A Guide To Feline Stress Cystitis (Feline Idiopathic Cystitis / FIC)

What is feline idiopathic cystitis (FIC) in cats?

Cystitis is common in cats and is often not due to infection within the bladder, but rather inflammation. This is the case with feline idiopathic cystitis (FIC) where there is inflammation in the bladder causing cystitis-like signs than can be recurrent. Symptoms can vary from mild to severe, and the condition can even be life-threatening if it results in a urethral obstruction (blocked bladder).

What are the symptoms of FIC in cats?

The signs can be variable, but typically include:

• Straining to urinate (often looking pained)
• Urinating more frequently than usual
• Passing small amounts of urine
• Digging in the tray / going in and out of the tray
• Blood in the urine
• Urinating outside of the tray, often in odd places
• Grooming excessively around the back end
• Vocalising/meowing more than usual

What causes FIC in cats?

We do not know what causes this inflammation, but it does frequently appear to be linked to stress. For example, there is often a recent history of a new cat in the house or street, building work, visitors to the house, or the arrival of a new baby. Even moving furniture around can be stressful for cats, who love stability and routine. FIC is also more common in overweight, indoor, male cats and those that live in multi-cat households.

When should I contact my vet if I think my cat is suffering from FIC?

As mentioned above, this condition can be life-threatening particularly in male cats, due to the risk of urethral obstruction (blocked bladder) where the cat is unable to urinate. It is therefore crucial to speak to your veterinary surgeon if you are concerned that your cat may be suffering from cystitis.

How is FIC in cats diagnosed?

At present there is no test to diagnose FIC, so we tend to use a combination of the tests below:

• Urine sample (to rule out bacterial infection and check for the presence of crystals that can cause bladder stones)
• Imaging of the bladder using x-rays and/or ultrasound scan

How can FIC in cats be managed?

There is no single treatment for FIC and it is best managed by a multifactorial approach using the strategies below to help reduce the frequency and severity of episodes. While drugs can help, it is now recognised that diet, environmental modification and reducing stress have the biggest impact and so the focus should be on these.

1. Dietary modification

• Increasing water intake appears to be beneficial, as it results in a more dilute urine that is less irritant to the bladder lining and where crystals are less likely to form. This can be achieved by feeding a wet rather than dry diet or adding water to the biscuits if your cat will not eat wet food. You could also try using a water fountain, as some cats like to drink from a moving stream of water (hence some like to drink from the tap!).
• Some specialised veterinary therapeutic diets are designed to help with FIC. They contain ingredients such as polyunsaturated fatty acids which may help to reduce bladder inflammation in FIC, as well as anti-stress products and additives that can help to increase water intake. You can find a couple of these diets in our shop by following this link.
• Some cats can be fussy and changing diets can therefore be hard. Do not make any sudden changes, gradually increasing the amount of the new diet over the course of at least several days, if not a few weeks for very fussy cats. Warming the food gently to around 30˚C can help to increase the palatability.

2. Environmental modification

• Be careful with your choice of water bowls. Having multiple bowls and using ones that are wide and shallow that do not irritate your cat’s whiskers can help to increase water intake. Also using glass or ceramic bowls is recommended, as metal and plastic bowls can lead to a bad taste in the water (this may explain why your cat loves to drink out of your glass of water rather than their own bowl!).
• Ensure you have enough litter trays and that they are kept clean. The rule of thumb is that you should have the same number of litter trays as you do cats, plus another one. Even if your cat normally toilets outside it is a good idea to have a litter tray available, in case they are stressed by another cat outside and it therefore gives them another option. Position them in quiet spots where they are not disturbed.
• Provide environmental enrichment such as scratching posts and shelves to climb onto.

3. Reducing stress

• Try to identify any potential stressors and avoid or minimise them where possible.
• Conflict between cats is probably the most common cause of FIC and this conflict is not always obvious. It can be between cats in the same household or those outside.
• Provide hiding places such as a box or enclosed bed where they feel safe.
• Pheromone therapy like a Feliway diffuser can be helpful for some cats as it can make them feel safe and secure. We have these in our shop so please follow this link to have a look.

4. Drug therapy

• Anti-inflammatory pain relief such as Metacam is often used during flare ups to make the cat feel more comfortable, and to help reduce inflammation in the bladder.
• Bladder supplements such as Cystaid Plus (also available from our shop) can help to soothe the bladder lining.

What is the prognosis for cats that are prone to FIC?

The management strategies above can help to dramatically reduce the frequency and severity of flare ups of FIC, although some cases do prove difficult to manage. Some cats will spontaneously improve as they get older.

Please speak to one of our vets to discuss an individual management plan for your cat.