If you or someone you know has suffered from cystitis, you know how tough it can be to deal with. Cystitis is a common problem for dogs and cats, and is the term used to describe bladder inflammation. The root cause for the inflammation requires prompt and thorough diagnostic testing and treatment. Cystitis symptoms can point to other more serious conditions.
What causes cystitis?
The most common cause of cystitis in dogs is a bacterial infection, although other causes include bladder stones, tumors or polyps in the bladder, and abnormal anatomy (especially in female dogs). Urinary crystals and bladder stones have sharp edges and rough surfaces that cause irritation as they rub against the bladder wall. Tumors or polyps can cause bleeding and straining to urinate.
Indoor cats are at risk for bladder inflammation. A common diagnosis for cats with cystitis symptoms is called Feline Idiopathic or Interstitial Cystitis (FIC). FIC is a type of cystitis with no bacteria present, but clinical signs and symptoms are present. Also known as “Sterile Cystitis,” FIC is the most common cause of cystitis in cats under 10 years of age. Diagnosis in cats can be trickier than dogs, as it can be more challenging to distinguish between the various diseases of the bladder, urethra, and urinary opening. Like dogs, cats can fall prey to bacterial infections, bladder stones and crystals and tumors/polyps.
For cats, anxiety can also be a cause. This condition is known as “Pandora Syndrome.” Cats have a special layer of the bladder that protects against harsh chemicals in urine. Anxiety can chip away at this protective layer and cause it to become patchy, resulting in inflammation. Research into FIC points to the importance of stress reduction and environmental enrichment in treating the disorder. Studies showed that cats with FIC experience significant symptom
reduction (as much as 75%-80%) in a reduced stress and enriched environment.
A dry food/kibble diet will raise pH levels in the urine which will predispose your pet to bacterial infections and crystal formation. Furthermore, many over-the-counter diets are too high in magnesium, ammonium, and phosphate, which are components of the common struvite crystal.
Traditional Chinese Veterinary Medicine
From a Traditional Chinese Veterinary Medicine (TCVM) perspective, Damp and Heat are the two primary pathogens that are associated with cystitis. Heat can arise from improper diet or other imbalances in the body. Dampness can also arise from dietary issues, such as excessive carbohydrate or dairy intake. Dampness causes obstruction, which in turn, generates heat. Heat can damage blood vessels and force blood into the urine.
In Traditional Chinese Veterinary Medicine, the bladder is represented in the Water element. Cystitis can be considered either an excess or a deficiency of Water. For example, Water excess can be the cause of urine retention as well as kidney and bladder stones. Frequent urination can signal a Water deficiency.
The Wood element is ruled by the liver and the liver is integrated with every system in the body. Liver Qi stagnation can result in straining or difficulty urinating due to Heat in the liver blocking normal energy (Qi) flow to the bladder.
Animals with Fire personalities are more likely to experience “Sterile Cystitis” since these pets often have “Shen” (mind or spirit) disturbances (anxiety).
The following symptoms warrant a visit to your veterinarian for examination and testing:
- Blood in the urine: Blood may not be detectable by the human eye, and its presence is confirmed by a urinalysis (urine test).
- Discomfort and pain while urinating: Your pet may cry out when urinating.
- Excessive squatting and straining, producing little to no urine
- Frequent urination
- Foul-smelling urine
- Abnormally cloudy urine
- Excessive licking of the urinary tract opening
- Abnormal litter box behavior, including urinating outside the litter box
- Large, firm bladder
How is cystitis diagnosed?
Your veterinarian should conduct a full physical examination including bladder palpation. The clinic team will document symptoms and research your pet’s health history. A history of bloody urine, straining to urinate, and urinating more frequently is strong evidence of some form of cystitis. The following tests should be performed:
- A urinalysis consists of several tests to detect abnormalities in the urine and urine sediment. Cystocentesis (urine extraction with a needle into the urinary bladder) is the preferred method for urine sample collection, as it will provide the most accurate results.
- A culture and sensitivity test determines if bacteria are present and what antibiotics are likely to be effective in killing them. Ask to have this test performed in conjunction with the urinalysis. Your veterinarian may want to place your pet on antibiotics before the results of the test. This prescription is simply a guess until the results of a culture and sensitivity are completed. It may take up to 48 hours or longer to receive the results from a culture and sensitivity test.
- Blood testing: A chemistry profile and a complete blood count (CBC) should be performed to assess metabolic and organ function. The most common diseases that can cause cystitis as a secondary problem are diabetes mellitus, Cushing’s disease, and kidney disease.
- Bladder X-Rays can be taken to evaluate the bladder for common types of bladder stones. X-rays rarely show bladder tumors, polyps, or other organ abnormalities.
- Ultrasound examination: When the results of a culture and sensitivity test are negative (no presence of bacteria) and bladder stones were not felt during the physical examination, an ultrasound examination can detect stones, tumors, polyps, as well as other abnormalities of the bladder, including wall thickening.
- Contrast X-rays of the bladder are taken when standard X-rays or an ultrasound examination does not provide a diagnosis. These special X-rays can show previously unseen bladder stones, tumors, polyps, diverticula (pouch), and wall thickening. This procedure is performed with sedation or general anesthesia. A urinary catheter is passed into the urethra and the bladder is filled with contrast material and X-rays are taken.
How is cystitis treated?
Treatment depends on the results of testing and diagnosis. Whether conventional, natural, or a combination of remedies is used, always seek the advice of a veterinarian. Natural Anti-Inflammatories can help reduce bladder inflammation and decrease pain.
- Omega-3 fatty acids (fish oil)
- CBD oils
- Vitamin C
- Coconut oil
- Glucosamine/Chondroitin supplementation
- D-Mannose may help treat or prevent urinary tract infection and support good bacteria in the gut.
- Palmitoylethanolamide (PEA) may help support healthy inflammatory and immune balance, comfort, and well-being. It is well tolerated.
- Herbs including turmeric, juniper berry, marshmallow root, and Uva Ursi reduce inflammation. Ashwagandha is a well-known anti-inflammatory herb that also eases anxiety and boosts immune function.
- Foods such as bone broth, blueberries, leafy greens, fatty fish like salmon and sardines, cranberries have anti-inflammatory properties that do not have the risks and side effects associated with NSAID drugs like Rimadyl, Metacam, Previcox, and Deramaxx.
- Homeopathic remedies: Arnica Montana is among the very best anti- inflammatories. Other homeopathic remedies combine several plant essences that aid in the relief of stress-related urination and also support normal urinary tract function.
- High-moisture diet: Moisture in the diet is critical for maintaining a healthy urinary tract and preventing another bout of cystitis. The increased water in the body will help flush out bacteria, inflammatory debris, and dissolve crystals. Chronic feeding of diets devoid of moisture causes chronic stress to the kidneys as well as the urinary tract. For this reason, I do not recommend kibble diets (2) including the prescription variety.(3)
- Antibiotic medications are used to treat bacterial infections, and the results of the culture and sensitivity test will point to the best antibiotic for the type of bacteria present. Antibiotics should be given only after a bacterial infection is confirmed. Treatment with antibiotics usually requires ten to fourteen days to clear the infection. Probiotics should be given along with the antibiotics and for an additional two weeks to repopulate the bowel with healthy bacteria. A urinalysis should be repeated after giving antibiotics to be sure the infection is cleared.
- Chinese herbal combinations can decrease infection, sooth the bladder, and decrease bleeding. Ba Zheng San (Eight Righteous) clears heat/fire and eliminates Damp. Long Dan Xie Gan San clears liver heat and drains Damp-Heat. Si Miao San Drains Damp in the “lower burner” (bladder) and strengthens the spleen.
- Acupuncture can reduce pain and inflammation, increase Qi, and increase flow when stagnation is present.
- Pheromone therapy, when diffused, releases an odorless substance which makes cats feel safer and less stressed. It doesn’t work for all cats but is very safe to use.
A species-appropriate, whole food, high-moisture (preferably raw or gently cooked) diet is the true antidote for cystitis for both dogs and cats. If your pet is already prone to recurrent bouts of cystitis, a whole-food high-moisture diet that specifically supports urinary function is recommended.
For cats, reducing stress (providing hiding places, “safe spaces” for litter and
food), and offering a constant supply of fresh water can reduce the incidence of FIC.
Remember that recurrent bouts of cystitis can point to other serious problems, so be sure to get your pet to your veterinarian for a thorough examination and testing as soon as you become aware of the signs and symptoms.
