Urinary tract infection. Feline cystitis. FUS (feline urologic syndrome). FLUTDS (feline lower urinary tract disease syndrome). Now it’s called FIC (feline interstitial cystitis).

Whatever you want to call it, it’s a pain under the tail! In the bladder, to be exact. For you and your kitty.

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I hate this disease. Truly. I hate it because we don’t have all the answers. The cats are uncomfortable, and the owners are unhappy. You may hear lots of opinions and lots of “cures.” Then you try the “miracle” on your cat and it doesn’t “work.” One diet may work for one cat but not for another. Drugs may seem to be the answer for one cat and not another. That’s because these cats don’t have identical disease, causes, symptoms, risk factors or response to treatment.

Signs and Symptoms of FIC

  • Straining to urinate
  • Blood in the urine
  • Inappropriate urination
  • Licking the urinary area
  • Urinary blockage (almost male cats exclusively) — a true medical emergency

Let’s narrow this discussion to cats who are healthy except for their feline idiopathic cystitis. These cats are usually young, median age of 4. Happily, many of these cats’ symptoms improve with age.

What Causes FIC?

We don’t know the cause of feline interstitial cystitis, but we have some theories. Hundreds of studies have been done, and a definitive cause for FIC has not been found.

What We Do Know

Of all cats showing signs of FIC:

  • 50 percent will not be diagnosed with a cause.
  • 20 percent will have bladder stones, either struvite, calcium oxalate or mixed.
  • 20 percent will be “blocked” (have a urethral blockage).
  • 1 to 5 percent will have a true urinary tract infection.
  • The remainder will have cancer, trauma, or a combination of bladder stones and infection.

We also know that:

  • This is a recurrent disease.
  • Wet (canned) food and more water intake have been proven to help.
  • Most experts believe there is an association between symptoms and stress.
  • Urinary crystals are not as significant as once believed.
  • Regardless of what drugs are prescribed, many episodes last a few days to two weeks and subside, with or without treatment.
  • The frequently prescribed antibiotics, anti-inflammatories or other drugs may not help.

Why Are Some Cats Affected?

The most valuable research has revealed that affected cats have a link between stress and signs of cystitis. These cats suffer from an imbalance in the way their brain controls neurohormones. It is unclear whether anti-anxiety medications or easing the anxiety can improve or curtail an acute episode.

It does seem that lessening environmental stress can prevent or lessen future episodes of cystitis.

Diet: What’s the Real Story?

This disease has been known to occur in cats for the past 100 years or more. Commercial cat foods have definitely made this disease more common.

With huge changes in formulation of cat foods in the 1980s, the syndrome decreased. But cystitis still occurs in cats fed commercial diets, raw diets, home-cooked diets, grain-free diets and diets particularly marketed as “urinary health” diets. So what do we do now?

Wet Food and Lots of Water

The one thing that has been proven is that wet foods and higher water consumption prevent or lessen the outbreaks of FIC. There is no miracle in the canned (or raw) diet that we can identify except the water content. The wetter the diet, and the more water the cat consumes, the more dilute the urine and the happier the bladder.

Why is a fuller bladder a happier bladder? Evidence suggests that as the bladder wall is normally stretched with more dilute urine, inflammatory chemicals leave the bladder wall and are released into the urine. As the bladder wall loses its irritating chemicals, there is less straining to urinate. Less straining means less inflammation, less bloody urine and less pain!

Prescription Diets?

If analysis of your cat’s urine and X-rays show your cat has bladder stones, your cat should be prescribed a special diet and/or have surgery. There are diets available that can dissolve one type of stone (struvite) and prevent more from forming. There is no diet that dissolves calcium oxalate stones.

If your cat has many stones or large stones, is in continual discomfort or if this is a male cat, surgery is recommended. Even while the stones are dissolving on a prescription diet, a male cat can suffer from a urethral blockage and, without immediate attention, can become fatally ill.

Drugs

Antibiotics, anti-anxieties, narcotics, steroids, anti-inflammatories, acidifiers, tranquilizers, anti-spasmodics, adequan, glucosamine. I’m sure I’m missing some.

Which ones work? On which cats?

Most of these cats don’t have infections, so antibiotics are probably of no help. Anti-inflammatories don’t seem to address the bladder inflammation. Anti-anxieties take a while to work, if they help at all. Maybe glucosamine and similar medications strengthen the bladder lining. We are not sure.

So the bottom line is, veterinarians probably are or have been over-prescribing medications. This leaves you trying to stick pills down your cat’s throat (what a thrill that is). Your stress is worse. The cat’s stress is worse, and we have a vicious cycle.

Natural Therapy

Along with a high-protein/low-carb wet diet, and elimination of stress wherever possible, there is evidence that the Chinese herb choreito (zhu ling tan) may be of benefit.

 

Prevention

1. Wet food/increasing water consumption

Some tips to make your cat drink more:

  • Fill the bowl in front of your cat!
  • If he likes to drink out of a glass by the kitchen sink, let him!
  • Drink out of the faucet? Let her!
  • Put different types of fresh water throughout the house.
  • Try a drinking fountain.
  • Take a shower with your cat. (Joking! But many cats like to lick water from a clean tub. Let him!)
  • Try low-sodium chicken broth, clam juice or tuna water.
  • Add water to canned food.

2. Enriching your cat’s environment and relieving stress

But My Cat Has No Stress. He Sleeps All Day.

How do you know he isn’t stressed?

Here are some things to think about. For more information, check out the Indoor Cat Initiative.

  1. Play with your cat. Every day. Wake him up if you have to.
  2. The cat should have free rein of a large area, without competition. Is he afraid of something in the environment?
  3. Each cat should have some privacy in a tranquil place. Easier said than done in a multi-cat household. No loud noises, no appliances, no other cats to upset his private time and space.
  4. Scratching posts or surfaces she prefers.
  5. Ever-changing supply of toys.
  6. Climate is important. Warm and cool areas, please!
  7. The litter box discussion, again. One litter box per cat, plus one. Keep them clean. Try different substrates if necessary. Boxes on each floor of the home. Privacy around the box. Achieving this is extremely difficult for some households.
  8. Each cat should have his own dishes (food and water) or access to dishes he prefers. No stress or intimidation when he wants to eat or drink.

I think we can all admit that even the mellowest-seeming of kitties may be under some stress. You may have no idea your cat is afraid of the dishwasher, or that you grind the coffee when he’s approaching his litter box. Maybe she hates your children! Or their friends. Maybe the sight of your suitcase reminds him of the time you went on vacation for two weeks. And the pet sitter forgot to clean the litter box. For some of these seemingly well-adjusted cats, environmental stress exists, and it triggers a neurochemical reaction that causes feline idiopathic cystitis.

Take-Home Message

If your cat is showing signs of FIC, seek the help of your veterinarian.

Your vet will want a urine sample at the very least. The best sample is a sterile one taken directly from your cat’s bladder with a needle (cystocentesis). This is usually very easy unless your cat has a tiny bladder at the time of the exam or if your kitty is difficult to handle (fractious). Your vet may want other bloodwork and radiographs as well.

Educate yourself on the risk factors of feline idiopathic cystitis and think about what you can do about your cat’s diet and lifestyle.

A bitter pill to swallow? There is no simple pill to fix FIC.

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