Hiss & Tell: Cat Behavior and Beyond

Peeing Outside the Litter Box? It Might Be FLUTD, Not a Behavior Problem

• Kristiina Wilson • Season 3 • Episode 40

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A cat peeing outside the box isn’t a grudge - it’s often pain. We bring back Dr. Gina Rendon, Medical Director of Williamsburg Vets, to decode FLUTD and idiopathic feline cystitis and show how stress biology, environment, and hydration collide to shape behavior. If you’ve wrestled with “inappropriate urination,” this conversation reframes the problem with compassion and clear next steps.

We break down how stress hormones can strip the bladder’s protective layer, why male cats face higher obstruction risk, and the subtle signs most people miss - over-grooming, tiny clumps, frequent box trips, or blood in the urine. We also explain exactly when urinary signs become an emergency, what evidence-based diagnostics look like, and why “just give antibiotics” is outdated and risky in an era of antimicrobial resistance.

From there, we get practical. Hydration-first management, wet food over dry, and multiple water stations can transform outcomes by reducing urine concentration. Environmental enrichment matters just as much: tall perches, safe pathways, duplicated resources, and daily play that taps a cat’s predatory motor pattern. For bright, anxious cats, clicker training adds mental work and predictable rewards. We also explore short-term anxiolytics for predictable stressors like travel or holidays and how multi-cat micro-tensions can quietly undermine litter box habits.

You’ll leave with a checklist you can act on today and trusted resources like the Ohio State Indoor Cat Initiative and iCatCare to go deeper. If this helped, subscribe, share with a fellow cat guardian, and leave a quick review so more people can find the show. Your support keeps these evidence-based conversations coming.

Kristiina Wilson:

Hey and welcome back to episode 40 of Hiss and Tell. I am your host, Christina Wilson, and today I'm joined once again by the wonderful Dr. Gina Rendon, Medical Director of Williamsburg Vets. In this episode, we're diving into fluted, which is feline lower urinary tract disease, and idiopathic feline cystitis, and why these conditions matter so much on a cat behavior podcast. House soiling is one of the most common reasons guardians reach out for behavior help, but all too often what looks like a behavior problem is actually driven by pain, inflammation, or stress-related medical disease. Let's go. Welcome to another episode of Hiss and Tell. I am your host, Christina Wilson, and with me today, as often is, is the amazing Dr. Gina Rendon, Medical Director of Williamsburg Vets. Welcome, Gina.

SPEAKER_00:

Thank you. Thanks for inviting me. Yay! You're back. And today we You're back.

Kristiina Wilson:

Today we're going to be talking about fluted and idiopathic feline cystitis. And we are talking about that on a cat behavior podcast because I will say, at least I get a lot of um house soiling cases. And a lot of the time when it's house soiling cases that have to do with what people used to call inappropriate urination, I always want to know: has the cat been checked for these two issues? Could it be a physical driver? And often these issues can be the physical driver of what people consider a behavioral problem. So here we are to discuss what the heck these things are and how how they pertain to your cat's behavior. So, Gina, for listeners who might be new to this topic, can you explain what fluted is and how idiopathic feline cystitis kind of fits under that umbrella?

SPEAKER_02:

Absolutely. So fluted stands for feline lower urinary tract disease. So that's an acronym, and we just pronounce it as fluid, fluted. And there's actually been several names for this basically umbrella term that that describes a bunch of different types of urinary issues. So this is not actually a diagnosis, it's a description of various things that can affect the urinary tract. So it used to be called FUS, so it was feline urologic syndrome, and then they called it fluted. FIC can be either feline interstitial cystitis or idiopathic cystitis. And then there was one person who came up with the term Pandora syndrome, which is the stress type of medical changes that can happen with cats. So stress-induced medical issues, which can include urinary issues, respiratory issues, dermatologic issues. And so that it's, you know, basically stress opens up the big box of bad things for kitty cats. But fluted seems to be the term that's most commonly used, even though people also use FOSS. So if you hear people talk about FUS, that's another kind of inner uh interchangeable term. But so basically, this is a description of a category of diseases that can affect the way a cat urinates. And so things like urinary tract infections falls under this umbrella, bladder stones, what we call idiopathic cystitis, which basically is a diagnosis of exclusion. You have to rule out some of these other things. Um, and then you can also have things like congenital issues. So not that long ago, we actually saw a kitty cat that had what we think was, we thought the cat was a hermaphrodite. Hermaphrodite. Yeah, which was really interesting. So they and it was a really young cat who was having urinary issues. And we we wanted to try to see if we could pass a catheter and realize that the anatomy was completely anomalous. It was not not what we expected. And so, and there were other issues going on with the kitty. So there were um renal issues as well. So we did end up sending that animal for referral and then I I don't know what ended up happening. We lost that cat to follow-up just because it was so young and there was a lot going on with it. Right. I'm not sure that the owners actually opted to continue treating. But so there can be anatomical issues, and then for older cats, sometimes there can actually be cancer causing issues that will make a cat not able to pee or to strain. So, so fluted, like I said, is an umbrella term. And then FIC is is feline interstitial cystitis and that or feline idiopathic cystitis, and that's specifically idiopathic cystitis tends to be associated more with stress and is actually the most common cause of urinary issues in cats more than UTIs and more than some of these other issues.

Kristiina Wilson:

Yeah. I can say from personal experience, we have one of those cats in our house, as you well know.

SPEAKER_02:

So, as you know, I just got back from a conference, and so I did sit in on a conference on fluted because I knew I was going to do this podcast, and so I just wanted to see if there was any new information. Actually, one of the interesting things that I learned was that, because I did not know this, that cats that tend to be more predisposed to this are the really sensitive cats, and that it's and they may have smaller adrenal glands and are unable to manage stress the way normal cats do. So there are, there do seem to be cats that are a little bit more predisposed to developing types of uh these types of reactions to stress. And they tend to be the cats that are just really, really sensitive. They're a little bit more fearful, they're much more reactive, they're always on guard. There may be a decrease in their production of cortisol, which is really interesting, and probably have higher levels of like norepinephrine and epinephrine that are are causing physical changes. But that was something that I had never heard before, and I thought that was very interesting.

Kristiina Wilson:

So that's super interesting. I would love to read if you if there's any papers or anything you got from that. I would love to read anything.

SPEAKER_02:

I'm sure this person had her references, which I they're probably in the proceedings, so we could probably find them for you.

Kristiina Wilson:

Yeah, that would be cool. But it's just, let's just talk about my problems. It's all about me. But you know, with with Kitten Man, he has always fit that bill, right? And he's also super, super smart. And I've noticed also with my clients who have cats that present like this, they've always been, they have a history of like always being very anxious, like kind of just just have being more reactionary, but also being, especially if it's a multicat household, being the most intelligent in the household. And I think that leads to like they need so much more intellectual stimulation, they need so much more engagement. But they're still just kind of that intelligence makes it so that they're in these worry stress loops and worry and anxiety. Yeah, yeah. So there's there's been a lot of that. But I will say that the effects are has helped so much. It has been excellent.

SPEAKER_02:

I'm happy to hear that.

Kristiina Wilson:

Really doing so much better.

SPEAKER_02:

So that's fabulous. Excellent.

Kristiina Wilson:

So that's anyway. Okay, back to the questions. Why do you think that urinary conditions in cats are like so often mistaken for purely behavioral problems? Because I could at least say from my end, so much of what I see, people come to me like, oh, my cat's peeing all over the house, and they have not gone to the vet.

SPEAKER_02:

Right. Yeah. I mean, I think it can go in both ways, which I think is kind of interesting because, you know, for cats, the stress behavioral part can result in medical issues, which I think is is, I mean, it's I think true for most biological creatures. You know, we all have our medical issues that can arise from stress. Cats, there are certain cats that just seem to be much more sensitive, but I think people just don't really think about it. And and I think one of the things that is frustrating from my point of view are people who think that it is because a cat is trying to express displeasure with them specifically. You know, they think a cat is being vindictive because of whatever or spiteful. And so now they're peeing outside the box and they're peeing on the carpet. And what they don't realize is that there are so many other factors that are involved, um, and that it really can be a medical issue, that it can be something where they have enough changes in their bladder that it's really uncomfortable. And so when they pee, it hurts, and they associate that maybe with the litter box. So I think people just don't really realize that really deep connection between behavior and medical issues, especially for cats. Yeah.

Kristiina Wilson:

Yeah, I agree. And it's it is just like you said, it's often like an overlapping Venn diagram that it's not purely one or the other.

SPEAKER_02:

Yeah. Um, yeah. But it's rarely because a cat is vindictive.

SPEAKER_00:

So that's absolutely. Yeah.

unknown:

Yeah.

SPEAKER_00:

It's not that the cat is trying to tell you off, you know, it's rarely that. So yeah.

Kristiina Wilson:

I I agree. Yeah. At what point should house soiling always be considered a medical emergency rather than a training or behavior issue? And I I can tackle this from my end as well, but let's hear your answer.

SPEAKER_02:

Well, so for me, a medical emergency means that um that something really serious can happen. Yes. And and usually for these types of cases, and we can certainly talk about this a little bit more, with um with if it is FIC, if it's um, you know, an intersticial cystitis type of a thing, cats can not be able to pee. And this is typically male cats where there's enough inflammation that their um that their urethra will basically just close down. And so it's an it's a medical emergency if your cat is trying to pee outside the box and they're not actually able to pee. And so, and anytime I think, you know, anytime you see a cat that's going in and out of the box or trying to pee around, you know, any places, trying to pee on the bed, and you're not seeing anything come out. I mean, as far as I'm concerned, anytime they're straining to pee, they need to be seen immediately, whether they're male cats or female cats, because either can be potentially obstructed. And that's a medical emergency. They can die from that.

Kristiina Wilson:

Yep. Absolutely agree. That's that's that's what I was gonna say, obviously. Um and you know that in our house we have cameras in front of all the litter boxes. So that makes it makes it a little easier to be able to be like, somebody's acting funny, like, especially with Kitman, who, you know, is our stressy guy who is blocked before, is I'll always notice, like, oh, he's he's doesn't want to eat, you know, even if I give him a churu, he doesn't want to eat. And then I'll go and look at the footage, and then I can see, like, oh, I've seen him go in and out of the litter box a lot. That seems strange. We better get him to the vet. And then every time that has happened, he's blocked and then has to stay in the hospital. Right. It's yeah, you can start to notice those signs, or is your cat super lethargic and you know, other signs like that?

SPEAKER_02:

Yeah, yeah.

Kristiina Wilson:

So, what are the most common signs of these issues that guardians might overlook or misinterpret?

SPEAKER_02:

I think the main thing is not using the litter box, even though there are multiple reasons for cats not using a litter box. And I think we've talked about this before in other episodes, you know, what an ideal box is and locations and number per uh cats in a household. I think we've talked about all of that. But but things like I think one of the really overlooked signs is over-grooming. And so kitty cats that have inflammation in their bladder will often they will groom their belly to the point where they're bald. And so, and that can be associated with other things as well. So sometimes that can be associated with things like pancreatitis, but it's it's also something that we see with cats that do have idiopathic cystitis. So that might be something that people don't realize, peeing outside the box. When it gets to the point where a cat is vocalizing while they're peeing, I think most people will kind of get the idea that that's not good. You know, and especially because at that point it's that really terrible, you know, distressing type growling. Yeah, which is so awful to hear. But but the more subtle things can be just not wanting to use the box, going more frequently, so going in and out of the box, and then over-grooming. Anytime you see blood in the urine, which is not always visible, there's that the pretty letter now can sometimes detect that early. So any type anytime there's blood in the urine, that would also be something that's a concern. And so sometimes actually, now now that I'd say that, people will report that their cat is peeing in the bathtub. And I don't know why cats love to pee in the bathtub, but a lot of them do. And that's sometimes one of the first times that you can actually recognize that there's blood in the urine because it'll show up on the white, on the white ceramic or whatever tubs are made out of. Yeah. So so blood is definitely a warning sign.

Kristiina Wilson:

I've had both bathtub and sink peers. And I I think it's I think it's because it's shaped like a giant litter box.

SPEAKER_02:

Uh-huh. Yeah. Yeah, sure. Uh-huh.

Kristiina Wilson:

So and I also think a lot of times they watch us on the toilet. At least the the cats that we had, they like to pee in the in the tub, would watch us go to the bathroom right next to the tub. And I think got some idea in their head about the drain and the toilet and the tub.

SPEAKER_03:

Uh-huh.

Kristiina Wilson:

Because they would try to go into the drain of the tub. Sure. Which at least made it easier. But I think generally, if you see that in your house, what that behavior tells you, not to go on a total tangent, but we're still talking about the litter box, is that your litter box isn't big enough because or is somehow else inappropriate.

SPEAKER_02:

Yeah. Yes.

Kristiina Wilson:

Yeah. That there's there's some kind of bathroom issue, but if they seem otherwise healthy, probably get a much bigger box. Yeah. Yeah. If that's what they want.

SPEAKER_02:

This is a good time to talk about those those other things in case people haven't seen our others. So if you have your litter box next to the washing machine, probably not a good idea. Yeah. Or a high traffic area if it's too small. Some cats don't like them covered. Some cats don't like crystals. Most cats really like the uh sandier types of litters and the scoopable litters, and they like clean boxes. So those are all factors that a cat will use to decide whether they're going to use the box or not.

unknown:

Yeah.

Kristiina Wilson:

Yeah. Yeah. There's there's definitely a lot of rules governing it. And it's it's interesting to watch in our house of 15 who uses what restrooms and what strong preferences they have. And most of them will use whatever box is closer, but we do have a few who have strong preferences that like they'll only use the litter robots or they'll only use, you know, the the traditional box. And we have a couple who will only use an enormous box that we put in a bathtub so that there's like a super extra jumbo giant box and then they go in.

SPEAKER_02:

The box in the box. Yeah.

Kristiina Wilson:

Yeah, the box in the box. It's just like, uh yeah, I have so much data. I could write a whole case study on it, but who wants to read that? And I certainly don't want to write it.

SPEAKER_02:

I'm sure there are plenty, plenty of people who would want to read that.

Kristiina Wilson:

Well, great. Anyway, moving on. Um, are there differences in how um these issues can present in male versus female cats?

SPEAKER_02:

Yes, definitely. So they both can have the same type of symptoms that that you know the human caretaker will will witness. So they can both go in and out of the box and go outside of the box and do the over-grooming. But one of the big differences that based on their anatomy, male cats are much more likely to have the urinary obstruction as opposed to female cats. And that's because the urethra in the male is longer and thinner. This is like in the humans as well. And so any kind of inflammation in the urethra could could potentially close down the urethra where they cannot pee. And so that can be, you know, in the absence of stones, which can also cause obstructions, you know, in the absence of other things, it really is just inflammation. I have seen female cats block very, very rarely, but so that can also happen. More frequently, they can block with stones, but I have seen it where they're where it has been idiopathic, there's no UTI, there's no stones, it's just a lot of inflammation. And I'm assuming that there's some anatomical variation as well with female cats, that some of them are going to be at higher risk. But the main thing is that if you have a male cat and you see this behavior, you need to go to your vet. You need to make sure that they're able to pass urine because it can be a problem. With female cats, you know, I feel like sometimes you have a little bit more time, but still, if they're uncomfortable, you really want to address their discomfort, you know, anyway. So but that's the biggest difference is that males are much higher risk for blocking.

Kristiina Wilson:

Okay. Can you talk a little bit about how stress actually affects the bladder in cats?

SPEAKER_02:

So we talked a little bit about this in terms of the hormones. So um increase in these uh these adrenaline-like hormones. And that actually has a an impact on the lining of the bladder. So the bladder is lined with mucus basically that protects it from the acidity of the urine or the pH of the urine, whatever that might be. And so if there's all of these hormones, that can actually break down that barrier. And so the urine can become irritating to the lining of the bladder. They don't have that protection anymore. And so it can actually cause ulcers within the bladder and a lot of pain. And so it's a physical disruption basically of that protective layer. Or, you know, in some cases, they can actually have stones that are developing, so either struvite or calcium oxalate stones, which is different from what we've been talking about. So it's not the behavior, that's not the behavior-related one. But there's definitely an overlap where that can potentially exacerbate an interstitial cystitis or an idiopathic cystitis. I guess at that point it is just interstitial.

Kristiina Wilson:

Yeah. Does it also cause urethral spasms? Because when it's a big thing, yes, absolutely. Yeah. Yeah. Okay.

SPEAKER_02:

For sure. Yes. Yeah. And that can also happen. Yeah. So it affects muscle too. Yeah.

Kristiina Wilson:

Right. That's just because I and I've read papers discussing whether or not this medication is actually helpful in these cases.

SPEAKER_02:

Prasosin. Yeah. Yeah.

Kristiina Wilson:

Yeah. But every time that Kitten Man has blocked, you know, they've they've scripted him Prasicin for the following few days after he goes home. And then, you know, four at their urethral urethral spasms. I don't know why that's so hard to say. But yeah, then I then I've read follow-up papers in in newer research saying, like, well, we don't know if this does anything. Yeah, exactly.

SPEAKER_02:

Yeah, yeah. It's interesting. There's always, I feel like there's always these shifts in thinking. And so, you know, we were using Prasosin for a very long time and then starting to get these reports that maybe it wasn't really doing anything and it wasn't indicated. Um, and then when we didn't use it, we would find that sometimes for some cats it would take longer for them to recover. So then you add it back on, and then it seems like it helps. So I feel like personally, I don't feel like it really hurts. I haven't seen any um serious side effects from, in fact, I haven't seen, I haven't had anybody report any side effects from Prasicen. Um, and so, you know, I think that's definitely something you want to discuss with your vet. I'm not gonna make specific recommendations about what your vet should do, but but it is an it is something that's available. And I think there is, you know, especially if you have a cat that's really not recovering, then um, then adding that on certainly would be an option.

Kristiina Wilson:

Okay. Do you see in your practice, do you hear like about what kind of stressors that are triggering these flare-ups? I'm guessing you do. I can also answer that for my practice.

SPEAKER_02:

But yeah, it really is the very first question that I ask whenever I have a cat that is that is having these types of symptoms. And so it's always this question of, you know, is there construction? Did you go out of town? Is somebody visiting? Is there, you know, you go through like the entire list. What has changed?

Kristiina Wilson:

Yeah. Did you add a new cat?

SPEAKER_02:

Did you add a new cat? Did you move the position up the litter box? And so this is, I think, one of the interesting things with these really sensitive cats is that you don't always know. And it and it can be something that you feel like is really minor, but to that cat is something that has just made their lives, you know, unpredictable. And they're so um, so I think, you know, it definitely can be the big things and and that's something to be aware of. But sometimes it's small things that we don't really think of as being a stressor. And for that cat, you know, that really sensitive cat, it can be something that sets them off.

SPEAKER_03:

Yeah.

SPEAKER_02:

But so the most common things we see, I feel like, are vacations. You know, people going on vacation and then they come back from vacation and it happens after they get back. And I'm not really sure why it's timed that way, but I feel like my just anecdotal experience is that that is the most common thing. It's after the holidays, after travel season. That's when we see a lot of cats that are symptomatic.

Kristiina Wilson:

That's totally fair. And this is again anecdotal, but you know, Kitten Man's been so good, and we were supposed to go again last week to Virginia, and because of the so we couldn't go because our flights got canceled like 800 million times. So we still haven't gone. No, it was so insane. Anyway, that was a whole thing. So we were at the airport all day, and their cat sitter, our friend Emily, who Kitten Man loves, like the second she came in the house, he ran up to her and was just like, yeah, he loves her. But because we left, he hates that. When he sees us even packing anything, he loves her, but it's still not right. He hates that. So we left, and while we were gone, he peed in the sink in the guest room. So very neatly, but it still was enough to cause stress.

SPEAKER_02:

Yeah.

Kristiina Wilson:

Yeah. Even though he loves her so much, there's someone there 24 7 to attend to everyone's needs. Like nothing has changed except for us leaving that stressed him enough to not push him into these, like into like any kind of influence. Hopefully, but to give him stress enough to house soil.

SPEAKER_04:

Right. Right.

Kristiina Wilson:

So that was a behavioral issue, but I do think it's interesting that that speaks to how stressy. Yeah.

SPEAKER_02:

You know, I was thinking about this. Yeah, yeah. And I was thinking about this, like when there are predictable stressors, like if you know something is gonna you know you're gonna have people who come to visit and it just whatever changes their routine. With with dogs, you know, the predictable stressors like fireworks or you know, you know, thunderstorms will set them off. I feel like we're much more proactive about starting them on uh on a you know anziolytic that will help them to get through things. And I don't think we do that with cats. And I don't really know how effective that is. I I would be curious, you know, if there were cats that were predictably disturbed by these things, if it would make a difference to get them started on something like trap a short term.

Kristiina Wilson:

I was gonna ask you about that for the next time that we travel. I wanted to try him on the night before the day, and then because he's very easily pilled, Emily can give him Trazod, like no problem. Just give him like a two to three day protocol of Trazodone or whatever you think would be good. Yeah.

SPEAKER_02:

And so that's what I was trying to think. Yeah, because I feel like with Trazodone, the only downside to Trazodone is that it just makes them, you know, glassy. Yeah. I don't know. Like you see them and they they they just look stoned. And yeah, I don't love that. And so I I was trying to think like, are there other things? Gabapentin also makes them sleepy. Yeah. You know, and and I was trying to think if there was some other thing that wasn't that you didn't have to wait a month for it to get on board to make a difference for things. And I'm not a hundred percent sure, but it's something that I I've been thinking about, and maybe you and I will we'll come up with something that we can try with K Man.

Kristiina Wilson:

Let's think about it, and then I'm more than happy to try it because I I really do feel badly for him. Like everyone else is fine, they don't care. They're like, Emily's here, yay! And then he is just like, I love Emily my routine. I've got a piss in the sink, you know. Yes, yes. And then we came home and he was like, Oops, you're home.

SPEAKER_04:

You know, I don't know. He was so confused.

Kristiina Wilson:

Everything is fine, right? Yeah. Um, he was like, Oh, you were just gone for eight hours sitting at the airport, like whoops. So I I would be really interested to try that and see how it goes. And then I think that would also make for a very interesting longer study at some point to see if that is actually effective. Just like my colleague did that at ACC with dogs, putting them on three days of trazodone when they come in as an intake to the shelter. And it really helps make adjustments. It made a huge, yeah, huge difference. And so now that's their protocol.

SPEAKER_02:

Yeah, yeah. And I mean, I think that's one of the protocols for a lot of vet hospitals these days is giving, I mean, it's what we started doing. Yeah. You give the sedatives the day before having to come in, you know, for just for routine visits if it's a really stressy animal. We do it a lot for cats now, but also for surgical if they're going to be there for the day, making sure that they have something ahead of time just so that they're not freaking out. And I do think it makes a big difference. So yeah.

Kristiina Wilson:

Yeah.

SPEAKER_02:

A good direction to be moving in.

Kristiina Wilson:

I agree. I agree. So have you seen multicat households complicate urinary issues, even when there doesn't seem to be conflict? Yeah.

SPEAKER_02:

I mean, I think that uh I mean, the the statistics are that cats in multi-cat households are definitely at higher risk. Right. So we see that a lot more. And I do think that you have to be a very attentive cat owner to sometimes be able to really detect when that stress is happening.

SPEAKER_04:

Right.

SPEAKER_02:

You know, I obviously I know that you are very attentive and you do have all of your cameras, but not everybody is. And so even if there's not overt aggression or overt um, you know, issues going on, it can be very subtle. And in, you know, one of the lectures that I went to was showing some of the, I can't remember, it was a completely, it wasn't on fluted, it was a different one. But it had there was a video of these cats in an 11-cat household, and you know, one cat was walking by the other. And if you weren't watching, you wouldn't think anything was happening. But if you're paying attention, you can see it's like the shift of the ears, like just the the tension in the body, like just enough subtle changes that you know, one of the other cats kind of veered out of the way. The wide circle, yeah. The wide circle. And if you weren't paying attention, you would just think, oh, he's just moving away. But there was obviously tension. There was obviously something going on, some communication that they were doing that's really subtle. So I do think that these things happen in multi-cat households a lot more than people think. And and it, you know, for especially for those really sensitive cats, it can be really impactful. So yeah.

Kristiina Wilson:

I agree. And that's that's one reason why I really believe in setting up motion sensor cameras for everybody. Just because not to turn your house into a police state, put them at cat level, people then you'll only be, you know, watching your feet. I do think that, especially because we're all busy, you miss out on a lot of these subtle behaviors. And it's so helpful to be able to go back and put things frame by frame or in slow motion and and see like that cat was giving this cat the side eye, or like you said, the ears move, or the the like the wide circle. Like, what's happening here? These guys are coming face to face, and that's really aggressive. Or, like, where do I need to put some height? Is there a narrow hallway like you were maybe describing? That's it sounded to me like that's probably a narrow hallway issue, and like maybe I need to put a little height there, like put an Amazon box or something so that they're not coming face to face. Right. There's so many little changes that we can do to improve the situation so that it kind of de-stresses things for cats when they're living in multi-cat households. And definitely we have too many cats, like 15 cats is too many cats, but unfortunately, in this small town, like we just can't find anyone to adopt all the cats that just show up at our house. And so it is it's it's a lot of work to constantly like watch out for these things and and you know, maintain the relationships and and try to make sure that everybody's happy. But it now I lost my train of thought. I was going somewhere and then my brain just went, No, you're not.

SPEAKER_02:

So yeah, that yeah, yeah, no, the train of thought that the a lot of cats can be harder to it's harder to monitor those individuals to see who's gonna be affected. So yeah. And I think, you know, uh the the cameras, I think are it was another thing that I got from this conference. I really feel like at a minimum, having cameras around litter boxes is really important. Yeah. And so that's something that I'll definitely start encouraging cat owners to do that, you know, they should they should yeah, monitor that.

Kristiina Wilson:

But I will say having all of our all of our cameras all over the house did help us figure out who knocked over our Christmas tree last week.

SPEAKER_02:

So who was it? Who was the culprit?

Kristiina Wilson:

It was it was a combo of our two two of our biggest guys, Dean, who's 16 and a half pounds, and Tops, who's 12. They're like not our fattest guys, but they're our physically biggest guys. And they're the two of them together. Yeah, they converged. They were running through the living room and they converged at the tree, and they didn't jump into the tree. I'll send it into you because it's really funny. Oh, they converged hilarious, and then they must have hit the pedal on the tree stand, you know, that like locks it. Because you hear you hear them hit the tree, and then you hear this gloom, and then the tree takes a second or two because I think it unlocked the pedal, and then the tree goes. And by then, yeah, by then they were in the kitchen. Like I could see that by the time the tree fell, they were already in the kitchen.

SPEAKER_02:

Thanks on, though, right? Yeah, thankfully. Thankfully, like my God, like a cartoon.

Kristiina Wilson:

It was so like a cartoon, and I had to go back. I'm always like, I'm gonna go the videotape you guys, because I can't. And I we can almost always figure out who did whatever the thing was. That's hilarious. Not like they didn't get any trouble or any of that, they didn't do it. Of course, of course, just but it was just funny to be like, what idiots did this? What?

SPEAKER_00:

How did this happen?

Kristiina Wilson:

Yes, yeah, exactly. So when there's 15, you do have to kind of wonder like what which ding dong was responsible for for this accident. Right.

SPEAKER_04:

Right.

Kristiina Wilson:

Anyhow, yeah. So how is FIC diagnosed, especially because it's a diagnosis of exclusion, like you said.

SPEAKER_02:

Yes. Um, so obviously you want to have your physical exam, you want to see your veterinarian, and they will start by, you know, doing their full physical exam. If a cat, if there's a question about whether the cat is obstructed, the first thing they do is feel the bladder. And um, if it's a, you know, an orange-size hard bladder, then that's when it's an emergency and you need to they, you know, take steps to unblock that cat, however that might be. So if the cat is not blocked, then you really do want to do things like collect a urinalysis. And so either having the vet collect a urine, or if you want to collect a urine at home, we can talk about how that's an option. But do a urinalysis, do a culture. The urinalysis is basically looking for inflammation, looking for crystals in the urine, protein cells, things like that, how concentrated the urine is, and then the culture is specifically looking at bacteria. And sometimes you'll see bacteria in a urine that's not what we call pathologic. It's not bad bacteria. And so you don't always treat bacteria in all cases. And so, even though I did say that it's really uncommon for urinary symptoms to be UTIs, it is really important to check for them for bacterial infections. And so, and as and especially because you can't just assume just because it's a boy, it's not going to be that. I've been surprised and have found male cats that have had UTIs, and so you treat it and then the behavior goes away. In some cases, kind of depending on what's going on, if it's an older cat that's showing symptoms, then doing blood work, because sometimes uh, you know, there can be other issues that are are involved. So, you know, cats that have diabetes, their their immune system is much more compromised. So that can be a UTI more, you know, more commonly than regular cases. And then in some cases, doing x-rays to rule out things like bladder stones that can be very irritating to the bladder, doing an ultrasound. So there are stones that are radio, which means they don't show up on radiographs. I've seen that once. These were, they were called xanthine stones in a young cat. So we took our x-rays, the cat was blocking. We took x-rays and we didn't see any stones, and the cat continued to have urinary tract issues despite everything. We did an ultrasound and it had these radiolucent stones that had to be surgically removed. So um, sometimes ultrasound. And then in some cases, like if you had a cat that the anatomy was questionable, then doing something like contrast uh urethograms, is that how you say it? Um, where you're actually yeah, sounds right. Uh, where you're actually you can you can see the the um flow of the contrast through the urethra into the bladder and make sure that there's no obstructions that way. So there are a variety of different diagnostic steps, but um, I do encourage the urinalysis and the culture just to rule out the easier things to treat.

Kristiina Wilson:

This is a really stupid question. So when you say that a cat is blocked, especially like a male cat, are they blocked always with a stone, or can they just be blocked with inflammation? They can be blocked with inflammation.

SPEAKER_02:

It can just be so swollen, yeah. Or there can be so much inflammation in their bladder that they can get what's called a plug, which is like a plug of mucus. Sometimes there are crystals in there, but it can just be cells. And so they can have these plugs in their in their urethra, yeah, that will cause the obstruction. But sometimes it really is just so much inflammation that that little tube basically just closes up. It just closes up.

Kristiina Wilson:

Okay. All right. Is there anything that you wish guardians understood more about the that whole diagnostic process for urinary issues that you just went over?

SPEAKER_02:

Oh, yes, actually, because we do see a lot of people that will come in and the cats are peeing outside the box and they just want the antibiotics. And um, and and that is so common. Just give me the antibiotics. I don't want to do any testing. I don't want to, you know, I'm not, I don't want the data. I just want to start antibiotics because that always helps. And we hear that a lot. And uh these cases do tend to be self-limiting, which means that if you wait long enough, they can improve on their own. And so people will start an antibiotic and even just waiting from time, eventually those symptoms will clear. And the antibiotic has done absolutely nothing. And so, especially now when there have been so many um antibiotic resistant infections developing on the human side, it's really a dire situation that we are in in terms of our antibiotic use. And so I really discourage antibiotic prescriptions that are not based on, you know, on actual proven infections. Yeah. Yeah.

Kristiina Wilson:

Yeah. Is there a similar crisis in the pet world as there is in the human world in terms of antibiotic resistance? Yeah.

SPEAKER_02:

Yes, definitely. It's it's uh it's across, yeah, it's across the globe. And the United States has higher rates of I just went to another talk. Higher rates of resistances because we use so many antibiotics. Yeah. So it's it's very high. Yeah, it's really scary, actually. I don't doubt it.

Kristiina Wilson:

So what does evidence-based treatment for a physique or fluted look like today?

SPEAKER_02:

So, evidence-based treatment, one of the um things that seems to help more than anything else is increased hydration. So getting your cat to drink more and switching if your cat is on dry food, and this go back to our discussion about nutrition, if your cat's on a dry food, stopping the dry food and trying to switch to an all-wet diet, because I have found, and again, this is anecdotal, but I think there's also evidence research that backs this. I've had cats that have had urinary issues, had issues with FIC. You start them on a wet food diet and they do great. You add water to their food, you hydrate them, and then a couple of years later, the clients will be like, I, you know, I'm it's just so easy. I'll give them some dry food and then they block again. And I've seen that enough times that I that I really, really, really believe that the diet is such an important element. And so um wet food diets, and I'm not gonna even, you know, they there are urinary diets that are on the market, but um, unless there are stones, and they actually even have urinary diets for like multicat household and you know, all of this thing, all of this stuff, but really it is wet food increasing their hydration. And so I recommend low-sodium chicken broth, tuna juice, water all over the house where that's easily accessible. There's the uh the hydrating supplements. Um, and I'm not gonna name the brand, but so there are different things that that you um can do to increase hydration. And basically what that do is doing is diluting the urine so that it's not irritating to the bladder. Right. So that is one of the main things. And then the other main thing is environmental enrichment. And so um the and the lecture that I went to that was talking about fluted, what she said is perches. You need to have high perches, and that is key.

SPEAKER_04:

Mm-hmm.

SPEAKER_02:

You know, cats like to look down on us because they are above us, right? They're they're superior to us in always. And so having those places that they can perch, where they can hide, you know, where they have, you know, access to good things.

Kristiina Wilson:

Yeah. I I agree, and I would I would add to that intellectual stimulation as much as you can. 100%.

SPEAKER_02:

Yeah. Like anything to keep those brains busy. We we talked about our five pillars. Remember the five pillars that we had talked about with the safe place, the, you know, separate feeding, scratching, drinking areas, but then play was a part of that, making sure that they have that opportunity to express their predatory behavior. Um, that's super, super important. And so I would say those are the two main things, the the diet, a wet diet, and environmental enrichment, those are the main things that you can do to prevent uh recurrences of urinary issues. Yeah.

Kristiina Wilson:

Yeah. I want to just go.

SPEAKER_02:

And then while there, while they are not feeling well, pain medications and anti-inflammatories. And so if there is an active flare, that can be really, really painful. And so just making sure that they they do have something to cover the pain.

Kristiina Wilson:

That is all good advice. So when should a veterinarian loop in a behavior professional and vice versa on these types of cases?

SPEAKER_02:

I would say if you're having repeated episodes of um of urinary issues, or if you're just having you've done all the things and your kitty cat still is not using the litter box, then I think that's a good time. Or, you know, as I think about it, if you're just seeing that if you're in a multi-cat household, you're not able able to manage the stress, then sometimes having a behaviorist come in and just have a fresh set of eyes to look at things to give you a better sense of what you could be doing or should be doing to make everybody's cat life better.

SPEAKER_00:

Right.

SPEAKER_03:

Yeah.

Kristiina Wilson:

Makes sense.

SPEAKER_03:

Yeah.

Kristiina Wilson:

Is FIC typically a long, like lifelong management issue? Is it something that like once a cat gets it, it's something that they're gonna have forever?

SPEAKER_02:

Not necessarily. I mean, I've definitely seen the kitty cats that have an episode and then you make the right dietary and environmental changes, and they don't necessarily have flares continuously. So it's not necessarily some there are definitely the cats that you'll see have multiple episodes, and like I said, you know, maybe at that point talking to beh a behaviorist. But no, it's not something that is necessarily always going to be an issue.

Kristiina Wilson:

Right. Okay. Yeah, that's good. What does successful long-term management look like then to you? Is it just that you don't see these issues anymore?

SPEAKER_02:

Yeah. So so there you don't see them having litter box issues. Yeah. Exactly.

Kristiina Wilson:

All right, yeah. Makes sense to me.

SPEAKER_02:

Yeah.

Kristiina Wilson:

What what would be the the most impactful change that a guardian could make today to reduce a reoccurrence?

SPEAKER_03:

Diet. Yeah. And purchase diet and water. Yeah. And environmental enrichment and playing and, you know, making life predictable for the kitty cat.

SPEAKER_02:

Yeah. So really those those two things are the most important.

Kristiina Wilson:

Yeah. And oh, I think I what I was gonna add earlier when we were talking about environmental enrichment and intellectual stimulation was that I have personally found with with our cat who has this is that clicker training is really great. Oh yeah, as we discussed, these guys can often be very, very smart, the cats who end up having these issues. And clicker training is so great for them because it gives them like a predictable they're learning, they have a love of learning.

SPEAKER_02:

Yes, absolutely.

Kristiina Wilson:

They know they're getting a reward. Yeah, it it can be so great. So Kitten Man, when he sees that like with the clicker come out and we're gonna do something, he's so excited that he'll localize because he's so happy. So, and it doesn't have to take a long time, it can take two to three minutes of your day because yeah, they don't have a long attention span, but it's really exciting for them. Yeah, so I really can't recommend that.

SPEAKER_02:

Yeah, it's fun for you, it's fun for your kitty. It's so fun. Yeah, it is so definitely highly, highly recommend.

Kristiina Wilson:

Yeah, yeah, I think that's really a great thing to do. I also, on just a completely other tangent tangent, wanted to ask about if you have seen a lot of cats have these issues who are also like have a lot of urine retention. It's just because I've noticed that that like with Kitten Man, that he, even back to when I did my during COVID and I did my little litter box study, that he and this was before Steve died. So this was before he was like a super stressed guy.

SPEAKER_02:

Uh-huh.

Kristiina Wilson:

He everyone in the house would go to the bathroom, would like urinate four to five times a day minimum. He would only go twice. He and which is still the past day. He goes once in the morning and once at night. And so it's always he's always retaining urine and it's always been very, very concentrated. Oh, interesting.

SPEAKER_02:

And and that's despite trying to get more fluid into him, like getting him to drink more.

Kristiina Wilson:

Yeah, he drinks. He drinks because when he pees, he pees so much. The volume is crazy. So he is walking around half the day needing to pee.

SPEAKER_00:

But he just he only wants to go.

Kristiina Wilson:

Yeah, and it's not he's not being bull, you know, there's there's not any litter box issues, and there certainly won't be crazy. He yeah, or it's just something in his head.

SPEAKER_02:

I I don't, I, I don't think that there actually is a okay. I mean, as far as I know, but I do feel like there is individual variation in both dogs and cats. Like I'll have some people tell me, and actually one of my dogs um would pee once a day and it would drive everybody crazy. Yeah. You know, if somebody, if I had a house um sitter come to stay, if I was traveling or whatever, yeah, and they would, you know, always text in a panic. Roger hasn't peed. Oh yeah, I forgot to tell you he peeds once a day. That's how he is. But I, you know, and so I think there is individual variation. I do think though, that if a urine is really concentrated, it can be more irritating. And so I feel like if anything, they're gonna probably try to pee more, but uh maybe that's not the case. I you know, I don't know if he's just like, I don't want to pee. You know, I'm not gonna do it. I'm I'm too lazy. I'm not gonna go to the bar. I I have no idea.

Kristiina Wilson:

It's very strange because this has been his behavior since he was a kid. And so it's it's just how he is. Yeah. But it it's just it has been in the back of my mind like, could this be not the only driver, but a partial driver if he's holding his urine all day and it's becoming irritating irritating his bladder and then to?

SPEAKER_02:

Yeah, yeah. Yeah.

Kristiina Wilson:

I don't know.

SPEAKER_02:

I think that's a possibility. Yeah. Yeah.

Kristiina Wilson:

Not that, not that he's had any issues in a long time, thank God. But it just like why just go to the bathroom. Like we have to go everywhere. It's like, please go to the bathroom. Yes, yes, yeah. Why are you doing this? Anyway, okay. Um, is there a piece of outdated advice about feline urinary health that you would love to people to just like retire?

SPEAKER_02:

I think the the biggest thing is the just do antibiotics would be the worst medical advice, you know. I I would want to get rid of that. But then I think the most outdated perception would be that your cat is doing it to spite you. So those those two things. Yeah. Would love to get rid of that.

Kristiina Wilson:

Yeah. Yeah. So is there one thing that you want cat guardians to kind of like take away from this or remember about urinary issues and behavior?

SPEAKER_02:

That they can be emergencies. Don't ignore when your cat is straining to pee. Make sure that you see your veterinarian sooner rather than later. That it is important to identify those kitties that are so sensitive. So because they're going to be at higher risk, and just make sure that you're paying attention to that. Make sure that you're really giving them stimulation, environmental enrichment, play. Oh, and so actually, there's have you heard of the Ohio Indoor Cat Initiative? Ohio State Indoor Cat Initiative. So it's Ohio State University Vet School. It has a website. It's the Ohio State Indoor Cat Initiative, and it is a whole website of information on how to give your cat a great environment, like what you should be doing. So yeah, that's very, very helpful.

Kristiina Wilson:

Okay. I will look that up and I will put it in the show notes for this episode. And do do you have any resources as to where listeners can find more reliable information about fluted and FIC? And I can also link those.

SPEAKER_02:

Yeah, iCatCare.org. Have you heard of that? Yes.

Kristiina Wilson:

I totally thought you were gonna say, have you heard of Google? And I was gonna be like, oh, Gino. Totally just Google it. Good lord.

SPEAKER_02:

Have you heard of ChatGPT?

Kristiina Wilson:

Just like totally.

SPEAKER_02:

No, no, no, no. And it's a really No, I haven't. Well, oh yeah, yeah. No, it's fabulous. It's got information on a variety of different things. Asthma, urinary issues. Yeah. So, so that's a great resource for clients.

Kristiina Wilson:

Cool. Thank you. I will link that also in the show notes. Excellent. Google Cat GPG. I know. I know you and I love AI so much. So much. So much. So much. All right. Well, thank you so much, Sheena. As always, you're the best vet in the whole world. And we love you so much. And thank you for putting up with me and coming on the show again to talk about this very important issue, actually. Very important issue.

SPEAKER_02:

Yes.

Kristiina Wilson:

It's very important for um cat owners and male cat owners, especially, and that I do really see a lot of in my practice, which is why really why I wanted to talk about it. So thank you. Thank you. No, thank you for having me. Thanks so much for listening to the show. If you're looking for one-on-one support with behavior issues like litter box problems, aggression, anxiety, or multicat dynamics, you can find me through my behavior consulting business, Catitude Adjustment, at catitude-adjustment.com. If you like the episode, please consider leaving a rating or review. It really helps us grow. For more episodes, show notes, and resources, head to hissandtellpodcast.com. Huge thanks to Cat Beats for the music, and I'll see you next time.

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Kristiina Wilson

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