What is FIC?
Feline idiopathic cystitis (FIC) is a term used to describe one of the causes of feline lower urinary tract disease (FLUTD). The term “idiopathic” means that the actual cause of the condition is unknown and “cystitis” refers to inflammation of the urinary bladder.
The diagnosis of this condition is reached by ruling out all other possible causes of inflammation of the urinary tract of cats.
The cause of FIC is unknown but there is quite a bit of active research going on in this field. The condition is thought to be similar to a syndrome called interstitial cystitis that affects women and is a type of sterile (meaning not infectious) cystitis. A lot of the work being done on human interstitial cystitis is able to be applied to cats with FIC.
Researchers think that the bladder lining becomes inflamed due to an exaggerated stress response - kind of like the fight or flight response but in cats with FIC it is not just a fleeting surge of chemicals, it’s turned on all of the time. A by product of the elevated levels of stress hormones is that the bladder wall starts to become ‘leaky’ and allows highly concentrated urine to permeate into the deeper layers of the bladder wall which in turn creates yet more pain and inflammation in the bladder wall.
Urination becomes painful and the cat will often associate that pain with the litter tray explaining why many cats will urinate outside of the tray when they have FIC.
Clinical signs of FIC include:
Haematuria - blood in the urine (which may be microscopic and only detectable on a dipstick)
Dysuria - difficult, painful urination
Stranguria - straining to urinate
Pollakiuria - increased frequency of urination attempts
Periuria - urinating in unusual or inappropriate places
It should be mentioned that male cats, because of the small diameter of their urethra, can develop a potentially fatal blockage of their urethra as a complication of this condition. This means that if you ever see a male cat who appears to be trying to pass urine and nothing comes out, they should be taken to a vet or emergency vet immediately.
Some misconceptions about FIC
Cystitis has been occurring in cats for just about as long as we have been feeding them commercially prepared foods (interesting) and there is a list of treatments used over the years that spans many pages. The truth is that episodes of FIC are usually self limiting and subside by themselves over 3-7 days. It is for this reason that a lot of the treatments that we used to prescribe appeared to work and have subsequently been promoted as ‘cures’ for this condition.
All of the large scale studies have shown that most of these treatments are not much better than placebo and this is why we now focus on managing the symptoms of this condition and not curing the problem per se.
Some specific examples of older treatments are the use of antibiotics to control FIC and focussing on reducing crystals in urine. Bacterial infection of the urinary tract of cats is extremely uncommon in cats under the age of 10 years, unlike dogs. This is because most cats in this age group tend to concentrate their urine so well that bacteria are unable to grow in it. It is for this reason that antibiotics are very rarely indicated for treatment of FIC and never without a positive urine culture. We, as vets, also used to focus on the presence of crystals in cat’s urine as a potential cause of clinical signs but it has since been shown that crystals are seen in the urine of healthy cats, as well as those with FIC, and do not play a role in the development of FIC.
Management of FIC
It has been shown that eliminating or reducing stress can resolve symptoms of FIC. It makes sense then that trying to understand the nature of cats will help to find ways to reduce stress and seeing the home environment from the feline point of view is essential.
An excellent reference for this is at http://indoorpet.osu.edu/cats/
Cats are creatures of habit and like routine. Therefore, any disruption in daily routine can cause a stress response. Potential ‘stressors’ in a cat’s life can include moving, whether across the country or just moving furniture around the current home Additions or subtractions from the household population of people or companion animals are also major sources of feline stress. Even a stray cat outside a window can make a cat anxious. A change in a cat caretaker’s schedule or stress in the caretaker’s life can also put a cat on edge.
In multi-pet households, there should be plenty of resources for each and every animal; these include food and water bowls, toys, resting spots, and, of course, litter boxes. Any change to the litter box style, litter, or location can make a cat seek alternative areas in which to eliminate.
Even though it may be hard to stay calm and in control when the household feline is eliminating outside the box, yelling at the cat or attempting any form of punishment will only serve to increase stress and lead to an exacerbation of the problem. Cats are not spiteful and do not hold grudges. They do not eliminate outside the litter box to ‘get even’ with their caretakers. they have chosen alternative toilets because their bladders hurt and they associate the litter box with pain.
Treatment of FIC (and preventing recurrences)
Since the cause of FIC is not well understood, there are no easy solutions to resolving the associated clinical signs. A multimodal approach has been shown to be most effective but it is important to remember that all changes must be made slowly to prevent a flare up in stress levels.
Increasing water consumption
Increasing water consumption reduces the concentration of urine therefore diluting the noxious substances in it. it will also increase urination which helps to reduce the contact time that urine has with the bladder. Part of the problem with cats is that they evolved in arid environments and as such do not instinctively drink a lot of water.
The easiest way to increase water intake and the only treatment that has been proven to help reduce the signs of FIC is to feed wet food exclusively. This includes sachet food, canned cat food and home cooked diets. Feeding wet cat food is the single most important step in treating FIC.
Electric pet drinking fountains may be useful in encouraging cats to drink more as they often enjoy drinking running water and may drink more when the water is constantly flowing.
Flavouring cat’s water with the juice from canned tuna can help can help some cats to drink more.
Also make sure that water bowls are always clean and wide and shallow as some cats don’t like their whiskers touching the sides of the bowls as they drink.
Some cats prefer bottled water or seem to dislike the taste of town water if given the choice.
Litter box management
Litter box management is very important in managing cats with FIC.
A household should have one litter tray for every cat plus one extra litter tray. They should be scooped or cleaned whenever they are used as some cats prefer not to use a tray that has already been used. Be careful of scented litter as this may cause aversion in some cats, although we humans may personally think the scent is great. Consideration should be given to trialling a few different types of litter until the one is found that the cat prefers. This really is one area that the cat has to be allowed to choose for themselves.
Placement of litter trays is important in that they should be in quiet areas away from children, other pets and noisy appliances like the washing machine or dryer. If your have a multi storey house then boxes should be located on all storeys.
MEMO (multimodal environmental enrichment) is a term that has been coined to describe a multipronged approach to making the indoor environment more stimulating for cats. The aim of this approach is to allow cats to feel comfortable and relaxed in their environment at home and therefore reduce the circulating levels of stress hormones. This should reduce the severity and duration of symptoms of FIC and at the very least your cat will be happier.
See the indoor pet website for more information on MEMO.
Cleaning urine stains
It is best not to use harsh chemicals to clean up cat urine or the cat could be stimulated to return to the same area again and again. Mild unscented cleaners like dishwashing liquid are good options for cleaning stains and then enzyme based products like Urine-Off should be sprayed over the stain to remove any residual odour.
FIC is a painful condition, and pain management should be considered an important part of managing the condition in cats.
Options are anti inflammatory medications or opiates, however it is very important that these medications are cat-specific dispensed from a vet as cats are not able to metabolise a lot of human over-the-counter medication.
Pheromones are secreted from a cats facial glands in front of their ears and are usually rubbed on surfaces and people when cats are feeling comfortable and relaxed.
Feliway is a synthetic analogue of the feline facial pheromone and can be used as a spray and a room diffuser. It has been reported to help calm stressed cats and therefore may help with FIC symptoms.
Behaviour modifying drugs are not a cure-all for stress-related diseases like FIC in cats.
They can however, sometimes be useful if all other methods have been tried and especially if used in conjunction with other dietary and MEMO techniques.
Other therapies which may help but have not been studied enough and are unlikely to harm your cat are fatty acid supplementation (fish oil capsules) nutraceuticals such as PSGAGs which are sometimes used in the management of interstitial cystitis in women.