Why feline idiopathic cystitis is so hard to diagnose

Not only is feline idiopathic cystitis (FIC), a disease that affects cats’ bladders and urethras, frustrating to pronounce, but it’s also difficult for veterinarians to diagnose. Formerly known as feline lower urinary tract disease (FLUTD) or feline urologic syndrome (FUS), it’s a condition that can affect all cats. 

FIC means the wall of a cat’s bladder is inflamed. The disease mimics symptoms of urinary tract infections and bladder stones, which is why it’s so important to take your cat to a vet immediately if you notice any change in their litter box habits. 

‍What is FIC in cats?

One telltale sign of FIC is when a cat strains to pee, but you might notice your pet's frequent trips to the litter box or household accidents, too. Other signs of FIC include producing bloody urine or excessively licking their genitals. 

Usually, cats will experience FIC symptoms for 5 to 7 days — but this condition is challenging to manage because the symptoms occur multiple times and spontaneously resolve regardless of treatment. However, FIC episodes are unpredictable, and some cats can go years without a flare-up, so it’s important to be aware of your cat’s regular bathroom routine. 

“A vet should be contacted any time you notice a change in your cat’s urinary habits,” Dr. Emily Singler, VMD, a veterinary consultant for Fetch, says. “Even if cats are otherwise acting normally, the pain associated with cystitis can affect their quality of life.”  

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How do veterinarians diagnose FIC?

Veterinarians diagnose FIC by ruling out other diseases. Unfortunately, there's no test made solely for diagnosing FIC as it has many contributing causes. Your veterinarian will likely start by ensuring your cat isn't experiencing a UTI or bladder stones. 

A note to parents with male cats: Your veterinarian must rule out a urethral obstruction if your best friend is showing FIC symptoms. Male cats are prone to urethral blockage because their urethras are so narrow. Cats can’t pee when the urethra is blocked by a small stone or by a plug of crystals and cellular debris. If your male cat is straining to urinate, you should get him to your vet’s office as soon as possible.

“Male cats that develop a urethral obstruction secondary to FIC, from either crystals, stones or a plug of mucus or cell debris, can die from kidney failure, heart arrhythmias and/or bladder rupture,” Dr. Singler says.

Your veterinarian will likely run a urinalysis, which is a test that looks at a cat’s urine microscopically and searches for blood, white blood cells, bacteria (which could mean infection), crystals and anything out of the ordinary.

To look for underlying infections, your vet may also order a urine-culture test to determine which bacteria is causing the infection and which antibiotic will be most effective for treatment. X-rays can also be used to spot possible bladder stones. Not only are bladder stones irritating to the bladder, but they can cause urinary obstruction if they travel into the urethra.

‍Treatment options for FIC

Unfortunately, there’s no proven effective therapy for FIC at this time. That said, there are many options to manage this condition — you and your veterinarian should work closely to manage your pet’s pain and limit any future FIC episodes. 

“The treatment will vary from one cat to the next,” Dr. Singler says. “In general, the treatment recommendations include a prescription diet, increasing water intake and moisture in the cat’s diet, either through canned food, a water fountain or adding water to the food, pain and anti-inflammatory medication and sometimes other treatments like cold laser therapy.”  

Other options, like pheromones, environmental enrichment and antidepressants, can help treat some of the underlying causes of FIC, like stress and anxiety. Staying in contact with your veterinarian if a treatment isn't working will make finding the best solution much more manageable.