Cat Cystitis: All The Facts You Need to Know
Does your cat seem to be visiting the litter tray more often than normal? Is it taking them longer to empty their bladder? Do they seem to be straining or are they a bit more grumpy than usual. Cystitis in cats is a pretty common issue but if you think a shot of antibiotics will make them better I'm afraid cat cystitis treatment is little more complicated than that.
When we think of cystitis our first thought is that a bacterial infection must be the cause and a short course of antibiotics will quickly clear things up. While this might be the case in dogs (and ourselves), cats are far more complicated than that. Infection is a fairly uncommon cause.
In fact "feline idiopathic cystitis" (FIC), also known as "feline lower urinary tract disease" (FLUTD), accounts for the majority of cases (although strictly speaking FLUTD actually refers to all forms of feline bladder and lower urinary disease). Idiopathic simply means that no-one know exactly what the cause is although it does seem to share many similarities with interstitial cystitis in humans.
Symptoms of cystitis
If you are asking "why cant my cat pee" then you are seeing one of the major symptoms of cat cystitis. First of all, if you are asking this and you have a male cat call your vet then read my article on cats with a blocked bladder.
Other signs of cat cystitis include frequent trips to the litter tray. Producing only small amounts of urine. Urine that may appear bloody or pink tinged. A cat with a painful tummy or just generally being grumpy, especially when picked up or urinating. Finally your cat may just seem unwell and a bit quiet, especially if they toilet outside and you are not able to see them straining.
There is no single test that can be used to diagnose your cat with this condition. Instead your vet can rule out the other causes, such as bladder stones or sludge, cancerous masses and infection. This can be done with xrays, ultrasound and urine testing. In some cases blood testing will also be advised to check on kidney health or any other concerns your vet may have.
If these tests all come back as negative then a diagnosis of idiopathic cystitis will be made. Even though we don't know the exact cause of this disease, we do know there are a couple of things that can increase the risk of your cat being affected:
Stress and an abnormal stress response
The most common common factor in cats suffering with FIC is stress. You might feel that you cat lives the life of Riley but very often they are under a certain degree of stress. This may simply be due to living inside and sharing their environment with another cat.
There is always stress in a multi-cat household no matter how well they may appear to get on. There may be more obvious stress factors such as the arrival of a new baby, having the builders round to carry out renovations, firework season may have arrived or a new cat may have moved into the neighborhood and be exploring your cats territory. While stress may be present your cat may be internalizing it and so seem relaxed.
Stress alone is not enough or else every cat would develop idiopathic cystitis. Something else that seems apparent is the fact that cystitis cats seem to have an abnormal stress response, releasing different levels of stress hormones compared to unaffected cats.
A disruption to the normal mucus lining of the bladder and inflammation to the bladder caused by nerve signals from the brain.
The bladder is normal lined by a layer of mucus that protects it from the harsh urine it contains. In cats that develop FLUTD it seems that this layer is disrupted which causes damage to the cells lining the bladder resulting in inflammation, ulceration and pain. Why this abnormal layer develops is not clear but it also seems that signals sent to the bladder from the brain, possibly due to stress, can actually cause also cause inflammation and pain in the bladder and so this may also play a role in the disruption of the normal protective layer.
What this all means is that certain cats are likely to be genetically predisposed to developing cystitis and their environment then tips them over the edge in one way or another. Knowing this allows us to make management changes to cats that have had an episode of idiopathic cystitis, helping to prevent repeat episodes in the future. As we lean more about this disease new approaches may be suggested. Watch this space.
So what treatment can we give. Well we can split treatment into the actual treatment of a flair-up and then preventative treatment for long term management .
In the short term feline idiopathic cystitis is actually a self-limiting disease. This means that it will tend to get better by itself given time. Often within 2-5 days. Giving pain relief, dispensed by your vet, and encouraging water intake (discussed later) during this time period should see the majority of cats remain comfortable and the symptoms should pass uneventfully. Remember that infection is actually rare and so antibiotics are generally not needed.
With males there is always the risk of a blocked bladder from developing. If you have a male cat be sure to check out why your cat can't pee, it's a real emergency.
Also half of all cats will experience at least one more episode of cystitis within a year. This is potentially a long term condition and so long term management is really important in any cat that has had an episode of cystitis.
Home Management: a holistic approach
Management focuses on two aspect:
Increasing water intake.
Reducing stress in cats
You might not feel that your cat is stressed but if they suffer from cystitis then they will be. Cats are very good at hiding problems and so stress can be hard to spot. In reality a lot things in a modern cats life can be a source of underlying stress. This includes:
multiple cats in a house
competition for resources such as food bowls, water and litter trays
being confined inside
long periods without owner company or interaction forced on them
strange cats competing for territory
A lot of cats will have one or more of these factors present in their lives. Trying to correct them will help a lot in preventing future cystitis. Small changes in your house, their environment, can make a huge difference. So what exactly can we do?
1 - food bowls, water bowls and litter trays
The number of each of these should be one more than the number of cats in the house. For example, if you have 2 cats there should be 3 food bowls, 3 water bowls and 3 litter trays. Food and water bowls can be next to each other but each station should be separate from each other to allow your cats to feed/drink/toilet without having to be next to each other.
Also make sure litter trays are cleaned out promptly. Some cats will refuse to use a dirty tray, hold on and so be more likely to develop cystitis. Litter trays should also be positioned in quiet places.
2 - 3D space
Cats are very three dimensional in the way they interact with their environment. They love to climb, sleep off the ground, explore and have safe retreats. For our indoor cats providing raised sleeping platforms, climbing frame style furniture (amazon links), having cupboards they can climb into and explore as well as having quiet, secluded sleeping areas can all help reduce a cats stress levels.
These changes are also great for cats which go outdoors. They may only want to go out for short periods, especially if there are lots of cats in the neighborhood. They may feel it is too dangerous to go outside at certain times and so be restricted indoors. This also means that if possible your cat should have free choice as to the time they want to go outside
3 - A secure home
Imagine if a stranger kept coming into your house, eating your food and using your toilet. You would be stressed out and so would your cat. If you have other cats coming through your cat flap then consider a more secure type such as one which reads your cats microchip and only opens for them, not any old pus.
Routine also helps feelings of security. Where possible try and be consistent with meal times, people in the house, noise levels and degree of interaction. Some cats love interaction with their owners, others only like it on their terms. Be consistent and don't force your cat.
4 - Extra help
For those cats that are super stressed, or during known stressful events (such as renovations or a new baby in the house), some cats will benefit from extra support. This can take the form of certain dietary supplements, or even pheromone therapy. Feliway mimics natural facial feline pheromone and is an excellent, safe product for all that can really help to relax a stressed out kitty. Your vet will have other suggestions that will be suitable for your cat.
For more details and extra tips on creating a stress free environment for your cat as well as learning how to tell if your cat is stressed watch out for future articles coming soon.
How to get cats to drink water
Increasing water intake is the second cornerstone of prevention. Cats generally have a very poor drive to drink and many people will never really see their cat use the water bowl. As such it can be a challenge to get more water into them. The following may help:
Change from a dry to a special prescription wet diet.
If a cat won't eat a wet food then a prescription dry veterinary diet is the next best food. These are designed and proven to reduce the number of flair-ups a cat with cystitis suffers from and also make any flair up less severe.
Use shallow bowls for water. Cats will often not drink if their whiskers tough the sides.
Experiment with different material bowls. Your cat may prefer plastic, metal or china as each one slightly flavors the water.
Use a cat water fountain. Some cats just love running water. A cat fountain is a great way to provide this without needing to keep the tap running.
Regularly refresh your cats water bowl, even if it looks untouched
Flavor the water using dilute tuna juice of chicken broth (avoid high salt additives)
Add extra water to your cats food.
Head over to this article for more details on how to get your cat to drink.
Urinary diets and cystitis
Special diets designed to reduce the frequency and duration of cystitis flair ups have been shown to have a good effect at helping control this disease. These diets include things like polyunsaturated fatty acids which may help reduce inflammation in FIC.
It may be that switching from a dry to a wet diet would be just as helpful at preventing disease flair ups but there have not been comparison studies run looking into this.
Either way, for cats that need to be fed on a dry diet, I believe that the specially designed therapeutic diets are definitely the number 1 choice. If your cat is a wet food eater then I would also strongly consider feeding the wet version of these diets, as clearly their previous wet food was not enough to prevent them developing cystitis.
Any diet change should be gradual and here are my top tips for changing diet.
There have been several drugs that have been put forward for the treatment and prevention of cystitis. these generally either target the bladder with the aim to try and repair and replace the protective layer of mucus that becomes disrupted. These are known as polysulphated glycosaminoglycans (GAGs) and come in injectible and oral forms. Unfortunately there is little evidence to show that they consistantly have a significant benefit. They are however very safe and could be something to try if all of the above strategies fail to control the disease. Is is important though that your cat does not become stressed when you give these treatment or else you may undo all your hard work in reducing stress levels.
Finally, stress relieving drugs such as the antidepressant amitryptiline can be used in cases of severe, persistent cystitis. These can be very effective but also come with potential side-effects and so are unlikely to be the first thing your vet suggests.
I hope this article helps you understand the sometimes frustrating condition of idiopathic cystitis in cats as well as give you some useful changes you can easily make to help prevent future episodes of this disease. If you have any questions or if you have any tips that have helped your own cat with this condition then please leave a comment below. I would love to hear from you. Also sign up to our newsletter to make sure you don't miss out and allow me to continue to help you and your pet live healthier, happier lives.
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