So good evening everybody, and thank you very, very much for joining us for tonight's webinar that has been presented by Claire Wilson. Claire graduated from Cambridge University in 2001, and whilst working in mixed practise in the Welsh Borders and then Warwickshire, Claire graduated from the Southampton University with a postgraduate diploma in companion animal behaviour counselling. Following on from this, Claire worked for a year for Sarah Heath behavioural referral practise based in Chester before setting up her own behavioural referral service in Warwickshire.
Claire continues to run her behaviour referral service in addition to working as a locum in general practise, providing CPD for vets and veterinary nurses, writing on behaviour topics, and sitting on the Association for the Study of Animal behaviour Accreditation Committee. And the Animal behaviour Training Council. And tonight, Claire is going to be discussing how soiling and feline idiopathic cystitis.
And if anyone has any questions that they would like to ask Claire, there is a question and answer box right at the very bottom of the screen. If you could type it in there and send it on over to us. And I will hand over to you, Claire.
Thank you very much. Thanks very much, Caroline. Good evening, everyone.
I'd like to welcome you all to this webinar on feline behaviour to follow up on the rather whirlwind tour I did on general feline behaviour back in September. For this presentation, we're going to focus on a specific area, which is one of the most common feline behaviour problems presented to us, house soiling. And in addition to looking purely at behavioural house soiling, we're also going to look at idiopathic cystitis, a syndrome, which requires a multi-modal approach to management, primarily focusing on stress reduction through environmental modification.
So although that's very often presented clinically, it's actually a a primary behaviour focus for managing the disease. So this is what I'm hoping to cover today. Just a quick summary.
So we're going to just quickly look over the feline territory and normal feline social behaviour and interactions as we looked at in September, but just a very speedy overview, because that stuff is really essential for understanding what I'm gonna talk to talk about today, and not everyone will have listened to the webinar in September. We're also going to learn to recognise underlying motivations for why cats might have soil. To distinguish between marking and toileting, to recognise when medical issues are an underlying factor, and to provide you with some basic first aid advice to help owners to get through until they can see a behaviourist, and to provide appropriate support for cats who are diagnosed with FIC.
So, first of all, we're gonna do this quick reminder on normal cat behaviour. It's really essential for being able to work effectively with behaviour problems to know what's normal. So we'll briefly look at territory layout, social structure, the normal behavioural repertoire.
And, this is primarily because actually, unless there are underlying medical issues, the vast majority of house so in cases involve normal behaviour, but it's inappropriate in the domestic setting. So in the cat's eyes, it's normal, but in the owner's eyes, it's not acceptable. And then, as I said, we'll look at the distinction between elimination and marking.
We'll also go on to look about how to identify the correct cat if there's a multi-cat household, or if there's a situation where there's an invading neighbour cat who, who may be causing the problem. Then we'll have a quick look at determining whether there are medical factors involved. Then we'll discuss what solutions there are, longer term solutions for resolving the situation and for managing it long term.
So we'll, when we go on to talk about idiopathic cystitis, we'll look at the pathophysiology, the risk factors, and management and treatment options. So just a quick reminder about who cats are. The ancestor of the domestic cat is a solitary living wild cat, and to some extent, our cats have retained this solitary nature.
However, this has changed over time and with, will be variable depending on genetic and experiential factors, particularly during the crucial early socialisation period. So, although the ability of our domestic cat to live in groups is different from their ancestors, what hasn't changed is that they're not dependent on social interaction for survival. So they've learned to make social relationships, but they don't depend on them.
They hunt alone, they eat alone. They still have very limited intra intraspecies communication strategies. Cats are not only predators, but they're also a prey species.
So they can feel very vulnerable if they're in exposed areas. They tend to use hiding and elevation for protection and also for viewing their surroundings to see if it's safe to come out. Therefore, the three dimensional space is really important in the feline environment.
So due to the fact that cats hunt alone and eat alone, they're also used to having an immediate access to resources, so they can become stressed if resources aren't available, either due to lack of provision or perhaps due to lack of ability to access them. So there may be competition from other cats, or there may be some other obs such as noisy children, a scary dog or something like that, that has to be passed on route to a food bowl. In fact, a feline case I just saw earlier this week was causing problems for the cat that she had to pass through a room where unfamiliar visitors were in order to get to her food, and that was creating stress for her.
So, groups of feral cats are based on related females, and the these groups are highly dependent on resource availability. So if the resources become depleted, then the groups will disperse. This is highly relevant in multi-cat households, and resources must be plentiful to avoid competition, conflict, and stress.
Cats would not usually share latrine facilities with the cats, so again, this is another resource that should be easily available and it's very often lacking in house soiling cases. The important resources that cats would normally expect to have immediate access to would be food, resting places, latrines, water, and also territory entry and exit points. So any restriction of those can lead to behaviour problems, and most commonly house soiling.
So owners also need to be aware of the natural activity pattern for cats. So, due to their nature as hunters of small mammals, they tend to be especially active at dawn and dusk, just as their prey would be. And this can often cause problems for owners.
So, for example, some owners may choose to shut their cats inside overnight and then become frustrated by high levels of activity while they're trying to sleep. And the cat themselves may become stressed at this restriction. Research has shown that some cats are actually able to adapt their own activity patterns, and it's possible that as breeding changes, we're becoming more selective inbreeding cats, that we might be able to see them becoming more adaptable to our domestic lifestyle.
So just a quick reminder of the territory layout. This is just a very basic, simple diagram. So the central area, the red spot, is called the core territory, and this is where cats would eat and sleep and play and rest and rear kittens.
They wouldn't expect to encounter cats outside their social group in this area. In reality, that's not likely to be just one area. It'll be lots of little patches that would be linked by home rangers.
So understanding the importance of core territory is essential for owners to enable them to understand how they need to distribute resources if they've got more than one social group living in their home, and also in terms of altering the cat's perception of areas it's using for inappropriate marking or toileting. Not all of the territory is controllable by the cat himself, but they try to control what they can in order to keep their stress levels low. And the two main factors they can influence are hygiene and security.
So cats will generally toilet away from feeding and resting areas, and feeling secure within the core territory involves not being able to see cats who are not in their social group. And so they'll mark the territory in order to main that security. They'll use claw marks at the edge of the core territory, urine sprays in the shared areas, and they'll use facial and flank marking in the core area, which is what the Feyway diffuser is based on, the, the classic feely way.
So these scent marks are topped up daily, and it's really important that owners don't clean these off, the facial and flank marking in the core area because if the owners are scrupulously cleaning, that's actually gonna stress the cat out because it's not gonna smell like a safe core territory. These marks are often used by cats to assess how safe it is to enter a particular area. So they'll use the level of degradation of marks to work out whether another cat has recently marked, in which case, it might still be quite near, or if it marked a while ago, and so it's likely to be quite far away by now, or whether actually it marked so long ago that it's gonna be coming back to top it up soon, and, you know, the marker might return at any minute.
So in terms of communication, they're very lacking in face to face communication skills, skills, because of their, history as, as solitary, individuals. So they tend to avoid conflict with other cats that aren't in their social group by avoiding close contact in the first place. And these marking signals are crucial for the success of this system.
So they use urine sprays and scratch marks, as we've already said, but they also will use faeces, and this is known as middening when it's used for marking purposes. And they would leave it out in the open as a signal rather than burying it as they would when they're toileting. So if we're seeing cats in the same social group, like the 3 in this picture, we'll see them using affiliative behaviours towards one another.
And if they're not, then we might see aggressive behaviours. So affiliative behaviours will include things like physical contact, which is sleeping in contact with each other, not just. Sharing the same sofa or the same bed, but actually in contact with each other.
Aloe rubbing, which is what these guys are doing, and aloe grooming. And the tail up greeting is a friendly sign, and cats may also vocalise with chirps or rills to say hi to to members of their social group. Aggressive behaviours are not necessarily overt, and a lot of owners will miss really subtle signs.
So staring is a very threatening behaviour in cats, but also, they'll block access by their physical presence, so they might sit in a doorway to prevent another cat passing through, or sit at the top of the stairs to stop the other cat coming upstairs and things like that. Then there are more overt signs of aggression, obviously, like chasing, hissing, growling, spitting, and all of that can end up resulting in a, an obvious physical fight with biting. So, I said at the beginning, it's really crucial that we determine the motivation for why the cat is toileting inappropriately within the house.
And you can see from the territory layout and from the communication strategies used by cats, it's crucial to determine whether we're looking at elimination or marking in order to know how to address this problem. So we can look at the volume of urine, that can be relevant in that smaller volumes tend to be used for marking, whereas elimination would normally be a larger amount of urine. But that may not always be the case, and it definitely shouldn't be used as the sole diagnostic factor.
And the same is true of the position of the urine. So, spraying would tend to occur on vertical surfaces, but some cats also mark horizontal surfaces. So they might, for example, urinate on the owner's clothes that are lying on the floor, or they might urinate on the bed or something like that.
The, the more important factor in determining whether it is elimination or marking is actually the location. So, marking will occur in locations which are significant to the cat, whereas elimination tends to occur in a much more private and hidden away place. So, if you're finding faeces behind the sofa, it's likely to be elimination, whereas faeces in the middle of the hallway is likely to be middening.
It's a clear signal to other cats or, or somebody else. So, Once we've decided whether it's elimination or marking, we also need to decide which cat. If you've got 3 cats in a household, who actually, the reason you can see my fingers at the bottom of the photo there is because they were all after the milk in my cereal one morning.
How are we supposed to know who it is? They're all looking quite sweet and innocent, and we don't know who it is. So often owners will have an idea, but actually, frequently, they, they are incorrect in their thinking.
Unless it's been obvious who the culprit is because the owners actually witnessed incidents. Although even when they've witnessed them, it doesn't necessarily mean only one cat is involved. There may be multiple cats within the household, or there may be other cats in the neighbourhood that are coming in through the cat flap.
If there's only one cat in the household and cat flap security is, is known, then obviously, we know who it is. So, if it's an elimination issue, the owner is much less likely to have witnessed it than if it's a marking issue. But again, they may have only found the urine marks and not seen who made them.
So, One mistake owners will make is that they may say, well, that cat is still using the litter tray, so it can't be that cat, but actually some will continue to use the litter tray and also use other locations. So that in itself is not a deciding factor. So, now that the world is full of so much amazing technology, my preference is to use a camera like this one on the top right of the slide, get actual video footage.
So, if a cat's using the same locations, this can be relatively straightforward, because you know where to set the camera up. It's harder if the cat is not, always reliably going in the same place. But the, the trail camera that's pictured here is like these ones on Springwatch and autumn Watch, and so on, that has a sensor that detects movement.
And so it films little short video clips each time it spots movement. And it films using infrared, so it can capture footage in the dark, and it also in daylight. So I tend to loan this out to my clients for 2 or 3 weeks, unless they have their own camera.
And it's certainly the best way to see without doubt who it is, and it's how the, the way I've done it for several years. However, in the old days, before I had this camera, and before clients had all this amazing technology that they now seem to have, we have other methods that we can still use. So for urination problems, fluoresin can be used.
If you have the liquid fluorescine, then that's the easiest way to administer it. But if you don't have the liquid version, you can use gelatin capsules and put 5 ends of the of the fluret strips in. And this gives a dose of about 5 milligrammes per cat.
That should be given once daily for a few days, but possibly longer if incidents aren't very frequent. So normal urine fluoresces slightly in UV light, anyway. So it's really important for the owners to tell the difference between the really bright glow with the fluorescent compared to just normal urine.
And I'll show you a quick image on the next, slide. If you're testing more than one cat in the household, you need to leave a 5 day washout period in between the two cats so that you make sure there's no overlap. For faeces, you can grate a bit of coloured wax crayons into the food, and that will come out unchanged in the faeces.
You can also try sweet corn, but not all cats are going to be willing to eat that. So this next slide just shows the flow of urine with a UV light. So that's a good way to spot it.
That's also actually a really useful way to identify marks where There's clearly a smell of urine in a room somewhere, but you're not actually entirely sure where it is, and you can just scan all over trying to spot where it might be. So, we discussed at the beginning that we would say whether this, how do we decide whether it's medical or whether it's behavioural. So what sort of things are we looking for?
When a case first presents, it can be difficult to decide whether it's medical or behavioural, or a combination of the two. It's really essential to have a good working relationship with your local behaviourist, and then in cases where the lines are a bit blurred, you can work together to make a diagnosis and provide that appropriate management and treatment. So, firstly, I would consider, is the behavioural change sudden or gradual?
If there's a sudden onset of behavioural change, if it's purely behavioural origin, I would expect there to be an obvious trigger, although that's not necessarily always obvious to a client. So, for example, a sudden change in the environment or the social setting that a cat lives in, could result in house soiling problems. So perhaps there may be a new cat in the neighbourhood, there may be arrival of a new dog or a new baby.
And so on. There may have been some building work that's caused some environmental disruption, or there may be changes to the garden. There might be, they may have had their garden landscaped and there's been a loss of latrine facilities that they used to use.
How soiling problems may also start relatively suddenly just because of a medical issue, such as cystitis or diarrhoea. So, if there's not a clear trigger, and it started suddenly, I would definitely be thinking medical, that you may need to question owners to try and find what that trigger is. And obviously, we'll discuss FIC shortly, but that, that is frequently triggered by stress.
And then we're trying to distinguish that from other potential medical causes. So householding may happen more gradually and intermittently if it's associated with something such as arthritic pain, because that may wax and wane. And so the sudden onset is not necessarily a pure indicator.
So if the behavioural changes are associated with a more chronic medical condition, then obviously, we'd be looking for other signs. So there may be associated loss of condition, muscle wastage, poor coat condition, things like that might be seen if it was, say, hyperthyroidism or dental disease. If there's a lack of normal maintenance behaviours, so it might be a poor appetite, or self-care, abnormal toileting pattern.
You can, do need to be careful because a lot of those changes could still be the result of environmental stress. So it can be difficult to separate, separate out the causes of that are purely behaviour. So, most importantly, I think the single most useful thing I can say is, is this behaviour out of the normal range of expected behaviour for that individual animal?
So, for example, there may be a cat who's normally really placid and tolerant, and suddenly they start to show aggression or hiding in contexts where they would normally cope. And then we need to be thinking, perhaps a high likelihood of pain involvement or some other underlying medical issue. And in the case of pain, we might see learned components due to associations made when the pain's been experienced, even if the pain is no longer current.
So a classic example is a cat who has had painful urination or defecation has associated that with the litter tray, and they continue to avoid the litter tray even after the medical issue has been resolved. So stress may be brought on by the environment itself because of social or physical changes, but it also may be exacerbated by medical issues, and especially those involving pain. So, as I said, it could be that the, medical issue is the entire problem.
And obviously, the relevant medical checks need to be done. We're not going to cover that today, because we're very short on time, and I learned my lesson with the last presentation, to not try and say too much. So, sometimes once a medical issue is resolved, the cat will then toilet appropriately again.
So, for example, in bacterial cystitis, however, as I just said, literary aversion may continue even after the pain has resolved. So a cat may choose somewhere more comfortable to toilet and continue to do that because it becomes a learned thing. And obviously there's also, as, as I said, the stress playing a major role in the development of idiopathic cystitis in cats, and this may also be relevant in cases of inflammatory gastrointestinal diseases, which we will talk about later when we talk about FIC and the importance of environmental modification to success with these cases.
So, these are some of the clinical signs that you might see when it's a medical problem. Abnormal urination, aggression, inappetence, over grooming of the lower abdomen or perineum. That's a classic sign of some discomfort.
Abnormal consistency of the faeces, or perhaps the frequency of defecation. So, increased frequency of urination is really common, and that's often seen by owners as repeated attempts of squatting in the litter tray or the garden. And for owners with outdoor cats, it's often unusual for them to see their cat toileting at all, because it's a very private affair for a cat.
So if the, if the owners do start to spot them going to the toilet, that may be indicative of a problem. And also, obviously, if the cat is urinating more frequently, the volume is likely to be smaller, and unless there's a concurrent polydipsia, in which case that the volume may stay the same. So blood is again, a common finding, but the problem with that is it only indicates damage to the urinary tract.
It doesn't actually tell us about the cause of that damage. Difficulty urinating indicates a partial or complete blockage, but again, that could have several potential causes. So, inflammation could cause narrowing of the urethra, there could be a tumour causing a partial obstruction, there could be urethral plugs, and maybe be calculate.
And urethral plugs are actually a very common finding secondary to inflammation. So this again, may be an indicator of FIC rather than the plug itself being the problem. So If a client comes to us complaining that their cat is toileting in the house, what first aid advice can we give them to keep them going, whilst they're waiting for some medical tests to be done or referral to a behaviourist, or a mixture of the two?
It can be really crucial to give this first aid advice, to improve life for the cat and the owner, and also in terms of long term compliance, because owners are really often at their wits end when they're referred for house soiling issues, and the problem's often been going on for a long time. Sometimes they're really embarrassed, and there may be tension within the family homes, there may be social effects, such as them not feeling they can invite visitors to their home because of the smell. So just giving some really basic advice can really help them to cope while they're waiting.
So the most important thing is to explain to owners that punishment is counterproductive. There's frequently an underlying stress affecting the cat's behaviour, and punishment is only going to serve to increase that stress and potentially exacerbate the problem. The cat's likely to misinterpret being told off for toileting in the wrong place and not actually understand it was the location that was the problem.
And that is likely to make the cat more keen to hide out of sight from the owner. If they're toileting, so that they avoid the punishment, and also, if it's a marking issue, they're actually probably more likely to increase marking because they'll feel their security has been even further compromised, and they're going to be even more stressed and even more in need of marking. So also, punishment can really serve to permanently damage the owner-ca relationship.
As we talked about in the first webinar, cat, cats don't really have a way to, make friends once they've fallen out. They don't have all those appeasing strategies that social, fully social animals have. So, understanding these concepts is really important for client compliance, and it can really have an immediate effect on lowering the stress for the cat and improving their welfare.
So an appropriate cleaning regime is also really important. Cats tend to urinate where they've previously urinated. So if there's any smell remaining, they're likely to go there again.
Firstly, the area should be cleaned with a 1 in 10 solution of biological washing powder or biological washing liquid. It's crucial. It's the biological kind, so it's got the enzymes in.
That will get rid of any protein components in the urine. And then you rinse that off and then spray with surgical spirit and you leave the surgical spirit just to evaporate. That gets rid of any fat components in the urine.
And that should really effectively clean the, the thing, the area. It's, it's important to cover a wide area as well, to make sure that any splash is covered as well. And in terms of cleaning litter trays, cats will show individual preferences for this.
But as a general rule, they're more likely to use a litter tray if it has still got a slight smell of urine about it. So one mistake owners make is actually over cleaning the litter tray, doing it too frequently and cleaning it all out, washing it all out, and leaving no smell of urine at all. It's actually much better just to scoop out weeds and leave a little bit of the smell behind and only wash it, maybe every week or every couple of weeks to fully clean it.
And also, in the non-domestic environment, cats would usually use separate latrines for urine and faeces. So each cat ought to ideally have a choice of two litter trays. And also, they prefer not to defecate when there is already faeces present.
So owners should be encouraged to quickly clean faeces out of a tray. Because if they go to the tray and it's dirty, they may then have to choose a different location to go next time. Also, in multi cat households, obviously, we mentioned earlier, cats wouldn't usually share a littrine site.
So having ample litter trays is really important. And the general rule of one per cat plus a spare one. We will talk in a bit about location of litter trays.
So what about management to avoid incidents? This again is useful first aid advice. So we've talked about the habitual component of toileting and marking in terms of cleaning the, the marks up.
. So each time they're going to go to the toilet in the wrong location, that's actually going to be accidentally self-reinforced. So if their behaviours modification is going to be successful, then we need to prevent them practising that. It's also really important that we don't give inappropriate management advice, because incorrect advice may cause additional stress and actually exacerbate the problem.
So, if the problem is inappropriate elimination, The owner may actually be perfectly happy just to put temporarily, another litter tray in the problem area, and that's an excellent short-term solution. . Alternatively, you can make the problem locations less private and less appealing.
So this photo just demonstrates having a light in the corner. If there's a nice cosy dark corner where the cat was choosing to go to the toilet, something as simple as putting a light there could make it less private and, and discourage them from using it. There are various aversive sub substrates that people try.
They're a bit hit and miss depending on what the individual cat, finds aversive. But people will try clingfilm or other waterproof surfaces, tin foil, prickly leaves, things like that, that just inhibit the cat from using that area. But it is crucial that to balance that, they have got appropriate areas where they can toilet.
If the problem is marking, then sometimes providing an alternative means of marking can be helpful. So you might put a scratch post, in the location for them to mark with scratching rather than toileting. If they're regularly toileting to mark in a specific location, even just as a short term solution to help the owners find it easier to clean and cope with, you could put a litter tray leaned up vertically against the surface.
At least that's not solving the problem, but it makes it easier to manage in the short term. So longer term solutions. Obviously, in the long term, the main aim of a behaviour consultation is to identify the reasons why the cat is urinating or defecating in those inappropriate locations and addressing the stresses that are underlying these problems.
There are numerous potential causes of stress, so I always do a home visit for these consultations, because it's the only way to thoroughly identify what's going on. Three dimensional space is really important. So assessing where the cat has access to is vital.
They need to have safe places, but they also need to be able to visualise their surroundings from vantage points. So over the next few slides, we're gonna have a look at these different factors that I've listed here. And also in multi-cat households, we would be looking to identify the social groups and have separate core areas.
We also need to identify issues within the neighbourhood, so there may be cats staring in through the window, that there may be issues with cat flap security. There may have been recent changes in the household that might be relevant, either environmental or social. Feely way.
I've put their care of appropriate use. I do use it a lot. I love feely way, but it's really important to use it appropriately.
And unfortunately, there's a lot of veterinary professionals and clients have a bit of a false perception that feelyway is some kind of magic device. Actually, the location of the diffuser and the situations where it can be useful really depend on a lot of individual factors. So, for example, if there's a general lack of resources, or there's one cat constantly intimidating another one in the household, feed away is not going to solve those underlying stresses.
So it's really useful to help create a safe atmosphere, but it needs to be done in conjunction with helping that cat to feel safe through practical changes as well. So, choice is really important. This is just a load of examples of my old cat, Mavis, who has several different choices of where she liked to sleep.
Predictability and control are really important for keeping stress levels low. So, Depending on what was going on in the house, Mavis would rest in different places. If it was really noisy because the children were being too noisy, she might take herself off into the airing cupboard on the bottom left-hand corner.
When the kids were at school, she might go and sleep on one of their beds. And in the evening when everyone's asleep, she likes to lie in front of the fire. Or actually, quite often the fire wins hands down whatever's going on in the house with most animals.
But having that choice of being able to hide or being able to elevate, for example, cats who like to use elevation, helping owners to remember to keep the top of the wardrobe clear, or keeping a cupboard door propped open, and so on is important. So the cat always has access to those places where they feel safe. And obviously, in multi-ca households, you may need to do separation in the short term, depending on the nature of the issues.
Obviously, if there's overt aggression between cats, I would definitely be separating them. But we also need to be really important, really careful not to accidentally disrupt social groups. So I wouldn't be advising separation unless there are physical injuries until you fully assess the situation and see what's appropriate.
It can be very hard to reintroduce cats again after they've been separated, so this needs to all be considered. And in particular, in terms of separating cats, sometimes we talked about in the first webinar, I think, that one cat can travel between different social groups. They act as a scent transfer between different members of the, household, even if they're not all in the same social group.
And this, this scent transfer carried out by this one can be really crucial for maintaining stability. So actually, if that's disrupted by separating. We could cause serious problems for all the cats in the household.
So it's also really important to just to consider how the resources are arranged. So each social group needs to have their own core area, and the litter trays, it must be in separate locations, not all bunched together. So this picture of 3 litter trays, this is effectively one litter tray.
It's one location. And although there are 3 separate trays, that's not sufficient for 2 cats in a household and or 3 cats in a household. They need to have different locations.
The same is true with food. Cats can become really stressed if they're forced together at mealtimes, just to eat something really palatable. So these three cats who've all been brought together to eat this really delicious wet food, that may actually be really stressful for them, but they're overcoming the desire to stay away from each other because the food is so palatable.
So providing food at lib and in many locations is really important. In, in multi-cat households, obesity can really often be due to competition causing overeating, and actually, once these resources are more widely distributed and freely available, the cats start to eat a more normal quantity. In some cases, it might be appropriate to do some scent swapping between cats, but again, it's really crucial that that's done on a case by case basis.
So, in terms of identifying which cats are friends, obviously, you need to be looking at the affiliative behaviours and the aggressive behaviours to try and figure out who is, friends with who, so that you know where, how to distribute the resources. And we talked about this in the first webinar, so I'm not gonna go through all this now, but we would be looking at all these different behaviours and drawing a diagrams to see who's friends with who. In terms of litter tra location, obviously I've already said about ensuring the distribution of litter trays is appropriate, but it's also important that cats don't feel vulnerable while they're in their litter tray or when they're toileting in the garden.
It's a private affair and they're vulnerable when they're toileting. So sometimes the layout of the house might restrict the ability to create private locations, and then you can do things like using a hooded litter tray, or, it, it's really also important to have them away from other cats facilities. So if you see in the bottom right-hand corner, this is actually some fancy cupboard that's pretending it's not a litter tray.
The The hole underneath where the grey cat is sitting, that dark black bit, is actually into the litter tray. But who is going to feel relaxed enough to go and toilet in there when there's somebody on top of the cupboard staring right down? It's a really bad design, and it's not OK.
It's not gonna encourage anyone to want to toilet in there. So they're gonna look for somewhere else to go. So what about neighbourhood threats?
Obviously, we've discussed some measures there that will help the feel, the cat to feel happier inside the home, but they also need to feel safe from outside. As I said when we were talking about core territory, cats don't expect to see unfamiliar cats when they're within their core territory. So they need to feel safe in their core territory and around the exit and entry points so that they can travel around safely.
Things like this opaque window film can be really useful. You can just buy this in DIY stores, and it just sticks onto plain windows to turn them into opaque ones. Can just help prevent visual access from neighbourhood cats staring in the window, and immediately makes cats feel safer.
Microchip cat flaps are being increasingly used, and these are a great way to prevent unwanted cats accessing the home. It's also a good idea to discuss with neighbours how they're feeding their cats if there is a problem with an invader, because often cats who are fed meals rather than ad lib may be seeking food from other places and just encouraging people to feed ad lib may solve that sort of problem. In the garden, we've talked about cat flap security.
This is just two examples of how exiting a cat flap can feel safe or or not. So at the back of the house, on the picture on the right hand side, you can see the cat flap in the back door there. There's no cover at all.
That cat's coming out into a really sparse environment and feeling really vulnerable. On the photo on the left, you see just simple things like arranging the plant pots so that there's a bit of a gap between the wall and the plant pots. Cat can come out, hover behind the plant pots, go under the bench, investigate, check that it's safe before actually venturing further afield.
And that sort of thing can make a huge difference. So these photos are from one of my clients who I saw for house soiling, and she was having problems with the, the fence in the left-hand picture. There were cats in the neighbourhood were sitting on top of this fence perching and staring through the window, intimidating her.
And also, the second one just shows how sparse it is down to the end of the garden. So there's some nice bushes and a shed at the end of the garden, but between the exit from the house and down there, she's really vulnerable. So, part of my treatment plan for her was planting up some more cover, rearranging the furniture, so it was all more covered, blocking the access on that fence there, just to help her feel safer, safer.
So, here's just an example. So, the ginger cat here has sat on the wall, staring in, and if you just simply put some trellising on there to block that seating position, that immediately helps the cat inside the house to feel safer. Obviously, it's still important that the home cat has places to perch and hide, but what I would do is face those away from the house so that other cats aren't in danger of using those to stare inside.
. And obviously it's, it's also important for cats to have areas where they can scratch to mark the garden and provision of an outdoor litter tray is also sometimes really helpful. Cat proof fencing can be really useful in some cases, but it is important to take care with the design, because, this fencing, as an example, would actually allow other cats to come and sit on top of the fence and intimidate the cats who are enclosed. So that's not ideal.
. And also, it might result in a massive reduction in territory. So, I saw a cat quite recently, where it would have been really nice to use cat proof fencing, but unfortunately, that cat travelled a long way from home, and it would have been too stressful to restrict his access. There were a lot of cats in.
In his neighbourhood. And the advantage of well designed cat fencing is that it also keeps other cats out. So it would have helped him feel really safe in his own garden.
But his own garden was really small. And so you need to balance up the, the stress of the other cats coming in with the massive reduction in territory if we'd done that in his case. So litre trade issues, to be fair, most of the house running cases that I see are due to environmental or social stressors, but stressors.
But sometimes I might see literate issues. So there might be inappropriate facilities. They cats prefer to have a depth of at least 3 centimetres of litter, and a lot of owners and probably veterinary hospitals as well, who are on.
A tight budget, are putting an inadequate depth of litter in the litter trays. A lot of the trays that are sold in pet shops are actually far too small for most standard sized cats. Really important they've got enough space, a nice big, deep tray, good dimensions for them to have plenty of space for climbing in and out and digging.
So sometimes I advise people to go down to a garden centre and buy a massive seed tray or something, which is, is sometimes easier than getting a litter tray. For older cats with arthritis, they may struggle to get in and out. So this, cutaway box has, got a, a low, a lower lip to help them to get, in and out.
And they, some, sometimes I would do a substrate test to see whether cats show a preference for a particular kind of substrate. So, let's just now look at idiopathic cystitis in a bit more detail. So with householding problems, there's often very clear behavioural reasons why cats are urinating inappropriately.
But with idiopathic cystitis, it's actually a really complex situation, where stress is brought upon by environmental and social factors, and it interacts with pathophysiological changes. So this is a condition where cats really enormously benefit from seeing a veterinary behaviourist, or from seeing a general practise, but who's got a really good relationship with a non veterinary behaviourist. So we're gonna have a look at the clinical presentation.
We're gonna look at the suspected pathophysiology and then focus on how we can reduce stress. So, say suspected pathophysiology, because although this condition has been really well researched, and it parallels considerably the same, disease in humans, so there has been a lot of research done on it because of that. It's still actually far from being clear and distinct answer as to what processes are going on and how to diagnose it.
We'll look at some medical treatments that may help, but as you'll see as we talk, actually, the primary focus of treatment really needs to be behavioural environmental management to reduce stress. The current medical treatments are really quite limited in their efficacy in this disease process. So, feline lower urinary tract disease is a very broad term.
It's not a diagnosis. It's simply a term that includes any disease of the lower urinary tract, including the bladder and the urethra. And as with other systems, the urinary tract has a really limited response.
It's only got so many ways it can respond. So similar disease processes can result in really very similar clinical signs. One paper by Osborne and colleagues published back in 1996, listed 36 different causes of lower urinary tract signs.
So we might see any of these, things that I've listed on here, and, . It's The clinical signs basically don't confirm the diagnosis, so it's whether to go on and investigate further or not. So, this is just a graph showing what a high proportion of cases are idiopathic in young cats.
So, the, dark grey columns show cats under 10 years of age, and the white columns show cats over 10. So as you can see from the column on the far left, cats under 10, the vast majority in 55% in this case, were idiopathic cystitis. You may well want to be using medical treatments as well, such as analgesia or neutral cuticles, but it's really crucial to be addressing the behaviour components in all these cases.
And particularly important to note, in the light of concerns over over usage of antibiotics, the majority of cases presenting with clinical signs associated with cystitis actually don't need antibiotic treatment. This is just another graph, which is slightly more recent, published in, in practise in April 2018, and this just shows several studies on the far left, we've got 6 different studies, each colour is a different research paper, and all of them are finding very high percentages of of of FIC in young cats. So, what is FIC?
Apart from it being the most common cause of lower urinary tract signs in cats under 10, we actually don't yet have a diagnostic test for this condition, and we need to diagnose it based on clinical presentation and by ruling out other potential causes. It's a condition that has very limited success with medical treatment, and it may require long term medical and environmental management, rather than a cure. Oh, sorry.
This paper, this is from 2013, and I haven't seen any new work on this. If any of the listeners know more whether this developed into anything, I'd be really fascinated to know, because this is from seven years ago now. These researchers used infrared micros spectroscopy to examine blood samples, and they actually found a significant difference between the tryptophan metabolites in cats affected by FIC compared to healthy cats.
And they were discussing whether a test might be developed. And it's very interesting because tryptophan is obviously an important metabolite involved in serotonin production. And so it's a really interesting finding in the, in the light of the role of stress.
But I haven't seen any more about this, so it's still a wait and see, I think, unless anyone knows more than I do. Which obviously, lots of people do, but I mean, specifically about that test, it would be good to hear. So there are several predisposing factors.
This is one of the things we need to be looking for when we're trying to make a diagnosis. All of the groups listed on this page here are more likely to suffer with FIC. So, neutered cats are more at risk than entire cats.
Those fed an entirely dry diet, those who are reluctant drinkers, even if they're not on a dry diet. Members of multi-cat households or high density neighbourhoods, are more at risk. The age of the cat is also relevant.
Obviously, we've discussed that already. Inactive and obese cats are more at risk, as are indoor only cats. And then we also need to be looking at the presenting signs and trying to identify a trigger for a potential stressor that's, triggered this episode.
And as I said before, owners may not be aware what stressors might be. So we can just ask them questions to help try and work this out. And I've just put some examples on the slide here about what we might ask them.
So what level of workup do we need in these cases? If it's the first episode and the clinical picture picture all fits with this, in terms of predisposing factors, clinical signs, you've identified a stressor, I would probably do a simple urine sample and dipstick, and so on, but I probably wouldn't do more than that. If the cat is suffering from recurrent episodes, or the clinical picture is a bit In mind, when asking owners to collect a urine sample is how much additional stress is this gonna cause the cat, and how much do we actually need to test that urine, or can we just go on the clinical picture?
So this is just a paper that looked at the predisposing factors for FIC. So in this 2004 paper, there were 31 cats with FIC that we looked at, and they also looked at 24 cats who lived in the same households but didn't suffer from FIC. And there were also 125 clinically healthy cats as a control group.
So the FIC cats were compared to their healthy housemates and also with the general population. And what they identified was that being male, being pedigree and being overweight were all risk factors. But what was most significant in this study was the interca conflict being the most significant risk factor.
And this supports the hypothesis that stress is a significant factor for FIC and also that there are differences between individual cats within the same household. So some cats are better able to cope with their environment than others. And when a cat from a multi-cat household presents with FIC, it's perhaps then even more important to encourage owners to be referred to a behaviourist.
So, diagnosis of FIC can be made based on ruling out all these other causes, and the clinical picture fitting with what we've discussed. So, let's have a quick look at the pathophysiology, and I need to speak twice as fast, cause I'm running out of time already. So the pathophysiology isn't fully understood, but, it's, and it's actually now thought to be a systemic condition rather than just isolated to the bladder, even if the obvious clinical signs are bladder related.
So abnormal stress responses have been identified in FICATs and it's also thought that there may be some abnormal bladder lining issues. So, Obviously, there's a known link between the effects of stress on general health and welfare. So it's not surprising to find a condition like FIC, which waxes and wanes.
Stress does play a significant role in relapse rates and likely the underlying pathophysiology. Every individual is unique in how they respond to potential stresses, and this is an important aspect for understanding the management of this disease. So, in multi-cat households, owners may be less aware of environmental inadequacies if some of the cats are more relaxed and confident.
So it's really important to explain to owners that what one cat can cope with is not necessarily the same as what another cat can cope with. So just the example there, one cat being very happy living with a dog, the other one not impressed at all. So stress response differences.
There've been a few studies on stress response differences between individuals, but this particular one, was published in the American Journal of Veterinary Research 2006. Jodie Westrop and colleagues have done a lot of work on this, as has Tony Buffington, if you want to read more about this syndrome. They assessed bladder permeability and urine, cortisol, creatinine ratios in cats with FIC, and in normal cats who are experiencing stress.
And what they found was that the FIC cats had much higher levels of circulating catecholamines, but actually no differences in the cortisol and creatinine ratios. So this suggests that in the FIC cats, there's actually an uncoupling between the sympathetic nervous system and the HPA axis stress response. So in the normal healthy cats, stress causes sympathetic activation, which results in the release of corticotrophin releasing hormone from the hypothalamus, and this then acts on the pituitary to release ACTH, which causes the adrenal glands to release cortisol.
That's the normal HPA access response, and that results in the flight and fight response. In FICAs, they showed sympathetic activation, but they had a reduced or failed release of ACTH and cortisol. So their behavioural response ended up involving displacement behaviours such as grooming, drinking, eating, urinating, rather than the fight or flight response.
There's also been seen to be differences in the acoustic startle response. So this response is increased if an animal is fearful or anxious. And further evidence that there's an abnormal stress response in system in cats with FIC comes from this study, where they found that the increased acoustic starter response in FIC cats compared to normal cats, even when they were in an appropriate environment.
And if they were placed into a stressful environment, then the difference was even more marked. So this is really important when thinking about treatment for FIC cats that we think about keeping their environment calm and peaceful, and especially if they're coming into the hospital for investigations. So these are just some examples of what might cause stress to a cat.
I'm gonna skip on from that, because we need to hurry up. So an innate sensitivity. So much of the research does point towards FIC cats being innately less able to cope with stress than unaffected cats.
And there are many potential causes of this. Much research has been carried out on laboratory species regarding the effects of neonatal stress and intrauterine stress. Generally, early mild stress during the neuronatal period primes the HPA axis and can be beneficial.
Although this priming results in stronger responses to acute stress, it's also showing that they respond less strongly to chronic stress, so they're better able to cope in a chronically stressful situation. However, anything more than mild stress, intrauterine or neonatal, can result in an abnormal development of the stress response system. There's also the paternal boldness gene to consider whereby cats inherit a predisposition to being confident and friendly from their father.
So understanding these individual differences are relevant to individual management and prevention of recurrent clinical signs. So, this is an explanation for how stress activation may specifically affect the bladder. Stress causes release of corticotrophin, releasing factor from the hypothalamus, and this affects two areas of the brain.
So it's already mentioned, it releases ACTH from the anterior pituitary. It also affects the locus currius to increase tone in the sympathetic nervous system. And this increase in sympathetic discharge can result in neurogenic inflammation in the bladder lining, and also, histology of the submucosa is indicative of such neurogenic inflammation.
The locus currius is the most important source of noradrenaline in the CNS, and bladder distension stimulates activity in this area of the brain, which is also involved in global functions such as vigilance and arousal, and is affected by both external and internal stressors. In cats with FIC this area of the brain has been shown to be more active and have a greater level of tyrosine hydroxylase, an enzyme involved in catechodamine synthesis. So this is very likely to be significant in terms of the symptoms of FIC waxing and waning in response to stress.
So research suggests that chronic FIC may be a manifestation of an underlying systemic disease. Buffington refers to this as Pandora syndrome. And this involves idiopathic cystitis, plus clinical signs related to other organ systems, such as the waxing and waning associated with stress.
So, resolution of these signs is very often associated with effective environmental enrichment and reduction in stress. So this is really important to consider when you're seeing cats with other concurrent disease such as gastrointestinal problems, cardiovascular disease, dental disease, for example, severe gingivitis or stomatitis, which may wax and wane, or recurrent respiratory disease. These cats may well be undergoing chronic stress and just suffering from this general deterioration in health.
So these cats are really very in need of behavioural referral to address environmental stress rather than just repeatedly trying to treat these medical issues that keep recurring. So, just going back to that West 2006 paper about bladder permeability, they used fluorocene to look at bladder permeability, and what they found was that the FIC cats had a higher permeability than normal cats. And in terms of the anatomy and physiology of the bladder, there are numerous things where it might go wrong in the disease process of FIC.
The epithelium, the neurovascular supporting tissue, the smooth and striated muscle, they're all at risk of pathological change. And there's also complex neuroendocrine communication involving many neural connections and neurotransmitters, and the adrenal cortical and the sex hormones. So it's all quite a complicated system, and there's still a lot of research to be done trying to figure out what's going on.
Changes in the bladder lining have been hypothesised as an issue. The bladder lining is composed of the urothelium and the tight junctions covered in a layer of glycose aminoglycans, peptides, or gags. And these gags protect the bladder from the irritant effects of urine.
They prevent crystal adherence and they also protect against microbe infection. So FIC cats may have alterations in this protective layer, changes in gagler effectiveness and changes in gag concentration in the urine. This is just a paper that was reported and in practise a couple of years ago.
And indeed, they did find that there were lower levels of gags in the FIC cats compared to healthy cats. The assumption being from this research was that the urine gag concentrations are related to the quantity of gags in the mucosal lining, but they didn't actually look at this, so we do need further research on this. So how can we help these cats?
As you can see, if they do indeed have abnormal stress response systems, what we really need to focus on is long term management to reduce the likelihood of flare-ups. Treatment for the flare-ups should focus on identifying and reducing the trigger factors and also providing pain relief. The importance of multimodal environmental modification was discussed in Buffington's 2006 paper in the Journal of Feline Medicine and Surgery.
If you want to look that up, there's a lot of work on it. Altering the environment to reduce the likelihood of stress response activation is the mainstay of behavioural intervention. So in this study of Buffington's, they looked at 46 indoor cats with FIC and they followed them for 10 months, and there were various recommendations given to clients, so altering the 3D environment, avoiding punishment, changing to wet food, increasing water intake, advice about litter trays, and they showed a massive improvement.
Unfortunately, there was no control in this study, so we haven't got a comparison, but the advice they gave was effective in reducing relapses. And environmental enrichment has been found to reduce the clinical signs of FIC. It's shown to make the cats less fearful and nervous, reduced respiratory signs, reduced aggression.
It normalised the circulating catecholamines, blood of permeability and cardiac function, and also decreased the acute acoustic startle response. So environmental enrichment is the key for these cats. Just very quick bit on medical treatment.
So, as I said, really, the, the most important medication to prescribe these cats is analgesia. They may also benefit from angiolytics or neutrocuicles that can help repair the bladder lining. Unfortunately, there's not actually a lot of research to justify the use of, these nutra cuticles.
And, personally, I haven't seen much success with supplements in, in terms of anecdotal reports, but obviously, I'm seeing a bio sample of cases, because I'm seeing those that are severe enough to warrant referral, and possibly milder cases are benefiting from these, but really, we need, again, more studies. Oh, sorry. .
And in terms of nutritional supplements for the bladder lining, unfortunately, although gags have been reported anecdotally to show some success in a proportion of cases, there's actually very little evidence of clinical efficacy. You can see all of these studies that were looking at cys aid and at Carter Fen found that absolutely no difference. So there's no evidence that these things are useful.
Treatment for anxiety may well be warranted in some cases, but really, the key needs to be the environmental management, because even if you have a cat that's so stressed that it needs medication to help, that in itself is not going to work. The environment must be addressed. So, I would normally address the environment first, and if a cat continues to show relapses and an inability to cope, I would then consider adding in medication as well.
And that's it. I wasn't too badly over. Hooray.
I've just got a cute little video for you to watch while you think of some questions. I was hoping we were going to play it. Well, well, thank, thank you very much, Claire.
That was absolutely fantastic. I've really enjoyed that, and I'm sure everyone else who, who has attended tonight has done as well, and hopefully has got lots of little hints and tips that they can take away into practise to help kitty cats and, that they are seeing. Good.
So while we watch, while we're watching Kitty Cats trying to escape boxes, we can, I've got the question and answer panel open. So if anyone does have any questions that you'd like to put to Claire, if you want to type away and then I can put them, put them across. We do have one that's come through already, Claire, from Tara, and she's asking, do you advocate the use of free feeding for most cats?
Yes, definitely. Yes, even really fat ones. I, yeah, absolutely.
And the thing I tend to do, if clients are worried about their cats massively gorging on food, because they've been meal-fed before, I tend to encourage them to use something like a slow feeder. So the, my favourite one is the Trixie active. Board, which is, sort of slightly bigger than a 4 sized plastic white board that's got various protrusions on it.
And you can cover it in dry food, and the cats have to use their paws to poke the food off. And it tends to take cats who have been meal fed and tend to gorge. It normally takes them maybe 2 or 3 weeks to adjust to ad-lib feeding.
Yes, I would absolutely always encourage people to do that. Cause yeah, I think my, I think my fat cat quite quite approves of that to her. But yeah, I've got that, we, we, I use the, that puzzle feeders and all that sort of stuff as well because I, I know she is a grazer and I know flat out a full well that I know she would never go straight to a bowl twice a day and eat.
She, she is definitely a grazer. Yeah, yeah. Right, so she's, I was actually asking again.
Yeah, if they were gonna be living out in the wild looking after themselves, they, you need to think about what they would be catching, and they're catching really tiny prey, and they would eat multiple times a day eating really little small meals. So we need to try and replicate that for them. So Tara's asking again, would you ask, would you advocate the use of this free feeding even in a multi-cat household?
Oh, it's even more important in a multi-cat household, yes, absolutely. And you need to have the food in multiple locations. Yeah, definitely.
And one of the, if, so some owners still like to feed some wet food, as well as feeding dry food. And if they, or if the cats aren't prepared to eat dry food, I would be using those feeders that have timed compartments that can pop up and stuff, so that they have still got access to food several times a day if the owners are out at work. Perfect.
Well, Clare, I think you're off the hook there a little bit. You know, it was just two questions that have come through. I think you've, you, I think you've had a, I think you've answered probably everyone's questions as you've gone through with that absolutely so thorough talk.
That was absolutely wonderful. So I would, I would like to thank you. Thank you again very, very much.
I'm just glad I stuck to the time because I could have I could have talked all day on this topic. It was, very, very informative, and I'm very impressed, yeah, you stuck to that time. Thank you very much for Dawn.
Thank you very much to Dawn in the background, doing all the, the webinar vet stuff. And thank you, everyone, and to everyone else who's attended this evening. So, Claire, you can go and have that very well deserved cup of tea now.
And thank you very much and good night to everyone. Thanks, Caroline.