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Recognition and Management of Feline Idiopathic Cystitis and Urinary Obstructions in Cats

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If your male cat is straining to urinate or has blood in his urine, these are considered “RED” – or true emergencies – on our Fast Track Triage system. We advise you to seek immediate veterinary care. Please call ahead of your arrival so the veterinary team knows to expect you!

Note that straining to urinate or blood in urine for a female cat is considered a “YELLOW” – or semi-urgent case – on our Fast Track Triage system. We recommend your pet be seen by a veterinarian within 24 hours.

Whether your cat is peeing outside the litter box, straining to urinate, or has another urinary issue, there is reason for a cat parent to be concerned. The two most common causes of urinary obstruction in cats are feline idiopathic cystitis (FIC) and urolithiasis (urethral stones). FIC is a complex medical problem found in both male and female cats. This condition can cause signs of lower urinary tract discomfort, and signs can be chronic and recurrent. In male cats, this condition can cause a life-threatening obstruction of the urinary tract. Feline urinary problems can feel overwhelming, frustrating, and scary, so we’ve got all you need to know to recognize and manage feline idiopathic cystitis and urinary obstructions in your cat! 

First off, what is feline idiopathic cystitis (FIC)? 

Feline idiopathic cystitis is an inflammatory condition of the lower urinary tract. The disease is not fully understood, which is why we use the term “idiopathic – meaning the cause is unknown.  

However, we do know that cats with this condition have inflammation in the lower urinary tract without the presence of a bacterial infection. FIC can cause urethral spasms as well as crystalline-mucous plugs within the urethra. The male urethra is quite narrow, so a life-threatening urinary obstruction can develop as kidney values and potassium levels elevate. Therefore, male cats must be treated for FIC immediately. It is important to note that FIC can cause clinical signs throughout a cat’s life, and urethral obstructions often recur 

Common Signs of FIC: 

Predisposing Factors: 

Young to middle-aged indoor cats appear to have a higher incidence of FIC. Cats may be predisposed to FIC during times of stress, including changes in routine. They also may be vulnerable to FIC if they eat a dryfood diet or drink water infrequently.

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How is FIC diagnosed? 

A veterinarian will perform a full physical examination. In an unobstructed cat, the urinary bladder will be small to moderate in size and soft. Obstructed cats often have a large, firm, painful urinary bladder that can be felt during the exam. Diagnosis of FIC is made by ruling out other medical conditions that can cause similar clinical signs: 

  • A urinalysis typically reveals inflammatory cells without a substantial number of bacteria. 
  • Urine pH is often neutral or basic.
  • Struvite crystals are commonly, though not always, present in the urine.
  • A urine culture is usually negative, ruling out infection.
  • Abdominal X-rays and/or ultrasound may reveal tiny grit within the urinary bladder and/or urethra.  

In-Hospital Treatment: 

Cats with signs of FIC without obstruction are treated supportively and symptomatically. Therapies often include medications for discomfort and fluid therapy. Cats with a urinary obstruction need to be sedated and unobstructed. A urinary catheter is placed, and inhospital management is indicated in these cats. 

Management Strategies at Home: 

FIC can be a challenging medical condition to manage. Signs may improve and then recur, making this disease process frustrating for cat owners. Helpful management strategies include the following: 

  1. Provide one litter box per cat, plus one. For example, if you have two cats, provide three litter boxes.
  2. Minimize changes in general routine and stressors when possible. Additionally, if you anticipate a stressful event for your cat (such as a move, addition or subtraction of a pet or human, or rearranging the furniture,) be diligent about monitoring for signs of FIC and urinary obstruction.
  3. Provide many opportunities for fluid intake. Some cats like to drink out of full cups of fresh water – leave a few around the house. Offer a canned food diet to provide increased fluid intake. You can offer low sodium chicken broth or add some to your cat’s water. Some cats enjoy drinking out of the faucet and can be enticed to drink by turning it on throughout the day.  

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If you are concerned that your cat may have urinary tract discomfort or is unable to urinate, please contact a veterinarian. It is important to recognize the signs of FIC so that the pet can receive potentially life-saving medical care as soon as possible.  Sarah Humphrey, DVM, DACVECC, board-certified criticalist, Animal Emergency & Referral Center of Minnesota

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