What is Feline Idiopathic Cystitis (FIC)?
Feline lower urinary tract disease (FLUTD) is an umbrella term for any disease affecting the feline lower urinary tract (bladder and urethra). Possible causes of FLUTD include bladder stones or, more rarely infection or cancer, but in many cases a cause is not identified. These cases are diagnosed with Feline Idiopathic Cystitis or FIC.
FIC is the most common subtype of FLUTD affecting around 2/3 of the patients seen with these signs. Although the exact cause of FIC is poorly understood, multiple abnormalities can be present, such as a defective bladder lining and abnormal stress responses. Feline stressors come in all shapes and sizes and include multi-cat households where the cats are not part of the same social group (which leads to conflict), inadequate resources (such as water bowls, litter trays, sleeping areas and scratching posts), changes in their routine or environment (such as building work or additional, unusual people or animals in the house, even an unusual scent or noise in the house). Cats with FIC have an excessive and inappropriate stress response which increases their risk of bladder inflammation.
Management of FIC is multimodal i.e. we use lots of different things to bring the disease under control.
- Management of urethral muscle spasm. The urethra is the tube which connects the bladder to the outside world. FIC can cause moderate to marked spasm of the muscles within the urethra which can which can cause a functional obstruction. Medications are sometimes prescribed to help these muscles relax.
- Pain management. Reducing the pain associated with cystitis and urination is important so that the pain does not prevent frequent urination. Thus, pain killers are one of the cornerstones of managing FIC.
- Dietary modification. Encouraging frequent urination and the production of dilute urine (which is less irritant to the bladder) is advised. This can be achieved by changing the diet. Wet food is high in water which is an easy way to get extra water in. Soaking dry food is also a good way to increase water intake. Feeding a urinary diet can be helpful in some instances. Other ways of encouraging water intake include: multiple, large water bowls filled up regularly (cats do not like the side of the bowl to touch their whiskers when they drink), a water fountain, flavoured waters such as tuna/ prawn/ chicken water. Cat milk is not recommended, unless your cat already drinks it regularly.
- Reduction of stress around urination. We want cats with FIC to urinate regularly so that the urine does not sit in the bladder for protracted periods. The advice from feline behaviourists is to have one litter tray per cat plus one. These litter trays should be located in a quiet place away from other resources such as food/ water and sleeping quarters.
- Reducing stress in general. Try to minimise changes in the environment as much as possible as this will reduce stress. If you have more than one cat, even low grade conflict between them can be highly stressful, therefore ensuring they all have access to essential resources is important. Cats should not be fed close together; this is a major feline stressor. The Feliway® website (https://www.feliway.com/uk) has a stress quiz which can be helpful in identifying feline stressors. Using Feliway® or Feliway® Friends diffusers is also highly recommended.
- Supportive supplements that contain L- tryptophan (which gets converted to serotonin; a happy hormone) and GAGS which are reported to support the bladder lining. At the moment there is little evidence to support the use of these supplements and the expected benefit of administering a medication should be balanced against the potential stress associated with administration.
FIC is a disease which is managed rather than cured. Many cats will have a very favourable response to increased water intake and environmental enrichment to reduce stress and boredom. The disease also appears to get better with age.
One final thing to mention is the risk of urethral obstruction which prevents urination altogether. This is more likely in male cats than female and is a life threatening medical emergency. If you see your cat straining to urinate and not passing any urine (sometimes this could be mistaken for constipation), please contact a vet immediately.
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