Feline Idiopathic Cystitis

This article is designed to help you better understand your pet’s condition. This is not a substitute for a veterinary diagnosis; it intended for reference purposes and to supplement an existing diagnosis after a veterinary examination. If you have questions or concerns, please contact us at 740-432-5980. It is absolutely vital to have a veterinary diagnosis prior to following any of the instructions provided here.

Feline Idiopathic Cystitis is a very common disorder seen in cats. It is extremely complex to treat and nearly impossible to “cure” medically. It is vital for us to rule out other urinary conditions such as infections or bladder stones: once we have diagnosed Feline Idiopathic Cystitis as the issue we can certainly help you through the process and offer some medications and treatments that may help you but a cure must come from home care.

Let us begin with a foundation of understanding the problem itself. Feline Idiopathic Cystitis (FIC) consists of any combination of the following symptoms: straining to urinate, blood in the urine, the frequent passage of small amounts of urine, and urinations in inappropriate locations. These symptoms are the result of complex abnormalities of the nervous and endocrine systems that cause behavioral and psychological stressors to be manifested into physical symptoms.  Although some medications and treatment may help this issue the primary therapy for your cat is to provide environmental enrichment that will influence your cats core instincts and reassure them that they are safe in their home. Although we as humans may be confident in the safety of our cats, our cats do not understand this. Imagine living in a place where you are constantly afraid and have no assurance that your resources (food, water, and litter) are limitless and any form of change is completely devastating to your world. This seems silly to us because we know better, but keep in mind our cats do not know this. When reading the rest of this handout keep your mind open and try to see the world from your cats perspective. Please utilize the checklist on the last page to evaluate the “cat friendliness” of your own household, and observe which areas you may want to make adjustments/improvements for your cat’s well being.


Behavioral and etiologic research suggest that cats prefer to eat individually in a quiet location, where they are not startled by other animals, sudden movement, or activity of an air duct or appliance that may begin operation unexpectedly.

Canned food may be preferable for cats with FIC because of increased water content and a more natural “mouth feel”. If a diet change is appropriate, offering the new diet in a separate adjacent container rather than removing the usual food and replacing it with new food permits the cat to express its preference.

Natural cat feeding behavior also includes predatory activities, such as stalking and pouncing. These may be simulated by hiding small amounts of food around the house or by putting dry food in a container from which the cat has to extract individual pieces or move something to release the food pieces if such interventions appeal to the cat.


Cats also seem to have preferences for water that can be investigated. Water-related factors to consider include freshness, taste, movement (water fountains, dripping faucets, etc.), and shape of the container. As with food, changes in water related factors should be offered in such a way that permits the cat to express its preferences. Additionally, food and water bowls should be cleaned regularly unless individual preference suggests otherwise.

Litter Boxes

Litter boxes should be provided in different locations throughout the house to the extent possible, particularly in multiple cat households. As a general rule in multiple cat households, there should be a minimum of one box per cat plus one additional box. Placing litter boxes in quiet convenient locations that provide an escape route if necessary for the cat could help to improve conditions for normal elimination behaviors. If different litters are offered, it may be preferable to test the cat’s preferences by providing them in separate boxes, because individual preferences for litter type have been documented. For cats with a history or urinary problems, unscented clumping litter should be considered. Litter boxes should be cleaned regularly and replaced; some cats seem quite sensitive to dirty litter boxes. Litter box size and whether or not it is open or covered also may be important to some cats.


Cats interact with physical structures and other animals, including human beings, in their environment. The physical environment should include opportunities for scratching (horizontal and vertical options may be necessary), climbing, hiding, and resting. Cats seem to prefer to monitor their surroundings from elevated vantage points, so climbing frames, hammocks, platforms, raised walkways, shelves, or window seats may appeal to them. Playing a radio to habituate cats to sudden changes in sound and human voices also has been recommended, and videotapes to provide visual stimulation are available.


Some cats seem to prefer to be petted and groomed, whereas others may prefer play interactions with owners. Cats may enjoy playing with toys, particularly those that are small, move, and mimic prey characteristics. Many cats also prefer novelty, so a variety of toys should be provided and rotated or replaced regularly to sustain their interest.


When a cat’s perception of safety becomes threatened, it appears to respond in an attempt to restore it’s “perception of control”. During such responses, some cats become aggressive, some become withdrawn and some become ill. In our experience, inter-cat conflict commonly is present when multiple cats are housed indoors together and health problems exist. Conflict among cats can develop because of threats to their perception of their overall status or rank in the home, from other animals in the home, or from outside cats. With a little practice, one can recognize signs of conflict and estimate its potential role in exacerbating signs of FIC. Some conflict between housemates is normal, regardless of species. Our goal is to reduce unhealthy conflict to a more manageable level for cats involved.

Signs of conflict between cats can be open or silent. Signs of open conflict are easy to recognize: the cats may stalk each other, hiss and turn sideways with legs straight and hair standing on end to make themselves look larger. If neither cat backs down, the displays may increase to swatting, wrestling, and biting. The signs of silent conflict can be so subtle that they are easily missed. The cat creating conflict (assertive cat) can be identified as the one that never backs away from other (threatened) cats, denies other cats access to resources, stares at other cats, and lowers its head and neck while elevating its hindquarters as it approaches less confident cats. Hair along its back and on its tail and tail case may stand on end, although not to the extent of cats engaged in open conflict, and the cat may emit a low growl. The assertive cat eventually may only have to approach or stare at a threatened cat for it to leave a resource, such as food or a litter box. If the threatened cat tries to use the do not seem to possess distinct dominance hierarchies or conflict resolution strategies, threatened cats may attempt to circumvent agnostic encounters by avoiding other cats, by decreasing their activity, or both. Threatened cats often spend increasingly large amounts of time away from the family, staying in areas of the house that others do not use, or they attempt to interact with family members only when the assertive cat is elsewhere. Signs of conflict can result from two types of conflict: offensive and defensive. In offensive conflict situations, the assertive cat moves closer to other cats and controls the interaction. In defensive conflict situations, a threatened cat attempts to increase distance between itself and the thing it perceives as a threat. Although cats engaged in either type of conflict may spray or eliminate outside the litter box, we find that threatened cats are more likely to develop elimination problems.

The most common cause of conflict between indoor-housed cats that we have been able to identify is competition for resources. Cats may engage in open or silent conflict over space, food, water, litter boxes, perches, sunny areas, safe places where the cat can watch its environment, or attention from people. There may be no obvious limitation of these resources for conflict to develop. The change may only be the cat’s perceptions of how much control it wants over the environment or its housemate’s behaviors.

Open conflict is most likely to occur when a new cat is introduced into the house and when cats that have known each other since kitten-hood reach social maturity. Conflict occurring when a new cat is introduced is easy to understand, and good directions are available from many sources for introducing the new cat to the current residents. Clients may be puzzled by conflict that starts when one of their cats becomes socially mature or when a socially mature cat perceives that one of its housemates is becoming socially mature. Cats become socially mature between 2 and 5 years of age and start to take some control of social groups and their activities. It may be surprising when two cats that have lived together for a long period of time can begin these behaviors but keep in mind that a cat’s perception of resource needs may expand with social maturity.

Cats that are familiar with each other but unevenly matched often show conflict in more subtle ways. One of the cats in the conflict asserts itself, and another cat is threatened by this cat’s actions. Silent conflicts may not even be recognized until the threatened cat begins to hide from the assertive cat, starts to hiss or fight back when it sees the other cat, or develops a health problem.

In addition to signs of conflict described previously, the assertive cat can be identified by its marking behavior. These cats rub their cheeks, head, chin, and tail on people, doorways and furniture at cat height. Unfortunately, silent conflict can also involve urine, including marking by the assertive or threatened cat and cystitis in the threatened cat. Conflict-related urine marking can include spraying, where the cat treads and kneads, raises its tail, and flicks the tip of it while spraying urine on a vertical surface or squatting and urinating outside the litter box (non-spray marking). Both male and female cats may spray, and although neutering reduces frequency of spraying, it cannot eliminate the behavior. The assertive or threatened cat can exhibit conflict-related urine marking, but in our experience, FIC usually occurs in the threatened cat; we have even seen threatened male cats spray bloody urine. Cats that urinate on bedspreads or other elevated open places may do so because their access to the litter box is restricted by another cat or if they are afraid to use to box because it is placed such that a quick escape from another cat might not be possible. Treatment for conflict between cats involves providing a separate set of resources for each cat, preferably in locations where the cats can use them without being seen by other cats. This lets cats avoid each other if they choose to without being deprived of an essential resource. Conflict also can be reduced by neutering all the cats and by keeping all nails trimmed as short as practicable. Whenever cats involved in the conflict cannot be directly supervised, they may need to be separated. This may mean that some of the cats in the household can stay together but that the threatened cat is provided a refuge from the other cats. This room should contain all necessary resources for the cat staying in it.

Cats generally require and use more space than the average house or apartment affords them. Addition of elevated spaces such as shelves, “kitty condos”, cardboard boxes, beds, or crates may provide enough space to reduce conflict to a tolerable level. In severe situations, some cats may benefit from behavior-modifying medications. In our experience, however, medication can help only after environmental enrichment has occurred; it cannot replace it.

Cats involved in the conflict may never be “best friends”, but they usually can live together without showing signs of conflict or conflict-related disease. In severe cases, a behaviorist may be consulted for assistance in desensitizing and counter-conditioning of cats in conflict so they can share the same spaces more comfortably if this is desired. Conflict with other animals, dogs, children, or adults is relatively straightforward. In addition to being solitary hunters of small prey, cats are small prey themselves for other carnivores, including dogs. Regardless of how sure you are that your dog will not hurt your cat, to the cat, the dog represents a predator. If the cat does not assert dominance over the dog, as often happens, it must be provided ways to escape at any time. For human beings, it usually suffices to explain that cats may not understand rough treatment as play but as a predatory threat. Children must be carefully monitored with cats and children being too rough with your cat should never be tolerated!

Most cats in urban areas in the US are housed indoors and neutered, so conflict with outside cats can occur when a new cat enters the area around the house the affected cat lives in. To cats, windows are no protection from a threatening cat outside. If outside cats are the source of the problem, a variety of strategies to make one’s garden less desirable to them are available.

Studies have shown that the most common cause of clinical signs for FIC in singly housed cats was separation anxiety; for the cats from multiple cat households, the most common cause of clinical signs was some form of conflict.

Additional Approaches

Once environmental enrichment strategies have been implemented, additional treatments may be considered. In our experience, these approaches are more likely to succeed after the environment has been enriched to the extent possible and more likely to fail in the absence of environmental enrichment. They are listed in the order in which we consider them.


Pheromones are chemical substances that seem to transmit highly specific information between animals of the same species. Although the exact mechanism of action is unknown at this time, pheromones seem to affect changes in the function of the limbic system and the hypothalamus to alter the emotional status of animals. There are 5 facial pheromones that have been isolated from cats. Cat deposit these pheromones on prominent objects (including people) by rubbing against the object when the cat feels safe and at ease. The function of this secretion is not only to mark objects but to serve as an antagonist for urine marking and scratching.

As humans the senses we rely on most are our senses of sight and sound; we tend to apply anthropomorphic personifications of our companions and assume those are the senses they utilize the most as well. This is not the case; cats communicate the most through smells rather than sounds or body language. We are not sensitive enough to detect the smells that our cats produce in their attempts to communicate with us: much like our attempts to communicate through sight and words with them are often ineffective. Pheromone products act as a catalyst for us to communicate with our cats and let them know that “all is well and you are safe”.

The most common, well known, reputable pheromone product available today is Feliway. Feliway is a synthetic analogue of this naturally occurring feline facial pheromone. It was developed to decrease anxiety-related behaviors of cats. It is sold as a spray and a room diffuser (much like scented plug ins we buy for our homes). Humans cannot smell this at all but it has proven to be very effective for our feline friends.

Pain Management

We can provide short-term pain management therapy in the case of flare-ups in clinical signs. More severe flare-ups may indicate the use of steroids as an anti-inflammatory aid. There is no drug more effective than environmental enrichment. Drugs that might be considered include “antidepressants” and sedatives.

Guernsey Veterinary Clinic, Cassie Gombeda RVT

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This is a large amount of information to absorb and we understand that. This is why we have handouts for you because presenting all this too you verbally may prove overwhelming. If you have concerns or questions beyond what is described here please never hesitate to ask! We want our clients to be well informed and our patients to be happy and healthy!

Guernsey Veterinary Clinic
2103 E. Wheeling Ave. Cambridge
Dr. Leia Hill
Dr. Michele Dangaran
Dr. Nikki Freshwater
Dr. Michelle Santangelo

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