In part 1 we took an overall look at feline lower urinary tract disease (FLUTD). Here, we’re going to explore the most common (and perhaps interesting) type of FLUTD – feline idiopathic cystitis

First, an admission. Idiopathic is a fancy way of saying ‘we don’t know what causes this’.

Second, we know a lot more now than when the condition was named FIC. And third, it’s got a new name now – Pandora syndrome!

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What is FIC?

As above, ‘idiopathic’ means that the cause is unknown. Cystitis is a medical term for bladder inflammation. So, feline idiopathic cystitis (FIC) is bladder inflammation in the cat of unknown cause.

FIC is one of the many different conditions that can affect the lower urinary tract (ie the bladder and urethra). It’s the one that we diagnose when we can’t find an obvious cause for FLUTD signs. And that’s around 60% of all cases!

There are many similarities between FIC and condition in humans called interstitial cystitis.


What are the signs of FIC?

The signs of FIC are the same for all types of FLUTD:

  • difficulty passing urine (dysuria) – your cat may appear to strain to pass urine and may even cry out in pain

  • frequently passing or trying to pass urine (pollakiuria) – if the bladder wall is inflamed and swollen, this creates a stretch sensation much like a full bladder does, hence your cat has a drive to keep trying to empty the bladder, even though it might be empty

  • blood in the urine (haematuria) – sometimes this is visible with the naked eye (as pink urine or small clots), or it may only be detected on urinalysis

  • urinating in places other than the litter tray (periuria) – this can be because of urge (your cat can't make it to the litter tray) or pain ('It hurts when I go into the litter tray so I'll go somewhere else')

  • licking around the vulva or prepuce

  • inability to pass urine – some male cats, the urethral may become blocked due to severe inflammation, spasm or urethral plug (not being able to pass urine is an emergency)

Not all cats will have all signs. Some may only have one.

With FIC, the signs tend to develop quickly then resolve over 5–10 days (regardless of what treatment is used) only to occur again at a later time.


What causes FIC?

While we don’t know the exact cause as yet, cats with FIC have a number of abnormalities in common. Now, hang in there with this next bit, it’s all a bit complicated and circular… here are the common abnormalities.


defective bladder lining

The bladder is lined by a layer of mucousy stuff called PSGAGs (which stands for polysulfated glycosaminoglycans). This layer protects the cells of the bladder wall from irritating substances in urine (such as toxins, crystals and high acid levels).

In cats with FIC, the PSGAG layer appears to be defective or rather it becomes patchy. This mean urine is able to contact/irritate some of the bladder wall cells. The result is inflammation (cystitis).

The recent research suggests that the reason for the patchiness of the PSGAG layer is stress/anxiety. For a long time we’ve worked on reducing the things that can irritate the bladder (especially crystals) and trying to improve the PSGAG layer, but a more effective approach is probably to reduce anxiety.


mixed up nerves

The nerves in the bladder are generally stimulated by stretch – when your bladder is full, the nerves fire off and tell your brain you need to pee (so get near a loo!) With FIC, the nerves are stimulated by local irritation of the bladder lining (see above) or by the brain (in response to stress/anxiety), creating a frequent urge to pee without the bladder being full.


Abnormal processing of stress

We think cats who get FIC are neurologically different – they’re extra reactive to any changes in their environment (ie they’re easily stressed) and extra sensitive to some forms of pain.

All cats will experience episodes of stress/anxiety during their lives, but not all cats get FIC. The ‘normal’ response to stress is release of stress hormones – cortisol and catecholamines (adrenaline and noradrenaline) – from the adrenal glands. The brain controls release of these hormones.

In cats with FIC, the catecholamine levels are high but the levels of cortisol are lower than normal. Catecholamines act on the autonomic nervous system (think ‘fight or flight). And while cortisol is a stress hormone, it’s also an anti-inflammatory. There’s a lot more to this, but you get the drift.


But what does my cat have to be stressed or anxious about?

It’s not so much about your cat living in bad or stressful place, it’s more that FIC cats are super sensitive. Their symptoms can flare up over things most of us don’t think would have any impact on pet. Triggers (also called stressors) include:

  • a change in household routine/schedules (eg leaving earlier for work, kids starting school)

  • stress among the humans in the home (arguments, illness)

  • someone visiting or moving in/out

  • travelling (to the vet, cattery, moving)

  • staying in a cattery

  • keeping a cat that has lived outdoors indoors

  • a new pet

  • a new animal in the neighbourhood that may come into your cat’s territory

  • construction in the home or outdoors

  • weather change

  • new furniture or furnishings

  • moving to a new home (even if that home is better for cats)

  • changing to a new brand of food

  • changing or moving the litter tray

Sometimes, your cat will get used to the changes and things will settle. But sometimes the stress continues – this is especially the case with multicat households and one cat who prefers to be alone.

In many ways, it’s worth considering FIC as a feline mental health issue, a bit like an anxiety disorder in people. Not everyone has the same trigger… and not all triggers are easy to identify.

Note: Most people recognise that their cat is the anxious type. If you don’t think your cat is one of these, it’s possible that FIC has been misdiagnosed. Remember, FIC is the diagnosis we make when we can’t find an underlying cause for the symptoms – and just because we can’t find it, doesn’t mean it’s not there.


How is FIC treated?

Think of FIC cats as being in one of two states:

  • having an active episode (experiencing symptoms)

  • having a quiet time between episodes (not experiencing symptoms)

We’re not able to cure the condition (ie stop your cat being super sensitive/reactive). Our aim is to try and minimise the time spent in active episodes and maximise the length of ‘quiet’ times.

The good news is that most cats grow out of FIC.


Treatment during an active episode

If you have a male cat who can’t pass urine, then bypass all this and get treatment immediately (call us on 9531 1771).

Back to treatment…

Multiple types of therapies have been tried to halt an active episode. Unfortunately, none have been successful. The episode will run its time course (5–10 days) regardless of what we do. Our aim is to manage pain and spasms until the episode passes. Medications used include:

  • drugs that reduce urethral spasms (eg diazepam, prazocin, phenoxybenzamine, acepromazine) – these may help relax and dilate the urethra so urine can pass

  • analgesics to reduce the pain (eg anti-inflammatories, opioids, tramadol) – sometimes we need to use multiple medications to achieve adequate relief


treatment (preventive) between active episodes

Once upon a time, FIC was thought to be caused by diet. Certainly, what your cat eats and drinks does affect things like urine pH and crystal formation. And these are involved (see ‘defective bladder lining’ above), so dietary manipulation is still part of a treatment plan.

But these days, the focus is on reducing stress and anxiety. And this is all about environmental enrichment, which also goes by the fancy name 'multimodal environmental modification' (MEMO). If you’ve read our A-Z of kitten care, you’ll be familiar some aspects of this. Key elements include:

  • having somewhere safe to hide/sleep/watch

  • providing multiple and separate resources (food bowls, water bowls, toilet areas, play areas, scratching and climbing options)

  • creating opportunities for play and hunting behaviour (toys should be rotated or replaced regularly)

  • providing predictable and positive social interaction (with people or other pets) that the cat chooses

The Safe Cat program has lots of ideas on how to keep your indoor cat happy and stress free.


Get in touch if you’d like more information.