Cat sniffs outside a litterbox
Your cat seems to have all the signs of a bladder infection, but your veterinarian can’t find any evidence of it. What the heck is going on?

He may have a condition called feline idiopathic cystitis, or FIC for short. FIC is a painful inflammation of the bladder that affects a quarter-million to a half-million cats every year. Cats with the disease, which can occur in males and females, urinate frequently — often outside the litterbox — and may strain to urinate.

Frustrating for Cats, Cat Owners and Veterinarians

The tendency to pee outside the box means that FIC is many times mistaken for a behavior problem. What’s going on, though, is that it’s really painful for the cat to urinate. He associates the pain of urination with being inside the litterbox. Quite sensibly, he tries to lessen the discomfort by peeing somewhere else.

That’s not the only problem with FIC. The word idiopathic in the name means that we don’t know what causes it. What we do know is that FIC is a disease of young to middle-aged cats. Stress may be a contributing factor.

If your veterinarian has used urinalysis, urine culture, radiographs and ultrasound to rule out other problems such as urinary tract infections or urinary stones, it’s likely that your cat may be suffering from FIC. The good news is that clinical signs of the unobstructive form of FIC usually don’t last beyond a week, even if they go untreated. That doesn’t mean you should just let it go. It’s painful for the cat, and besides, if he’s not using the litterbox, chances are you’re plenty unhappy, too. Throwing antibiotics at the disease isn’t helpful if there are no signs of infection.

Managing FIC

So what can you do? A few simple strategies can help improve quality of life for a cat with FIC and potentially reduce the severity and duration of the signs caused by the disease. The recommendations have not been validated by controlled clinical trials, but they are easy to implement and will do no harm.

Make sure your cat drinks plenty of fresh water. That not only dilutes the urine, it also ensures that your cat urinates more frequently. Less urine hanging around in the bladder means less likelihood that the urine will irritate the bladder wall. If your cat doesn’t seem to lap much out of his water bowl, try changing the water a couple of times a day so it’s ultra-fresh and cool. Another trick you can try is to provide him with a pet fountain. Many cats prefer drinking running water. Or you can just turn the faucet on to a trickle so he can drink from it.

Feed a high-quality canned food. It’s another way to get water into your cat if you can’t get him to drink more. If he’s not used to eating canned food, offer small amounts alongside his regular food to encourage him to eat it.

Clean that litterbox! You want to do everything you can to make the litterbox attractive for your cat to use. Scoop it at least twice a day. Every two weeks (or weekly, if your cat is especially fussy), toss the litter, scrub the box with a mild, scent-free dish detergent and warm water and fill it with fresh litter. If that seems like an awful lot of work, just pretend like it’s an extra bathroom in your house that needs to be cleaned. And keep in mind that just like humans, cats like options: Add an extra litterbox, maybe with a different type of litter, so he has a choice when he needs to go. A good equation to remember is one litterbox per cat, plus one more.

Manage your cat’s pain. Talk to your veterinarian about prescribing a short-term pain-relief medication to help ease your cat’s discomfort. You may also want to ask your veterinarian about chewable cat treats that contain a natural amino acid supplement called L-theanine that may help reduce stress in cats with FIC.

Enrich Your Cat’s Environment

My colleague Dr. Tony Buffington, DVM, is a professor at Ohio State University College of Veterinary Medicine who has extensively studied urinary tract disease. He believes FIC is a disease of the central nervous system that affects not only the bladder but also other organs.

His advice for managing FIC may seem a little unusual: Provide your cat with environmental enrichment. While enrichment has never undergone controlled studies, it is generally considered an effective treatment for FIC, according to a presentation earlier this year at the Western Veterinary Conference by Dr. John Kruger, DVM, Ph.D., an internal medicine specialist at Michigan State University College of Veterinary Medicine.

To add some entertainment and playtime to your cat’s life, try offering food puzzles that contain kibble or tiny treats; rotate favorite toys so he always has something new to play with; give him some fun places to play and hide, such as teepees and tunnels; and stimulate his visual senses with a perch in front of a window where he can watch the birds and squirrels and daydream about hunting them. Using pheromone sprays or diffusers can also help your cat to chillax.

We may not know what causes FIC, but we do know that cats who live in interesting environments have significantly reduced levels of stress and fearfulness. Less stress seems to mean fewer incidents of FIC, which is good for your cat — and for you.