Feline Idiopathic Cystitis (FIC)

A stress-free environment with lots of elevated areas and hiding places will help reduce the risk of FIC

Picture this: your cat is struggling to pee, there is blood in his urine and he is clearly uncomfortable. You take him to the vet, they run a bunch of tests, and despite what you initially thought must have been a bladder infection, your vet doesn’t prescribe antibiotics. Shock and horror? Is your vet being negligent? Well, if your cat was diagnosed with Feline Idiopathic Cystitis, then your vet did exactly the right thing. How does that work?

What is Feline Idiopathic Cystitis?

FIC is an inflammatory condition of the bladder that is not associated with bacteria. Another name for the condition is Feline Interstitial Cystitis, referring to the type of tissue that is likely to be inflamed. I affectionately call this disease “stress bladder”, because as we will learn, stress is a major contributor in this disease.

The symptoms of FIC can look identical to bacterial UTIs, but when the urine is tested, no bacteria is found, meaning it is a sterile inflammation. This means that antibiotics will not work for this condition, and may actually cause harm.

What Causes Feline Idiopathic Cystitis?

The word “idiopathic” is a medical term that refers to a condition for which the cause is unknown. In other words, it is a fancy way of saying that we don’t know why it happens. There are some known risk factors that can increase the likelihood of getting this disease. The disease is also described as multifactorial, meaning that there are probably multiple factors that combine to cause the disease.

1)Stress

Cats are very prone to stress, but also very good at hiding it. Common stressors for cats may be moving house, changes in feeding, litterboxes, new pets or humans or changes in owner schedules.

2) Obesity

3) Decreased activity

4) Poor quality diet

5) Inadequate water intake

6)  Genetics

Persians and long-haired cats are at an increased risk, while Siamese cats seem to have a reduced risk, but any breed of cat can get FIC.

What Are The Symptoms Of Feline Idiopathic Cystitis?

The symptoms of FIC can be identical to other lower urinary tract conditions such as UTIs and bladder stones, and include:

·       Struggling to urinate

·       Staying in the litterbox for long periods of time

·       Vocalising when urinating

·       Urinating outside the  litterbox or in unusual places

·       Blood in the urine

·       Frequent passing of small amounts of urine

FIC can also cause bladder blockages, where a cat is completely unable to urinate. This is a medical emergency and needs to be seen by a vet without delay.

How Is Feline Idiopathic Cystitis Diagnosed?

FIC is a diagnosis of exclusion, meaning that other causes of the same symptoms need to be ruled out. It is very poor practice to skip all diagnostics in these cases, as the wrong treatments can cause harm to your cat.

1) Urinalysis

Your vet should be performing a urinalysis any time your pet has symptoms related to the bladder or kidneys. A urinalysis usually consists of a specific gravity (SG) measurement to see how concentrated the urine is, a dipstick analysis, a sediment analysis and a smear to look for bacteria, crystals and other significant cells. A urinalysis can be done manually, with special machines or by a laboratory.

Some of the tools your veterinarian will use to perform a urinalysis: A microscope, dipstick, refractometer and urine sediment stain.

2) Urine culture

If your vet saw bacteria on the smear, or if they have reason to suspect a bacterial infection, they may recommend sending the urine to a lab for culture and sensitivity testing. This will help determine the exact species of bacteria involved (if at all), and which antibiotics they are sensitive to.

Without culture, your vet can only make an educated guess about which antibiotic to use, and sometimes we are wrong. Unfortunately, antibiotic resistance is a real problem in our world today, and we frequently encounter resistant infections that require less commonly used antibiotics. Culture is a good example of responsible antibiotic use, and will help to ensure that our children (human and animal!) will have effective, life saving antibiotics in the future.

A microscope image of a urine smear showing severe pyuria (white blood cells in the urine) with bacteria.

3) X rays or ultrasound

If your vet may recommend x -rays to rule out bladder stones or anatomical abnormalities  of the urinary tract.

4) Bloodwork

If your vet is suspicious that your cat may have another underlying problem, they may recommend a blood panel to check organ function and blood cell counts.

If It’s Not FIC, Then What Is It?

As mentioned above, there are several conditions that have identical symptoms to FIC, but require different treatments, which is why it is necessary to run tests to confirm the diagnosis. Veterinarians call this differential diagnoses, and some of the differential diagnoses for FIC includes:

·       Bacterial urinary tract infections (UTIs)

·       Behavioural problems (e.g. territorial marking)

·       Bladder stones

·       Anatomical defects (e.g. vesicourachal diverticula)

·       Bladder cancers

Radiographs revealed that this cat with lower urinary tract symptoms had a bladder stone.

How Is FIC Treated?

Once other causes of lower urinary tract symptoms have been ruled out, treatment for FIC will commence. Due to the complex nature of this disease, treatment is also not straightforward, and a holistic approach is required for successful management.

1) Stress management

Entire books can be written about stress management in cats, and I will not be going into great detail in this article, but some measures will include:

·       Provide one food bowl, water bowl and litterbox per cat PLUS ONE to prevent stress around resources in multi-cat households.

·       Provide appropriate hiding places and safe spaces for cats in the house.

·       Manage inter-cat conflict (this may require professional behavioural consultations)

·       Use pheromones (Feliway) in the house

·       Severely anxious cats may require prescription anxiety medications. Speak to your veterinarian about this.

2) Diet or supplementation

There are some excellent urinary diets and supplements on the market that help manage FIC and other urinary issues. Overweight cats also need to lose weight, as obesity is considered a risk factor for FIC.

Some examples of diets and supplements that your vet may recommend for a cat with bladder problems.

3) Medicine

Your veterinarian may prescribe medication to reduce pain and inflammation in the bladder. Some commonly used medications for this purpose is anti-inflammatories such as meloxicam, or injectables like pentosan polysulphate. Some cats experience a lot of pain and may require stronger pain medications.

4) Increased fluid intake

Inadequate water intake is a common problem in cats that worsens FIC symptoms. Some ways to encourage water intake in cats is:

·       Providing additional water bowls

·       Placing water bowls far away from food bowls and litterboxes

·       Trying running water (such as cat fountains

·       Water additives to improve the taste

·       Increasing the amount of wet food vs dry food when feeding your cat

5)       Relieving obstructions

Some cats with FIC may experience obstructions of the urinary bladder due to mucous plugs, blood clots or spasms of the urethra. This is a medical emergency, and your cat will need to be sedated to relieve the obstruction, and require intensive care afterwards.

What Is The Prognosis For FIC?

Most cats respond well to treatment, but this is a disease that may recur any time there is a new stressor, diet change or anything else that could be a risk factor for the disease. Owners of cats with FIC must be aware of the cost of diagnosis and treatment each time the condition comes back. Owners must understand that there is no magical injection that will cure the disease, and they must be committed to the lifelong holistic management of the disease.