‘Don’t pee on that!’ Comparing environmental modification and medical management in cats with FIC

Amelia Poole, DipAVN DipFB CertVN(ECC) CertISFM(FN) RVN

1 Harper Adams University, Edgemond, Newport, TF10 8NB
* Corresponding author email:

Published: 13 Apr 2023

In this Audio Summary, Amelia looks at whether environmental modification is superior to medical management in the treatment of feline idiopathic cystitis. Read the full Knowledge Summary here. 

Audio Summaries are a free resource that enable vets and vet nurses to more quickly and more easily access and digest relevant and up-to-date evidence! A time-saving way to make better and faster evidence-based decisions.

Audio Summary Transcript

Welcome to this podcast from Veterinary Evidence, an online open-access peer-reviewed journal, owned and published by RCVS Knowledge.

Hello, I’m Amelia Poole, a registered Veterinary Nurse, and my Knowledge Summary was inspired by my own cat Dylan, who had obstructive idiopathic cystitis for ten years.

In cats with feline idiopathic cystitis is environmental modification superior than medical management in preventing a reoccurrence?

I critically reviewed sixteen papers, which included fourteen randomised trials and two case studies. The literature search uncovered thirteen papers that addressed pharmaceutical treatments for cats with idiopathic cystitis and three papers addressing environmental modification as a treatment. Pharmaceutical treatments included oral preparations of non-steroidal anti-inflammatory drugs, steroids, tricyclic antidepressants, glucosamine, and prazosin. Parenteral treatments included intravesical glycosaminoglycan, pentosan polysulphate and lidocaine, and subcutaneous pentosan polysulphate. Of these studies only one paper found that long-term use of amitriptyline successfully decreased clinical signs of recurrent cystitis in nine out of the fifteen cats treated, however this improvement was only apparent in the last six months of the twelve-month treatment.

Three studies included environmental modification as a treatment option, which included the use of facial pheromones. The use of facial pheromones did not have a statistical difference in the reoccurrence of signs when compared to the placebo, however there was a clinical difference shown with those exposed to facial pheromones having a reduced occurrence and a reduced severity of idiopathic cystitis signs. A case study by Seawright et al in 2008 followed a case with environmental modification for an extended period of time showing that episodes of cystitis only occurred during extraordinary stressful situations such as building works. A study into multimodal environmental modification showed a resolution in signs for 75% of participants for a ten-month period, however each study into environmental modifications had a number of uncontrollable variables, due to each cat’s condition and environment, so further studies are required to confirm any success.

Overall there is weak evidence that any medication or environmental modification is successful in reducing the reoccurrence of idiopathic cystitis when compared to a placebo. Further research is required into the cause of idiopathic cystitis before comparisons on treatment options can be made. However, environmental modification and systemic treatment of clinical signs did not contribute to an increase in occurrence of idiopathic cystitis. From personal experience, as both a veterinary nurse and an owner, I would use this evidence to better inform other owners about the treatment options for their cats with idiopathic cystitis. A combined approach of treating clinical signs to make the cat more comfortable and free of pain alongside environmental management, as long as it doesn’t stress the cat out further should help to relieve any clinical signs that the patient is having. Environmental management consults can be performed by the veterinary surgeon or the veterinary nurse and keeping up communications with the owners are vitally important to managing these cats in an appropriate way.

Thank you for listening to this podcast from Veterinary Evidence. We publish freely available content relating to evidence based veterinary medicine and its application to enhance the quality of patient care. Tweet us @RCVSKnowledge and learn more at

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