Hemorrhagic Cystitis Syndrome 1

Litter Box Problem? Maybe Not A Behavior, But A Urologic Problem.

When a previously well trained cat decides, for no apparent reason, to avoid the litter box and starts to urinate in inappropriate places the first impulse may be to think the cat is misbehaving for what must be called purely anthropocentric reasons: vindictiveness, anger, jealousy, getting even, being mad at the owner. Of course, the cat is not likely to be misbehaving for any of these reasons. In fact, among veterinarians there has never been any doubt that non behavioral causes are responsible for the majority of cases of house soiling. That is the reason veterinarians begin treating such problems by first ruling out common medical causes. Veterinary behaviorists who treat these cases usually tell owners that the cat is responding to stress, a disturbance in its routine, the introduction of another cat (even another human) into the
household, etc.

Now Dr. C. A. Tony Buffington, a veterinarian at The Ohio State University who has recently taken an interest in feline urologic problems, is suggesting another very plausible reason why the litter box mishaps may occur. This expert's investigations have led him to consider the similarities between urinary tract and a problem that is often common in people, especially women. The condition in humans is called interstitial cystitis, a lower urinary tract syndrome characterized by difficult, painful, and frequent urination. The similar condition in cats is called idiopathic (of unknown cause) cystitis. As the name implies, there is often no discernable or diagnosable cause.

It is Dr. Buffington's belief that some cases of lower urinary tract disease in cats, cases in which a cause is difficult to pinpoint, are surprisingly close in symptoms to interstitial cystitis in people. Cats with idiopathic cystitis have increased frequency, pain, and urgency of urination. Affected cats resent being handled and resist the veterinarian's effort to palpate the abdomen during examination. An uncontrollable urgency to urinate may catch the cat off guard and at a distance from the litter box.

Buffington also says that stress plays a role in cats' urinary tract disease, which parallels stress related flareups in women.
"Flare ups of bladder problems in cats are often seen two to three days after stressful events, such as a move to a new house, the arrival or departure of house guests, holidays and vacations, weather changes and abrupt diet changes,"

Dr. Buffington points out another link between interstitial cystitis and feline idiopathic cystitis-the same drug that is usually prescribed to treat people, amitriptyline, is also used by many veterinary behaviorists to treat inappropriate urination in cats.

Veterinary behaviorists were on the right track when they made a connection between stress and breaks in litter box training. Dr. Buffington says that worsening of clinical signs of idiopathic cystitis, a condition called flares, can occur when cats with the condition are stressed Stress can come in many forms- everything from an earthquake (there is actually documentation of more cases of urinary tract disease in cats after an earthquake) to changes in the owner's work schedule, additions or subtractions of humans or animals in the household, etc. Even something like moving a cat to a different cage in a hospital can bring on an increase in urine pH, which can in turn influence the development of urinary tract problems.

Treating idiopathic cystitis in cats is complicated because the condition may be difficult to diagnose and also because thus far no therapy has proven 100 percent efficacious. As noted, the drug amitriptyline does help some cats. Dr. Buffington recommends shielding susceptible cats from all stressful factors in the environment. Behavior altering medication should be used only on the direction of a veterinarian, who can monitor the cat for side effects. If the cat's bladder is inflamed, steroids might help in reducing the
inflammation.

Dr. Buffington is also on record as saying that idiopathic cystitis should be recognized as a painful experience for the cat. That is why he urges his fellow veterinarians to study the effect that adequate pain control would have on the condition and on its well known tendency to recur.