{"id":5737,"date":"2021-05-14T14:06:20","date_gmt":"2021-05-14T18:06:20","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?post_type=articles&#038;p=5737"},"modified":"2022-06-22T17:00:10","modified_gmt":"2022-06-22T17:00:10","slug":"nutrition-and-behavior-therapy-for-feline-idiopathic-cystitis","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/nutrition\/nutrition-and-behavior-therapy-for-feline-idiopathic-cystitis\/","title":{"rendered":"Nutrition and Behavior Therapy for Feline Idiopathic Cystitis"},"content":{"rendered":"<p>Forms of feline lower urinary tract disease (<strong><a href=\"https:\/\/todaysveterinarypractice.com\/urology-renal-medicine\/diagnosing-and-managing-feline-lower-urinary-tract-disease\/\" target=\"_blank\" rel=\"noopener\">FLUTD<\/a><\/strong>) are common presenting complaints in veterinary practice. FLUTD encompasses disorders affecting the urinary bladder or urethra, including feline idiopathic cystitis (FIC). FIC is categorized as an inflammatory disease and refers to cystitis from an unknown cause despite a thorough diagnostic evaluation.<\/p>\n<p class=\"p1\"><span class=\"s1\">While cats diagnosed with FIC present primarily for acute or chronic obstructive or nonobstructive disease with signs of lower urinary tract disease such as hematuria, dysuria, pollakiuria, and stranguria, these signs are not specific for any one disease.<sup>1<\/sup> Published studies support common risk factors associated with FIC, such as age (2 to 7 years), excessive body weight, environment, and stress.<sup>2,3<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Given that the underlying cause of FIC is unknown and presentation and clinical signs vary widely, the cause is likely multifactorial, and treatment may be multifaceted. While some treatment regimens include medical management, this article focuses on stress reduction through nutrition and behavior therapy.<\/span><\/p>\n<h2 class=\"p2\">The Environment and Nutrition History<\/h2>\n<p class=\"p1\"><span class=\"s1\">There is currently no cure for FIC and treatment is focused on decreasing the cat\u2019s clinical signs, which also helps reduce the recurrence of \u201cflares.\u201d Veterinary nurses can play a key role by obtaining an accurate and comprehensive environment and nutrition history to determine the areas for improvement (<\/span><strong><span class=\"s2\">BOXES 1 AND 2<\/span><\/strong><span class=\"s1\">). These questions can be discussed during a scheduled veterinary nurse appointment as part of an FIC management program. Once the history is collected, the veterinary nurse can collaborate with the clinician to create appropriate goals, beginning with 1 or 2 initial changes. Introducing changes slowly can help avoid overwhelming the client and preserve the human-animal bond as they work through diet and lifestyle adjustments.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 1 Environmental History Questions to Aid in Managing a Diagnosis of Feline Idiopathic Cystitis<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><\/span>1. Have you had [cat\u2019s name] since he\/she was a kitten?<\/p>\n<ul>\n<li><span class=\"s1\">If not, how long have you had [cat\u2019s name]? <\/span><\/li>\n<\/ul>\n<p>2. Are there any new human or animal additions to the home?<br \/>\n3. How many cats and\/or dogs are in the household?<\/p>\n<ul>\n<li><span class=\"s1\">Are there issues between the other cat(s) and\/or dog(s)? <\/span><\/li>\n<\/ul>\n<p>4. Are there exotic pets in the household?<br \/>\n5. How big is the living space (e.g., apartment, condo, detached house)?<br \/>\n6. Did you move recently?<br \/>\n7. Is [cat\u2019s name] indoor only?<\/p>\n<ul>\n<li><span class=\"s1\">If no, how does he\/she behave outside? <\/span><\/li>\n<\/ul>\n<p>8. Does [cat\u2019s name] have access to a screened-in outdoor area?<br \/>\n9. Do you leash-walk [cat\u2019s name]?<br \/>\n10. How many litterboxes does [cat\u2019s name] have access to?<\/p>\n<ul>\n<li><span class=\"s1\">How frequently are they cleaned? <\/span><\/li>\n<li><span class=\"s1\">Where are they in the home? <\/span><\/li>\n<li><span class=\"s1\">What type of litter do you\u00a0use? <\/span><\/li>\n<li><span class=\"s1\">How deep\/thick is the litter? <\/span><\/li>\n<li><span class=\"s1\">What kind of litterboxes do you use (e.g., open, covered)? <\/span><\/li>\n<li><span class=\"s1\">Does [cat\u2019s name] consistently use the litterbox for elimination? <\/span><\/li>\n<li><span class=\"s1\">If he\/she eliminates outside the litterbox, where? <\/span><\/li>\n<\/ul>\n<p>11. Does [cat\u2019s name] have access to the following resources without competition?<\/p>\n<ul>\n<li><span class=\"s1\">Toys <\/span><\/li>\n<li><span class=\"s1\">Scratching area <\/span><\/li>\n<li><span class=\"s1\">Safe vertical space <\/span><\/li>\n<li><span class=\"s1\">Safe sleeping area <\/span><\/li>\n<\/ul>\n<p>12. What is the general noise level inside the home and nearby?<br \/>\n13. What is [cat\u2019s name]\u2019s general temperament when at home (e.g., aggressive, fearful, playful, solitary, anxious)?<br \/>\n14. Has [cat\u2019s name]\u2019s \u201cnormal\u201d temperament changed recently?<br \/>\n15. How often and for how long are you away from home?<br \/>\n16. How frequently does the household receive visitors?<br \/>\n17. How does [cat\u2019s name] respond to visitors?<br \/>\n<\/div><\/div>\n<p class=\"p1\"><span class=\"s1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 2 Nutrition History Questions to Aid in Managing a Diagnosis of Feline Idiopathic Cystitis<sup>a<\/sup><\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><\/span>1. Have you noticed any recent changes in [cat\u2019s name]\u2019s weight or body condition?<br \/>\n2. What do you currently feed [cat\u2019s name]?<\/p>\n<ul>\n<li><span class=\"s1\">Have you changed his\/her diet recently? <\/span><\/li>\n<\/ul>\n<p>3. How much food do you give [cat\u2019s name], and how often do you feed him\/her?<\/p>\n<ul>\n<li><span class=\"s1\">Have you changed the amount or frequency recently? <\/span><\/li>\n<\/ul>\n<p>4. How is [cat\u2019s name]\u2019s appetite?<\/p>\n<ul>\n<li><span class=\"s1\">Do you \u201ctop\u201d his\/her food with anything to entice eating? <\/span><\/li>\n<\/ul>\n<p>5. Where are [cat\u2019s name]\u2019s food and water bowls?<br \/>\n6. How many bowls are there for fresh water?<br \/>\n7. If there are other cats in the household:<\/p>\n<ul>\n<li><span class=\"s1\">Do they share bowls? <\/span><\/li>\n<li><span class=\"s1\">Is there competition for food? <\/span><\/li>\n<\/ul>\n<p>8. Do you give [cat\u2019s name] treats?<\/p>\n<ul>\n<li><span class=\"s1\">If so, what brand\/type\/flavor? <\/span><span class=\"s1\">How many per day? <\/span><\/li>\n<\/ul>\n<p>9. If [cat\u2019s name] goes outside, does he\/she have access to other food?<br \/>\n10. Do you give [cat\u2019s name] any dietary supplements? If so, which ones?<br \/>\n11. How do you give [cat\u2019s name] medications (if any)? Do you use food?<\/p>\n<p class=\"p1\"><em><span class=\"s1\"><sup>a<\/sup>Body weight, body condition score, and muscle condition score should be assessed during the visit.<\/span><\/em><\/p>\n<p class=\"p1\"><span class=\"s1\"><\/div><\/div><\/span><\/p>\n<h2 class=\"p2\">Behavioral Goal: Stress Management<\/h2>\n<p class=\"p1\"><span class=\"s1\">Cats can be sensitive to life stressors or events and usually prefer predictable, routine settings.<sup>4<\/sup> A variety of circumstances can prove overwhelming for cats depending on their personality and age. Common stressors include diet change, transportation, novel or <\/span>unfamiliar objects and places, loud noises, and strangers<span class=\"s1\"> (human or animal) approaching their personal space.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Stressful surroundings often exacerbate FIC, leading to undesirable behaviors such as inappropriate urination, aggression, vomiting, and selective appetite.<sup>5<\/sup> Therefore, a major area to address in efforts to reduce stress is environmental needs. Regardless of the number of cats in the <\/span>household, it is important to provide a safe environment <span class=\"s1\">with multiple areas for food, water, litterboxes, rest, scratching, and vertical space. This allows cats to avoid interaction with other cats, minimizing bullying, competition, and thus stress.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Cats generally prefer a private, often raised location where they can monitor the environment. Encouraging owners to provide hiding places for cats to help reduce stress can be as simple as taking a cardboard box and creating an entry and exit so the cat can rest inside or jump on top. Ideally, there should be as many hiding places as there are cats, keeping in mind the \u201csafe places\u201d should be distanced from each other.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">If adjustments to environmental resources appear to have minimal impact on the cat\u2019s stress level and negative behaviors, a consultation with a board-certified veterinary behaviorist may provide additional support for the owner and cat(s). The resources in <\/span><strong><span class=\"s2\">BOX 3<\/span><\/strong><span class=\"s1\"> may also be helpful.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 3 Online Resources<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><\/span><span class=\"s1\">American Association of Feline Practitioners <strong><a href=\"http:\/\/catvets.com\">catvets.com<\/a> <\/strong><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">American College of Veterinary Behaviorists <strong><a href=\"http:\/\/dacvb.org\">dacvb.org <\/a><\/strong><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">American College of Veterinary Nutrition <strong><a href=\"http:\/\/acvn.org\">acvn.org <\/a><\/strong><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Indoor Pet Initiative <strong><a href=\"http:\/\/indoorpet.osu.edu\">indoorpet.osu.edu<\/a><\/strong><\/div><\/div><\/span><\/p>\n<h2 class=\"p2\">Pheromone Environment<\/h2>\n<p class=\"p1\"><span class=\"s1\">Cats evaluate their security by gathering information from their surroundings through olfactory and chemical senses. Chemical sensing refers to the detection of pheromones, which are used to communicate information between members of the same species. Specifically, in cats, scent or pheromonal marking is done through facial and body rubbing to establish boundaries for their safe and secure territory. Cats produce pheromones from scent glands located in their cheek, temporal, and caudal regions, as well as paw pads. Providing interior scratching stations is an easy way to encourage and improve the cat\u2019s ability to deposit its scent, assisting them in feeling secure and potentially decreasing stress.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Synthetic feline facial pheromones (SFFPs) are available and have been suggested as a means to mimic the natural markings cats create by rubbing their faces on objects.<sup>6<\/sup> At this time, the use of SFFPs is lacking strong evidence to support it as a tool for managing FIC, although it is possible that SFFPs could decrease stress in some individual cats with FIC by activating specific sensory neurons.<\/span><\/p>\n<h2 class=\"p2\">Nutrition Interventions<\/h2>\n<h3 class=\"p3\">Water Intake<span class=\"Apple-converted-space\">\u00a0<\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">Cats evolved from the desert environment and therefore can survive on less water than other species and drink less frequently. With conditions like FIC, increasing water intake may prove beneficial by decreasing the urine specific gravity and increasing urination, thereby \u201cflushing\u201d the bladder more frequently.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">When ways to increase a cat\u2019s moisture intake are being considered, canned diets should be an option. Canned and dry diets vary considerably in their moisture content, with canned products generally containing more than 60% moisture and dry products generally less than 10%. Theoretically, increasing the proportion of canned food and thereby increasing water intake may decrease the urine specific gravity.<sup>7<\/sup> However, cats generally have very selective and individualized taste and texture preferences. Some cats may refuse canned food and become more stressed through a diet trial, working against the goal for overall stress management. Veterinary nurses can use the tips in <\/span><strong><span class=\"s2\">BOX 4<\/span><\/strong><span class=\"s1\"> to help <\/span>clients limit stress around the introduction of new food.<\/p>\n<p class=\"p1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 4 Tips for Transitioning to Canned Food<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\">Advise the client to offer the new diet next to the old diet in a similar container. If the cat does not consume the new diet within an hour, it should be removed. This routine can be repeated until the cat is readily eating small amounts of the new diet.<\/p>\n<p class=\"p1\">When the cat is eating the new diet, the amount of old food available should be decreased in small amounts every day until it can be removed entirely. This may take a couple of weeks.<\/p>\n<p class=\"p1\">Once the cat is fully transitioned, schedule a veterinary nurse recheck appointment to monitor the cat\u2019s weight, body condition score, and appropriate intake\/feeding recommendations; review stress management success strategies; and troubleshoot any concerns from the owner.<\/div><\/div>\n<p class=\"p1\"><span class=\"s1\">If the effort to transition a cat to canned food is unsuccessful, other approaches can be used to encourage additional water intake. One option involves a nutrient-enriched water supplement for cats, targeting hydration. In addition, modifying the way water is offered\u2014for example, location, water dish size, and water cleanliness\u2014may entice the cat to drink more. <\/span><strong><span class=\"s2\">BOX 5<\/span><\/strong><span class=\"s1\"> lists actions for owners to try. While these methods have not been proven to benefit every cat with FIC, they may have a positive impact on the cat\u2019s wellbeing, thereby limiting stress.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\"><div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\">BOX 5 Ideas for Increasing a Cat\u2019s Water Consumption<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><\/span><\/p>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Select an appropriate water dish <\/span>\n<ul>\n<li class=\"p1\"><span class=\"s1\">Should have low edges or a wide opening to limit whisker fatigue <\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Can be easily cleaned and sanitized <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"p1\"><span class=\"s1\">Choose a good location for the water dish <\/span>\n<ul>\n<li class=\"p1\"><span class=\"s1\">In a quiet place with low foot traffic <\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Away from litter pans and food bowl <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"p1\"><span class=\"s1\">Provide fresh, clean water <\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Offer a canned diet <\/span><\/li>\n<li class=\"p1\"><span class=\"s1\">Provide a water fountain<\/span><\/li>\n<li class=\"p1\"><span class=\"s1\"> Offer hydration supplements<\/span><\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><\/div><\/div><\/span><\/p>\n<h3 class=\"p3\">Therapeutic Urinary Diets<\/h3>\n<p class=\"p4\"><span class=\"s1\">Several available therapeutic urinary diets may prove beneficial in management of lower urinary tract disease; however, not all target stress reduction. Therapeutic urinary diets targeting FLUTD and\/or FIC in cats may use the following nutritional approaches:<\/span><\/p>\n<ul>\n<li class=\"p5\"><span class=\"s1\">Increasing solubility of crystalloids within the urine<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Decreasing the retention of urinary crystals<\/span><\/li>\n<li class=\"p5\"><span class=\"s1\">Limiting proinflammatory mediators and increasing anti-inflammatory mediators<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/li>\n<li class=\"p6\"><span class=\"s1\">Increasing intake of L-tryptophan and <\/span><span class=\"s3\">\u03b1<\/span><span class=\"s1\">-casozepine<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/li>\n<\/ul>\n<h3 class=\"p3\">Stress-Reducing Supplements and Supplemented Therapeutic Diets<span class=\"Apple-converted-space\">\u00a0<\/span><\/h3>\n<p class=\"p1\"><span class=\"s1\">L-tryptophan is an essential amino acid that is a precursor for synthesis of serotonin, an inhibitory neurotransmitter. It may have an anxiolytic effect in cats. One 2-month study observed significant changes in behaviors such as vocalization, agonistic behavior, house soiling, and scratching in cats eating a diet supplemented with L-tryptophan.<sup>8<span class=\"Apple-converted-space\">\u00a0<\/span><\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s3\">\u03b1<\/span><span class=\"s1\">-Casozepine is available as a supplement and is an additive in some therapeutic urinary diets. It is derived from bovine milk and has anxiolytic properties. One study suggests that <\/span><span class=\"s3\">\u03b1<\/span><span class=\"s1\">-casozepine is beneficial in limiting anxiety and socially stressful conditions in cats.<sup>9<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">Long-chain omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) and antioxidants such as vitamin E and <\/span><span class=\"s3\">\u03b2<\/span><span class=\"s1\">-carotene have been considered as agents to reduce bladder inflammation. To date, there are no studies evaluating the therapeutic dose for cats with FIC, but studies have supported the long-term use of multipurpose therapeutic urinary diets containing a wide range of omega-3 and antioxidant content.<sup>10<\/sup><\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">While oral supplements may be beneficial, consideration should be given to minimizing any stress associated with their administration. When possible, the use of formulated therapeutic urinary diets that also target stress reduction through the addition of beneficial ingredients and\/or supplements should be considered.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n<h2 class=\"p2\">Conclusion<span class=\"Apple-converted-space\">\u00a0<\/span><\/h2>\n<p class=\"p1\"><span class=\"s1\">FIC is a complex disease process and is currently not completely understood. Nevertheless, veterinary nurses can play a key role in management and guidance around successful FIC treatment. Since FIC appears to be a disease that is not solely related to the bladder, exceptional client communication in conjunction with supportive therapies can benefit both acute and chronic cases. Working with owners to appropriately structure the environment for their cat(s) and providing feeding guidelines to support urinary health and ideal body weight will, at a minimum, increase the cat\u2019s wellbeing. Ultimately, for cats with FIC, after any necessary medical treatments\/procedures, focusing on stress reduction through environmental enrichment and maximizing water intake and urine volume to limit bladder irritants are the best approaches to limiting clinical signs associated with FIC.<span class=\"Apple-converted-space\">\u00a0<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The underlying cause of FIC is unknown and presentation and clinical signs vary widely.<\/p>\n","protected":false},"author":187,"featured_media":5699,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[157],"tags":[145],"class_list":["post-5737","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-summer-2021","tag-peer-reviewed","column-nutrition_notes","clinical_topics-nutrition"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Nutrition and Behavior Therapy for Feline Idiopathic Cystitis<\/title>\n<meta name=\"description\" content=\"Modifications to a cat\u2019s environment and water intake may help limit clinical signs of FIC.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, 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