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The Daily Vet by petMD

The Daily Vet is a blog featuring veterinarians from all walks of life. Every week they will tackle entertaining, interesting, and sometimes difficult topics in the world of animal medicine – all in the hopes that their unique insights and personal experiences will help you to understand your pets.

Feline Urinary Issues: Treating Feline Idiopathic Cystitis (FIC)

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We’ve already talked about treatment options and their potential pitfalls for cats suffering from bladder infections and bladder stones. Today, on to the conundrum that is 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.


Litter Boxes

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.


I’ll talk about how to switch a cat that prefers eating dry food to canned, and other options for increasing water consumption next week.


Glycosaminoglycan Supplements

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.


Next Week: How to Get Cats to Drink More Water



Dr. Jennifer Coates



Image: Oliver Eyeing his Prey by Mr. T in DC

Comments  2

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  • 02/04/2014 04:11pm

    I have been having almost identical issues with my 2 year old male cat. This started Christmas day 2013 and has not ended since. He has been on Hills CD, amitriptyline daily (was 5mg now 10mg) and off/on phenoxybenzamine, buprenor and prednisolone. He just started taking glucosamine supplement.
    Since this all began he's had "better" days but has never really been able to pee normally since. He blocked twice when this all began and they determined the issues is red blood cells. They have done repeated blood tests, xrays, ultrasounds, urinalysis and have ruled out everything and believe this is FIC.
    However, we can't seem to get him back to normal, even with the higher dose of amitriptyline. He is currently lacking energy, seems to have dry mouth and has almost totally lost his appetite. I am at a loss of what to do next, this has already cost us thousands of dollars. He still has to use the box multiple times to empty his bladder and still has days where I have to give him his "as needed" pain meds so he isn't in/out every 20 seconds.
    He is currently on just the amitriptyline 10mg and glucosamine. I am wondering how long it took your cat to recover with these meds, and what side effects did you see from the amitriptyline? I am wondering if his lethargy, dry mouth and loss of appetite are from the higher dose.
    Thank you...

  • Chronic FIC
    01/05/2013 01:44pm

    This Chronic FIC is driving my poor little boy Makaveli and I crazy. He has had all the tests, and all "seems" well, but he always ends up with an episode of FIC on a Friday night or a Saturday no matter what meds he is on. As a pet parent, it is like torture watching him be in pain. I started getting anxiety myself and couldn't eat, not to mention his vet bills have piled up and being a single mother, this has been another source of stress. I feel like he is never going to be well, and it makes me feel horrible and helpless. This has been going on all of December. Practically every weekend. I saw another comment where she mentioned she thought it was neurological, which I suspect what is going on with Makaveli. I find it so strange that all week he is fine, and once Friday and Saturday come he has another episode. I am just at a loss.

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