A Multimodal Approach to Feline Idiopathic Cystitis

Andy Sparkes 

BVetMed, PhD, Diplomate ECVIM, MANZCVS, MRCVS 

Simply Feline Veterinary Consultancy 

Shaftesbury, Dorset, United Kingdom 

Q. How is feline idiopathic cystitis (FIC) diagnosed? 

A. Clinical signs of feline lower urinary tract disease (FLUTD) include pollakiuria, periuria, dysuria, hematuria, and stranguria. There is no specific diagnostic test for FIC, but when investigations such as urinalysis, urine culture, and diagnostic imaging fail to identify an underlying cause, FIC is a disease diagnosed by exclusion. In most studies, FIC is the single most common diagnosis made in cats presenting with signs of FLUTD.^1-4 Clinical signs in FIC often recur (with variable frequency), but signs tend to spontaneously resolve within a few (typically 2–7) days.^1,5 

Q. What are the general principles of management of FIC? 

A. Because the etiopathogenesis of FIC remains poorly understood, management of the disease is challenging, and few interventions have proven efficacy. Utilizing a multimodal approach may help increase success. Medications, environmental management, dietary modification, and increasing water intake are strategies that have been used to manage cats with FIC: 

• Medications: To date, no drugs have been demonstrated to be effective in controlled clinical trials of the management of FIC.^2,6 However, as the condition is painful, short-term analgesic therapy is an important welfare consideration.⁶ 
• Environmental management: Reducing stressors is widely recommended for cats with FIC,^1,4,6 based on evidence that stress may play a role in the pathogenesis of the disease. Clinical observations and the results of an uncontrolled trial of cats with severe recurrent FIC⁷ suggest that multimodal environmental modification (MEMO) can be beneficial. The aim of MEMO is to create an enriched, reassuring, and safe environment for the cat, to reduce sources of stress, and through this to hopefully reduce the frequency of recurrent FIC episodes and improve the cat’s welfare. Environmental enrichment can include strategies to enhance feeding management such as using food puzzles or allowing cats to “forage” for food indoors. 
• Dietary modification: Dietary studies suggest an increased water intake and a reduced urine specific gravity may be beneficial in cats with FIC, and along with MEMO this has become a standard recommendation.^1,2,7 Further, controlled dietary studies suggest feeding a high quality complete and balanced diet, or a veterinary diet designed to manage feline lower urinary tract disease, may result in a reduced frequency and/or severity of FIC episodes. The use of these diets is therefore recommended, although what specific dietary aspects that may contribute to the improvements seen are uncertain at this stage. Nutritional strategies to help reduce signs of stress such as calming probiotics or supplements may also be beneficial; however, to date, there are no published data on their efficacy in cats with FIC. 
• Increasing water intake: While feeding wet rather than dry food helps increase water intake, increase the volume and frequency of urination, and reduce urine concentration, not all cats adapt to a wet diet. Dry urinary veterinary diets with a moderately increased salt content may also successfully increase water intake and urine output and dietary manipulation can be combined with other strategies to encourage the voluntary intake of water. 

1. He, C., Fan, K., Hao, Z., Tang, N., Li, G., & Wang, S. (2022). Prevalence, risk factors, pathophysiology, potential biomarkers and management of feline idiopathic cystitis: An update review. Frontiers in Veterinary Science, 9, 900847. doi: 10.3389/fvets.2022.900847 
2. Sparkes, A. (2018). Understanding feline idiopathic cystitis. In Practice, 40(3), 95-101. doi: 10.1136/inp.k435 
3. Nururrozi, A., Yanuartono, Y., Sivananthan, P., & Indarjulianto, S. (2020). Evaluation of lower urinary tract disease in the Yogyakarta cat population, Indonesia. Veterinary World, 13(6), 1182-1186. doi: 10.14202/vetworld.2020.1182-1186 
4. Piyarungsri, K., Tangtrongsup, S., Thitaram, N., Lekklar, P., & Kittinuntasilp, A. (2020). Prevalence and risk factors of feline lower urinary tract disease in Chiang Mai, Thailand. Scientific Reports, 10(1), 196. doi: 10.1038/s41598-019-56968-w 
5. Eggertsdóttir, A. V., Blankvandsbråten, S., Gretarsson, P., Olofsson, A. E., & Lund, H. S. (2021). Retrospective interview-based long-term follow-up study of cats diagnosed with idiopathic cystitis in 2003-2009. Journal of Feline Medicine and Surgery, 23(10), 945-951. doi: 10.1177/1098612X21990302 
6. Forrester, S. D., & Towell, T. L. (2015). Feline idiopathic cystitis. Veterinary Clinics of North America: Small Animal Practice, 45(4), 783-806. doi: 10.1016/j.cvsm.2015.02.007 
7. Buffington, C. A., Westropp, J. L., Chew, D. J., & Bolus, R. R. (2006). Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. Journal of Feline Medicine and Surgery, 8(4), 261-268. doi: 10.1016/j.jfms.2006.02.002