bladder blues: dr. kim smyth explains feline idiopathic cystitis
Feline idiopathic cystitis (FIC) is a big name for a very frustrating disease of the bladder and urethra in cats. Formerly known as feline lower urinary tract disease (FLUTD) and feline urologic syndrome (FUS), it is a condition that can affect young, healthy male and female cats.
The classic case of FIC is a cat who is experiencing difficulty urinating. Clinical signs include:
Painful urination/straining to urinate
Blood in the urine
Increased frequency of urination
Excessively licking genitals
Urinating outside of the litter box or in strange places
Usually, cats with FIC will experience symptoms for 5 to 7 days, and symptoms will resolve spontaneously regardless of treatment. Generally, the symptoms are cyclic, with patients being completely normal between episodes. Recurrence is unpredictable, and some cats can go years without an episode.
The diagnosis of FIC is one of exclusion, meaning that by ruling out other diseases, we can come to a diagnosis of FIC. There is no one test for FIC, as it a syndrome with many contributing causes, some of which we don’t yet fully understand.
The symptoms of FIC are similar (and often identical) to symptoms that cats with other urologic conditions show. Before making a diagnosis of FIC, your vet will have to first make sure that a urinary tract infection or bladder stones aren’t to blame for your pet’s signs.
One very important condition that will need to be ruled out in male cats is urethral obstruction. Male cats are prone to urethral blockage because their urethras are narrow. When the urethra is blocked by a small stone or by a plug of crystals and cellular debris, cats are left unable to urinate. When urine builds up, it causes clinical illness and can lead to death within a couple of days. If your male cat is straining to urinate, please consider this a veterinary emergency and get to your vet’s office as soon as you can.
Cats with FIC will likely need all of the following diagnostics:
Urinalysis. We use this test to look at the urine microscopically, searching for blood, white blood cells and bacteria (which could mean infection), crystals, and anything else out of the ordinary.
Urine culture. This test is usually sent to an outside laboratory (although some clinics run their own) and is used to look for underlying infections. Cultures can also determine which bacteria is causing infection and which antibiotic will be most effective at treating it.
X-ray. X-rays will show most kinds of bladder stones. Not only are bladder stones irritating to the bladder, they can also cause urinary obstruction if they travel into the urethra.
If these tests are negative, your cat may have FIC. Unfortunately, we don’t fully understand the underlying causes of FIC, which is why we call it idiopathic. There are similarities to the human condition interstitial cystitis, which is mostly seen in women, and it is thought that stress plays a role, too, as many cats will respond to environmental enrichment.
There is no proven effective therapy for FIC at this time. Many different therapies have been proposed, and cats with FIC will respond differently to each. If FIC is the diagnosis for your cat, you and your veterinarian will work closely with each other to come to a solution that leads to the least amount of FIC episodes for your cat.
Diet change, increasing water intake, pain control, and the use of anti-depressants are all viable options, as is environmental enrichment. As I said above, FIC is frustrating for both you and your veterinarian. Keeping the lines of communication open is key to finding the best solution to this chronic condition.