Follow Veterinary Practice News on Twitter at @vetpetnews. For cat-owning clients, caring for a pet with feline idiopathic cystitis (FIC) can be frustrating. As one type of feline lower urinary tract disease, FIC causes a range of aggravating clinical signs in cats, signs that often lead to trips to the veterinary office—or to the local shelter. "FIC is an unfortunate disease," says Kara Burns, MS, MEd, LVT, of Wamego, Kan., president of the Academy of Veterinary Nutrition Technicians. "Owners don't quite understand what's happening when their pets [eliminate] outside the litter box. It ends up being one of the top reasons owners bring their cats to the veterinarian, and then why they relinquish them to shelters." Besides describing signs like urinating outside the litter box, clients with FIC-afflicted pets may also report frequency or straining when their cats urinate, vocalizing or perceived pain when they urinate, or blood in the urine, says Claudia Kirk, DVM, PhD, Dipl. ACVIM, Dipl. ACVN, head of the department of small animal clinical sciences at the University of Tennessee in Knoxville. Veterinarians and their health care teams can help, Burns says. "We in the profession can help reduce the numbers of relinquished pets by helping to educate clients, and through nutritional management and environmental enrichment." 'Dilution is the Solution' Veterinarians counseling owners of cats with idiopathic cystitis often recommend moist cat food as one form of treatment, says S. Dru Forrester, DVM, MS, Dipl. ACVIM, director of scientific and technical communication for Hill's Pet Nutrition in Topeka, Kan. The water in foods such as Prescription Diet c/d Multicare Feline Bladder Health may help by diluting the concentration of substances that can cause inflammation or minerals that contribute to formation of stones or plugs, she says. "Dilution is the solution to pollution," Dr. Forrester says, citing an oft-repeated maxim in the veterinary community. "Generally, that concept has been applied to managing uroliths and struvite plugs. Any time a substance builds up in the bladder, the liquid in the urine dilutes it, making its concentration decrease and making it less likely for it to form stones—or for the inflammation to affect the bladder lining. "We think that feeding moist food might help [with inflammation in FIC], but there's not strong evidence to say it's definitely the treatment of choice," she continues. "For lack of more effective treatment, vets will recommend increasing water intake and feeding moist food if acceptable to the cat and owner." Dr. Kirk explains that increased water intake could "reduce inflammatory cytokines that may be released in response to pain fiber activation," adding that the most favored opinion is that the moisture dilutes inflammatory mediators' impact on the cat's urinary bladder mucosa, which provides feedback to the pain fibers that are perceived centrally by the cat. "If there is exposure of the epithelial layer of the bladder to irritants, you can certainly imagine that diluting those irritants would help reduce the inflammation and the pain response," Kirk says. In addition to increased water intake, certain nutrients and antioxidants may help reduce inflammation, too, Kirk says. "There may be some advantages to feeding fatty acids or fish oils, as we know in cats that omega-3 fatty acids have an anti-inflammatory effect," she says, noting that there has yet to be a controlled study on the subject. "Glycoaminoglycans is another option, as we know they are a major component of the mucous layer that covers the urothelium of the bladder." Kirk says that although studies have shown that glycoaminoglycans did not have a significant influence on populations of cats with FIC, the supplement may benefit individual cats. "If we've implemented the major therapeutic strategies to reduce recurrence of FIC, then glycoaminoglycans is something we can consider if we're still having recurrence after managing the major issues," she says. Lowering Stress Levels When managing feline patients with FIC, veterinarians should recommend that owners enrich their indoor cats' environments to replicate their natural surroundings, because higher stress levels have been associated with recurrence of the disease, Forrester says. "They're in an environment that's perhaps not typical for their natural behaviors, and so the stress associated with that might affect the neurologic pathways and result in secondary inflammation in the bladder, or idiopathic cystitis," she says. To lower stress in a cat's indoor environment, Burns recommends that clinic staff encourage clients to "allow their cats to express their natural cat behaviors by providing scratching posts, perches and opportunities to hunt and explore," she says. "They should also have predictable routines and interactions, as well as good litter box location and management, providing one more litter box than there are cats in the household and keeping it clean." FIC-diagnosed cats that need to switch from a dry kibble to a therapeutic moist pet food may also feel stressed, so veterinarians should advise a slow transition from one to the other, Kirk says. "Offer a palatable food and gradually transition the cat from dry to moist," she says. "It can sometimes take up to 30 days to really get a cat to move predominantly to canned food. It takes a lot of encouragement, usually petting the cat and providing social stimulation when they're eating." Feeding multiple meals throughout the day can help, too, Kirk says. "If the cats are accustomed to nibbling on dry food, owners should be actively engaged in giving multiple meals of canned food so they get frequent meals," she says. "They can also flavor the cat's food differently, using tuna, beef or chicken broth. Some contain higher salt, so that may drive water intake as well." Forming New Habits Cats are creatures of habit, so veterinarians and their health care teams should encourage their clients to gradually switch their FIC-diagnosed cats to moist food, provide a mentally and physically enriching environment and keep their litter boxes clean, says Forrester. "The standard of care is to recommend—if it's acceptable to the cat and the owner—a gradual transition to a moist food, and environmental enrichment," she says. This Education Series article was underwritten by Hill's Pet Nutrition of Topeka, Kan. Need more cat health news to stay in-the-know? Read these: Cats and FIC: Discover the Signs and Some Solutions Top 10 Vet Visit Reasons for Dogs and Cats Winn Feline Foundation Awards Nine Cat Health Research Grants Interpret the Signs of FLUTD in Feline Patients Want more Veterinary Practice News? 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