Monday, September 28, 2009

Cats with Interstitial Cystitis--Blood in Urine

Dear Dr Gordon: I am having a real problem with my cat. She is a 4 year old, spayed female calico cat. I adopted her later in life from one of my co-workers and she has always been a little stand offish. Lately, she has started to urinate outside the litter box and there is a small amount of blood in the urine. I have tried everything to discourage this. I have changed the litter. I have purchased an additional litter box. I have even contemplated letting her go outside during the day because she used to be an outdoor cat and now is completely confined to the indoors. She has been to the doctor several times and the doctor is able to give medication to stop the bleeding and accidents, but it always seems to return. What is your take on this? TR

Dr. David Gordon, Holistic Veterinarian: Well my answer is going to come as quite a surprise to the majority of readers of this column and even to some veterinary old timers.

There are many things that potentially could cause bloody urine in your cat, and those should definitely be ruled out before proceeding. These include stones in the bladder, crystal plugs, bacterial infection, and congenital defects of the urinary system (like a persistent urachal remnant). But, given the age of the cat and the living circumstances, there is an excellent chance none of the potential causes listed above is the culprit. In fact, less that 1% of cats in this age group have bloody urine due to infection.

Well, if infection was not at fault, what was causing the bloody urine. Many hypotheses came forth by veterinary researchers in the field. Some doctors thought there was some mysterious viral disease that caused most of these cats to develop bloody urine. Others thought these cats must have some sensitivity to something in the environment, and this type of allergic reaction was causing the bloody urine. But we now know that these cats are not getting better because the antibiotics are making them better. It is true that veterinarians have been prescribing antibiotics and doing urine cultures on these cats for years and the cats invariably got better. The latest information reveals that the cats were getting better despite being put on the antibiotics.

We now know that most of these cats suffer from a malady that many women suffer from, called interstitial cystitis. By examining the interior of the bladder wall of affected cats, it was discovered that there were focal points of hemorrhage that mirrored what was being seen in these women suffering from a similar syndrome. Not only that, but the bladder wall was extremely inflamed.

The current theory is that STRESS is the underlying factor in the cat’s interstitial cystitis problem. Stress perceived by the cat causes the release of neurotransmitters that adversely affect different organs. In susceptible cats, this organ is the bladder wall. Once inflammation sets in, the bladder wall, in essence, loses its’ integrity and there is leakage of urine within the layers of the bladder wall itself. Urine is a very irritating substance, and the leakage of this urine further perpetuates the inflammation and leads to focal areas of hemorrhage.

Cats suffering from this syndrome have frequent attempts to pass urine, and this is invariably bloody. These cats are very painful and most women that have interstitial cystitis will attest to that. Cats may associate this pain with their litter boxes and could be urinating outside the box because they are associating the litter box with pain.

It makes sense then that to treat interstitial cystitis in women and cats, that the patient should respond to anti-inflammatory, anti-anxiety, and analgesic medications. That is, in fact, the types of treatment that has been shown to be the most effective. Some cats will have repeated episodes of this over the course of their lifetimes but usually relief and amelioration of symptoms will occur with the above mentioned medications. 

How can we prevent this from occurring in susceptible cats? Provide many litter boxes and clean them daily in addition to trying to eliminate stress. That is easier said, than done because each cat is probably being stressed out by his or her own individual circumstances. Is it the neighbors loud rock and roll band? Is it the construction going on outside? Is it the neighbor’s barking dog? Are outdoor cats that your indoor cat can see teasing?

Some veterinarians also hypothesize that there is a certain group of cats that feel frustrated, unfulfilled, and downright bored with their sedentary lifestyles that we offer. Providing these cats with play time and stimulating their hunting and predatory instincts can help alleviate their frustration and boredom.

Patience and understanding is the key to living with these cats.

Author:  Dr. David Gordon, Holistic Veterinarian