Everything You Need to Know about Feline Idiopathic Cystitis

A few weeks ago, I started our morning litter box routine. Newt and Ripley share three boxes: one upstairs, one in the laundry room, and one in my bathroom. Twice a day, I start with the box upstairs, scoop all three, then move on with our day!

That morning, I scooped the upstairs box and noticed a rusty color in one of the urine scoops. Odd, I thought, but figured our natural litter maybe just had a discoloration. (This is the litter we use.) It happens.

Then I went downstairs…

I started to scoop the laundry room box, and right at the top was a small clump of blood. Something you never want to see in the litter box, of course, and with two cats that share all three boxes pretty equally, I didn’t know which cat was having the problem. So, I separated them for a short while, each with access to one box. Luckily, Ripley went almost right away. I peeked in and–sure enough–a lot of blood. I immediately called the vet.

The next day, I took her in. After a hands-on exam, the vet told me that Ripley’s bladder was teeny tiny and also empty. She recommended that I leave Rip with her. They’d put her in a crate with a non-absorbing litter, give her fluids, then wait for her to go. As much as I hated to leave her, it seemed to be the most sensible course.

A couple hours later, the vet called: Ripley peed a ton of blood. There were crystals but no bacteria.

The diagnosis? Feline Idiopathic Cystitis.

What is Feline Idiopathic Cystitis (FIC)?

Also called Pandora Syndrome, it sounds scary–but, honestly, what diagnosis doesn’t? The tricky thing with FIC is that its symptoms overlap with a bunch of other symptoms of various lower urinary tract diseases. The signs include bloody urine, straining to urinate, having accidents, excessive licking of the area, and so on. Each of these symptoms applies to all sorts of other problems like infections (which is what I assumed Ripley had) to tumors to bladder stones and so on.

FIC is a diagnosis of exclusion; once all that other stuff is ruled out, your cat is diagnosed with FIC.

OK, so what is FIC? Idiopathic cystitis in cats is “a psychosomatic problem that stems from an inability to handle stress,” according to Veterinary Partner. The reference goes on to explain that the lining of the cat’s bladder becomes “patchy” when the cat experiences anxiety. This results in inflammation, which we all know by now is the root of all evil. (Hyperbole? Sure, but inflammation causes so many problems, so let’s roll with it!)

We’ll dig into the treatment in a minute, but for now, it’s super important to realize that if your cat has been diagnosed with this stress-related illness, it does not reflect poorly on you. My first instinct was, “ARH!!! We’re a stressful home! We caused poor Ripley’s bladder to bleed!” Of course, that’s not exactly true. While stress management is key–again, more on that in a minute–the reality is that some cats are prone to this because of an imbalance in their brain that affects how their hormones are controlled. According to the Veterinary Partner article: “These cats are neurologically different in a way that makes them extra reactive to any change in their world, extra anxious, and extra sensitive to pain relating to the back half of their bodies. … FIC cats are very sensitive and can flare up with symptoms over events that humans frequently discount or pay no attention to. Most pet owners, however, are aware that the cat in question has a personality that is somewhat anxious or sensitive.”

Ripley is extra sensitive. We’ve known this since the first week we brought her home. She’s also rambunctious and playful, silly and athletic, cuddly and lovely. She’s a wonderful cat who just happens to be wired a little differently. If your cat receives this diagnosis, don’t feel guilty! Feel grateful! Because now that you know what you’re up against, you can help your cat live a wonderful, well-managed life!

How does a cat “catch” Idiopathic Cystitis?

Well, they don’t. As it says above, this is just how some cats are wired. Newt will never be at risk, despite sharing a home with Ripley. (Newt is clearly NOT wired for stress. She is one tough cookie who keeps everyone in this household shipshape.) If your cat receives this diagnosis, rest assured that it’s pretty manageable and isn’t communicable to any other animals or people at home.

Perhaps the more appropriate question should be: What triggers idiopathic cystitis in cats?

Stress.

What “stress” means for your cat might be different than Ripley. For instance, she’s been in a home with a child her entire life, so she’s used to Violet. A cat who’s never been around a child might get triggered if a small child comes to visit. Ultimately, you need to examine your own home and lifestyle to figure out your cat’s triggers, but some common ones include:

• changes in routine
• changes in diet
• moving or even just swapping around furniture
• adding or losing family members
• construction
• weather pattern changes
• a stressful family
• too much Baby Shark (just kidding… sorta…)
• changes in the family’s schedule

That last one, we think, triggered Ripley. Her FIC started the weekend after John started his new job, which took him away from home for very long days for the first time in Ripley’s life. It also affected what time the animals eat breakfast each day and resulted in me being gone for more hours each day for Violet’s school drop off and pickup. We also switched their food often because we rotated diets for Newt forever, so that’s what we were used to. All big changes, all at once. Obviously had we known about her condition first, we would’ve handled things differently, but I’m grateful we know now and can take steps to mitigate flare ups in the future!

How do you treat Feline Idiopathic Cystitis?

It starts with stress management.

Clearly you can’t control everything. No one can. But, you can take a handful of measures to ensure a safe, calm environment to keep your cat from having an FIC “flare up.” Here are three big things to consider:

1. Plug in pheromone diffusers: Our vet recommended Feliway, which we put in the three spaces Ripley uses the most. It does seem expensive, but the refills are less costly than the whole kit, and… imo… if it helps, it’s worth it.
2. Environmental enrichment: Cats with FIC need “safe” spaces that fit their personality. Ripley isn’t a “tree-dweller” like Newt is, so for her it’s access to under the bed, in cozy corners, and piles of blankets. For those reasons, she prefers our bedroom, so we make sure she has unfettered access. I’m considering a baby gate for the bedroom door to keep Cooper and Violet from rushing in when she needs down time, but I’m not totally sure on that one yet. Environmental enrichment also includes play time with you, as well as stimulating experiences like a window perch, interesting toys, and so on.
3. Prescription food: Your vet might want your cat on a prescription diet. I know many people have mixed feelings about those diets, but talk to your vet with an open mind and do your own research. For us, we chose to put Rip on a prescription for ongoing maintenance. Most sources recommend canned, if possible, to add the moisture. Ripley gets canned food for breakfast and dinner plus a puzzle toy with kibble at lunchtime.

Your vet might also prescribe anti-inflammatories during a flare up because the condition is painful, including spasms in the bladder.

I know what many of you are thinking: Is there a “natural” solution? Honestly, the environmental enrichment piece and stress management piece are as natural as you can possibly get. In fact, studies show that this–more than the diet and more than any medications–prevents FIC flare ups.

How’s Ripley faring with her FIC diagnosis?

She’s not peeing blood anymore so, you know, #winning!

In all seriousness, she’s doing well. She’s due for a recheck this week, but the Feliway has been working. She actually loves her prescription food and gobbles it right up. We’re a little over a month into the new routine and schedule, and it seems like everyone is finally starting to adjust. (How the toddler handled a total upheaval of her schedule is a whole other topic for a whole other blog, but whooooooooo boy.)

When we first got the diagnosis, the vet put her on an anti-inflammatory to help with the pain and spasms associated with the condition. She hasn’t strained to go to the bathroom since we started the treatment.

Quick aside: I panicked when she gave me the packet of pills. We’ve never *knock on wood* had to pill a cat. Well, wouldn’t you know? Ripley just ate the pill right off the kitchen counter where I set it to find some cheese or something to stick it in. ¯\_(:/)_/¯

What next?

Our next steps include: continued stress management in the house with enrichment activities added in, the prescription food, a recheck with the vet, and emergency appointments if we ever spot a flare up. If your cat gets this diagnosis, definitely check out Feliway and consider what changes you can make at home to create a more secure, more enriching environment for your cat. (Check out some ideas here.) We have a pretty cat-friendly setup around here, but there are some things we can add, like maybe some cat grass in the window and a climbing structure other than their same-old cat tree. (A girl can dream. Just kidding… kind of…)

So, that’s our plan, and I think that’s just about everything you need to know about Feline Idiopathic Cystitis! Have I left you with questions? If so, leave any Qs in the comments, and I’ll try to answer them or find an expert who can! Or, if you’ve had a cat diagnosed with FIC, what has worked for you? I’d love to share first-person insights and anecdotes so we can all learn and help our cats feel better!