You may be familiar with the term cystitis, as something that also affects humans. Cystitis is basically any type of inflammation occurring in the wall of the urinary bladder, and that results in clinical signs. While dogs aren’t susceptible to the disease, felines are, especially young and middle-aged cats. While cystitis may develop in older cats, such incidences are extremely rare, and it is considered unlikely for a cat older than 10-12 years to develop cystitis. Idiopathic sterile cystitis is perhaps the most common urological affliction to manifest in young cats. If your older cat is exhibiting symptoms, it’s more likely to be due to bladder stones, or an infection.

The equivalent of sterile cystitis in cats would be interstitial cystitis in humans.

What causes cystitis?

Cystitis (which is also known as feline interstitial cystitis, feline idiopathic cystitis, or FIC, for short) is usually the result of a bacterial infection making its way to the bladder, or alternatively, bladder stones. That’s not always the case, though. While these are primarily the causes of cystitis, younger or middle-aged cats may well develop idiopathic sterile cystitis for no obvious reason (even after investigation).

This causes obvious problems in the treatment of the disease. Illness is treated by addressing the root cause. In the case of bacterial infections, the cystitis is combated through antibiotics. When the disease is caused by bladder stones, the vet will focus on dissolving the stones. But when the cause of sterile cystitis is unknown, the vet doesn’t know what to treat.

This will usually lead to a full evaluation, during which the vet will consider your pet’s medical history, perform a physical examination, and decide on additional tests. For instance, in diagnosing and treating sterile cystitis, the vet will most likely conduct a full urine analysis, and may also commision X-rays and an ultrasound for the abdomen, as well as blood analysis, and complete blood count (CBC).

What are the signs of sterile cystitis in cats?

While every patient is a little different, there are some common clinical signs of urinary tract disease, such as:

  • Blood in the urine;
  • Painful peeing;
  • Straining while urinating;
  • Increased urinary frequency;
  • Genital licking (more frequent or excessive than normal);
  • Inappropriate urinating behavior (such as peeing outside of the box);
  • Blockage (this refers to an inability to urinate despite repeated attempts, and is considered a medical emergency).

The trouble with such symptoms is that some (like painful urination) may be difficult for even the most caring owners to spot. Likewise, while bloody urine is the most common sign of sterile cystitis, the blood may or may not be visible to the naked eye, making cystitis hard to notice.

Always observe your cat’s habits and behavior carefully, and contact a veterinarian if you suspect something is amiss so that they can run the appropriate tests.

Sterile cystitis and other issues

Sterile cystitis has a complex relationship with the rest of the body. Obviously, if your cat’s struggling with a diseased bladder, it will also struggle with other issues, such as skin or gastrointestinal disease.

This is why experts also refer to it as Pandora syndrome. Usually, cats with Pandora syndrome (or idiopathic sterile cystitis) are suffering from the disease as a result of chronic early stress in their infancy. Exposure to prolonged stress affects gene expression in young cats, meaning it changes the way the cat’s genes carry out their “tasks”. For many cats with Pandora syndrome, early exposure to stress leads to a permanently stressed and anxious state of being.

Some felines are more at risk of developing Pandora syndrome than others. For instance, cats who have been orphaned, were exposed to an unstable or abusive environment, suffered disease, required bottle feeding, or were otherwise traumatized, are most likely to develop sterile cystitis.

Because of this early trauma, the cat’s response to stress is skewed. While “normal” cats only produce catecholamines and cortisol (fight or flight hormones) when endangered or stressed, cats with Pandora syndrome produce them regardless, and often for no understandable reason. This response to stress produces and promotes inflammation and pain in the bladder for the affected cats, which will in time become a chronic condition, resistant to treatment.

As with humans, other stress-related symptoms such as shyness, obesity, vomiting, aggressiveness, asthma, or over-grooming may be observed.

Treatment of Pandora’s syndrome

Because idiopathic sterile cystitis often becomes resistant to normal treatment, it’s recommended to use multiple therapies to prevent new flare-ups of Pandora’s.

Diet, for instance, can make a big difference. Special veterinary diets for cats with sterile cystitis are designed to dilute the urine and contain helpful fatty acids to reduce inflammation. This prevents blockages (accumulation of mucus and protein) in the cat’s urethra and can prevent life-threatening urinary blockages.

Medical treatments are usually left to the vet’s discretion since no medication has been proved effective so far.

You may also have success through Multimodal Environmental Modification (MEMO), which is basically a program designed to reduce stress for the affected feline. MEMO is centered around creating safe spaces, providing preferred foods and extra water, play therapy, litter box satisfaction, and conflict resolution.

Studies have shown that the MEMO approach works to reduce stress for the cats, and create an environment in which they feel at home, and not threatened. This alleviates stress-related conditions like sterile cystitis.

The MEMO approach has been shown to even alleviate conditions not directly stemming from stress and may be prescribed by your vet as a way to control flare-ups.