Post by Angel Macy on Jan 26, 2014 14:34:16 GMT -5
Feline Idiopathic Cystitis (FIC) is a possible explanation for cats showing signs of feline lower urinary tract disease (FLUTD) that do NOT have evidence of bacterial urinary tract infections, cystic calculi (i.e. bladder stones), renal disease, or other endocrinopathy that would explain inappropriate urination. Signs of FLUTD could include straining to urinate, urinating small amounts frequently, pain with urination, vocalizing, urinating outside the litter box or spraying, blood in the urine, etc. Sometimes the diagnosis of FIC can be most obvious when episodes of inappropriate urination coincide with obviously stressful events in a cat’s life. The disorder of FIC is very similar to what is known as “interstitial cystitis” in women.
Less than 2% of male cats between 1-9 years of age have true bacterial urinary tract infections. ~10-30% of cats have bladder stones or crystals. A very small percentage have abnormal anatomy, tumors, or other causes. The remainder of cases are “idiopathic”.
Our current understanding of FIC indicates that it is a systemic disorder related to the autonomic nervous system that manifests itself in some cats as a chronic syndrome of pelvic pain. These cats usually exhibit signs that are considered consistent with lower urinary tract disease, such as straining to urinate, increased frequency of urination, urgency to urinate, hematuria, etc. The typical course of the disease is a waxing and waning of episodes. These episodes can be of variable intensity and duration, ranging from in-apparent to urethral obstruction (“blocked cats”), and they vary between episodes and between cats. There are other disorders that have been observed to occur commonly in cats with FIC, so some cats may display symptoms beyond those associated with the urinary tract (such as vomiting, diarrhea, hypertrophic cardiomyopathy, obesity, etc). but this is not yet well categorized. The important thing to realize is that FIC is a painful condition in these kitties when they are having a flare, and urinating outside the litterbox often is a result of feeling an urgency to urinate and/or associating the litterbox with pain. Although managing a cat with FIC can often feel very frustrating, we are usually able to find a way to keep the disease under control.
FIC can be additionally complicated by the development of a behavioral component to urinating outside the litterbox. Cat urine acts as an olfactory cue to a cat that it is “OK” to urinate in that spot. Once a cat has urinated in a specific place, if the scent of the urine is not completely removed, it can continue to signal to the cat that it can urinate there. Unfortunately, we all known how notoriously difficult it can be to completely remove the scent of cat urine. There are some reasonably effective products available on the market (such as Zero Odor & Anti-Icky-Poo) for removing cat urine, but sometimes it is necessary to consult a carpet cleaning service and obtain an industrial strength cleaner.
In cases of either behavioral or FIC related urinary “accidents” it is recommended to use environmental modification to achieve the desired result of making the cat want to use the litter box again. This means we want to make the litter box the most attractive place for the cat to urinate, while making other areas of the home unattractive for urination. Things to consider are the total number of litter boxes available for use (more is better), the location of the litter boxes in the home (more options is better and locating them in quiet places is usually recommended), the type of litter used (clumping, scent-free is preferred by the majority of cats), how often the boxes are cleaned (at least 1-2 times per day), and how often the litter is changed completely (once a week is recommended). Additionally, if there are specific locations within the house where a cat repetitively urinates, it may be helpful to make these places inaccessible in some way. For example, placing a care floor mat upside down over an area (so the spikey side is up) or using motion activated pressurized air canisters (SCAT) or other devices may discourage cats from visiting these areas. Cats can be very sensitive to perceived punishment from owners, so effort should be made to remove yourself from these negative reinforcements and make them automated.
Although there are medications that can be used in chronic cases to help control the display of symptoms related to FIC, most of them take several weeks to achieve therapeutic doses and none of them have been well studied for true efficacy. The most commonly prescribed is Amitryptyline (Elavil), but there are other possibilities (such as Prozac) available. These medications are not useful in treating an acute episode. Most of the time, FIC flare-ups are self-limiting and will resolve without intervention (provided there are not continued stressors in the environment). The concern with severe flare-ups in male cats is the development of urethral obstruction (UO). UO in these cats is caused by severe spasming, inflammation, and debris in the urethra and results in the inability to urinate. This is life-threatening and fatal if not treated. In cases of severe flare, sedation and pain medications (such as acepromazine and buprenorphine respectively) can be used to break the pain-inflammation cycle, decrease stress-related responses, and prevent further progression of the episode. In instances where stress is anticipated to occur, a lower dose of acepromazine or other sedative may be used as a preventative.
The best treatment we currently have available for FIC is known as environmental enrichment. From what we know about FIC, our understanding is that clinical symptoms associated with FIC are induced by stressful events or conditions in a cat’s life. Different cats have varying sensitivities to the amount of stress they can tolerate before they will display these clinical signs. Some cats are very sensitive (low threshold), while other cats can tolerate much more. This is why some cats go for many years without displaying any problems. Once a cat has passed its personal threshold, however, keeping the overall stress level below their tolerance may be more difficult. Our goal with environmental enrichment is to make the overall stress level in a cat’s life as low as possible, so he will have a greater capacity to deal with any unexpected stressors. Allowing the cat as many choices as possible within his given environment and determining his preferences is usually the most effective way to accomplish this. Multiple water sources, multiple litter boxes, multiple food options, multiple toy types, etc allow an owner to learn what the cat likes best (and therefore keeps his sympathetic nervous system tone lower = less stressed). Other sources of increased sympathetic tone (sympathetic tone is “flight or fight” response) can occur from interactions with strange cats, dogs, people, loud noises, or any abnormality within a cats’ prescribed home environment. Examples could include construction noise down the street, a sad, stressed, or angry owner at home, etc. If there are free-roaming neighborhood cats that could potentially interact with your cat through a window, for example, this could upset your cat (and may cause a flare). For this reason, we recommend providing perches so that your cat can gain the territorial advantage by placing himself higher than the other cat, and/or discouraging other cats from visiting. Although there are many things that could potentially cause a flare, observant owners are often able to find a few key triggers for their own personal cat. Once these stressors are identified, they can be avoided altogether, or pre-emptively treated in order to prevent a full blown flare or cystitis.
Although FIC can be frustrating to deal with, and we don’t have any way to offer a definitive cure, it is a manageable disease. Although it may take some trial and error (and a lot of personal patience!), we can often achieve a reasonable quality of life for both the kitty and the owner.
Less than 2% of male cats between 1-9 years of age have true bacterial urinary tract infections. ~10-30% of cats have bladder stones or crystals. A very small percentage have abnormal anatomy, tumors, or other causes. The remainder of cases are “idiopathic”.
Our current understanding of FIC indicates that it is a systemic disorder related to the autonomic nervous system that manifests itself in some cats as a chronic syndrome of pelvic pain. These cats usually exhibit signs that are considered consistent with lower urinary tract disease, such as straining to urinate, increased frequency of urination, urgency to urinate, hematuria, etc. The typical course of the disease is a waxing and waning of episodes. These episodes can be of variable intensity and duration, ranging from in-apparent to urethral obstruction (“blocked cats”), and they vary between episodes and between cats. There are other disorders that have been observed to occur commonly in cats with FIC, so some cats may display symptoms beyond those associated with the urinary tract (such as vomiting, diarrhea, hypertrophic cardiomyopathy, obesity, etc). but this is not yet well categorized. The important thing to realize is that FIC is a painful condition in these kitties when they are having a flare, and urinating outside the litterbox often is a result of feeling an urgency to urinate and/or associating the litterbox with pain. Although managing a cat with FIC can often feel very frustrating, we are usually able to find a way to keep the disease under control.
FIC can be additionally complicated by the development of a behavioral component to urinating outside the litterbox. Cat urine acts as an olfactory cue to a cat that it is “OK” to urinate in that spot. Once a cat has urinated in a specific place, if the scent of the urine is not completely removed, it can continue to signal to the cat that it can urinate there. Unfortunately, we all known how notoriously difficult it can be to completely remove the scent of cat urine. There are some reasonably effective products available on the market (such as Zero Odor & Anti-Icky-Poo) for removing cat urine, but sometimes it is necessary to consult a carpet cleaning service and obtain an industrial strength cleaner.
In cases of either behavioral or FIC related urinary “accidents” it is recommended to use environmental modification to achieve the desired result of making the cat want to use the litter box again. This means we want to make the litter box the most attractive place for the cat to urinate, while making other areas of the home unattractive for urination. Things to consider are the total number of litter boxes available for use (more is better), the location of the litter boxes in the home (more options is better and locating them in quiet places is usually recommended), the type of litter used (clumping, scent-free is preferred by the majority of cats), how often the boxes are cleaned (at least 1-2 times per day), and how often the litter is changed completely (once a week is recommended). Additionally, if there are specific locations within the house where a cat repetitively urinates, it may be helpful to make these places inaccessible in some way. For example, placing a care floor mat upside down over an area (so the spikey side is up) or using motion activated pressurized air canisters (SCAT) or other devices may discourage cats from visiting these areas. Cats can be very sensitive to perceived punishment from owners, so effort should be made to remove yourself from these negative reinforcements and make them automated.
Although there are medications that can be used in chronic cases to help control the display of symptoms related to FIC, most of them take several weeks to achieve therapeutic doses and none of them have been well studied for true efficacy. The most commonly prescribed is Amitryptyline (Elavil), but there are other possibilities (such as Prozac) available. These medications are not useful in treating an acute episode. Most of the time, FIC flare-ups are self-limiting and will resolve without intervention (provided there are not continued stressors in the environment). The concern with severe flare-ups in male cats is the development of urethral obstruction (UO). UO in these cats is caused by severe spasming, inflammation, and debris in the urethra and results in the inability to urinate. This is life-threatening and fatal if not treated. In cases of severe flare, sedation and pain medications (such as acepromazine and buprenorphine respectively) can be used to break the pain-inflammation cycle, decrease stress-related responses, and prevent further progression of the episode. In instances where stress is anticipated to occur, a lower dose of acepromazine or other sedative may be used as a preventative.
The best treatment we currently have available for FIC is known as environmental enrichment. From what we know about FIC, our understanding is that clinical symptoms associated with FIC are induced by stressful events or conditions in a cat’s life. Different cats have varying sensitivities to the amount of stress they can tolerate before they will display these clinical signs. Some cats are very sensitive (low threshold), while other cats can tolerate much more. This is why some cats go for many years without displaying any problems. Once a cat has passed its personal threshold, however, keeping the overall stress level below their tolerance may be more difficult. Our goal with environmental enrichment is to make the overall stress level in a cat’s life as low as possible, so he will have a greater capacity to deal with any unexpected stressors. Allowing the cat as many choices as possible within his given environment and determining his preferences is usually the most effective way to accomplish this. Multiple water sources, multiple litter boxes, multiple food options, multiple toy types, etc allow an owner to learn what the cat likes best (and therefore keeps his sympathetic nervous system tone lower = less stressed). Other sources of increased sympathetic tone (sympathetic tone is “flight or fight” response) can occur from interactions with strange cats, dogs, people, loud noises, or any abnormality within a cats’ prescribed home environment. Examples could include construction noise down the street, a sad, stressed, or angry owner at home, etc. If there are free-roaming neighborhood cats that could potentially interact with your cat through a window, for example, this could upset your cat (and may cause a flare). For this reason, we recommend providing perches so that your cat can gain the territorial advantage by placing himself higher than the other cat, and/or discouraging other cats from visiting. Although there are many things that could potentially cause a flare, observant owners are often able to find a few key triggers for their own personal cat. Once these stressors are identified, they can be avoided altogether, or pre-emptively treated in order to prevent a full blown flare or cystitis.
Although FIC can be frustrating to deal with, and we don’t have any way to offer a definitive cure, it is a manageable disease. Although it may take some trial and error (and a lot of personal patience!), we can often achieve a reasonable quality of life for both the kitty and the owner.