Feline Idiopathic Cystitis

Also known as:

  • Stress cystitis
  • Feline interstitial cystitis
  • Pandora syndrome
  • Idiopathic feline lower urinary tract disease (FLUTD)

This is my favourite disease of all time to educate clients about!

Whilst it can be a very frustrating disease, with some patients experiencing recurrent bouts of FIC throughout their lifetime, there are many different options for management and treatment.

Environmental modification and enrichment has been shown to reduce the frequency and severity of clinical signs by 70-80%, which in my opinion is pretty outstanding! Just by improving your cats home environment, it is likely you can effectively manage this disease for the rest of their lives with very minimal long term costs.

This post is just an overview of the fascinating topic of feline idiopathic cystitis, and treatment options will be elaborated on in future posts – so stay tuned!


Feline idiopathic cystitis is a chronic sterile inflammation of the bladder. Although they may show symptoms of having a urinary tract infection, there is no infectious component (i.e. bacteria) contributing to the bladder inflammation.

Studies have shown that in young cats showing urinary tract symptoms, less than 2% will actually have a true urinary tract infection.

It is likely that there are multiple factors that lead to sterile inflammation of the bladder including interactions between the bladder wall, the nervous system, the adrenal glands and the environment.

Symptoms may include:

  • Increased frequency and/or urgency of urination
  • Straining to urinate
  • Urinating in unusual places (towels, sheets, sinks, showers)
  • Excessive grooming
  • Blood in the urine
  • Behavior changes (aggression, hiding)
  • Distressed crying (while urinating or near the litter tray)

FIC can be classified into ‘obstructive’ or ‘non-obstructive’

Non-obstructive FIC occurs in approximately 80-95% of cases, and symptoms will usually resolve within 1-2 weeks

Obstructive FIC occurs in approximately 15-25% of cases. Obstructive FIC causes the urine to be unable to drain from the bladder. This is a potentially life-threatening condition, and symptoms include, in addition to those listed above, lethargy, vomiting and/or inappetance. Obstructive FIC predominantly occurs in male cats due to their narrow urethra, however can still occur in female cats.

Diagnosis of FIC:

FIC is a diagnosis of exclusion, meaning all other causes of urinary tract inflammation must be ruled out. Other causes of lower urinary tract signs include a urinary tract infection, urine crystals and bladder cancer.

First, your veterinarian will need to evaluate a urine sample from your cat. Ideally, the urine sample is retrieved via a short procedure called cystocentesis. This procedure is performed by inserting a small needle through the skin and into the bladder. The urine sample is sent to an external laboratory for comprehensive testing. Your veterinarian may also request blood tests.

Risk factors for FIC:

Some cats are more prone to FIC. As stated above, this is usually a combination of factors including genetics and the environment.

Cats that are more at risk of developing FIC include:

  • Male cats (especially neutered males)
  • Overweight cats and sedentary cats, with very little exercise
  • Cats in multi-cat household, particularly when there is tension between cats
  • Cats in a new or different environment to their usual routine
  • Cats that eat mainly dry food or cat biscuits (leading to inadequate water intake)
  • Cats that do not have adequate number or size litter trays


There is currently no cure for FIC, and due to the waxing and waning nature of the disease, goals of therapy are to reduce the severity and duration of clinical signs. Treatment also aims to prolong the time between FIC episodes in cats that experience recurrent FIC.

Treatment includes a multi-modal response, including:

  1. Environmental modification to reduce stress
  • Multiple and separate resources such as food and litter trays (particularly in multi-cat households)
  • Hiding places and high viewing points
  • Increased play, exercise and human-cat interaction
  • Outdoor runs and enclosures
  1. Increasing water intake and diet management
  • Low calorie weight loss diets
  • Specific urinary health diets
  • Pet fountains to promote drinking water
  • Increasing wet food component of diet
  1. Litter tray management
  • Increasing the number and locations of litter trays in the house – particularly in multi-cat households (one litter tray per cat PLUS one)
  • Regular cleaning
  • Trialing different types of litter – your cat may have a preference!
  • Increasing the size of the tray
  1. Use of medications (over the counter and prescription from your veterinarian)

I always recommend an examination by a veterinarian each time your cat has a recurrence of FIC to ensure that they are not experiencing a life-threatening urinary obstruction. By working with your veterinarian, the aim is to reduce the severity of symptoms during a FIC flare up, and reduce the frequency of recurrence long term.

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