Help With Chronic Cystitis, Constipation :(

Hi everyone,

I’ve been browsing these forums for the past few weeks, and I’ve found so much helpful information. After another frustrating visit to the vet this morning, I am hoping someone who has been in a similar situation might have some advice for me.

My cat Charlie is 14 years old, male, neutered, has always lived indoors. He has been eating a combination of dry and wet food for the past 7 years or so (just dry before that) and recently switched to just wet. He’s a very happy and social cat, loves pats and to be around people. He is a big guy and the only health concern the vet has ever had about him was his weight, until now.

Last June, I noticed him drinking water in a frantic way. I took him to the vet and, after blood work, urinalysis and an exam, they found blood in his urine and diagnosed him with cystitis and said it was likely stress-induced. They prescribed Metacam and gave him an antibiotic shot. All was well after that, though I do wish I would have brought him in for a follow-up urinalysis.

Fast forward to the beginning of this year, one morning he peed in the recycling box and I noticed blood in his urine. Hoping it was a simple bladder infection or inflammation like last year, I took in a urine sample to the vet. They called to let me know that this was worse than last time - more blood in the urine and higher protein. They told me that they thought there was a “deeper cause.” After blood work, urine culture and 3 different antibiotics (4 weeks total, concurrently), they told me it didn’t seem as if there was an infection and that they didn’t know where the blood was coming from. They recommended an ultrasound, which will be $325, to rule out polyps, tumours, etc, which may be the source of the bleeding. He visits the litter box often to pee with very little result - sometimes a small pee, sometimes a few drops. He drinks lots of water and always has.

After ending his long bout of antibiotics last week, as well as having some painkillers intermittently (Bupenorphine), Charlie seemed constipated. I know antibiotics and opiates can cause constipation. My vet also had me switch from a combo of dry and wet food, to just wet a couple of weeks ago and I wondered if this might have contributed? I added pumpkin to his food, which he does eat, but still straining in the litter box with barely any pooping.

I took him in this morning because I was getting really worried about the constipation. They did an X-ray and it showed no blockage and that he was not backed up. He was a bit dehydrated so they gave him some subcutaneous fluids. The vet mentioned the possibility of kidney issues, making it painful for him to try to poop (all blood work showed kidney function as normal) and also mentioned pancreatitis (no mention of it until today) - I feel at this point that they’re just grasping at straws. They sent us home with some Zantac to give him 3x a day, and I don’t even understand why.

I started using Feliway last week. Charlie gets lots of attention and generally seems extremely laid-back and stress-free. I gave him a perch in the window which he enjoys, he has 2 litter boxes to use (cleaned daily) and 2 water dishes (one upstairs and one downstairs). He is currently in and out of the litter box a lot, straining to poop or peeing a tiny bit. I checked the colour of his urine yesterday and it was clear, no pink tinge like earlier this month.

I just don’t know where to go from here. I will continue with wet food - his appetite has increased since being off the meds. I’ve been adding water to it, but no pumpkin in the last few days as I was worried that he had a blockage.

I’m happy to go ahead with the ultrasound, but I have a feeling they won’t find any cause (they might), and then I’m back to square one. I am thinking about getting a 2nd opinion from another vet.

If anyone has experience with chronic cystitis or any info or advice to offer, I would really appreciate it. I’m emotionally exhausted. I love Charlie so much and hate to see him uncomfortable. I just want him to feel good again.

Thank you in advance and I apologize for the length of this post!

Hi Jess_and_Charlie , it's nice to meet you! I do have a cat with stress-induced cystitis so I know how frustrating this situation can be to deal with when it feels like you don't have any answers. My advice to you is to go ahead and do the ultrasound.

I am not a vet, but my opinion is that 1) since Charlie (I assume) doesn't have any lifelong history of interstitial cystitis, 2) doesn't appear to be stressed in his day to day life, 3) isn't showing classic symptoms of the illness according to the test your vet administered, and 4) is at an advanced age, your vet may be right and there could be something more sinister going on behind the scenes. If it does turn out that he has stress-induced cystitis then there are different environmental enrichment approaches you can take, like playing hunting games with him, food puzzles, etc. that can help manage his stress levels. Given his age though, I would do the ultrasound.

Wile said:

Hi Jess_and_Charlie , it's nice to meet you! I do have a cat with stress-induced cystitis so I know how frustrating this situation can be to deal with when it feels like you don't have any answers. My advice to you is to go ahead and do the ultrasound.

I am not a vet, but my opinion is that 1) since Charlie (I assume) doesn't have any lifelong history of interstitial cystitis, 2) doesn't appear to be stressed in his day to day life, 3) isn't showing classic symptoms of the illness according to the test your vet administered, and 4) is at an advanced age, your vet may be right and there could be something more sinister going on behind the scenes. If it does turn out that he has stress-induced cystitis then there are different environmental enrichment approaches you can take, like playing hunting games with him, food puzzles, etc. that can help manage his stress levels.

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Thank you for your reply!

I agree that the ultrasound is the only way to move forward. I can’t really know what the next step is until I rule out other possible causes.

Hopefully it will give us some answers, or at least rule things out!

I don’t feel entirely trusting of his current vet. I have considered asking the clinic where I’ve been taking him for all of his test results, and having the ultrasound done with the vet he saw as a very young cat, who used to work out of this clinic but left a few years ago - I recently tracked her down at a new practice. She was warmer and more compassionate, always provided lots of info and options and had a particular fondness for cats.

Jess_and_Charlie said:

Thank you for your reply!

I agree that the ultrasound is the only way to move forward. I can’t really know what the next step is until I rule out other possible causes.

Hopefully it will give us some answers, or at least rule things out!

I don’t feel entirely trusting of his current vet. I have considered asking the clinic where I’ve been taking him for all of his test results, and having the ultrasound done with the vet he saw as a very young cat, who used to work out of this clinic but left a few years ago - I recently tracked her down at a new practice. She was warmer and more compassionate, always provided lots of info and options and had a particular fondness for cats.

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Probably a good idea to find a new vet if you aren't happy with your current one Ultrasounds can require a lot of expertise to perform/read, so you might want to ask around to find out of a specialist can perform it for you. I don't know what is normal for your area, but $350 sounds low to me for that kind of ultrasound. A few years ago I was quoted $600 CDN for an ultrasound on a new machine.

I will definitely do some checking around, thank you for that tip!

I did like this vet intitially, but lately he has been asking me questions like, “was his kidney function normal when we did the blood work?” - like he hasn’t even looked at his chart, so I’m losing confidence!

To save yourself some money, get copies of all the records your current vet has on Charlie so they can be given to the new vet - at least that way some of the testing that has gone on likely won't need repeated. And, it will give the new vet a complete history on Charlie, which should help with decision making on what to do going forward.

FeebysOwner said:

To save yourself some money, get copies of all the records your current vet has on Charlie so they can be given to the new vet - at least that way some of the testing that has gone on likely won't need repeated. And, it will give the new vet a complete history on Charlie, which should help with decision making on what to do going forward.

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That’s a great idea. I just called the new vet and they told me to request that Charlie’s current vet send all of his results to them. I’ll double check what they’ll be sending.

The new vet is on holidays next week so won’t be able to examine Charlie until the first week of March. I just hope he’ll be okay until then!

FeebysOwner said:

To save yourself some money, get copies of all the records your current vet has on Charlie so they can be given to the new vet - at least that way some of the testing that has gone on likely won't need repeated. And, it will give the new vet a complete history on Charlie, which should help with decision making on what to do going forward.

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I called to make an appointment with the new clinic and was informed that in order to give any kind of opinion on Charlie, the vet would need to redo ALL diagnostic testing, which I can’t afford to do on top of the ultrasound. I feel really trapped. I don’t trust his current vet and don’t want to proceed with the ultrasound with him, but it seems as if that’s my only option? ((

Jess_and_Charlie said:

I called to make an appointment with the new clinic and was informed that in order to give any kind of opinion on Charlie, the vet would need to redo ALL diagnostic testing, which I can’t afford to do on top of the ultrasound. I feel really trapped. I don’t trust his current vet and don’t want to proceed with the ultrasound with him, but it seems as if that’s my only option? ((

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Did they give you a reason why the tests need to be redone? It could just be a case where they don't know much about how/when the tests were done.

The receptionist was pretty rude. I suppose I can understand wanting to have an updated blood panel and urinalysis? Because things have definitely been fluctuating over the past couple of months. But she made it seem as if none of those tests would be helpful in moving forward - as if the vet couldn’t possibly HAVE an opinion without updated tests.

Wile said:

Did they give you a reason why the tests need to be redone? It could just be a case where they don't know much about how/when the tests were done.

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Oops - I didn’t reply directly to this - I haven’t figured out how to edit posts yet!

My cat had BAD stress induced cystitis when we had a puppy in our house. We started Hill’s Science Diet prescription CD Stress dry cat food 5-6 weeks ago pet vet recommendation and her issues were almost entirely cleared up in a week or two of starting it. Sooooo glad! Your post sounded like us up through a month ago before we found the food. We also did an ultrasound to rule out any other issues. Luckily our vet is very trustworthy and did not have that same issue as you are experiencing there. So happy (and NOT happy) there are others like us. I too have felt hopeless about this condition.

Regarding the vet wanting to retest everything: I know it is frustrating but I think that is probably normal. It is like that with many “what’s wrong/how do I fix it” industries. They don’t want to steer you in a direction that (for all they know) your previous vet wasn’t advising you appropriately or testing your cat properly, or maybe wants more recent tests. Our vet did my multiples of the same tests each time our cat Salem had a flare up with cystitis too and they were covering their bases.

Jess_and_Charlie said:

The receptionist was pretty rude. I suppose I can understand wanting to have an updated blood panel and urinalysis? Because things have definitely been fluctuating over the past couple of months. But she made it seem as if none of those tests would be helpful in moving forward - as if the vet couldn’t possibly HAVE an opinion without updated tests.

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Keep in mind that the receptionist is not the vet, so I would discount what she says unless it was just something that she relayed directly on behalf of the vet.

Updated blood/urinalysis could certainly be helpful depending on how recently the last ones were performed. Usually when my cat is treated for a UTI or cystitis flareup they will want to take another sample a few weeks after finishing his antibiotics to make sure everything is cured. The x-ray you mention is recent as of Monday so I can't imagine them feeling like they need to do another. Having the previous tests can let them know if things are improving or worsening, so they will almost certainly want to see them to figure out what has been done and hasn't worked in the past.

SalemSweetie2013 said:

My cat had BAD stress induced cystitis when we had a puppy in our house. We started Hill’s Science Diet prescription CD Stress dry cat food 5-6 weeks ago pet vet recommendation and her issues were almost entirely cleared up in a week or two of starting it. Sooooo glad! Your post sounded like us up through a month ago before we found the food. We also did an ultrasound to rule out any other issues. Luckily our vet is very trustworthy and did not have that same issue as you are experiencing there. So happy (and NOT happy) there are others like us. I too have felt hopeless about this condition.

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That’s so wonderful that the food has helped! Thanks for your response! It’s easy to feel very alone and like no one else understands.

Even though I don’t want Charlie to have chronic cystitis with no particular cause, I hope the ultrasound doesn’t reveal anything scarier. I’m keeping my fingers crossed - at least if it’s the cystitis, I can try changes in food, environment, etc.

I’m feeling a bit more relieved tonight because he pooped twice today (small but at least it’s something!) and I took a look at his urine today and it had no hint of pink! Hoping he can manage to feel okay until the ultrasound. I’ll do my best to help him.

Wile said:

Keep in mind that the receptionist is not the vet, so I would discount what she says unless it was just something that she relayed directly on behalf of the vet.

Updated blood/urinalysis could certainly be helpful depending on how recently the last ones were performed. Usually when my cat is treated for a UTI or cystitis flareup they will want to take another sample a few weeks after finishing his antibiotics to make sure everything is cured. The x-ray you mention is recent as of Monday so I can't imagine them feeling like they need to do another. Having the previous tests can let them know if things are improving or worsening, so they will almost certainly want to see them to figure out what has been done and hasn't worked in the past.

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Yes, the receptionist definitely hadn’t consulted the vet before giving me that information. I can’t imagine the vet wouldn’t be willing to just have a conversation with me, give me her take on things and talk about last experience with similar situations. That’s all I really want - the thoughts of a different vet.

He did have updated blood work in January, and many urinalysis tests done between then and now. I agree for sure that it would be important to have very recent results. The X-ray was to rule out constipation and everything looked fine, so I’d be a little annoyed if they wanted to redo that! Unrelatedly, I had never seen an X-ray of Charlie and it was pretty neat to see!

Good luck and I hope they don’t find anything either. But chronic cystitis is no walk in the park to deal with either unfortunately.... Our ultrasound cost $320 so I guess that cost is about right. Ask the ultrasound vet if they have samples of the Stress food if you want to try it. Our cat hated the wet food but eats the dry stuff just fine. We unfortunately had to give our puppy back to the rescue because we could t control our cats frequent urinating 100%. Now I am faced with a problem of: is there ANY dog out there we can have as a pet in the same home as our cat salem? Our kids are young now and that’s what we wanted. But our cat is only 5 yrs old so we have another 10+ years ahead of us with this. Sigh....

Jess_and_Charlie said:

He did have updated blood work in January, and many urinalysis tests done between then and now. I agree for sure that it would be important to have very recent results. The X-ray was to rule out constipation and everything looked fine, so I’d be a little annoyed if they wanted to redo that! Unrelatedly, I had never seen an X-ray of Charlie and it was pretty neat to see!

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Why don't you go ahead and request a copy of all Charlie's records to have for yourself. Then, when you go to a new vet take them with you. Something like recent x-rays should not have to be re-done, and if you have it with you when you see the new vet, they can look at it and probably would agree that no new x-ray would be needed. Maybe true for some of the other records as well - but, yeah probably not blood work and urinalysis/urine culture.

SalemSweetie2013 said:

Good luck and I hope they don’t find anything either. But chronic cystitis is no walk in the park to deal with either unfortunately.... Our ultrasound cost $320 so I guess that cost is about right. Ask the ultrasound vet if they have samples of the Stress food if you want to try it. Our cat hated the wet food but eats the dry stuff just fine. We unfortunately had to give our puppy back to the rescue because we could t control our cats frequent urinating 100%. Now I am faced with a problem of: is there ANY dog out there we can have as a pet in the same home as our cat salem? Our kids are young now and that’s what we wanted. But our cat is only 5 yrs old so we have another 10+ years ahead of us with this. Sigh....

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I’m so sorry to hear that. I sure hope you are able to find a pup who is the right fit!

Chronic cystitis definitely seems like it will be a frustrating and exhausting situation, if it ends up that that’s what Charlie has. Just the last 2 months have stressed me out so much, I can’t really imagine having it go on forever. I just hope it’s not a diagnosis that would require surgery, and I hope it’s nothing life-threatening.

No has mentioned anything yet to you about calming products that might help Charlie? If they did somewhere above and I missed it, sorry for repeating it.
There are tons of them on the market, just do an internet search on 'cat calming products'. One of them is Bach Rescue Remedy which are drops you can rub into a cat's ear. Some people use these to calm their cat before a vet visit. Not all of them work on all cats, so you might have to experiment with a few to find one that might work for Charlie.