Feline Urinary Accidents – The Bladder May Be Innocent!!

Feline Interstitial Cystitis: It’s Not All About The Bladder!

Inappropriate urination, straining, hematuria (bloody urine), small urine volumes, caterwauling in the litter box, and hiding. It’s every cat owner’s nightmare. You want to blame the bladder, but it may just be collateral damage – an innocent victim of stress and a hyperexcitable nervous system.

Over my 38 years in practice, veterinary scientists have recommended a plethora of treatments for Feline Lower Urinary Tract Disease. From antibiotics, low “ash” foods, urine acidifiers to low magnesium diets, a variety of prescription diets (sure to control this problem), water fountains, medications like amitriptylline, letting cats go outside to urinate, and more special diets. Yet in 2017, sterile bladder inflammation remains the single most common cause of lower urinary tract signs in cats.

Top researchers in this field have coined the term “Pandora’s syndrome” to describe sensitization and upregulation of the feline stress response that’s often most dramatically manifested in the urinary bladder. When a sensitized cat is put in a provocative environment, it ends up with the signs that constitute FIC. Here are some risk factors for FIC:

Male cats. Young, overweight, indoor-only cats that have nervous or anxious personalities. Cats that eat a diet of more than 50% dry food without adequate water intake. Members of multicat households due to the potential of intercat aggression, especially around litterboxes. These cats are often unable to engage in typical hunting behaviors. They tend to not have protected access to food, water, resting areas, and litterboxes because something bothers them in these areas, be it a human, a dog, another cat, a buzzing clothes dryer, or rattling furnace. A main trigger of FIC is the family moving from one house to another.

Cats prone to FIC have elevated levels of adrenaline and a heightened startle response to noises that leads to a flood of stress hormones in the body, such as cortisol. They also have an enhanced transmission of pain. This is important because all this sends these cats into a constant hyperexcitable state of fight, flight, or freeze, and they feel pain more acutely than normal cats. They also have a disrupted protective layer in the bladder wall which is incredibly irritating.

The good news is that FIC is a SELF-LIMITING CONDITION. This is what made understanding effective treatment in the past so challenging. Give antibiotics, various medications, supplements, special foods, etc., etc., and eventually there was improvement, although often temporary.

So What Does Actually Work. The key component of managing FIC involves the owner inventorying the cat’s environment and identifying potential stressors. Once they are identified, the owner can modify the environment and interaction of bullying housemates to make that cat’s nervous system less hair-triggered. Ohio State’s veterinary website has a good online reference called the Indoor Pet Initiative that can walk you through this Multimodal Environmental Modification (MEMO).

Nutrition and Increasing water intake are important components of managing FIC. Urinary therapeutic diets like Hills CD Multicare Stress Formula contain anti-anxiety supplements that have been proven to reduce flare ups of FIC by up to 88% in susceptible cats. Increasing water intake by adding water to foods, placing additional interesting water containers / fountains around the house helps speed resolution of signs during an episode and help prevent future flare ups.

Pain Management and Decreasing Urethral Spasms during an acute episode are extremely important to shorten the length of the flare up. We sometimes will use pharmaceutials to decrease hyperanxiety states when detected.

In some households where cats are prone to FIC, the owners themselves may be going through a fair amount of stress. Recognizing their own stressors and considering how to cope with them may result in a better quality of life for both our clients and their cats.

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