Cystitis in Cats

A number of cats will experience lower urinary tract disease in their lifetimes, including issues involving the bladder. This is known as cystitis in cats, and it is a common health condition affecting our feline friends.

Cystitis can be frustrating, as it has many different causes and treatments. In addition, cats with cystitis require lifelong management. 

The following is a comprehensive guide to understanding cystitis in cats.

What is Cystitis?

Cystitis means inflammation of the bladder. There are many causes for this, and it results in a lot of discomfort for our cats. Cats often show this discomfort with a change in their urination habits. 

There are several types of cystitis that affect cats, including:

• Sterile cystitis: No bladder infection present.
• Urinary tract infection (UTI): Bladder infection present.
• Feline idiopathic cystitis (FIC): A condition where cats have bladder inflammation recurring due to stress and possibly low water intake; also called interstitial cystitis.

What Causes Cystitis in Cats?

There are many causes of cystitis in cats, including:

• FIC (Feline idiopathic cystitis)
• Bacterial infection
• Bladder stones (urolithiasis)
• Urethral plugs (debris blocking the ability to urinate)
• Rarely cancer or incontinence (lack of control of urination)

Bacterial infection is rare in cats. When bladder stones are present, they will increase the risk of bacterial infections and may one day cause your cat to stop being able to urinate. Urethral plugs typically occur in male cats, and require an advanced procedure to flush it out so your cat can urinate.

Crystals in the bladder (crystalluria) are not a cause of cystitis, but may occur along with cystitis. These crystals will exacerbate symptoms and cause your cat’s cystitis to occur over and over again. 

Feline idiopathic cystitis (FIC) is the cause of cystitis in over half of cats diagnosed with the condition. Each cat diagnosed with FIC requires his own treatment plan. 

The main factors associated with developing FIC are:

• Male cats
• Overweight
• Pedigreed breed (any)
• Stress in the home

Stress in the home can include moving, new people visiting or moving in, lack of environmental enrichment, significant change in your cat’s environment, and conflict with another cat.

Symptoms of Feline Cystitis

When people describe urinary tract problems, they feel a constant urge to urinate and a lot of discomfort. Cats with cystitis experience the same discomfort, and you may see the following symptoms:

• Urination outside of the litter box
• Change in frequency of urination (i.e. smaller amounts more frequently)
• Straining to urinate (i.e. standing in the litter box a long time and not urinating or urinating very little)
• Vocalizing while urinating (meowing or howling)
• Change in color of the urine (darker yellow, brown or bright red)
• Change in normal behaviors (i.e. hiding or eating less)
• Licking genitalia more frequently (the area under the tail)

Cats may experience these symptoms of cystitis repeatedly. With FIC, the stress that causes it may be apparent, such as a new pet or fighting between cats in the home. 

Some cats with cystitis are unable to urinate, due to a blockage. They will experience severe pain, lethargy (low activity) and anorexia. Without treatment, a urinary blockage is life threatening.

If your cat is straining to urinate, and you have not noted any urine from your cat for 12 hours, seek veterinary care immediately. 

Diagnosing Cystitis in Cats

A veterinarian examination, followed by testing, is required to diagnose cystitis in cats. 

Specifically, a veterinarian will obtain samples of urine from your cat. Often, this is done with a small needle, punctured through the skin and directly into the bladder. This process is called cystocentesis. 

A technician will then examine the urine under a microscope, looking for proof of cystitis as well as possible complications, such as urinary crystals.

Some cats with cystitis urinate so often that their bladder is empty and your veterinarian cannot obtain a sample via cystocentesis. If this is the case, you may be asked to collect a cat urine sample at home. 

To collect a urine sample, your veterinarian may provide a type of litter that will not absorb your cat’s urine. You will need to save a sample of this urine in a small container and place it immediately in the fridge until you can bring it to your veterinarian. The sooner you bring the sample to your veterinarian, the better. It must be less than 24 hours old to be accurate. 

There are certain causes of cystitis that require more advanced testing and your veterinarian may recommend one or more of the following: 

• X-rays – A good way to look for bladder stones (urolithiasis). 
• Ultrasound – Another type of imaging looks at the bladder more closely than x-rays, and may reveal stones, crystals, or tumors. 
• Urine culture – Urine is sent to a laboratory to test for bacterial infection, and takes a couple days for results. 
• Bloodwork – Your veterinarian may also recommend general bloodwork to rule out other issues such as kidney disease.

How to Treat Cystitis in Cats

If you cat has a more serious form of cystitis, involving the inability to urinate or stones, he may require surgery. Sometimes the surgery needs to be done right away in an emergency setting.

If surgery is not necessary, feline cystitis requires lifelong management to prevent the recurrence of symptoms. It is rarely fully curable. 

A couple of steps commonly used to manage cystitis in cats include:

Increased water intake – Common methods include feeding canned food only (no dry food), ensuring unlimited access to clean water, and installing a cat water fountain to encourage more drinking.

Prescription diets – These urinary diets manage crystals if present and may reduce stress.

Increased enrichment – Providing a variety of interesting things for your cat’s senses, including a variety of scratching surfaces, cat-friendly scents, a variety of toys changed weekly, and playing with your cat daily.

Weight loss – This may be recommended if your cat is overweight.

Modification of your household – This may be recommended to keep cats from fighting. This requires behavioral advice from your veterinarian and/or a behaviorist.

Increase in litter boxes – The quantity of litter boxes in your home should equal the number of cats + 1.

Daily cleaning of litter boxes – Daily litter box management and cleaning is an important step to maintaining urinary health. 

Medications for Cystitis in Cats

When your cat is having symptoms of cystitis, your veterinarian may prescribe a variety of medications that are specific to your cat’s test results and level of discomfort. 

These medications may include:

• Non-steroidal anti-inflammatory medications (NSAIDs) – Used to treat pain and inflammation in the bladder.
• Pain medications (besides NSAIDs)
• Antibiotics
• Behavioral medications – Used to treat anxiety or stress.
• Polysulfated glycosaminoglycans (PSGAGs) – Injections and/or medication in food.

Home Remedies for Cystitis in Cats

There are many holistic remedies for cystitis that are intended to decrease inflammation in the bladder. 

However, these remedies will not work without a veterinary assessment for issues such as infection or crystals. Ideally, seek a holistic veterinarian for treatment.

Examples of holistic or home remedies for cystitis in cats include:

• High-quality canned food diet
• Acupuncture
• Pheromone therapy to decrease stress in specific rooms
• Commercially available herbal therapies
• Veterinary herbal therapies (like choreito)
• Chinese herbal therapies (like Ba Zheng San)

Please speak with a veterinarian before giving your cat any supplements or herbal remedies. If given incorrectly these remedies could be harmful for your cat.

General Cost to Treat Feline Cystitis

All cats with cystitis require a veterinary clinic visit. When visiting your veterinarian, you are likely to spend $100 or more for a thorough examination, urine testing, and medications. If your cat needs imaging or more advanced tests, this will likely cost $300 or more. 

The cost to treat and manage cystitis in cats is highly variable depending on where you live and how severe your cat’s condition is. If your cat has a severe form of cystitis that requires surgery or emergency care, the price will go up.

How to Prevent Cystitis in Cats

In order to prevent cystitis in cats, pet parents should:

• Feed a high-quality canned food diet (no or minimal dry food)
• Increase environmental enrichment – Provide a variety of interesting things for all of your cat’s senses.
• Promote a healthy weight – Speak with your veterinarian if your cat is overweight.
• Prevent stress during major life changes – This can include veterinary medications to decrease stress during events like airplane flights or moves.
• Treat fighting between cats – Speak with your veterinarian or a behaviorist right away when issues occur.

Related Conditions 

There are several conditions related to cystitis, including:

• FIC
• Bacterial infection (UTI)
• Crystals in the urine (crystalluria)
• Bladder stones (urolithiasis)
• Urethral plugs (debris blocking the ability to urinate)