ABSTRACT:: Feline lower urinary tract disease IFIUTD) is a term used to encompass a number of conditions which affect the bladder and urethra and which may be associated with inappropriate urination. FLUTD is most common in young and middle-aged cats. There are several important medical causes of FLUTD but idiopathic FLUTD – also known as feline idiopathic cystitis (FIC) – is the most common by far. Successful treatment depends upon addressing sources of stress and encouraging affected cats to produce more dilute urine.

What is FIC?

Feline idiopathic cystitis (FIC) is the most common cause of lower urinary tract disease in cats. It is the cause of FLUTD in 50 to 75 per cent of young and middle- aged cats. FIC can be obstructive or non¬obstructive. Male cats are most vulnerable to obstructive disease and this needs emergency treatment.

Clinical signs with non-obstructive FIC are usually self-limiting – affected cats get better on their own, usually within five to 10 days. However, most affected cats suffer from repeated episodes of clinical signs which can be very distressing for both cat and owner. In general, the frequency and severity of these episodes gradually decreases with time. Unfortunately, in spite of more than 30 years of research, no one knows the precise cause of FIC. Stress is now known to play a very important role in triggering and/or exacerbating FIC, and the causes of chronic stress suggested to be most damaging are those over which the cat has little or no control.

Urine specific gravity measurement is a key component of the diagnostic work-up in a cat with FIC

How is FIC diagnosed?

Diagnosis of FIC depends on:

•   taking an accurate behavioural and medical history

•   performing a physical examination to help rule out other causes of FLUTD

•   urinalysis to look for evidence of haematuria, bacterial urinary tract infection and other abnormalities

•   haematology and serum biochemistry to look for relevant underlying systemic disease (for example, renal disease, diabetes mellitus) and more

serious abnormalities that might occur in a blocked cat, such as dehydration, hypocalcaemia and hyperkalaemia diagnostic imaging (radiography, ultrasonography) to look for stones in the bladder and/or urethra, tumours and other problems.

How is FIC treated?

Optimal treatment of FIC depends on making an accurate diagnosis. Although non-obstructive FIC is considered to be a self-limiting problem, treatment is usually recommended since this is such a painful and debilitating condition. Although FIC is common and has been a subject of much research, very few treatments have been assessed in a rigorous way. Since FIC usually resolves spontaneously, many treatments can appear to be effective when in fact the cat is making a spontaneous recovery.

All of the current medical treatments for FIC are palliative – aiming to support the cat through an episode and reduce the risk of further episodes from occurring. The biggest long-term improvements are seen using a dual approach to reduce stress and encourage the cat to produce dilute urine. MEMO or multimodal environmental modification is an acronym coined by Professor Tony Buffington and his colleagues at Ohio State University where much research on FIC has been conducted.

MEMO encompasses tactics to reduce stress and encourage the cat to produce less concentrated urine. In one study MEMO was effective in curing around 70 to 75 per cent of cats with severe FIC and greatly reduced the severity of signs and frequency of relapses in the remaining cats.1

Multiple-cat homes are especially vulnerable to cases of FIC

Strategies to reduce stress in the home

Efforts should be focussed on identifying and addressing potential causes of stress in the home. For example, these may include conflict between the FIC cat and other cats in the home or neighbourhood, addition of new pets or people into the home, sudden changes of routine and so on. FIC is very common in households where there are large numbers of cats. In severe cases, referral to a veterinary behavioural expert may be valuable to accurately diagnose and resolve causes of chronic stress.

Conflict between cats is a common cause of stress. In order to address this, care needs to be taken to understand the number of social groups within the home and determine whether there are adequate resources for each social group.

Each social group needs access to litter boxes or other toileting facilities, food, water, somewhere to rest/hide and safe entry and exit routes. Some cats, especially the elderly, have specific requirements for feline or human companionship. Several social groups may exist in the home and each of these needs its own separate resources – they will not enjoy having to share!

Synthetic F3 feline pheromones preparations, such as Feliway (Ceva Animal Health), can also be helpful in reducing tension found in multi-cat households. These act as a confirmatory signal that the environment is safe and, therefore, must be used in conjunction with other environmental management, such as ensuring that there are adequate litter boxes and so on. Feliway alone is not sufficient to prevent signs of FIC associated with stress but it can be very helpful if introduced just prior to periods of increased stress – for example, if a new baby is to be introduced to the house.

Environmental enrichment is also beneficial as a means of reducing stress. Examples of positive ways of improving a cat’s environment include provision of climbing frames with resting areas and playing games that stimulate natural cat behaviour.

Restricting (or reducing) the number of cats in the home to socially compatible levels and resisting the temptation to expand the household by introducing new cats will help to reduce the incidence of stress-related diseases such as FIC.

Environmental enrichment is especially important in cats leading an indoor-only life Image by kind permission of Professor Danielle Gunn-Moore

Strategies to encourage production of less concentrated urine

Cats will be less likely to suffer from episodes of FIC if they produce more dilute urine. The aim is for the cat to be producing urine with a urine specific gravity (USG) around 1.035. This encourages frequent urination and dilutes any irritant components of the urine. Producing dilute urine does not treat the underlying cause of FIC, so issues such as stress also need to be addressed.

Where possible a moist food should be offered. Tips for encouraging drinking include:

•   ch
oosing a bowl which the cat likes to use – generally this means glass, metal or ceramic rather than plastic bowls. Cats usually prefer wide, shallow bowls which are filled to the brim

•   avoid putting the water bowl next to the food bowl. Cats have evolved to choose water sources away from food sources, since these may be contaminated

•   try using a drinking fountain

•   try offering tasty liquids, such as the juice from a defrosted pack of prawns (or by liquidising some prawns in water)

•   feed moist rather than dry food. Some cats with a preference for dry foods will tolerate water being added to this – offer a prescription dry food designed to encourage production of less concentrated urine.

Monitoring USG using free catch samples collected at home can help to incentivise owners that the above strategies are worthwhile.

A more detailed guide to encouraging increased fluid intake is available.2

Encouraging water intake is a vital component of preventive care of cats with FIC. Some cats prefer to drink from unusual receptacles!

Other medical treatments

A number of medical treatments may be suggested in cats with FIC.

These include:

•  painkillers and anti-inflammatory drugs – while these will not alter the course of FIC, they can help an affected cat to feel as comfortable as possible. Examples include non steroidal anti-inflammatory agents, such as meloxicam and opiates, such as buprenorphine.

•   therapy for urethral spasm such as prazosin, dantrolene and phenoxybenzamine

•   glycosaminoglycan (GAG) supplements – are believed to work by attaching to the lining of the bladder and reducing the permeability of this to noxious substances. Unfortunately, several clinical studies have shown that GAG supplements are not effective in the majority of cats affected by FIC 

•  tricyclic antidepressants (TCAs) – clomipramine and amitriptyline have been found to be helpful in some people with interstitial cystitis and hence have also been trialled in cats with FIC.

Summary of nurse's role in FIC case management

Explaining treatment for FIC is time-consuming; but it is an essential component to optimal care. As demonstrated by Buffington and colleagues (2006), time spent supporting owners of FIC cats is rewarded by greatly improved outcomes.1

Nurses can play a vital role in collecting a thorough and accurate behavioural history, identifying potential stressors relevant to the FIC cat and supporting owners in long-term management of the FIC using the tactics discussed in this article. 

Author

Sarah M A Caney

BVSc PhD DSAM (Feline) MRCVS

Sarah is a 1993 graduate of the University of Bristol. She is an RCVS Specialist in Feline Medicine and loves both first opinion and referral feline medicine. In 2007, she founded Cat Professional which aims to provide cat owners and veterinary professionals with the highest quality information, advice, training and consultancy services.

Cat Professional has published three books, Caring for a cat with kidney failure, Caring for a blind cat and Caring for a cat with lower urinary tract disease which are all available as 'softbacks' and electronic books via www.catprofessional.com.

To cite this article use either

DOI 10.1111/j.2045-0648.2011.00078.x or Veterinary Nursing Journal Vol 26 pp 349-351

References

1.   BUFFINGTON. C. A. T„ WESTROPP, J. L„ CHEW. D. J. and BOLUS. R. R. 120061 Clinical evaluation of multimodal environmental modification IMEM0I in the management of cats with idiopathic cystitis. Journal of Feline Medicine and Surgery 8: 261-268,

2.   Cat Professional (2011) Encouraging your cat to take in more fluids. Free downloads section of the Cat Professional website, www.catprofessional.com

Further reading

CANEY. S. M. A. and GUNN MOORE. 0. A. 120091 Caring for a cat with lower urinary tract disease. Published by Cat Professional and available through www.catprofessionat.com

Veterinary Nursing Journal • VOL 26 • October 2011 •