheromones and urine to mark their scent within the boundaries of their safe, secure territory. Cleaning pheromones off these areas can increase stress, especially if introducing a new cat, or other household changes.

Feliway is a synthetic feline facial pheromone that mimics the cat’s natural facial pheromones and can provide a calming effect. Liberal use of Feliway plug-ins around the home can be very beneficial.

Minimise exposure to threatening smells such as the smell of unfamiliar animals, or the use of scented products, cleaners or detergents.

The Environmental Needs Guidelines are available to download free online: http://jfm.sagepub.com/content/15/3/219.full.pdf+html

2.      Increase water intake

Increasing water intake is a very important component of FIC management:

The best way to achieve this is to gradually change your cat over onto a wet food diet, however care must be taken to do this slowly to ensure your cat likes the new food. Rapid diet changes can be stressful to cats which can exacerbate FIC.

Other options include adding water to the food (canned or dry), placing extra water bowls in several extra places around the house and garden (e.g. upstairs, on the porch, downstairs, outside), pet “fountains” and leaving water in the bottom of the sink, bath or shower. For more tips on how to get our cat to drink more water, read our blog post here.

3.      Litter tray management:

Providing enough number of litter trays that are of adequate size, cleanliness and placed in a quiet location is another key component of FIC management.

Number of litter trays: The ideal number of litter boxes to have per household is one box per cat, plus an extra one.

Type of litter: Most cats prefer fine-grained, unscented litter substrate e.g. clumping litter. Many cats prefer a litter depth of approximately 4 cm however preferences may vary.

Size of litter tray: Most litter trays are too small, cats need litter boxes that are at least 1.5 times their body length.

Location of litter tray: Place in at least two different locations that are private and have easy access, preferably more if a multi-cat household. Don’t place trays next to noisy appliances (e.g. laundry). Don’t trap or corner the cat in the litter box to give medication or perform procedures the cat dislikes. Multi-storey houses need litter trays on every level. Prevent one cat blocking litter box by ensuring multiple exit & entries, have at least two ways for the cat to enter and exit the box.

Regular cleaning of litter tray crucial: Boxes should be scooped 1-2 times daily. Clumping litter should be completely changed at least weekly and more often if more than one cat uses it. Clay litter should be changed a minimum of every other day (more frequently if other cats are using it).  Wash litter box with warm, soapy water and dry well before adding new litter.

4.      Drug therapy

Analgesia:

This is often necessary to provide your cat with pain relief during an acute FIC flare up. There are a few drug options including opioids (buprenorphine given orally via the mucous membranes in the mouth) and non-steroidal anti-inflammatories (meloxicam). These drugs are given purely for symptomatic control of pain and there is no evidence they provide any long term benefit to FIC.

Anti-anxiety/antidepressant medications (Fluoxetine, Clomipramine)

Antidepressant medications such as fluoxetine (Prozac) can be a useful adjunct for cats with FIC with anxiety that does not respond to environmental modification, or, alternatively where issues with environment cannot be changed/improved (e.g. arrival of a new baby). It is recommended to perform baseline bloods prior to therapy then repeat blood testing at 1, 2 and 6 months and every 3-6 months thereafter.

Glucosaminoglycan (GAG) replacements

GAG therapy is used for short term treatment in humans with interstitial cystitis. The rationale is to help repair the defective urothelium to decrease its permeability, in addition to providing analgesia and anti-inflammatory effects.

To date, clinical trials of various oral GAG supplements such as glucosamine have not demonstrated a significant benefit to FIC cats.

There has been one case report that showed successful use of injectable GAGs (pentosan polysulfate) in a cat with refractory FIC however other trials have failed to repeat this data. A course of pentosan (Zydax) can be consider for recurrent and refractory cases where all other therapies fail.

Anti-spasmolytics

For cats with obstructive FIC, anti-spasmolytics are used to prevent urethral spasm which is a common cause of re-obstruction after removal of the urinary catheter. A combination of two drugs is required to act on both smooth and skeletal muscle in the cat’s urethra.

It is imperative to taper gradually off these drugs, and to withdraw each drug sequentially. Some cats may need these drugs to be used intermittently.

Disclaimer: Please note that the information provided on this page does not replace the advice of your veterinarian. If you are concerned about your cat’s health in any way, we strongly recommend you seek veterinary advice. 

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