Animal Hospital News

Pandora Syndrome: Inappropriate Urination not just about the Bladder

posted by Dr. Deb on April 17th, 2017 in Cats

FELINE URINARY PROBLEMS is it “Pandora Syndrome”?

“Pandora’s Box”:  a process that generates many complicated problems as the result of unwise interference in something.

 Inappropriate urination.  Urinating around the house.  This is one of the most common complaints of cat owners about their otherwise beloved feline companions.

Facts:

  • Less than 10% of cats under the age of 10 get urinary tract infections. So, cats under 10 years likely does NOT have a UTI.
  • Cats don’t urinate on your stuff or your house guests stuff or anyplace else, for that matter out of “spite”. There is either a physical problem, a behavioral challenge, or a nervous system issue.
  • The two most common reasons for inappropriate urinary behavior (urinating outside of the litter box) in cats under 10 years of age are:
  •       Microcrystals of mineral in the urine (crystaluria). This causes pain as the shards of mineral are passed through the urethra during urination. This causes the urgency and desperation that leads to urinating anywhere possible. Cool, hard surfaces such as bath tubs, sinks and countertops are often targeted.  Crystauria is diagnosed with microscopic examination of a urine sample.  It is often treated with a prescription diet.
  •      Pandora Syndrome, previously referred to as “ Interstitial Cystits” (“ FIC”), “ Stress Cystitis”, “ Idiopathic cystitis”, Feline lower urinary tract disease ( FLUTD )and “ Feline Urologic Syndrome” (“ FUS”). 

 

Pandora Syndrome

As the name suggests, this “urinary” condition is no longer considered to be restricted to the urinary system.  It is now known to be “multi-systemic”.  The fact that this very common condition in cats has been renamed half a dozen times over the last 100 years tells us how very little has been understood about it!

In the 1970’s, we blamed urinary problems in cats on “ash”, the mineral content in their food.  We recommended canned foods, which had less “ash” than dry foods, by weight.  Well, yeah… because 1/3 of the weight of the food was water!  But, guess what?  The incidence of crystaluria in the cat population decreased and so did the incidence of inappropriate urination!  Well, it wasn’t decreasing the ash that was helping the kitties of the 70s.  It was increasing their water intake!

Around the 1990’s we blamed the problem on a disruption of the protective mucous layer of the urinary bladder. This lead to increased inflammation and symptoms.  Now we were getting closer to understanding. Cats with urinary symptoms do have a disrupted mucus layer. Unfortunately, attempts to bolster the mucus layer by giving cats glucosamine, a major part of that mucus layer, wasn’t very helpful.  Cats kept peeing around the house.

In the mid 90’s to early 2000’s, we started to learn about the unique qualities of the feline nervous system. Now we’re getting closer…  We figured out that we could control a LOT of inappropriate urinary behavior with anti-anxiety medication.  Stressed out cats pee inappropriately.  Ah-hah! We’ve figured it out!  …Almost.

Since 2015, with the evolution of genetic science and genetic mapping, we’ve been learning even more!

We have discovered that cats that develop inappropriate urinary behaviors are actually “wired” differently, genetically, than their non-peeing counterparts!  … Really!

First, let’s remember that cats are unique to the animal kingdom in that they are both predator (‘hyper” carnivores) and prey.  They need to be ready to fight for food or flee for their lives, both at the same time, at any moment.  You can see how this is a huge conflict for the nervous system!  Now, it’s clear why cats are so sensitive to everything in their environments!  Some cats are more sensitive than others.  Wild cats are the most alert. Domestic cats less so.  But cats have been far less domesticated than any of our other community animal species, like dogs, cattleor horses. Genetically, even the domestic housecat is almost identical to its brethren of a thousand years ago!  Hence, a lot of that “wild”, cranked up nervous system is still in play.

Recent studies have identified that cystitis (irritated urinary bladder) cats are genetically programmed to produce more Tyrosine hydroxylase which creates norepinephrine, which becomes epinephrine, or adrenaline.  These cats can often be identified by their high “startle response”.   Of course, we know that adrenaline is the flight or fight hormone in all animals.  Some cats are genetically, more prone to be high strung than others. Now take these cats who constantly want to fight or flee and “domesticate” them.  Put them in a tiny box (your house or apartment), that they never get out of because we want to keep them safe.  Add another cat or two, maybe a dog, maybe some noisy, rambunctious kids, our crazy irregular schedules.  Cortisol levels skyrocket! No place to flee. No way to fight.  It’s no wonder cats freak out in their heads!  

All that adrenaline and cortisol targets stress organs in the cat- the gastrointestinal tract, the lungs and particularly, the urinary bladder. Those stress chemicals cause sthe protective mucous layer of the bladder to erode. Chemicals in the highly concentrated urine of the cat irritate the exposed bladder walls, causing pain and even bleeding in extreme cases.  Pain cause the cat to pee around.  Now add the fact that every time she uses the litter box to urinate, it hurts!  Who wants to go back there?  Try the tub. Maybe that’ll feel better. Maybe the bed, the counters, etc.   Poor kitties!  At the mercy of their genetic code and our imposed environmental constraints.

Stressed cats also vomit. Usually just occasionally. Often right after eating, especially if they feel that they need to wolf their food so the other intruder cats in the family don’t steal it.  Sometimes they vomit in association with stressful events like guests coming over, being medicated, or your going away on vacation.

These high strung kitties are also more prone to over-grooming hair loss

So, we can see that inappropriate urinary behavior may be the most obvious, most offensive (to us) symptom of a much larger, multi-system, whole- cat condition. “Pandora Syndrome”-  the new name for what was once believed to be a disease limited to the urinary tract of cats is now known to be a nervous system disorder affecting multiple other organ systems!

HOW DO WE TREAT IT?

                We’re stuck with the genes, so what can we do to prevent or treat this annoying condition?

  • Treat the CAT
    • Treat the pain with medication
    • Treat the stress. This may take medication in addition to the environmental suggestions listed below.
  • Control and Mange the ENVIRONMENT

Minimize stress from an early age.  There is evidence that even cats who are saddled with the super Tyrosine Hydroxylase gene may never “turn it on” if they are never subject to excessive stress How can we do that?

  • Keep the household schedule routine.
    • Feed at the same times of day, preferably by the same person.
    • Avoid People coming and going at different times daily and weekly ( a chaotic houseshold may not be a good home for a cat, unless he is very laid back)
  • Ensure that the environment is “safe”.
    • Ensure that access to food, water and the litter box is not impeded by other pets in the home.
    • Ensure that those resources are also easily accessible, physically, especially for older or disabled cats.
    • Ensure that there is a place to rest, undisturbed: high perches, rooms with cat door access only- “No Dogs Allowed”
    • Ensure that the home has a quiet place for the cat to go, especially if he has a high “startle response”.
  • Enrich the environment so the cat can act out his natural hunting/ fighting instincts
    • Play games with your cat encouraging him to chase a toy or laser light.
    • Play hide and seek (as long as your cat isn’t inclined to actually latch on to you when he does cat you!)
    • Provide meals in food toys that require kitty to first find the toy, then play with it to get the food out. Simply throwing food crumbies around the room can work fine! (watch out not to throw food under furniture of course!)
    • Provide lots of climbing opportunities in your house or in an enclosed outdoor cat run.

 

  • Take Care of YOURSELF
    • Realize that all cats are still a little wild. Some, more so than others.
    • Yours may be a “more so” kind of cat. (Savannah, Bengal, or any mixes with those breeds, Chausie, Pixie Bobs are only a few generations away from their wild roots. They often exhibit signs of Pandora Syndrome, often requiring anti-anxiety medication to live in homes with multiple pets or children)
    • This is going to take some effort to help your kitty cope with domestication
    • This is going to take patience
    • This is a life- long way of living with cats, especially a more ‘high strung” cat.

Your veterinarian can help you along the way.  It can be frustrating and even infuriating, but you have a team of partners ready to help.  From figuring out whether there is a physical cause for inappropriate urination to helping you help your kitty psychologically, and helping to support you emotionally, your veterinary team will be right there with you!l

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