Cystitis in Cats: Symptoms, Causes, and Treatment

1. Introduction

Understanding cystitis in cats is so important that February is designated National Cat Health Month. Cystitis is an inflammation of the bladder, and it affects nearly one in five cats. Symptoms of cystitis can vary, and in some cases, indicate the seriousness of a blockage that can become life-threatening within 24 hours. Since cats are good at hiding pain, it is even more crucial for pet parents to pay attention to symptoms, such as any of the following: urinating outside the litter box, straining to urinate or not being able to urinate at all, increased frequency of urination, licking around the vulva, blood in urine, and loss of bladder control.

Due to the complexity of feline cystitis, many different factors contribute to the development of this condition, such as stress. Stress was a common theme in cats showing lower urinary tract signs. Even "little" events, such as changing one’s work schedule, may be all that is needed to upset a cat’s bladder. The lack of correlation between clinical signs, such as frequency of urination, and the extent of inflammation and damage in the bladder points to a significant role of the brain contributing to lower urinary tract signs. Due to bacteria being infrequently isolated from cats with cystitis, antibiotics are not considered to be a mainstay treatment. Using certain diagnostic and treatment strategies—calm, quiet, and sparsely decorated waiting rooms, using whispers, and also providing boxes, caves, bags, gauzes, blankets, and sleeping platforms of different sizes, shapes, layers, and textures—can help enrich the household.

1.1. Definition of Cystitis in Cats

Cystitis refers to the inflammation of the bladder. The word "cystitis" originates from the Latin word "cystis," indicating the bladder, and the Greek word "itis," signifying inflammation. The term is used to describe the phenomenon in feline medicine. Commonly found in cats, inflammation of the bladder results in pain and discomfort, as well as urinary issues. The term cystitis in itself can lead to some confusion as it does not describe the underlying reason for the inflammation in the bladder. The synonym of inflammation is swelling that occurs because of noxious stimuli. It is used to serve defensive purposes and may have adverse effects for the host. Cystitis is a relatively common clinical condition in veterinary clinics. About 1% of adult cats may have an episode of urinary tract disease during their lifetime. It may be challenging to manage in settings with multiple cats, such as an animal shelter, boarding facility, or pet caregiver's home. Cats are solitary by nature and are known to develop clinical signs when forced to share facilities with another cat. Due to pain, cats with cystitis might stop using the litter box. Besides causing physical discomfort to the affected animals, cystitis also imposes problems for the emotional, social, and financial well-being of cats, as well as their owners.

Two distinct forms of cystitis have been described, including idiopathic and infectious cystitis, which differ in terms of patients' signalment, disease course, diagnostic approach, treatment options and outcomes, associated risk factors, and clinical relevance. Understanding the mechanisms differentiating these two forms has therapeutic implications. Currently, the interstitial cystitis version of idiopathic cystitis is thought to probably be related to luminal instability, although our understanding is continually evolving. The current model of idiopathic cystitis includes dysregulation of the micturition reflex and inflammation in a bladder that in many cases appears structurally and bacterially normal. In this sense, cystitis is considered to be a neurogenic/topical inflammation in the bladder. Various studies have indicated that the central nervous system has a profound impact upon the bladder and vice versa.

2. Symptoms of Cystitis in Cats

Cystitis in cats usually becomes evident around four to ten years of age. In this section, we'll go over the signs that your cat may be experiencing cystitis. Frequent urination is common in cats with cystitis. The cat may make frequent trips to a litter box with little to no output. Second, cats with cystitis may strain in the litter box in an effort to urinate. It is common for owners to mistakenly assume that their cat is constipated as a result of straining. The cat may produce a small volume of urine. The inability to produce urine is referred to as urinary blockage. It occurs more frequently in male cats than in female cats since the urethra is narrower. Lastly, if you're spotting blood in your cat's urine, that's a clear indication that your cat has cystitis. Many pet owners who have cats with cystitis mistake urinary blood for feces on the floor. Cats with cystitis, if they can find a spot outside of the box, will void small amounts of urine in atypical regions around the house. Therefore, it's important to keep an eye out for inappropriate urination as a result of your cat's cystitis.

In general, cats with urinary blockage are weak, rest a lot, and lick their genitals excessively. Cats may also scoot along the floor or generally show signs of discomfort, such as crying or growling. When a cat exhibits these signs, it is important for them to be handled and examined immediately. Moreover, cats with possible urinary blockage may hold their abdomen upright, and it may have a swollen bladder as a result of urine accumulation. They are frequently dehydrated and have an elevated heart rate as a result of electrolyte imbalances. Finally, cats with cystitis will refuse to eat, not perform normal activities, vomit, and lose weight. That is due to the loss of appetite caused by inflammation. In essence, a cat with cystitis will not strive to interact as much with humans as it normally does because of the pain. In brief, common signs of cystitis in cats include increased urination, straining to urinate, urinary blockage, blood-stained urine, inappropriate urination, and various clinical signs such as pain and lethargy.

2.1. Common Clinical Signs

Frequent urination refers to both an increase in the total amount of urine voided and in the frequency of urination. This can include urination outside the box and may contain blood or mucus. It is important to recognize the specific signs experienced by your animal. Vocalizing during urination is a classic clinical sign of pain, and is commonly heard when animals have urinary obstructions. Historically, many owners relate tail twitching and vocalizing to constipation in cats, even though the majority of cats experience incontinence in this area instead of increasing discomfort to the point of meowing. It is associated with a decrease in the percentage of voiding cats. While closely associated with PD, results from another study found that only the frequency of pollakiuria was significantly increased in PD-affected cats compared to controls. Consequently, this specific clinical sign could be simply related to unfamiliar housing conditions instead of PD. Behavioral changes such as an increase in hiding and lethargy have been linked to signs of lower urinary tract disease in cats, but these were subjective indications associated with the housemates of the affected cats.

Cystitis, or inflammation of the bladder, is frequently associated with lower urinary tract signs seen in cats, though the most common sign of PD in cats associated with bladder inflammation is normal symptoms. Unfortunately, the heterogeneity of clinical signs in cats with cystitis makes it incredibly difficult to diagnose based on clinical signs alone. In a case series of cats with cystitis, typical clinical signs reported were hematuria, pollakiuria, and periuria, consisting of signs of straining to urinate such as painful vocalizations, spending an increased amount of time in the litter box, and urinating in inappropriate locations. Many cats with cystitis have the sole complaint of the owner being hematuria, or blood in their urine, whereas others may have clinical signs that are so severe they present for emergency care. Regardless of the severity of the clinical signs, the duration from onset of clinical signs to initiating veterinary treatment is imperative for getting an animal over their illness quicker and may result in fewer relapses in recurrent cases.

3. Causes of Cystitis in Cats

There are many causes for cystitis, which is unfortunately one reason that the condition can be so difficult for pet owners and veterinarians to understand and treat in our patients. Some cats can develop cystitis because of bacterial infections, whereas others can develop cystitis that is not due to bacteria. Infections of these types become important to distinguish, since the treatment may consist of antibiotics in some cases. So far, the clinical signs of idiopathic and bacterial cystitis are so similar that we still have to resort to difficult and invasive methods to arrive at a true diagnosis. This type of problem is compounded by the fact that stress is an important factor that can affect the cat and may be associated with idiopathic cystitis. Once more, we find a combination of environmental and individual risk factors that often come into play. Cortesly, the discomfort of urination, and possibly defecation, every 1 cat in 5 will be found to have medical conditions that can affect the lower urinary tract. These conditions include urinary stones and tumors. A contributing factor for idiopathic cystitis is the tendency of the disease to hit older and more obese cats, thus predisposing them to other health concerns of a behavioral nature. In addition, diets may have a role by increasing urine concentration or increasing incidence, and drug treatment choice due to its effect on the bladder smooth muscle and the way in which it affects metabolism in the tissue may also be relevant.

The term substrate is often used to describe factors in the environment that predispose an animal to the disease. A number of subjective and objective conditions have the potential to contribute to the development of idiopathic cystitis and are listed. These are also considered to be risk factors for acute disease of the lower urinary tract. In cats that have idiopathic cystitis and clinical pyuria associated with acute occlusion of the urethra, owner reports suggest that 1 in 8 cats may have had similar problems before. Not all the factors we are referring to are equally important, and some that we have not identified may be of significance. When we undertake the diagnosis of idiopathic cystitis, it is essential to have ruled out other diseases, including bladder stones and tumors. A variety of health conditions can cause signs of cystitis, but some cats will appear to have cystitis without an obvious cause. In these cases, the word idiopathic is useful to indicate that we do not understand the reason for the disease. Several factors have been detected in the environment of these cats and in their biological tissue and fluids that may induce the abnormal behavior that leads to the disease. A rough indication of the proportion of cats that may be affected by these factors and predispose to idiopathic cystitis is provided.

3.1. Bacterial Infections

One of the primary causes of cystitis in cats is a bacterial infection. When bacteria invade the bladder, they cause the body's own immune response to release inflammatory chemicals that damage the bladder wall. At the same time, bacterial toxins can also directly damage the bladder wall. These factors combine to form the clinical entities known as bacterial cystitis. To determine if an infection is the cause of a cat's cystitis, urine testing, including bacterial culture and susceptibility, must be performed.

The most commonly isolated bacteria when a cat has bacterial cystitis are various species. None are generally present in the cat's bladder, but they are common gut bacteria. When a cat suffers from different conditions that affect litter box hygiene or increased grooming, there is the potential to increase grooming debris that ends up in the genital area; those bacteria have the opportunity to ascend the urethra and invade the bladder. Conditions that alter bladder function, such as suboptimal diet, environmental stress, and anything that alters the immune system's normal function, are also explicitly listed risk factors for bacterial cystitis. However, any primary cystitis, regardless of cause, can have bacterial overgrowth. Suitable oral or injectable antibiotics are critical to treating bacterial cystitis, and the antibiotic choice is typically based on the bacterial culture and susceptibility. Owners should seek veterinary care for a cat that they think has bacterial cystitis, as such conditions should be diagnosed through appropriate testing and professional guidance. Antibiotics should never be given to cats unless prescribed by a veterinarian.

4. Diagnosis of Cystitis in Cats

Diagnosis of cystitis in cats is primarily done through a veterinary evaluation. A combined method of physical examination, laboratory tests, and sometimes radiography is recommended to help in getting an accurate diagnosis. Most of the time, more tests may be required in cystitis diagnosis to disqualify or prove the existence of other potential causes of the mentioned signs. In the case of suspected feline patient history and physical examination, laboratory tests are the diagnostic plan. These may include complete blood count, serum chemistry, and urinalysis. The results of these tests may suggest an abnormality that may be responsible for causing cystitis. Additional tests like x-rays with contrast urine and peritoneal tap tests may be recommended in some cats. Results from these tests will be used to rule out the possible causes of cystitis. Most cystitis case histories, signs, and physical examination findings help the vet to progressively narrow the list down to the most likely diagnosis. It is important to realize that there is no reliable test to definitively diagnose cystitis. Therefore, cats showing the mentioned signs should be taken to the vets for assessment and tests. Laboratory tests that are likely to be useful in the evaluation of cats with cystitis are serum chemistry, complete blood count, urinalysis, and urine culture. These tests should help in the evaluation of significant findings such as urethral obstruction, other causes of pollakiuria, and changes in appetite, vomiting, persistent fever, weight loss, and hematological abnormalities. Additional tests such as radiography, abdominal ultrasound, and culture of urine may also be useful in helping with cystitis diagnosis.

4.1. Veterinary Examination

Examination is the first step, and it is carried out by a veterinarian. From the first minutes of examination, the veterinarian assesses the general condition of the animal: if it displays passive behavior or shows an active interest in the surroundings; how it orients itself in the examination room; how it greets both the owner and the veterinarian. The veterinarian then goes ahead with the physical examination and evaluates pain, how the animal moves, breathing, and abdominal movements. A thorough anamnesis is fundamental so that the veterinarian may take into account any previous pathologies, feeding regime, any drugs the cat is taking, cohabitants housed at home, and its relationship with these individuals. A detailed examination is essential, collecting information by asking the owner some questions before starting. The following should be investigated: the number of daily urinations, episodes of hematuria, the different places where it urinates, and the existence of preference or avoidance in differentiated situations. Any changes in the environment and the patient's habits and behavior.

The observation occurs through the examination of the cat both in a static and dynamic position with climbing furniture present in the examination room and litter present with or without virgin litter. The veterinarian also observes and evaluates the presence of scratching immediately outside the sandbox. While the cat is walking, the veterinarian observes, in particular, the symmetry of walking, the position of the feet, the curvature of the back, the position on the floor (crooked back, stomach), and the reaction to contact with the surface on which the animal is walking (dirty, cold, rough, smooth). The development of the physical examination is composed of the following points: palpation of the abdominal wall, between the iliac crest and the last rib and in the cystitis area, decorated dorsoventrally to understand the reactions, the presence or absence on both sides, the degree of consistency, cystitis, kidney and liver, and the favorite desensitizers; palpation of the bladder to understand if the bladder is normal, if it is empty, or if there is a residue due, perhaps, to a reduced outflow; observation of the skin and the hair.

5. Treatment of Cystitis in Cats

Cystitis in cats is a common disorder related to the accumulation of urea and electrolytes in the bladder, resulting in inflammation of the bladder wall and urinary discomfort. The most important aspect of the therapy is therapy dependent on the cat's symptoms and based on the individual underlying causes of cystitis. If the cat visits the veterinarian promptly, the first symptoms of cystitis can be alleviated and the likelihood of subsequent feline cystitis episodes can be minimized. Treatment of feline cystitis must be chosen by the veterinarian. The therapy of the basic cause of cystitis should be focused on in the symptomatic treatment of the inflamed bladder mucosa. It is very important to maintain a quiet and stress-free atmosphere at home. No treatment will work on an anxious animal. The environmental adjustments can be part of the therapy as well. Treatment requires a holistic approach. Cystitis should be managed not only by medication but also by dietary adjustments and stress relief through improved environmental management and improvement of the atmosphere in the development of the cat and its environment. The dietary adjustment is absolutely different. The urine may be made more alkaline or acidic by the composition of the diet. Various methods are available to help relieve these symptoms when it comes to symptomatic therapy and treatment; in turn, relief of those signs and symptoms should be closely related to the underlying cause of the cystitis.

5.1. Medication and Therapies

Antibiotics may be given to treat bacterial cystitis or interstitial cystitis caused by infection with a specific bacteria. If there is a stone in the bladder, your veterinarian will recommend a specific diet or other therapy that needs to be given. In case of pain or discomfort, pain and urinary tract medication can be given. There are various drugs that are classified as painkillers with anti-inflammatory properties. For example, nonsteroidal anti-inflammatory drugs such as meloxicam, robenacoxib, firocoxib, or ketoprofen. Anesthesia such as amitriptyline, duloxetine, gabapentin, and milnacipran can be given to control the pain associated with sterile cystitis. If the cats show stress-related signs in the event of pain or discomfort, management of stress and environmental changes may also be needed. In some cases, alternative therapies can be prescribed. Glucosamine and chondroitin supplements can support bladder health and help repair the inner lining of the bladder. Omega-3 supplements and milk thistle are natural anti-inflammatory promoters. Adequate water intake and increased dietary supplements or medication that heal the inner layer of the bladder can help.

Failure to drink enough water or eat a diet that supports a healthy water balance only makes the problem worse. Additional challenges can cause dehydration when vomiting or diarrhea are present. Feeding wet or canned food that has more than 75% moisture supplies the majority of moisture to the body. Because canned food is rich in meat, it also allows for the intake of the appropriate minerals since meat should be moist in nature. In the case of viral diseases, adding additional dietary supplement tablets or water to the diet may be helpful. It is important to give drugs as prescribed by the veterinarian. Be sure to complete the treatment with antibiotics or other medications. Drug treatment may include several examinations and progress follow-ups to ensure that the drug works and is safe for your cat. An antibiotic course is usually administered for 3-4 weeks, while the withdrawal time is a minimum of 1 week. The drugs provided need to be taken until stated. In cystitis, antibiotics are generally taken for a 7-14 day period. In case of interstitial cystitis with tuberculosis, an additional hospitalization period is usually given in which the test is to be repeated. The therapeutic period will also be supported by medication and connection with the physical environment. During the administration period between the medicines, it should be prepared for the possibility of examinations based on changes that may occur in the sick cat. Home care and follow-up programming will be conveyed by the veterinarian in charge.

References:

He, C., Fan, K., Hao, Z., Tang, N., Li, G. and Wang, S., 2022. Prevalence, risk factors, pathophysiology, potential biomarkers and management of feline idiopathic cystitis: an update review. Frontiers in Veterinary Science, 9, p.900847. frontiersin.org

Puccinelli, C., Lippi, I., Pelligra, T., Mannucci, T., Perondi, F., Mattolini, M. and Citi, S., 2021. Pseudomembranous cystitis: an uncommon ultrasound appearance of cystitis in cats and dogs. Veterinary sciences, 8(7), p.125. mdpi.com

Gòdia, M., Brogaard, L., Mármol-Sánchez, E., Langhorn, R., Nordang Kieler, I., Jan Reezigt, B., Nikolic Nielsen, L., Rem Jessen, L. and Cirera, S., 2022. Urinary microRNAome in healthy cats and cats with pyelonephritis or other urological conditions. Plos one, 17(7), p.e0270067. plos.org

Kovarikova, S., Simerdova, V., Bilek, M., Honzak, D., Palus, V. and Marsalek, P., 2020. Clinicopathological characteristics of cats with signs of feline lower urinary tract disease in the Czech Republic. Veterinární medicína, 65(9). agriculturejournals.cz

Lonc, K.M., Kaneene, J.B., Carneiro, P.A. and Kruger, J.M., 2020. Retrospective analysis of diagnoses and outcomes of 45 cats with micturition disorders presenting as urinary incontinence. Journal of veterinary internal medicine, 34(1), pp.216-226. wiley.com

Ayoub, S.M., Mostafa, M.B. and Abdelgalil, A.I., 2024. Studies on Feline lower Urinary Tract Disease in Egypt Cat Population. Journal of Applied Veterinary Sciences, 9(1), pp.61-72. ekb.eg

Kimani, W. K., Nguhiu-Mwangi, J., Mande, J. D., & Mbugua, S. W., 2021. Prevalence of urinary tract conditions and factors associated with urolithiasis in domestic cats in Nairobi, Kenya.. archive.org