Idiopathic Cystitis: The Signs, Symptoms And Treatment

Idiopathic cystitis is a common condition in cats of all ages, and can cause a range of different symptoms. Many cats will improve quickly with treatment, but others can need ongoing support. In a few cats (almost always males) it can lead to urinary obstruction, a life-threatening condition.

What Is Idiopathic Cystitis?
Idiopathic cystitis” is inflammation of the bladder that is caused by stress. Not all cats will develop this inflammation when they are stressed, but for those who do, the symptoms can be severe and painful. We do not know exactly what causes this inflammation, but is thought to be related to changes in cats’ hormone levels as a result of stress.

“Cystitis” means inflammation in the bladder, and “idiopathic” means that we do not understand the exact cause.

There are currently no tests available that can tell us whether or not an individual cat is likely to develop Idiopathic Cystitis, but we know that the risk is genetic. This means that if a cat’s mother, father or siblings have this condition, then it is more likely that they will develop it, too.

What Can Cause Stress in Cats?
There are many different reasons why a cat might become stressed. Some are obvious, but others can be quite difficult for us to instinctively understand.  Most commonly, it is caused by changes to their normal environment or routine, such as:

• A new cat in your home or the local neighbourhood (even if your cat is indoor-only)
• Guests staying in your house
• Building works in your house, or a nearby house

Cats also have a strong need to feel in control of their environment and may become stressed if they feel they cannot easily access necessities such as food, water, litter trays or hiding spaces.

How Can I Tell If My Cat Is Stressed?
Cats are private creatures, and it can be very difficult to tell when they are stressed.

Some of the signs of ongoing stress in cats include:

Other things can cause these kinds of symptoms, which is why your vet may need to run some additional tests to rule out other illnesses.

Symptoms of Idiopathic Cystitis
The early signs of cystitis are subtle, and your cat may simply appear quiet and withdrawn, and be less interested in their food. Occasionally the opposite will be true, and cats appear agitated, but this is less common.

This inflammation in the bladder is uncomfortable, and having urine present in the bladder will cause it to become even more irritated. This means that cats want to urinate more often, so you might see them take more trips to the litter tray, or outside. Sometimes they may start to pass urine in the house, too.

The irritation can make it feel as though there is urine present in the bladder even when it is empty, so you may see cat straining to urinate, or taking longer to pass urine than normal.  Some cats will mew or yowl whilst passing urine, which is a sign of discomfort.

Sometimes the inflammation may lead to blood in the urine, which causes it to appear red or pink. In severe cases, you may see blood clots in the urine as well.

Urethral Obstructions
Male cats who suffer from idiopathic cystitis are at risk of a urethral obstruction – a blockage in the pipe that connects the bladder to the penis. This is sometimes called a “blocked bladder”, and is a serious condition that can quickly become life-threatening if not treated.

The symptoms are very similar to those for cystitis, and indeed some cats may have cystitis for a few days before they develop a blockage. The main difference is that affected cats will strain repeatedly but not be able to pass urine. They are also generally more unwell than cats with idiopathic cystitis and may appear very tired, stop eating, and vomit. If left untreated, sadly most cats with a urethral obstruction will pass away.

It is very rare for female cats to suffer from a urethral obstruction. The vast majority of affected cats are male.

 Treatment for Idiopathic Cystitis
There are many different things that can help cats who suffer from idiopathic cystitis. In the short term, medication can relieve their symptoms and make them more comfortable. In the long term, the most important thing to help them to find ways to reduce their stress levels. This is usually done with a combination of supplements, pheromones, changes at home, and sometimes medication, too.

Medication

Pain Relief
Cats who are suffering with idiopathic cystitis are usually in pain and need medication get them comfortable. Not only is this important for their quality of life, but it is also necessary to treat the underlying cause of their cystitis. Pain is stressful, and so being in pain from their cystitis can actually cause cats to become sicker.

There are several different pain medications that can be helpful to treat cats with cystitis. These include:

• Anti-inflammatory painkillers like Metacam® or Onsior ®, for short or long-term pain
• Buprenorphine and other opiate painkillers, for short-term pain
• Gabapentin, a nerve painkiller, for long-term pain.

Most cats will only need short-term treatment, though this may need repeating if they have flare-ups. Some cats with more severe issues may need longer-term treatment.

Supplements
There are supplements available that claim to help cats with Idiopathic Cystitis.  These include:

• Supplements for urinary health, such as VetPro® Urinary Function, Cystaid®, or Cystophan®. These may help to maintain a healthy bladder lining.
• Supplements for stress, such as VetPro® Stress & Anxiety, Zylkene®, or Calmex®. These may help your cat to relax more easily.

Supplements are not the same as medications, and there is very limited evidence to suggest that these products may help cats with Idiopathic Cystitis. However, the chances of them being harmful are very low, and some people do find that they help to relieve their cat’s symptoms.

Behavioural Medications
Some cats who are stressed or anxious, or are suffering from repeated episodes of idiopathic cystitis, may benefit from medication to help with their stress and anxiety. There are several different medications that we may use for this purpose, depending on your cat’s exact issues.

However, these medications should only be used alongside a detailed plan from a behaviour specialist that sets out other changes at home to help your cat feel more relaxed.

Antibiotics
Cats with idiopathic cystitis do not have an infection in their bladder, and so do not need treatment with antibiotics. However, the symptoms of idiopathic cystitis are very similar to the symptoms of a bacterial infection, and sometimes it can be hard to tell the difference between the two. Your vet may recommend collecting a urine sample for analysis, in case your cat does need antibiotics.

Special Diets
One of the most important treatments for cats with idiopathic cystitis is to change them onto a special diet. This will help to keep their urine more dilute, so it is less irritating to the lining of the bladder, and will also reduce their risk of developing a urethral obstruction if they are male.

Some of these foods are available in “light” or “moderate calorie” versions, which can be useful if your cat is overweight.

Wet food is thought to be better for cats with Idiopathic Cystitis as it has a higher moisture content, and so will help to increase your cat’s water intake. However, it is still better for them to eat the dry version of these foods than to eat a normal wet diet.

It is usually best to wait until your cat is feeling better before changing their food. Otherwise, they may associate the new food with feeling unwell, and may be less keen to eat it. Your vet can advise you on when is the best time to introduce the new food.

Changes At Home
Idiopathic Cystitis is triggered by stress, so it is important to try and help your cat feel as relaxed as possible at home. It can be quite hard to tell if cats are stressed as they show very few outward signs, so it is worthwhile making a few changes and seeing if they make a difference.

Safe Spaces
Make sure your cat has safe places in your home that they can hide away, undisturbed by other cats or humans.  These spaces might be high up, such as the top of a wardrobe, or low down, such as a spot under the bed. Whatever spaces your cat likes to use, make sure they can access them at all times, and do not disturb them when they are in these places.

Litter trays
Stressed cats may wait longer than they should before emptying their bladders. This causes the urine to become concentrated and sometimes to form crystals, which can irritate the bladder even more. This means that it is important to make sure that cats always feel comfortable enough to go to the toilet.

Make sure that your cat has a choice of several different places to toilet. If they use a cat flap, some of these places may be outside, but we would recommend providing at least one litter tray. This allows your cat to safely go to the toilet if there is something outside that is stressing them. If your cat regularly uses a litter tray, then consider putting a second one in a different part of your home, so that they can always have that choice.

These trays need to be big enough to allow a cat to comfortably turn around inside (around one-and-a-half times their length), and should be put in quiet spots away from their food and water. Use a gravel-texture litter that clumps, so you can scoop out any urine or faeces easily. You should scoop the trays out at least once a day, and change the litter completely every 1-2 weeks, depending on how often it is used.

Water
It may be helpful to encourage cats with idiopathic cystitis to take in more water, as this will allow them to produce less dilute urine that does not irritate their bladder as much.

All cats have different preferences when it comes to how they drink their water. Some will prefer moving water, and so may benefit from a cat water fountain. Otherwise prefer to drink from a bowl or glass, but may have preferences for “fresh” water, or for water that has been out for a little while.  Try offering your cat several different “kinds” of water, to see if they have a preference.

Cats should always have a choice of drinking spots, so if they are stressed about using one then they can go to the other. If your cat goes outside, then one of these might be an outdoor spot. Water bowls should not be kept near food bowls, as cats do not like to drink near where they eat.

Other Cats
Issues with another cat are one of the most common causes of Idiopathic Cystitis. This might be another cat who lives in your home or one who lives nearby. Even indoor-only cats can be upset by seeing local cats prowling around outside.

Make sure that other cats cannot gain access to your home, so that your cat can feel safe there. Microchip-reading cat flaps can be a useful way to keep out unwanted visitors. If your cat spends a lot of time staring at other cats through the window, consider using stick-on frosting on the lower sections to give your cat some privacy.

Expert Help
Cats who get repeated episodes of Idiopathic Cystitis may benefit from seeing a behavioural specialist. This is especially true if you have more than one cat in the household, as tension between cats can be subtle and difficult to spot. Fighting is the last resort for cats who do not get on, but low-level stress from a kind of “passive-aggressive” behaviour can still easily lead to cats developing Idiopathic Cystitis.

Prognosis

The long-term outlook for most cats who are diagnosed with idiopathic cystitis is usually good. Once the symptoms have been relieved and the necessary changes made at home, most cats will go on to have few  or no repeat episodes of bladder pain.

However, Idiopathic Cystitis cannot be “cured” – your cat will still be at risk of the symptoms coming back in the future if they become stressed again. It is important to continue with the changes they need to stay comfortable.

A few unlucky cats may have a more severe form of Idiopathic Cystitis that may cause more frequent flare-ups of their bladder pain. These cats are more difficult to treat, and may need to stay on medication in the medium– or long-term to control their symptoms. In some extreme cases, their quality of life may become poor and it may be kinder to put them to sleep.

Urethral Obstruction
Cats who suffer from a urethral obstruction are very unwell and need emergency treatment in a veterinary hospital. This treatment is usually successful, and around nine out of ten cats treated will recover from their first obstruction.

However, cats who have had one urethral obstruction are at risk of developing another one in the future. Somewhere between a quarter and a third of cats who have previously had a urethral obstruction will go on to develop another obstruction in the future. This might be days, weeks, months,  or even years later—but they can become just as sick again.

This means that it is especially important for cats who have had a previous urethral obstruction to continue with the changes they need to prevent it from happening again. In particular, it is important to keep them on one of the special diets to reduce the risk of crystals developing in their urine again.

If you’re concerned your cat may have urine issues, or if they’ve already been diagnosed and you need guidance, we’re here to help. Contact your nearest practice today to speak with our caring veterinary team and ensure your cat gets the support they need.