Idiopathic Sterile Cystitis in Cats
by Akif Demirel, DVM
Idiopathic sterile cystitis is a disease of cats that is characterized by the painful and/or frequent urination of small amounts, often with blood and white blood cells in the urine. These signs can also be caused by other conditions such as bladder stones, bladder cancer, kidney failure, and kidney or bladder infections. The only way to diagnose idiopathic sterile cystitis is to rule out other possible causes of the cat's symptoms. In order to rule these things out, necessary tests may include a urinalysis, bloodwork, urine culture, radiographs, ultrasound, and special contrast radiographs.
Most cats with idiopathic sterile cystitis have their first episode between the ages of 2 and 6 years. Up to 50% of cats with the above-mentioned symptoms will never have an underlying cause diagnosed. These cats will be diagnosed with idiopathic sterile cystitis. There is no known cause and no definitive treatment. A leading theory now is that it involves some measure of stress effects on the bladder made worse when concentrated urine is retained in the bladder. This means that reducing the frequency of flare-ups will involve: 1) reducing stress in the cat's life; 2) litter box management; and 3) decreasing the concentration of urine (increasing fluid intake).
Reducing Stress: Each cat's environment and lifestyle must be evaluated since each cat will have different stressors. Does the cat have enough time alone? Does it have enough interaction with people? Are other house cats picking on him/her? Does it have its own food bowl? Does it live in an extremely noisy environment? Do the household children pester it?
Litter Box Management: Is there at least 1 litter box per cat? Is the litter box cleaned daily? Are litter boxes with this cat's favorite substrate available (clay, clumping, paper, etc.)? Does this cat prefer a covered or non-covered box? Is the litter box always accessible or is it sometimes behind closed doors? Is the litter box large enough to be used comfortably?
Increasing Water Consumption: This may require some creativity on the owner's part. Try a fountain with constantly running water. Liquid treats such as tuna water or chicken broth can be made into ice cubes and added to water (which must then be changed frequently). Switching to a canned diet or adding water to a dry diet may be a reasonable option (for some cats, a specific urinary diet will be recommended).
Even if all these measures are undertaken, most cats will still have occasional flare-ups. During flare-ups, we may prescribe a pain reliever to alleviate bladder/urethral pain. For cats that continue to have frequent flare-ups, we may also recommend higher level diagnostic tests. In a very few cases, an anti-anxiety medication may be prescribed.
Idiopathic sterile cystitis can be a very frustrating disease, and owners should be aware that it is a chronic disease - most cats can be managed, but not cured.
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