Stress Cystitis Explained

Stress Cystitis Explained

This disorder is known by a number of different names but essentially, what we’re talking about is a cat that has ongoing or recurring cystitis or inflammation of the bladder or urethra, where no medical cause can be found. 

It can be known as chronic cystitis, stress cystitis, sterile cystitis, Feline Interstitial Cystitis, Feline Idiopathic Cystitis or FIC.  It can also be referred to as FLUTD which stands for Feline Lower Urinary Tract Disease – this is the umbrella term used for a number of different urinary diseases in cats.  Throughout these pages, I will refer to it as stress cystitis because we know that stress is very often a trigger.

It’s important to bear in mind how painful and miserable having cystitis is.  If you haven’t experienced it as a human then you are fortunate.  We often hear about it being a burning sensation when you urinate.  This is true but also, it’s the feeling of needing to pee and you are at absolute bursting point but when you go, nothing comes out and if it does, only a tiny amount.  It can become excruciatingly painful and be difficult or impossible to think of anything else.    

Signs of cystitis can include difficult or painful urination, a need to urinate more frequently (little and often), blood in the urine which can show as anything from a slight pink tinge to bright red blood in the urine, urinating in places where the cat wouldn’t normally urinate e.g. rug, bed, etc, excessively licking the genital area, unsettled and vocalising or yowling.   Episodes may develop quite quickly, then often naturally subside and resolve over a few days, only to recur again later. In severe cases, the episodes may recur frequently and persist for long periods.

Diagnosis of stress cystitis can be difficult as there is no way to test for it.  However, it is often diagnosed based on what it ISN’T.  So tests will be run to rule out other common bladder diseases such as infection, urinary crystals, bladder stones or changes to the bladder wall.  If these tests are all clear then it may point to stress cystitis.

Stress cystitis can affect cats of any age and is often a recurring disease.  Some oriental breeds are known to have more sensitive or anxious personalities which makes them more likely to suffer from this disorder.  It is also thought that stress cystitis may develop in certain cats that are genetically prone to respond to stress in a slightly abnormal way, and may also have some defect in the bladder lining.  Stress cystitis is also more commonly seen in indoor cats and cats who live in multi-cat households.  Therefore, it would be wise to try to give your cat access to the great outdoors wherever possible and limit the number of cats in the home.




Treatment of Stress Cystitis

Treatment of Stress Cystitis

Stress plays a significant role in triggering stress cystitis.  For this reason, modifying the environment to help reduce stress is key in the management of this disease.  As well as this, encouraging drinking so that your cat urinates more frequently can also make a difference. 


Environmental Triggers

If an environmental trigger can be identified, this will give you the best chance of success with this disease.  When the symptoms started, was there a change in the household?  A new pet, moving house, even moving furniture, a member of the family moving in or out, had you been away on holiday?  Cats are very sensitive animals and even something that appears minor could be the trigger.  The single most common stress factor for a cat is conflict with another cat in the household. This may be very difficult to detect, but should always be suspected in a cat with stress cystitis.

In situations where there doesn’t seem to be an obvious cause, it could be changes that you can’t see or understand.  For example, if it is a multi-cat household, there may be changes in the dynamics of the group.  The neighbour’s cat could be coming into the garden, or even the house while you’re at work or asleep. It could be that you are stressed and your cat is picking up on this.

In some instances, you may be able to identify a stress trigger that can be minimised or is no longer an issue.  Where a stress trigger is suspected, if there’s any way to reduce the occurrence of this then this should be done. 

Most often, unfortunately, the trigger is something that can’t be identified or avoided too easily so the next step is to manage the environment to help reduce your cat’s stress levels. 

It’s important to note that even if you can’t do anything about the trigger, identifying it still gives you an advantage in that you will know what may trigger an episode in the future.  


Environmental Management

Our goal here is to create a calming, yet enriching environment for your cat to reduce the recurrences of stress cystitis or help to resolve a current episode. 

Indoor cats are surprisingly susceptible stress.  It is thought that this is because they have little to occupy themselves.  They ultimately lack environmental enrichment which can cause them stress.  Simple things like making a reasonable amount of time each day to play with your cat using different toys and getting them to run around.  Allowing the cat time outside – depending on the reasons the cat is indoors only, it may be that this is done using a cat harness and lead or investing in an enclosed run. Ensure there are plenty of other things of interest for the cat.  Cats like to view things from up high so a cat scratching tower with different levels and hiding places and a place to sit at the top can be great for a cat to feel like they have control of their space. 

In multi-cat households, make sure your cat with stress cystitis has their own quiet, safe space they can go to get away from the other cats in the home.  This could be a bedroom with the door slightly ajar and a space under the bed just for them, or it could be somewhere up high where they can easily see who’s around from a vantage point.  It could be that your cat’s favourite place to sleep needs to become off limits to the other animals in the home.  Ensure your cats can eat and urinate far away from each other and in a quiet area where there isn’t a lot of hustle and bustle.  This may mean multiple bowls of food and multiple litter trays. It’s important that a cat with stress cystitis has the opportunity to go to the toilet regularly so that they aren’t holding onto their pee for too long.  A covered litter tray can be great at helping a cat with stress cystitis feel less vulnerable when going to the toilet.  

In all situations, using the synthetic feline facial pheromone Feliway® may be of help – either as a spray on bedding and furniture and/or as a plug-in diffuser to help reduce stress and anxiety.  This can have a significant positive affect on the anxiety of your cat.


Water Intake & Diet

The most important thing when supporting your cat through this disease, is to ensure your cat has plenty of access to fresh water.  

In addition to fresh water, you can help increase their water intake by feeding them mainly wet food.  Cats have an amazing ability to get water from food so providing a food that is already higher in water content (in gravy or jelly for example) is a great way to increase their fluid intake.

Although wet food is ultimately the best option for a cat with stress cystitis, it also has some disadvantages.  It can be a much more expensive option to feed them ONLY on wet food and it also can go off quickly when left out in a bowl.  As most cats tend to graze on small portions of food throughout the day (as this is what they would be doing in the wild), feeding your cat dry food in addition to wet food would be a good compromise if they are a grazer.  You can also add some water or gravy to the dry food to increase the water content, but only if your cat will eat it this way.  We all know how fussy they can be!  

Your vet may have mentioned special veterinary diets which can help with stress cystitis.  This food helps by supporting your cat’s bladder health while also containing ingredients to help manage stress. 

More information about the foods available can be found here {link to foods} as well as tips on how best to change your cat onto this food and how to get a fussy cat to eat it. 



Stress cystitis is a painful condition so if your cat is showing signs of discomfort, some pain-relief from your vet may be valuable but will not cure your cat if the underlying causes are not addressed.

If your cat is having recurring episodes of stress cystitis and the underlying cause is not known or cannot be managed, then your vet may feel they are suitable for short or long-term anxiety medication.

There is also an injectable drug called Pentosan (or Cartrophen) which is not licensed for use in cats (currently in Australia) but many vets will use it ‘off-label’ as it is believed it may protect the bladder lining from irritants in the urine.  However, opinions vary on its effectiveness for stress cystitis.



If you know your cat, you will likely know when an episode has resolved and your cat returns to their normal, happy selves.  You will also hopefully know when your cat starts behaving strangely and an episode is beginning. 

If it has been some time between episodes and an obvious stress trigger cannot be identified, it is wise to get your cat checked at the vet.   It is not impossible for a cat who has a history of stress cystitis to later develop other bladder diseases which can be more clearly diagnosed and treated.



Veterinary Foods for Stress Cystitis

Veterinary Foods for Stress Cystitis

There are two main brands of veterinary specific diets which support diseases in dogs and cats, these are Hills and Royal Canin.  

For sterile cystitis, these foods are called Hills C/D Stress and Royal Canin Urinary Calm.  Both are essentially very similar in terms of how they support your cat with stress cystitis.  Most importantly, the food helps by promoting desirable urine pH levels which are less irritable to the bladder and contains ingredients to help manage stress.

Now I’m going to show you the difference between the brands of stress cystitis food available and the flavours.  I would offer to try the foods myself but I’m not stupid so, instead, I’m going to use Milo as the taste tester!