Feline idiopathic cystitis

[4] On the other hand, FIC does show several similarities to an analogous disease in humans called bladder pain syndrome.

In the case of non-obstructive FIC, the underlying inflammatory process has begun but the disease has not progressed to the extent that it prevents urination (i.e. the cat has not "blocked").

[7] The cat's lower urinary tract is inflamed and the urethral passage may have narrowed due to swelling but it remains open ("patent") and it can urinate to varying degrees, albeit in discomfort.

However, if the bladder remains distended (i.e. full of urine), it is considered "large" and together with the obstructive clinical signs listed above, could suggest blockage.

The cat could be resisting the vet's intervention by "pushing back," due to anxiety or a desire to avoid a painful urination.

This suggests a possible intermittent spasming of the urethra (i.e. an "on-off" § functional block) which allows voiding at times when the cat is able to relax himself, but prevents it when the urethral muscles tense involuntarily again.

[20] The condition is painful and analgesia (via NSAID or opiates such as buprenorphine) is essential to reduce discomfort and control further stress (which could in turn trigger further inflammation).

In the case of a male cat, spasmolytics such as prazosin and/or dantrolene may also be prescribed to control painful urethral spasms and prevent the risk of a § functional blockage.

Since stress is considered to be a key aggravator in triggering cases of FIC, the most important non-pharmacological/non-dietary intervention is to modify the cat's environment to minimise stressors and improve general well-being (see § environmental modification below).

[20][22] Oral supplements to reinstate the protective glycosaminoglycan (GAG) layer of the bladder (often deficient in cats suffering from FIC) may also be considered.

Supplementation with antioxidants and essential fatty acids such as high quality fish oil have also been shown to reduce the severity of the episode.

Obstructive episodes occur in the rarer instances (approximately 15% of FIC cases) when the initial, § non-obstructive attack (see above) is not self-limiting and escalates into partial or full block of the urethra.

For this reason an anti-spasmodic drug such as prazosin or dantrolene is often advised as it will prevent spasming of the urethra and allow any incipient plug to pass during urinating before it is fully formed and causes obstruction.

Regular urinalysis will indicate the nature and extent of crystal formation, together with urine pH, to determine if there are any areas of possible concern which need to be addressed.

The vet will usually attempt to relieve the blockage with a catheter, draining the backed-up urine and flush the bladder of any sediment (this may include crystals).

The cat should then be hospitalised with the catheter in place and hydration administered intravenously to encourage healthy urination and good kidney function, ideally for three days.

While the catheter is in place, intravesical instillation (which is also used to treat human interstitial cystitis[28][29][30][31]) may also be administered to repair the compromised bladder lining.

With this proviso, he can return home and the anti-inflammatory and anti-spasm medication indicated for non-obstructive cases will be prescribed, as well as oral supplements to calm the cat and replenish the protective bladder lining (see above).

Therefore, some of the clinical signs for non-obstructive FIC may still be apparent post-discharge until the inflammation subsides and cat has fully recovered (e.g. frequent voiding, blood in urine, possible leaking).

The owner must focus above all on good hydration (from a wet food diet if the cat will accept it) and frequent urination to keep the bladder clear.

A urinary acidifier (e.g. DL-Methionine) may be added to the latter to prevent struvite crystal formation but as animal protein is already acidic, it is not strictly necessary.

This could trigger recrudescence i.e. a further acute attack, as well as encouraging calcium oxalate crystal formation which forms in highly acidic urine.

Environmental modification to reduce stress, itself suspected to be one of the principal causes of FIC, must also be considered (see below) as the risk of re-blocking is highest within the first week after catheterisation.

[35] The symptoms of bacterial infection in the lower urinary tract are very similar to those for non-obstructive FIC (i.e. straining, blood in urine etc.)

Probiotics should be considered after a course of antibiotics to avoid any digestive distress and to allow beneficial gut flora to recolonise which is essential to feline immunity.

[17] Supplementing wet food with antioxidants and essential fatty acids such as high quality fish oil have also been shown to reduce the severity and recurrence of FIC episodes.