Treating Feline Idiopathic Cystitis (FIC)
Cats are diagnosed with FIC when they have one or more of the typical symptoms of lower urinary tract disease (e.g., urinating outside of the litter box, straining to urinate, painful urination, producing only small amounts of sometimes discolored urine, and/or frequent attempts to urinate) and other potential causes have been ruled out. Fifty-five to sixty percent of cats with the aforementioned symptoms are eventually diagnosed with FIC.
One of the biggest difficulties in treating FIC is that we don’t really know what causes it; risk factors like stress and obesity seem to play a role. Other possibilities include viral infections, immune dysfunction, a deficient glycosaminoglycan layer protecting the inside of the bladder, or an abnormally permeable bladder wall. You’ll notice that the following treatment recommendations are all aimed at one or more of these potential causes.
Stress Relief and Environmental Enrichment
Research has shown that cats with FIC tend to have a neurohormone imbalance, making them especially sensitive to environmental stress. So while all cats benefit from environmental enrichment, it is an essential part of treating cats with FIC. Indoor cats are primarily stressed by boredom, so play with your cat, regularly rotate the toys that are available, routinely buy or make new toys, keep several different types of scratching posts available, and place a comfy perch near a window (even better if it is screened and you can safely open it). Cats also don’t like surprises, so try to keep your cat’s routine as predictable as possible.
If you have multiple cats and their interactions are stressful, consider separating them, or at least have individual feeding stations and lots of hiding places and covered escape routes available.
Dirty litter boxes are another common source of stress, so keep them scrupulously clean. Open boxes don’t smell as bad and are less cramped than those that are covered, and you should have multiple boxes (at least one more than the number of cats in the house) to spread the waste around and prevent conflicts around elimination sites.
Dietary Changes and Water Consumption
Eating canned food can help cats with FIC. We think that the reason this works is because the primary ingredient in canned food is water, so feeding canned food is a simple and effective way to increase a cat’s water consumption. Cats that are well-hydrated produce dilute urine, which is less irritating and "washes away" inflammation from the bladder wall. Dilute urine is also beneficial if your cat has been diagnosed with urinary crystals or stones, so talk with your veterinarian to determine if an over-the-counter or prescription cat food is best for your cat.
Glycosaminoglycans are primarily used to treat osteoarthritis, but they may be helpful in some cases of FIC as well. Research hasn’t really supported this claim yet, but these injectable or oral products are very safe, so there is not much risk in giving them a try.
An ideal treatment protocol would completely eliminate a cat’s symptoms for the rest of her life — and this may occur in some cases — but if you and your veterinarian come up with a plan that is not too difficult to follow, and dramatically reduces the intensity and frequency of flare-ups, you’ve made major strides in improving your cat’s quality of life. Hopefully, future research will come up with both a cause and a cure for the frustrating condition that is FIC.
Dr. Jennifer Coates