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Cystitis in a cat: how to recognize and treat the disease?

Cat cystitis

Cystitis in a cat is a common problem with a complex etiology.

Domestic cat, or Felis catus, has been extremely popular for many years, being probably the most popular domestic animal in the world.

The attitude of many cat owners in terms of prophylaxis, nutrition or treatment of this species has also changed, which is happy.

Cats in many cases have become typical domestic animals, possibly going out to a nearby fenced garden and living in close contact with people away from their wild relatives.

All these changes are, of course, dictated by concern for the health of feline charges and they are certainly a step in the right direction because they significantly eliminate the risk of any infectious or parasitic diseases that can be infected from stray animals.

Routine castration or sterilization significantly changes the behavior resulting from the sexual behavior of felids, eliminating to a large extent aggression or defense of the territory and competition with other individuals for the favor of cats in heat due to high testosterone levels.

Many cats have become nice, fluffy animals to cuddle, which on the other hand often entailed a significant reduction in their natural behavior resulting, for example, from the way of gaining food and hunting.

Nowadays, cats living in households very often do not have to find food themselves, but they get everything ready on a plate.

Such a drastic change in lifestyle is also associated with more common diseases of various systems and organs, including obesity in dogs and obesity in cats.

A perfect example of this is precisely the problems of a urological nature with the infamous feline urological syndrome and bladder problems.

In fact, the terms "feline urological syndrome " or "lower urinary tract disease ", although often used interchangeably, do not precisely define the location of the disease process and mean more generally a syndrome of ailments related to urine output.

In this article I will try to introduce you to the subject of cystitis in a cat and everything important to know about it.

  • Cystitis in a cat
    • Idiopathic cystitis
  • Veterinary and human urology
  • Cystitis in a cat symptoms
  • Idiopathic cystitis in the cause of the cat
    • Bacteria
    • Diet
    • Viruses
    • Stress
  • Interstitial cystitis. Pathophysiology
  • Diagnostics of cat cystitis
  • Treatment of cystitis in cats
    • Stress reduction
    • Cat pheromones
    • Anxieties
    • Diet

Cystitis in a cat

Cystitis in a cat

Many owners, when talking about the diseases of their charges, use short terms regarding the existing problems, simplifying the matter a bit.

And so you often hear about inflammation of the urinary bladder in a cat without specifying what specific pathology we are dealing with.

However, it is worth using professional terms that precisely describe the pathology that has arisen, which will undoubtedly be an expression of the great care and knowledge resulting from it of cat owners.

In the past, terms were commonly used feline urological syndrome and feline lower urinary tract disease however, they do not specify which specific section of the exit roads is affected by the problem.

Hence, more specific terms have now been introduced.

And this is how we distinguish:

  • idiopathic cystitis,
  • interstitial cystitis.

The term idiopathic cystitis it will focus on the cat's inappropriate behavior during voiding that is, the excretion of accumulated urine in the bladder.

We can talk about it excluding other similar diseases, so:

  • bladder stones,
  • any type of bacterial background contamination,
  • anatomical abnormalities,
  • neoplastic processes.

Idiopathic cystitis it may be acute or chronic.

It is the result of overlapping interactions between the bladder, nervous system and adrenal glands secreting corticosteroids, and is determined by environmental factors in which the domestic cat lives.

In turn, interstitial cystitis chronic course is characterized by a recurrent nature and as yet unknown cause.

It is obvious that we can only make such a diagnosis after excluding other causes of the underlying symptoms of dysuria.

Interstitial cystitis (FIC Feline Intestinal Cystitis is one of the most common disorders, part of the group of health problems referred to as the English name FLUTD or Feline Lower Urinary Tract Disease which in translation means lower urinary tract disease syndrome.

In fact, although we are talking about feline interstitial and idiopathic urinary tract inflammation, the listed disease entities refer to the same problem and are used interchangeably in many sources.

In other words, idiopathic cystitis is otherwise called interstitial and both terms more or less mean the same pathology.

Importantly, we do not know their etiology, and the pathogenesis itself is more guesswork than certain, documented information.

The concept of dysuria defines difficult, painful urination by an animal and is generally a consequence of diseases of the pathways leading to the produced urine, i.e. the bladder or urethra, or it results from diseases of the prostate gland or vagina.

Feline interstitial cystitis is very similar to the same human disease.

Idiopathic cystitis

Idiopathic cystitis which is a bit more about the common urological problem of felids

It is one of the most frequently diagnosed changes in the urinary bladder, affecting even approx 60-70% of cats with difficult, disturbed urine output.

It occurs with the same frequency in males and females, so we do not have a sexual predisposition here.

Spayed and neutered animals are much more vulnerable to them, i.e. most domestic, well-groomed and indoor cats.

This is a problem for wild cats not applicable.

Estimated epidemiological data indicate a significant share of FIC in the FLUTD group, even approx 60%.

Interestingly, a typical cat showing symptoms of idiopathic cystitis is in the age range from 1 to 10 years with the peak incidence at age 2-6 years.

Thus, the problem usually concerns young animals in their prime.

They are individuals that do not leave the house, so settling into the litter box and mostly consuming commercial dry food.

They are often accompanied by their lifestyle and low mobility obesity.

Outdoor cats can also show disease symptoms when the surrounding environment is inhabited by a large number of wild cats.

So we can see at the very beginning that stress caused by high density or staying at home i boredom the ensuing factor is an eminently contributing factor to the disease.

Idiopathic interstitial cystitis in cats is a type a disease of civilization found in well-groomed domestic cats whose owners make full use of the commercial way of feeding and keep their pets as typical companion animals.

Veterinary and human urology

In scientific experiments trying to explain the pathogenesis, etiology and course of a given disease entity, scientists often use the so-called. animal models.

They choose the species of animal in which the clinical symptoms of a given disease entity will be the closest to that in humans, so that the obtained results are as similar and reliable as possible and could be used practically in human medicine.

After many experiments, it has been shown that idiopathic interstitial cystitis occurs in felids and humans.

Thanks to this discovery, it was the cat that became the object of interest and research on this problem, and the obtained results tried to explain the essence of an analogous problem in humans.

Cystitis and the resulting symptoms in humans for no apparent reason have been a huge problem in human urology for over two centuries.

The disease is more common in women who complain of chronic, recurrent pain located in the pelvic area, a feeling of discomfort with a full bladder that disappears after emptying it, and additionally there is pollakiuria and hematuria.

The diagnosis of characteristic lesions in combination with the exclusion of other possible causes allows for the diagnosis.

I am mentioning it to make you aware that the same symptoms occur in our feline pupils, hence the great interest in this disease in cats, which raises hopes for finding out the cause and effective treatment in humans.

Cystitis in a cat symptoms

Cystitis in a cat symptoms

One of the main clinical symptoms of this type of inflammation will be the urgent need to urinate as a consequence of the ongoing inflammation.

Sick cat definitely urinates more often, it goes to the litter box more times and takes a characteristic posture, instead, it passes urine in smaller portions.

So we will notice the typical symptoms associated with difficult urination, i.e. dysuria.

The inflammatory process itself will be associated with painful urination, i.e stranguria, his frequent expulsion, which is defined by the term polakiuria and blood in the urine (hematuria).

The cat often excretes urine in unusual places, outside the litter box (periuia), which by many owners of these animals is interpreted as a cat's maliciousness or a desire to attract the owner's attention and seek help.

Cats may experience pain when urinating meow so we'll meet vocalization.

They can also lick the area around the genitals, manifesting, as it were, the existence of a problem in these places.

These symptoms usually occur suddenly, often for no apparent reason, and resolve spontaneously in the vast majority of sick cats, even if left untreated for up to a week.

In some individuals, they may take a chronic, recurrent form and repeat themselves from time to time.

In cats (males), due to the specific structure of the urethra, they may run among the symptoms of obstruction, which unfortunately requires quick and decisive medical intervention due to the potential risk of serious health consequences related to azo-mia and uraemia.

There are also sick cats that may not show other serious systemic symptoms and, despite the presence of inflammation, eat and drink normally, do not have elevated body temperature, i.e. fever and other disturbing symptoms from other organs and organs.

Therefore, we do not always come across a full picture of clinical symptoms.

This does not mean, of course, that they hate bladder discomfort or pain and always require diagnosis and drug treatment.

Therefore, you need to carefully observe the cat in order not to overlook the symptoms of the urinary system and their unusual treatment.

Remember that a lot of valuable information will be provided by a properly collected and conducted medical history, which should direct us to the suspicion of cystitis.

Idiopathic cystitis in the cause of the cat

Cystitis at the cause of the cat

Bacteria

Until quite recently, because in the seventies of the last century, the existing bacterial infections.

At that time, the diagnosis was made on the basis of the existing clinical symptoms, laboratory test results and effective antibiotic treatment.

Importantly, urine bacteriological cultures were not performed and the diagnosis was made on the basis of the presence of bacteria in the urine, which was obvious due to the method of collecting urine for analysis (urine was collected from a litter box, which was contaminated with bacteria from the urethra).

In later years, it was clearly shown that FLUTD dysuria resolves spontaneously, even without antibiotic treatment, which resulted in the decline of the theory about the bacterial basis of the disease.

So nowadays even presence red blood cells in the urine, his alkaline pH or suspicion damage to the mucosa of the urinary tract they are not indications for the routine introduction of antibiotic treatment.

Diet

In the nineties of the last century, the focus was on another issue common to cats, namely magnesium ammonium phosphate urolithiasis that is, struvite.

Dry, industrial, frequently used feeds with a composition with a high content of magnesium changed the pH of the urine and thus caused the precipitation of struvite and bladder stones.

Only urine-acidifying foods with a limited magnesium content reduced the frequency of this problem.

It was also seriously considered whether struvite urolithiasis did not cause interstitial cystitis, as evidenced by the presence of crystals in the urine.

Remember, however, that sick cats fed dry food produce small amounts of concentrated urine, and stress and related hyperventilation may change the urine to alkaline, which favors the precipitation of stones in the bladder.

The crystals should not damage the healthy epithelium of the urinary tract, so they should not cause bothersome clinical symptoms in the course of cystitis.

Sometimes, however, they can cause obstruction of the urinary tract, and in such cases the use of kidney diets that acidify the urine seems to be the most appropriate.

Viruses

There is also a concept viral idiopathic cystitis.

According to her, it is calicivirus it is responsible for triggering specific disease symptoms, which, despite numerous doubts, seems likely.

Viruses can damage cells or stimulate an excessive response of the immune system, which can be encountered in cystitis.

The features of the disease itself, e.g.:

  • its recurrent nature,
  • spontaneous passing after about a week,
  • more frequent occurrence in cat clusters.

Stress

Recently, much attention has focused on as a potential trigger of inflammation stress and hormonal changes accompanying him. The relapsing nature and spontaneous recovery of symptoms may support the above concept.

Therefore, an active participation of the endocrine and nervous systems in the pathogenesis of cystitis is suggested, the more so that in sick cats an increase in the concentration of certain characteristic hormones (e.g. norepinephrine).

Stress is recognized as an important trigger for the development of interstitial / idiopathic urinary infections in cats.

Increased, long-term concentration catecholamines in the body can damage the protective barrier in the bladder and thus expose the wall to the irritating effect of urine.

And we all know very well how many different environmental factors can cause stress in our feline pets.

Knowledge of all these potential factors that may cause inflammatory changes in the cat's bladder seems to be basic knowledge in the context of skilfully implemented treatment and preventive measures taken.

We can see, however, that despite many theories trying to explain the pathogenesis of this cystitis, none of them has been sufficiently confirmed and we are still moving in the sphere of guesswork.

Interstitial cystitis. Pathophysiology

In cats, as in humans, the epithelium lining the interior of the bladder is covered with a layer glycosaminoglycans making up extremely important urothelial barrier.

This layer is designed to:

  • prevent the adherence of microorganisms to the bladder wall,
  • regulates the flow of water, protein and ions,
  • protects the deeper parts of the bladder against the harmful effects of urine.

Urine toxins with a long-lasting effect on the damaged barrier may cause changes characteristic of interstitial cystitis.

Human urologists recommend their patients to use glycosaminoglycan analogs which, however, does not always bring beneficial effects.

Similar recommendations also apply in veterinary medicine.

However, actions aimed at reducing the toxic properties of urine, i.e. minimizing its irritating effect on the bladder wall, seem to be the most advisable and medically justified.

Damage to this barrier also causes the exposure of the sensory fibers located in the deeper layers of the bladder and the sensation of pain, and the release of neurotransmitters that intensify the clinical symptoms of inflammation.

Thus, briefly, the development of inflammation of a neurogenic nature.

The wall of the cystitis also takes place mast cell degranulation that is, mast cells.

This process entails an increase in the concentration of inflammatory mediators accumulated in them, for example histamine if interleukins 6.

So how exactly do we see the changes accompanying interstitial cystitis are really complicated, multifactorial and difficult to simply classify.

Everything causes troublesome clinical symptoms for a sick cat.

Diagnostics of cat cystitis

Diagnostics of cystitis

In the case of a young cat showing clinical signs of idiopathic cystitis for the first time, especially when the clinical signs disappear within a week, there is no need to undergo sometimes complicated diagnostic tests.

You may possibly be tempted to do a urine test and an X-ray of the abdominal cavity.

We can diagnose idiopathic cystitis after ruling out bladder stones, bacterial infection, cancer and after confirming everything in a urine test.

In the case of recurring and chronic problems, additional tests are always recommended.

And so, radiography, i.e. an X-ray picture or an ultrasound, can be helpful here.

We can see some urinary stones in these studies.

Ultrasound examination will visualize the pathways leading out urine, the presence of urinary stones, even if we do not find them in the X-ray examination.

We can also, which is extremely valuable, diagnostically examine the bladder wall and measure its thickness.

In university clinics, it can sometimes be performed uroendoscopy that is, view the urinary tract with the use of very thin fiberscopes.

Urine test results can also be very helpful, although they are not sensitive and specific.

A very typical picture of changes in the urine shows the features of hemorrhagic inflammation, i.e. a large number of red blood cells and single white blood cells, and often no crystals.

Remember that even a statement of presence struvite crystals if Calcium oxalate it should not damage the healthy wall of the bladder and their presence in a small amount is a physiological phenomenon, especially in the situation of high specific gravity, i.e. concentrated urine.

In healthy, wet-fed cats, the urine weight fluctuates around this value > 1.025 and after dry food > 1.035.

Cats with high urine load that is, its significant concentration (value above 1.060) are much more likely to develop idiopathic cystitis.

You can also do urine culture but only taken by puncture of the bladder.

However, we will only find bacterial growth in a few cases.

The biggest problem may be the simple act of collecting urine from a cat.

Many owners ask themselves how to do it efficiently and effectively.

In theory, we should buy a container at a pharmacy in which we will put the captured urine for analysis.

We can steam the cat's litter box and collect urine from it, or use a special litter for this purpose, which we can buy in pet stores or clinics.

In extreme cases of cats that do not cooperate with us, we can ask the doctor to collect urine during the visit, provided that it is present in the bladder.

Remember, however, that the collected urine should be fresh, because if stored for too long (several hours), it will not have a greater diagnostic value.

It should be submitted for analysis immediately after its collection, or after a short storage in a refrigerator.

In rare cases, when we have a thickened bladder wall and we suspect a cancer process, it may be helpful to wall biopsy and histopathology the obtained slice.

Treatment of cystitis in cats

Cystitis treatment

We certainly do not have a single treatment regimen developed for suspected cat interstitial cystitis, but we use different frequently combined treatments.

This is largely due to the lack of a clearly defined cause of the disease, i.e. the factors that initiate it.

Stress reduction

Let's start with all the ways to reduce the impact of stress on the development of the disease itself.

So we use methods aimed at diversifying the living environment of domestic cats who often feel bored and frustrated, we try to provide them with proper human-cat relations and appropriate relations between cats living together.

Cats should have constant access to a properly located and clean litter box, where they can take care of their physiological needs, feeling safe and not disturbed by anyone.

They should not compete with each other for food or water, which, unfortunately, often happens when animals kept at home are overcrowded.

In some cases, it may be necessary to allow the cat to leave the house, even into a nearby and relatively controlled environment, e.g. to a fenced garden.

We should certainly modify the living environment of sick cats to make them friendlier and less stressful for the cat.

Let us be clear, some cats kept constantly in their homes alone or with other animals can live in a state of permanent stress caused by the monotony of life and its predictability.

So we have to diversify the cat's surroundings so that keeping it in captivity does not cause excessive stress and neuroendocrine disorders.

Often the cause of stress in cats is conflicts between animals living under one roof, competing for different things (e.g. food, a place to sleep or a play object).

So we should do everything to minimize this competition and thus minimize stress.

Cat pheromones

In order to minimize stressful situations, it is recommended to use artificial ones cat's facial pheromones present in the preparation Feliway (Ceva).

Its use in the domestic environment of cats causes positive changes in the behavior of cats and reduces the number and duration of possible relapses of the disease.

Synthetic pheromones sedate, reduce the cat's alertness and thus reduce the influence of the sympathetic nervous system.

Therefore, it is worth always using this type of solution as a complementary treatment.

Anxieties

In therapy, an analogous human problem is used antihistamines, preventing the activation and degranulation of mast cells, e.g. hydroxyzine.

In veterinary medicine, however, there is no documented, effective action of these preparations, although their use does not seem to be pointless.

In difficult cases, not amenable to traditional treatment, it is used psychotrop medicines and so tricyclic antidepressants (anitriptyline) with properties:

  • anti-inflammatory,
  • painkillers,
  • antihistamines.

Drugs from this group:

  • stabilize mast cells,
  • limit the contraction of the urinary detrusor muscle,
  • lower the threshold of pain excitability,
  • hinder the reabsorption of norepinephrine.
The use of these drugs should be limited to cases where other, traditional drugs do not bring the expected effect.

The dose for a cat is approxd 2.5 mg to 10 mg once daily, in the evening with food.

Its effectiveness has been demonstrated in a long-term study, which in a way reserves this drug for chronic, not acute cases.

In the perspective of a week of treatment, improvement is unlikely to be expected, and additional side effects in the form of lack of care, urinary retention, formation of urinary stones if weight gain rather, they eliminate this drug from emergency administration and thus most cases of idiopathic cystitis.

Can be used too clomipramine if fluoxetine.

However, long-term use of these drugs has been associated with thrombocytopenia if neutropenia thus changes in the blood picture and requires follow-up examinations (morphology).

As I already wrote, the use of antibiotics is rather pointless, although these methods are still often used in routine veterinary practice.

Bacterial infections are extremely rare in cats under 10 years of age and therefore there is no indication for their use, except for an earlier catheterization.

We can, however, use it as an adjunct to treatment aminoglycan analogs e.g. in the form of pentose polysulfate or glucosamine. And although there are many preparations of this type on the market, their sufficient effectiveness has not been demonstrated so far.

In humans it is only obtained 10% effective after administering these drugs.

We certainly use painkillers from the group of non-steroidal anti-inflammatory drugs, bearing in mind, however, their limitations and side effects.

You may find it particularly useful meloxicam and ketoprofen and tolfenamic acid.

Interestingly non-steroidal anti-inflammatory drugs they are completely ineffective in human medicine in treating this condition.

We must also remember that their chronic, long-term use in cats, especially dehydrated cats, may be associated with the risk of developing acute renal failure.

Pain relief is recommended in all acute cases of idiopathic / interstitial inflammation and during relapses.

Oral use seems to be a good idea buprenorphine at a dose of 5-20 microgranes per kilogram of body weight every 8-12 hours, for 3 to 5 days.

In rare cases of very severe pain, you may even be tempted to apply fentanyl patches.

Diet

It is extremely important diet modification consisting in the use of foods with a high water content.

So we give up dry food in favor of wet food and use all methods to encourage the cat to consume as much fluid as possible.

So you can install your cat special fountains with constantly dripping water or let the cat drink the slowly dripping water from the tap.

Increased water consumption must come from a thorough understanding of the cat's preferences for its freshness, taste and movement.

Some cats like, for example, only fresh water, others stand out more, others taste or dripping from the tap.

It is important that our cat takes as much of it as possible, which will allow the kidneys to produce a large amount of diluted urine.

You can also add a tuna or other fish stock to the bowl, which will make the water more attractive and thus increase its uptake.

Increased water consumption causes dilution of the resulting urine and dissolution, i.e. reducing the concentration of toxins present in it, which results in less irritation of the bladder wall.

The optimal weight of diluted urine should be less than 1.035.

We should also avoid a high salt diet that causes significant fluctuations in urine pH.

We can see perfectly well that the treatment of a trivial problem, which may seem to be cystitis, is complicated, multi-faceted and may not always result in a quick relief of symptoms.

It requires a comprehensive approach, including modification of the living environment to eliminate stress.

Summary

Problems with cystitis in a cat only seem trivial and should not be underestimated by the owners under any circumstances.

It is true that we don't fully know the triggers or the etiology, but there is a lot we can do.

First of all, by making even small, in our opinion, changes in the environment of the cat, we can achieve a significant improvement in the comfort of his life, and thanks to the elimination of potential stressful situations, remove many problems.

After all, we, the people, are responsible for the environmental conditions in which our feline pupils live.

So we owe them the best care, which will certainly translate into fewer problems and life in better health.

The interstitial / idiopathic inflammation can really be dealt with effectively in many cases, so do not wring your hands, but take care of our cats wisely and they will certainly repay us with their behavior, for which we love them.

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