No Infection, but Kitty Can't Go? Try This Now

sick cat

Story at-a-glance -

  • Cats with feline interstitial cystitis (FIC) are stressed, and stressed out cats can behave like sick cats and can actually become sick as well
  • Antibiotics are often unnecessary in treating FIC, however, due to the complexities of the condition, stress reduction and environmental enrichment should always be part of the healing protocol
  • Three steps in helping a cat with FIC include creating a refuge at home, arranging for fear-free veterinary visits, and taking steps to avoid caretaker burnout
  • If your cat has recurrent FIC, it’s a good idea to keep both homeopathic Aconitum and bladder support flower essences on hand to begin using at the first sign of a problem. Continuous probiotic therapy may be very beneficial
  • There are many other things owners of FIC cats can and should with regard to litterbox cleanliness and location, addressing problems between kitties in multi-cat households, feeding an appropriate diet and providing a constant supply of clean, fresh, filtered water

By Dr. Karen Shaw Becker

Sick cats are stressed cats, and stressed cats can behave as if they're sick or can actually become sick in response to their anxiety. Kitties with certain conditions, especially feline idiopathic cystitis (FIC or inflammation of the bladder), require treatment protocols that go well beyond the antibiotics and anti-inflamma­tories that are typically prescribed (and very often over-prescribed, in my experience).

Why Antibiotics Are Usually the Wrong Way to Treat FIC

FIC is a diagnosis of exclusion, meaning there are no abnormalities visible on X-rays or ultrasound imaging, and a urinalysis with sediment examination and culture and sensitivity testing rules out a bacterial infection. Kitties with FIC typically have sterile urine, so they do not require antibiotic therapy.

Unfortunately, too often these cats are given antibiotics, and when symptoms subside within five to seven days, everyone incorrectly assumes it's due to the medication. However, the antibiotics had nothing to do with the cat's recovery, because there was no bacterial infection present to begin with. It's simply the nature of FIC that symptoms wax and wane. Controlled studies show that over 70 percent of cats with FIC also respond to placebo treatments.

Unnecessary antibiotic therapy has long-lasting, negative consequences to a cat's microbiome, and in turn, the overall immune system. I strongly recommend declining antibiotic therapy unless your vet has definitively proven (via culture) your cat requires it. A remedy that can be incredibly beneficial in helping cats recover from an FIC episode and prevent future flare-ups is a high-quality probiotic supplement. Probiotics can improve the bladder microbiome, which can have lasting, long-term benefits.

The Symptoms and Complexities of FIC

If your kitty is suffering with bladder inflammation, he may strain while urinating, and you may notice he's in and out of the litterbox a lot. This is because he's not able to completely empty his bladder in one visit. You may or may not see blood in his urine (sometimes it's visible, other times it's not) as a result of an inflamed and irritated urinary tract. He might also be in pain and he may cry out while attempting to urinate.

Research into FIC highlights the importance of stress reduction and environmental enrichment in treating cats with the disorder. In a 2011 study of 12 healthy cats and 20 cats with FIC, researchers observed that healthy cats behave as if they're sick when their routine is altered.1

For example, sickness behaviors like refusal to eat, vomiting and litterbox avoidance tripled in healthy cats whose routines were disturbed. The cats with FIC also showed changes at the microscopic level that indicate they are hormonally and neurologically different than healthy cats.

The study suggests that cats with FIC experience significant symptom reduction in an enriched environment. In kitties with the disorder, symptoms improved by 75 to 80 percent when they were fed at the same time each day, their litterboxes stayed in the same location, and regular playtime was encouraged.

Veterinarian Dr. Tony Buffington of Ohio State University, an expert in the role of stress and disease in companion animals, believes FIC is part of a larger disorder he refers to as "Pandora syndrome."2 The condition can't be accurately described as simple inflammation of a single organ (the bladder), but rather appears to be the result of a potentially wide range of problems that extend beyond the bladder and lower urinary tract.

'MEMO' for Cats With Feline Interstitial Cystitis

Stress reduction and environmental enrichment must be a central feature of treatment protocols for kitties with FIC. "What these cats need more than anything," says Dr. Sarah Wooten, writing for veterinary journal dvm360, "is MEMO (multimodal environmental modification), more water and dietary changes."3

Wooten created a handout for cat parents to help address the stress their kitties may be feeling when they're ill. She suggests taking the following three steps:4

1. Create a refuge at home. Convalescing kitties need someplace to hide and rest that's quiet, safe and warm. This location should be away from high-traffic areas — bedrooms are good — and contain all the things the cat needs: bed, food, water, a litterbox and favorite toys. Let your cat come and go freely, but if you have children or other animals, keep them out of this area so kitty can rest quietly.

If your cat doesn't want to use the area, up the comfort level by spraying a feline pheromone like Feliway in her refuge, or add some treats, catnip or a piece of clothing that smells like you.

2. Happy vet visits matter. If your cat has a medical condition that requires frequent visits to the veterinarian, you should make every effort to work with your vet to make the visits less stressful. If kitty's getting poked with needles, there's only so much you can do to manage his anxiety, but here are some basic tips:

  • Leave the carrier out and open at home so he can investigate and get used to it
  • Take him for car rides in his carrier that don't end at the hospital
  • Give him special treats or toys that are reserved for the hospital
  • Try to schedule appointments for the least busy time of day at the hospital
  • Avoid loud reception areas or barking dogs by waiting with your cat in the car (temperature permitting), and asking to be called or texted when an exam room is immediately available

If your kitty gets really stressed out, ask your veterinarian about anti-anxiety medications or whether the practice team does home visits. Read here for more tips for fear-free vet visits.

3. Avoid caregiver burnout. Caring for a sick pet can be stressful. In addition, your sick cat may pick up on your stress, which is not healthy for either of you. If your kitty needs ongoing care, it's even more important to take care of yourself. You know how flight attendants ask you to put the oxygen mask on yourself before you assist others?

If you're feeling stressed taking care of your cat, talk to someone about it. Make time to do other things you enjoy, try not to stress about your cat, breathe and get plenty of rest. Read here for more recommendations for staying emotionally healthy while caring for a sick pet.

Additional Recommendations for Stress Reduction and Environmental Enrichment for Cats With FIC

If your cat is prone to recurrent episodes of FIC, I recommend keeping homeopathic Aconitum on hand and at the first hint of a problem begin homeopathic intervention (remedies vary depending on a cat's specific symptoms), as well as institute flower essences for bladder support and stress.

Environmental enrichment to reduce stress is an effective management tool for all kitties, especially those with FIC, and litterbox cleanliness is one of the most important pieces of the puzzle. Litterboxes should be cleaned frequently (scooped at least once daily and fully sanitized at least weekly).

They should be located away from noisy areas, and should give cats easy access to and from them so they don't feel trapped or unable to escape. It's also important to have the right number of boxes (one for each cat in the household, plus one extra), as well as the size and type of litter your cat prefers.

In a multi-cat household, especially, access to more than one source of fresh water and food will help reduce stress, avoid intercat aggression, and increase water intake. It's also important that food and water stations are in safe, secure locations.

In the wild, cats not only hunt prey, they are prey for other animals. They feel most vulnerable while eating, drinking or eliminating. This vulnerability creates stress when your cat's food dish or litterbox is in a noisy or high traffic area. Increased interaction between you and your kitty with FIC may also reduce her stress. Petting, grooming and play that stimulates hunting behaviors may help.

As Dr. Wooten recommends above, increasing your cat's access to a private area is imperative, especially if there are other pets in the home. Kitty needs her own resting place and a hiding place (sometimes these are the same spot) where she feels untouchable.

It's also important to realize that introducing a new cat to the household is one of the biggest stressors for kitties already in your home, and it can trigger or exacerbate FIC. If your feline housemates are enemies, it's important to take action, and you can find guidance in my article on how to stop cats from fighting.

Last but not least, if you're still feeding kibble, I strongly encourage you to transition your kitty to a high-quality canned diet, and then to a fresh food diet. Studies show that moisture-rich diets help reduce the symptoms of FIC. In fact, this is often the most important piece to this frustrating puzzle, along with supplements that help build bladder defenses, including MSM and glucosamine, as well as proteolytic enzymes and several blends of herbs to naturally reduce inflammation.

In my experience, a nutritionally balanced, species-appropriate fresh food diet can actually prevent many cases of lower urinary tract disease in kitties because it eliminates dietary and metabolic stress. Choosing foods free from synthetic nutrients, colors and rendered additives, GMOs, as well as minimally processed foods (to avoid feeding AGEs and acrylamides found in all extruded kibble) can also help reduce digestive, and in turn, immunologic stress.

Offer your cat fluoride and chlorine-free, fresh, filtered water from glass or stainless steel bowls. Consider creating a quiet, ultra-low stress zone for your feline friend, including a room with natural sunlight (no LED lighting), no electrical equipment or routers emitting EMFs, with an optional dark hiding spot to snooze in during the day.