Who Peed on the Rug?? Or...Feline Idiopathic Cystitis (FIC)

A complaint cat owners sometimes have is that their cat is urinating outside of the litter box. There are various medical and behavioral problems that can cause this, but we will focus on one condition in particular called feline idiopathic cystitis, or FIC for short. FIC is a sterile inflammatory disease of the bladder in cats, particularly indoor cats.

While all the causes of FIC are not entirely understood, stress is an important component. Research has shown that in susceptible cats, stress can result in inflammation of the inner lining of the bladder. Once this happens, the cells in the bladder can become further irritated by the urine and cause even more inflammation. Some cats are more prone to feeling stressed when their owners' schedules change, new people or animals are around the house, stray cats are in the yard, if there are any changes to the litter box, etc. 

Just because your cat is lounging around the house does not mean he is not stressed! Cats are good at hiding their feelings so we do not always know what they are thinking or feeling.

Signs you may see at home can include urinating out of the litter box, urinating small, frequent amounts, straining to urinate, and bloody urine. Male cats with this condition can develop a urinary obstruction, meaning that they have an obstruction in their urethra (the tube that goes from the bladder out) preventing them from being able to urinate: this is a medical emergency. Signs of FIC are often mistaken for a urinary tract infection (UTI). UTIs in young, healthy cats are actually quite uncommon (less than 1-2% incidence), so it is important to check for infection before treating with antibiotics! Bouts of FIC usually run their course in 3-7 days, so just because a cat has been treated with antibiotics and improved does not mean there was an infection present. This inflammatory disease is often a recurrent problem, which can be frustrating for owners and uncomfortable for the cats.

If you notice any of these signs in your cat, he or she should be evaluated by a veterinarian and have tests done (usually a urinalysis and urine culture) to make sure there is not an infection present. There are some medications that can be used to help decrease pain and spasming of the urethra, but ultimately the inflammation has to run its course. Crystals can sometimes be seen on the urinalysis, but unless there are bladder stones present (which would be seen on x-rays), these are considered secondary to the disease, not a primary cause, and therefore do not necessitate treatment.

There are, however, some changes that can be implemented at home to help decrease the risk of recurrence or decrease severity of signs:

  1. Water Intake: It is believed that increasing water intake can help to promote more frequent urination and prevent accumulation of debris which can trigger inflammation or cause an obstruction. This can be done by feeding wet food rather than dry, making sure there are multiple bowls of fresh water, adding tuna juice to the water to entice water consumption (although be sure to change this frequently to make sure it does not go rancid), or by getting a running water bowl.
  2. Litter Boxes: Maintaining an adequate number of clean litter boxes also serves to promote more frequent urination. There should be one litter box in excess of number of cats (for example, if you have two cats there should be three litter boxes). It is also important that the boxes are cleaned regularly. If clumping litter is used, it should be scooped every day to every other day (ideally twice daily!) and cleaned entirely every 1-2 weeks. Many cats do not like liners or covered boxes as well, so if this is present it is recommended to remove the liner and uncover the box.
  3. Environment: Environmental enrichment, especially for indoor cats, can help decrease stress. This includes making sure there are an adequate number of toys and positive interaction with people by setting aside play time every day. It is also important to have areas that the cat can call his or her own to escape to, as well as providing elevated surfaces (for example, cat towers) they can climb and sleep on. Sometimes leaving music or television on while you are gone can be helpful. Also, it can be stressful for cats inside to see another cat outside in the yard in their territory. If this is the case, blocking the window so that they stray cat cannot be seen may help decrease stress.