FELINE IDIOPATHIC CYSTITIS (FIC)

Cats may be afflicted by many different conditions involving the lower urinary tract (that part of the urinary tract starting from and including the bladder, including the urethra all the way to the point at which urine leaves the body at the penis or in the vagina.

There is one type of lower urinary tract disease in cats which frustratingly does not have an obvious underlying cause - Feline Idiopathic Cystitis.

  • Idiopathic - of unknown cause,
  • Cystitis - inflammation of the bladder.  

This disease has many features in common with a condition in humans called’ Interstitial Cystitis’. We believe that about 60% of all lower urinary tract symptoms  are caused by FIC.  It is possible that there may be one specific or many different causes FIC.

Unfortunately we do not know the underlying cause/causes of this condition.  Fortunately after years of extensive research we are beginning to understand some of the important factors that play a role in this unpleasant condition:

Stress –studies show that in many instances of FIC a stressful event is associated with an  episode of FIC .Sometimes even though there is no obvious source of stress, a careful analysis of the cats circumstances reveals an circumstantial or environmental stress. Some cats that are kept solely indoors and some cats sharing their environment with one or more other cats are typical examples of where stress can occur and influence the disease, even if no other obvious outward signs are present that suggest the cat is stressed. Also prowling cats on your property, even if you are unaware of them may cause tremendous stress to your cats. There are so many other causes of stress to your cats, some obvious and some obscure, that it is not practical to go in to them here.  

Abnormal  neuronal and hormonal response  to stress-  cats that develop FIC have been shown  to show an abnormal physiological response to stress with increases in nor-adrenaline and adrenaline but not an expected accompanying increase in cortisol. The relevance of this is poorly understood and is a matter for neurophysiologists. The bottom line is that these individuals  do not show normal well-orchestrated stress response and this affects the bladder. 

Defective bladder lining –the bladder is lined by a protective layer of mucous called glycosaminoglycans (GAGs) that protects the of the bladder wall .Urine contains a high many substances that would irritate the cells of the bladder wall if this layer were not present. Cat  with FIC appear to have  a defective GAG layer with resultant  irritation and/or ulceration of the bladder

Neurogenic inflammation –nerves going to and in the bladder may be stimulated by local factors such as stretching or irritating substances .They may also be stimulated by factors occurring in the brain such as stress. We believe that release of substances called    neurotransmitters from  nerves may also cause bladder irritation.

As we have said before FIC bears many similarities with Human Interstitial Cystitis. It is opinion of scientists at the moment in human and cats  this condition may develop in certain individuals that are may have a  genetic  predisposition to respond to stress in an abnormal way  and may also have  a localized  dysfunction in the bladder lining. The bottom line  ,though is that we do not why or exactly how FIC develops.

 

SYMPTOMS

The  symptoms of FIC are exactly the same as any other cause of Feline Lower Urinary Tract disease

  • Dysuria – difficulty or painful urination
  • Pollakiuria – increased frequency of urination
  • Haematuria – blood in the urine
  • Periuria – urinating outside the litter-box
  • Overgrooming – especially around the perineum(area between baseof tail and penis or vulva) and sometimes under abdomen
  • Hairloss – perineum and under abdomen
  • Stranguria  -  when urinating
  • Irritability or Depression

There are may be other symptoms related to environmental causes of stress, physical illness causing stress or the secondary complications of this FIC.

In some male cats with FIC, urethral blockage may also occur as a result of severe inflammation and spasm of the muscles surrounding the urethra, or if a urethral plug develops.

With FIC, many cats develop recurrent episodes of clinical signs. They may develop quite rapidly, and then often naturally subside and resolve over 5-10 days, only to recur again later. In severe cases, the signs can recur rapidly and frequently, and in some cats the signs may persist for long periods. FIC can lead to severe bladder inflammation and the thickened bladder wall that develops may be difficult to distinguish from an underlying tumor without a biopsy.

 

DIAGNOSIS

IT IS IMPORTANT TO REALISE THAT AT PRESENT THERE IS NO SPECIFIC TEST TO DIAGNOSE FIC.  We therefore have to rule out other causes of feline lower urinary tract disease before arriving at this diagnosis or the results could be catastrophic (forgive the pun)

  1. Examine cat to check that urethra(pipe from bladder) is open especially in males-Every case
  2. Analysis of urine samples -Every case
  3. Bacterial culture of urine samples-First time cat comes in for this condition
  4. X-rays of the bladder (including contrast studies)
  5. Possibly ultrasound of the bladder and abdomen
  6. Blood tests

The first three should be performed in every case and the second three according to the situation.

The analysis of a urine sample  in cats with FIC  often reveals the presence of blood and white blood cells and protein. No specific  underlying cause can be found to explain these changes-no infection ,no stones , no trauma or other causes . It is common to also find microscopic evidence of crystals in urine samples especially if they have been standing  more than a few minutes. However, these crystals are not the cause of the cystitis and are often found cats both with and without FIC .

 

MANAGEMENT

The best way to managing a cat with FIC is to use is making a number of different changes to reduce the chances of repeated episodes of FIC. We must also make all efforts to eliminate or reduce the pain and discomfort the cat with FIC experiences-this is where together with nutrition drugs will be helpful. Drugs do not control or prevent the disease-rather they are used to make your cat feel more comfortable. Therefore, it is important to concentrate on changing your cats diet, circumstances and

 

DRUGS

FIC IS A PAINFUL CONDITION, so in acute episodes so it imperative in acute episodes to use analgesics (pain killers) prescribed by your vet (NB many pain killers are toxic to cats)

Sedatives may be used but only for short periods to deal with transitional  stress.There are also other CNS drugs but we prefer not use them if possible.

We can  drugs to try to protect the mucous layer GAGS –we are not sure how effective these are but they do not have side effects..

DIETARY MODIFICATION

You must encourage more frequent urination and urine which is less irritating to the bladder. We can achieve this by two means changing the substances in the urine and making the urine more dilute. This we do by feeding a superior quality moist diet or a special veterinary prescribed diet or a combination of both, as well as encouraging your cat to drink more. 

Changing cats to a new diet can sometimes be difficult. These tips may help:

  • Always make a change in diet gradual – for several days at least and sometimes over a few weeks if your cat is quite fussy
  • Warming the food to body temperature (around 30°C) may help increase the palatability

Other measures to increase water intake

  • Making sure a good supply of fresh water is always available – cats should be encouraged to drink by offering water from different bowls, etc
  • Using flavoured waters (chicken or tuna, for example) or water fountains to encourage drinking

Encourage drinking and urinating by altering the environment to suite your cats.

To encourage cats to drink, it is important to provide water in different places, where the cat is comfortable to spend time and drink. Avoid noisy places or anywhere close to a litter box. Ideally provide water (and food) in several locations and use ceramic bowls rather than metal or plastic which can leave an unpleasant odour or taste. Try using shallow bowls rather than deep-sided bowls so that the cat can see what is going on around at the same time as drinking and so that the whiskers do not brush against the sides of the bowl (which can be irritating for cats). Also try flavoured or running water (pet fountains) as these are preferred by some cats.

Make sure your cat has every opportunity to urinate frequently. Make sure there is at least one litter box for every cat in the household PLUS AN ADDITIONAL ONE. Experiment with litter boxes in different locations and use different types of litter in the box to the  location and type of litter your cat

Reduce Stress

It is crucial investigate and eliminate or reduce  any specific stressful situations or set up in the environment - this could be another pet in the house, abrupt changes in diet, overcrowding, owner stress, or changes to the people in the house.

One of the single most common cause of probably conflict with another cat in the household or strange cats  encroaching on your cats environment. This is not always  easy to detect, but should always be suspected in a cat with FIC.

Many, but not all that cats spend most of their time indoors, are susceptible to stress. This is because they do not experience the different stimuli and environmental stimuli that the outdoors provide. The become bored, stressed and depressed.

We can do many different things to help them.

  • Set aside some time every day to play with your kitty-play a variety of different games .
  • Give them toys to play with
  • Allowing the cat some outdoor access, even in an enclosed run if necessary, can provide interest and stimulation
  • Modify the environment so that there is plenty of interest for the cat (scratching posts, etc) and resting places for the cat. Cats need a certain amount of space, and need to be able to have a degree of control over that environment. It is important that they can explore their environment and have hiding places - ideally in elevated locations (eg, on top of furniture or cupboards).
  • There are synthetic feline facial pheromones in the form of a spray, and a collar.

 

LONG TERM OUTLOOK

Most cats with FIC respond well to a change in diet and enviroment as described above.There are a few cats who have recurrent\ episodes even with dietary and enviromental modification.These cases should undergo more intesivive investigation. If they are still unresponsive a trial of other CNS drugs and/or GAGS should be instituted.
 

Dr Larry Kraitzick B.V.Sc
Bruma Lake Veterinary Clinic (Find Dr Larry on Facebook)

Dr Larry KraitzickQualified in 1990 with Bachelor of Veterinary of Science from Onderstepoort Veterinary Faculty.
In 1991 he ran a welfare clinic in Alexander Township. He went to the United Kingdom to register as a Member of the Royal College of Veterinary Surgeons in 1992 and began working at Yeoville Veterinary Clinic, which he took ownership of in 1993. Whilst running Yeoville Veterinary Clinic Dr Kraitzick  collaborated with Dr Leo Reinecke (Human Radiotherapy Specialist)  in treating selected pet cancer Patients with Chemotherapy.
He started Bruma Lake Vet Clinic in Johannesburg in 2002.  He travelled to the USA in 2013 to learn about the value of client communication and education using Media  with the emphasis on Electronic and Social Media. In October 2014 he started The Old Folk Pet Support Group and was part of a group who intervened to prevent senior residents of Tweedy Park (a government housing project on the East Rand) from being forced to get rid their pets.
Dr Kraitzick is married with two sons, three cats and a dog.


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