Yellow cat laying down
In my practice, I see feline patients every week that present with vague urinary abnormalities: everything from bloody urine to straining in the litterbox to inappropriate elimination. Cat owners are often flabbergasted as to why their beloved pet would choose to urinate on their expensive sheets!

Though the cause can range from a mild urinary tract infection to a serious urinary blockage, I find that more often than not, these cats are suffering from feline interstitial cystitis (FIC). FIC is a term that describes a collection of signs that are affiliated with inflammation and irritation of the lower urinary tract (the urinary bladder and urethra, the tube that leads from the bladder to the exterior). I had a chance to catch up with Elizabeth Colleran, DVM, and ABVP Diplomate in Feline Practice to ask her some questions about the latest in research for cats suffering from FIC.

Q: Feline interstitial cystitis (FIC) has had a lot of names over the years, including FLUTD (feline lower urinary tract disease) and FUS (feline urologic syndrome). A new name that has emerged is Pandora Syndrome. Who coined the term, and why?

A: The names of medical disorders influence how we think about them. All the previous names of this disease have focused on the lower urinary tract, which, in turn, focused all investigation, diagnostics and therapeutic planning on urinary signs.

We now know that it is an incomplete picture of these cats, and a more comprehensive investigation is warranted. Until a more appropriate name develops, Dr. Tony Buffington coined the term "Pandora Syndrome" to describe cats with chronic recurrent lower urinary tract signs along with two or more simultaneous chronic diseases or conditions in other body systems outside the lower urinary tract.

Q: I have heard that stressful events in cats with Pandora Syndrome can predispose them to chronic, recurrent urinary issues. Can you point cat owners to studies that have researched this theory?

A: Probably the most convincing evidence comes from a study published in the Journal of the American Veterinary Medical Association (JAVMA)  in 2011, entitled "Sickness behaviors in response to unusual external events in healthy cats and cats with interstitial cystitis.” It was a 77-week study that investigated sickness in cats related to the gastrointestinal tract, urinary tract, and/or skin and behavior in response to stressors. It is a fascinating read. These findings suggest that abnormalities in the cats’ behavior were observed after all cats, including healthy ones, were exposed to stressful situations.

There are also changes at the microscopic level that show that cats with Pandora Syndrome are hormonally and neurologically different than normal cats.

Q: You talk about how stress — an influence outside of the urinary tract  could apparently elicit urinary tract problems in cats, whether they currently had urinary tract disease or not. But one thing many cat owners may not know is that introducing a new cat to a household can stress the resident cat or cats out and, thus, exacerbate lower urinary tract signs, including accidents outside the litterbox. Could you explain how cats form social groups and what cat owners should know about them?

A: Most successful social groups are formed by related youngsters who grow up together. The cardinal rule in the cat world is that “cats don’t like cats they haven’t known their whole lives.” You can easily count social groups by discovering which cats sleep curled up together, groom each other willingly, rub against one another and engage in nose touching. 

It is possible but less likely for cats who don’t know one another to bond, but typically only in an environment where each cat has everything he/she needs without stress or competition in an environment that is stable enough for cats to relax. Cats are rarely happy enough to relate socially unless they feel their territory is safe.

If you have more than one feline social group in your household (and a social group can consist of only one cat), then make sure each social group has their own bedding, toys, litterboxes, and food and water bowls. Also, make sure each social group has enough space to get away from other cats in the household.

Q: We know it’s important to make sure these cats aren’t getting bullied by other cats in the household. We know there are ways to help ease stress including environmental enrichment and therapeutic diets. What else is available to cat owners to help cats with FIC?

A: There are key resources that must be provided in enough abundance. These include feeding places (cats are not social eaters and come together to eat only when forced to do so), drinking places, climbing places, litterboxes, resting places, scratching places, escape routes and places to hide alone. The number of bonded social groups or preferred associates dictates how many of all of these resources are required — you need resources for each social group.

Environmental enrichment strategies are composed of animate ones and inanimate ones. Animate social strategies include social stimulation from preferred associates (other cats in the social group), interactions with humans including petting and play, and potentially interplay with other animals, principally dogs living in the home, assuming socialization has been successful.

Play with prey-size toys that move and change shape, texture and appearance as they are played with — simulating the hunting sequence — is an example of inanimate strategies for enrichment. Feeding strategies that alter behavior to more closely mimic hunting, such as hiding food, small “mouse-size” meals and food puzzles, can be helpful as well to enrich the environment, provide mental stimulation and reduce stress. 

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