Feline Idiopathic Cystitis (FIC)

Overview of Feline Idiopathic Cystitis (FIC)

Feline idiopathic cystitis (FIC) literally means an inflammation of the urinary bladder in cats of unknown origin. It is also called feline idiopathic lower urinary tract disease (FiLUTD), painful bladder syndrmoe (PBS) or feline urologic syndrome (FUS). FIC has been estimated to affect up to 1% of the cat population.

Despite many years of research, the cause of FIC remains unknown. Factors that may play a role in the development of FIC include viruses, type of diet fed (especially dry food diets with high mineral content), stress, confinement to a strictly indoor environment, and genetic factors (longhaired cats, for example, seem to be more commonly affected). Treatment often involves a change in diet from a dry food to a canned food and attempts to minimize stress in the animals environment.

It’s believed that accumulated inflammatory debris and mineral crystals may form a plug that obstructs the urethra of male cats resulting in a life-threatening medical emergency. FIC affects both male and female cats, but female cats rarely develop urinary tract obstruction because their urethra is shorter and wider than the urethra of male cats.

What To Watch For

• Blood in the urine
• Increased frequency of urination
• Straining to urinate
• Distressed meowing while urinating
• Increased grooming of the genital region
• Urinating in inappropriate locations (often in cool smooth surfaces such as bathtubs and sinks).

These symptoms can be mistaken for constipation. Frequent unsuccessful attempts to urinate, distressed meowing while attempting to urinate, lethargy, loss of appetite, vomiting and reluctance to move are symptoms that may signal urinary obstruction in a male cat and may constitute a medical emergency. Call your veterinarian immediately if you think your cat is showing these symptoms. Complete urinary obstruction can develop into a life-threatening emergency with 48 hours.

Veterinary Care

Diagnostic tests are needed to identify FIC and exclude other diseases. Tests may include:

• Complete medical history and thorough physical examination including abdominal palpation of the bladder. The medical history will include questions about previous urinary problems and type of cat food (dry versus canned) fed to your pet.
• Urinalysis.

Additional diagnostic tests may be necessary to distinguish FIC from other diseases that cause lower urinary tract symptoms in cats such as bacterial urinary tract infection (rare in young to middle-aged cats), stones (also called calculi or uroliths), and tumors (rare in cats).

Additional tests may include

• Serum biochemistry tests to evaluate your cat’s general health and evaluate for the metabolic effects of urinary tract obstruction.
• Abdominal Radiographs (X-ray) to evaluate for dense stones (calculi) such as those made of struvite and calcium oxalate.
• Urine culture and sensitivity Culture to evaluate for bacterial urinary tract infection.
• Special contrast X-rays to evaluate the urethra and bladder for less dense stones that cannot be seen on plain X-rays and to identify tumors or anatomical abnormalities such as an outpouching of the bladder (urachal diverticulum).
• Abdominal ultrasound to evaluate for tumors and less dense stones that cannot be seen on plain X-rays.
• Cystoscopy to evaluate the inner surface of the urethra and bladder. In this procedure a flexible or rigid scope is passed into the urethra and bladder while the animal is under anesthesia. If cystoscopy is necessary in your cat, your veterinarian likely will refer you to a veterinary specialist for this procedure.

Treatment for FIC may include one or more of the following:

• Unrestricted access to large amounts of fresh clean water is very important so as to increase water intake and cause the cat to produce less concentrated urine. Some companies have developed products such as the pet “waterfall” to increase the cat’s interest in drinking.
• Change in diet from a dry food to a canned food to increase water intake and cause your pet to produce less concentrated urine. Bouillon, clam juice, juice from canned tuna, and water also can be added to dry foods to increase water intake.
• Attempts to reduce stress, such as providing climbing toys, scratching posts, and toys to chase are recommended by some veterinarians. Learn more about how to Reducing Multicat Household Stress.
• Although antibiotics are frequently prescribed for cats with FIC, there is no evidence that FIC is a bacterial disease.
• Likewise, occasionally cortisone-like drugs are prescribed for their anti-inflammatory effects but there is no evidence that they hasten recovery.
• Some veterinarians prescribe analgesic (pain reducing) drugs such as Butorphanol Tartrate (Torbugesic®, Torbutrol®) during a bout of FIC.
• Most cats with an acute bout of FIC will get well within in 5-7 days regardless of the treatment employed.
• The tricyclic antidepressant drug amitriptyline has been tried in refractory cases of FIC after owners have become frustrated with other medical approaches. This drug also has anti-inflammatory properties and encourages bladder filling. It should only be tried in refractory cases.
• Male cats that develop urinary obstruction should be seen by a veterinarian as soon as possible. Urinary obstruction of more than 48 hours can become life-threatening. Such cats lose their appetite, become lethargic, and make frequent distressed attempts to urinate.

Home Care

At home, it is important that you allow free access to fresh clean water and provide a fresh, clean litterbox at all times. You should administer as directed any medications prescribed by your veterinarian and follow-up with your veterinarian for examinations and urinalysis.

If your pet does not respond to initial treatments, additional diagnostic evaluation and treatment is indicated.

Preventative Care

Since the exact cause of FIC is unknown, it may be difficult to prevent. However, you can do some of the following:

• Provide your cat with frequent opportunities to urinate (make sure to provide a clean litterbox at all times).
• Provide plenty of fresh clean water for your cat to drink.
• Help your pet maintain a healthy body weight and prevent obesity by feeding the correct amount of a healthy diet.
• Feed a canned food product if at all possible.
• Try to minimize stress for your pet by keeping the environment as stable as possible (for example, do not introduce new animals). Provide scratching posts, climbing toys, and toys to chase. For tips on how to enrich your cats environment, please read Selecting the Right Environmental Enrichment for Your Cat.

In-depth Information on Feline Idiopathic Cystitis (FIC)

Other medical problems can lead to symptoms similar to those encountered in FIC. These conditions should be excluded before establishing a diagnosis of FIC.

• Bacterial urinary tract infection Acute (bacterial cystitis). Bacterial urinary tract infection is a very uncommon cause of lower urinary tract symptoms in young to middle-aged cats.
• Bladder stones (bladder calculi or uroliths).
• Congenital anatomic abnormality (urinary system defects present at birth) such as an outpouching of the bladder (“urachal diverticulum”).
• Constipation. It is very easy to confuse difficult urination and difficult defecation. Cats assume a more upright posture when defecating than they do when urinating and observing the cat’s posture can help you decide whether the cat is attempting to defecate or urinate.
• Urinary Bladder Cancer. Tumors of the bladder are very rare in cats.
• Nervous system abnormalities that interfere with the normal control mechanisms of urination.
• Inappropriate urinations due to a behavioral disorder. Cats are territorial animals. When they sense their “space” has been invaded, cats often will mark their territory by urinating outside of the litter box. Sometimes it can be very difficult to differentiate inappropriate (behavior-mediated) urinations from urinating outside of the litter box as a manifestation of FIC.

Diagnosis In-depth

Diagnostic tests must be performed to confirm a diagnosis of FIC and exclude other diseases that may cause similar symptoms. The following diagnostic tests are often recommended:

• Your veterinarian will take a complete medical history and perform a thorough physical examination. Special attention will be paid to palpation of the abdomen to feel the bladder.
• Urinalysis usually is performed to diagnose FIC. Sample collection by cystocentesis in which a needle is directed through the abdominal wall and into the bladder avoids contamination of the urine sample by the urethra or genital tract. However, the possibility that red blood cells will be introduced into the bladder by cystocentesis and the fact that a sample collected by cystocentesis does not assess inflammation in the urethra have led to the recommendation by some veterinarians that a voided sample also be evaluated. The concentrated or dilute nature of the urine is evaluated by a test called “urine specific gravity.” Its relative acidity or alkalinity is evaluated by pH, and several chemical tests (for protein, glucose, etc.) are performed. The urine sample is evaluated microscopically for red blood cells, white blood cells, crystals and bacteria.

Your veterinarian may recommend additional diagnostic tests to exclude or diagnose other conditions that may cause urinary tract symptoms and to better understand the impact of FIC on your pet. These tests ensure optimal medical care and are selected on a case-by-case basis.

Additional Tests

• Urine culture and sensitivity to evaluate for bacterial urinary tract infection (bacterial cystitis). Bacterial urinary tract infection is very uncommon in young to middle-aged cats.
• Serum biochemistry tests may be recommended to evaluate the general health of your cat or to evaluate for the metabolic effects of urinary obstruction in male cats.
• Plain abdominal X-rays may be taken to evaluate for dense stones in the bladder such as those made of struvite or calcium oxalate.
• Special contrast X-ray dye studies may be recommended to evaluate for less dense stones, tumors, or anatomical abnormalities such as an outpouching of the bladder (“urachal diverticulum”). Such studies are called “positive” contrast studies if the inside of the bladder and urethra are outlined by the radiographic contrast dye. This material appears “white” on the X-ray or “negative” contrast studies if the inside of the bladder and urethra are outlined by injected air which appears “black” on the X-rays. Studies that include the use of both contrast dyes and air are called “double contrast” studies. Your veterinarian will decide which of these procedures is indicated in your pet.
• Abdominal ultrasound examination may be recommended to evaluate for less dense stones or tumors that cannot be identified on plain X-rays.
• Cystoscopy is a technique in which a rigid or flexible scope is passed into the urethra and bladder with the animal under general anesthesia for direct visualization of the inside lining of the urethra and bladder. This technique allows direct visualization of characteristic bladder hemorrhages in FIC and allows biopsy specimens of the bladder to be obtained. Your veterinarian likely will refer you to a veterinary specialist if this procedure is necessary.

Treatment In-depth

Treatment of FIC must be individualized based on the severity of the condition and other factors that must be analyzed by your veterinarian. Treatments may include:

• Unrestricted access to large amounts of fresh clean water is very important so as to increase water intake and cause the cat to produce less concentrated urine. Some companies have developed products such as the pet “waterfall” to increase the cat’s interest in drinking.
• Change in diet from a dry food to a canned food to increase water intake and cause your pet to produce less concentrated urine. Bouillon, clam juice, juice from canned tuna, and water also can be added to dry foods to increase water intake.
• Fluid therapy may be recommended in dehydrated pets. Fluid therapy also facilitates increased production of dilute urine (“diuresis”) which may aid in the elimination of inflammatory debris and crystals.
• Although antibiotics frequently are prescribed for cats with FIC, there is no evidence that FIC is a bacterial disease.
• Likewise, occasionally cortisone-like drugs are prescribed for their anti-inflammatory effects but there is no evidence that they hasten recovery.
• In severe cases, the anti-inflammatory agent Dimethyl sulphoxide (DMSO) may be infused into the bladder while the cat is under general anesthesia. Your veterinarian may suggest referral to a veterinary specialist for such a procedure.
• Attempts to reduce stress such as providing climbing toys, scratching posts, and toys to chase are recommended by some veterinarians. For tips on enriching your cats life, please read Selecting the Right Environmental Enrichment for Your Cat.
• Some veterinarians prescribe analgesic (anti-pain) drugs such as butorphanol during a bout of FIC.
• Most cats with an acute bout of FIC will get well within in 5-7 days regardless of the treatment employed.
• In some cases, drugs to relax the urethra (acepromazine, phenoxybenzamine) are prescribed to reduce the likelihood of urethral obstruction.
• Most cats with an acute bout of FIC usually recover within in 5-7 days regardless of the treatment employed.
• The tricyclic antidepressant drug amitriptyline has been tried in refractory cases of FIC after owners have become frustrated with other medical approaches. This drug also has anti-inflammatory properties and encourages bladder filling. It should only be tried in refractory cases.
• Male cats that develop urinary obstruction should be seen by a veterinarian as soon as possible. Urinary obstruction in cats for more than 48 hours can become life-threatening. Such cats lose their appetite, become lethargic, and make frequent distressed attempts to urinate.

Home Care of Cats with Idiopathic Cystitis

Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be crucial and includes the following:

• Physical examination and urinalysis in Cats should be repeated 5-7 days after resolution of clinical signs or discontinuation of drugs administered on a temporary basis such as butorphanol for pain and acepromazine and phenoxybenzamine to relax the urethra.
• Give all medications prescribed by your veterinarian, as directed.
• Provide your pet with frequent opportunities to urinate (make sure to provide a clean litterbox at all times).
• Provide plenty of fresh clean water for your cat to drink.
• Help your pet maintain a healthy body weight and prevent obesity by feeding the correct amount of a healthy diet. For tips on preventing obesity – please read Obesity in Cats.
• Feed a canned food product if at all possible.
• Try to minimize stress for your pet by keeping the environment as stable as possible (do not introduce new animals), provide scratching posts, provide climbing toys, and provide toys to chase. If you have multiple cats – please read Tips on Reducing Multicat Household Stress.
• Contact your veterinarian if you are experiencing difficulty treating your cat or if you are concerned that your male cat may be developing urinary tract obstruction. Frequent unsuccessful attempts to urinate, distressed meowing while attempting to urinate, lethargy, loss of appetite, vomiting and reluctance to move are symptoms that may signal urinary obstruction in a male cat and may constitute a medical emergency.