What Can Be Done for a Cat With Chronic Bladder Problems?


Here’s a question on cat health I received not long ago from Sherry in Nebraska. She reached me by way of the contact form at my website (which, along with Facebook and the comments section below, is one of the best ways to get in touch with me).

My male 4-year-old cat has been suffering from FLUTD for about two years and we are not getting anywhere. We have tried just about every med out there. Some cause other problems like diarrhea, and others seem to have no effect. I am at my wits’ end and my husband feels that if we can’t get this under control we will have to put him to sleep.

We have changed foods, increased canned foods, given him plenty of water, and scoop the litter box at least once a day. I live in a smaller town in Nebraska and don’t know where else to turn. Any help would be greatly appreciated.

Thank you for your time,


Whether you choose to call it FUS (feline urological syndrome), FLUTD (feline lower urinary tract disease), or FIC (the current nom de rigueur, short for feline idiopathic cystitis), chronic intermittent bladder irritation causes major discomfort for the cats involved. The names are interchangeable, but the condition is the same.

Photo by Shutterstock

When veterinarians can’t even agree on a syndrome’s name, you can bet the syndrome is poorly understood. Here is what is known: FIC causes recurrent episodes of bladder pain, increased frequency of urination, straining to urinate, and often house soiling, symptoms that are clinically identical to bladder infections. Symptoms usually persist for a few days to more than a week. In male cats, episodes of FIC can lead to an urgently life-threatening situation called urinary obstruction.

The causes of FIC are debated among experts. Most experts believe that individual predispositions to chemical imbalances in the urine, which are linked to abnormally high pH and to crystals called “struvites,” contribute to the syndrome. Most experts also believe that stress and obesity contribute. Rare experts believe that only urine chemistry is to blame. For what it’s worth, my experience has led me to strongly believe that urine chemistry, stress, and obesity are all risk factors. Therefore, I recommend treating the syndrome by trying to address all three of the risk factors above, as well as by treating the symptoms that occur during episodes of bladder pain.

Many cats are stressed by babies. by Shutterstock.
Cats experience many stress factors. Hiding cat photo by Shutterstock

The first step is to confirm the diagnosis. Urine tests, combined with imaging such as X-rays and ultrasound, will rule out bladder infections or bladder stones, which can cause symptoms identical to FIC.

Of the three risk factors above, the one that responds most directly to treatment appears to be urine chemistry. The urine chemical imbalances often are diet-responsive. Sherry, you mentioned that you have changed diets, but have you tried a long-term switch to a diet specifically designed for FIC? Several companies manufacture these diets, and your veterinarian should be able to make a recommendation. These diets work by acidifying the urine (lowering its pH). In my experience, switching to an acidifying diet is the most effective way to reduce FIC symptoms, but for some cats diet change alone is not sufficiently acidifying. These cats may benefit from dietary supplementation with DL-methionine (an amino acid that acidifies the urine further).

Consumption of additional water may help the syndrome, by reducing the strength of the affected cats’ urine. Wet food (for cats that will eat it) is therefore recommended, because it contains more water than dry food. Cats with FIC should also be supplied with multiple sources of fresh water at all times. In some cases, owners mix water into wet food to make a urine-diluting soup. Owners of severely affected cats sometimes administer injections of fluids under the skin.

Stress reduction may reduce symptoms of FIC, but it is often easier said than done. Most house cats do not experience anything in their lives that you or I would find stressful. However, exposure to other cats is a leading stressor for feline family members. Owners of cats with FIC may want to avoid adding more cats to the house, and also should be aware that house cats can be stressed merely by seeing another cat in the yard through a window. I recommend that owners of cats with FIC do their best to provide a stable, loving home — which the overwhelming majority of Catster readers already do.

Photo by Shutterstock

Weight management may help to reduce FIC symptoms. However, weight management is very difficult in cats (and it also can be stressful), so this angle may be the most difficult one to approach. The most basic tactic for feline weight management is not to free feed.

Finally, owners of cats with FIC may want to consider symptomatic management for bladder pain and spasming. Pain killers such as buprenorphine are often prescribed to treat bladder pain during flare-ups. Some experts recommend the use of the dietary supplement glucosamine. Antispasmodics such as prazosin or phenoxybenzamine may promote urination, prevent urinary obstruction, and reduce the pain associated with urination during episodes of FIC. Owners of cats with FIC should be aware that antibiotics do not impact and are not recommended for the syndrome.

Sherry, I would not recommend euthanasia for your cat unless you have aggressively explored all of the options above. You can find more information about FIC on my website.

Got a question for Dr. Barchas? Ask our vet in the comments below and you might be featured in an upcoming column. (Note that if you have an emergency situation, please see your own vet immediately!)

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