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As the question says, we have a 10 year old cat (spayed) about 4kg who seems prone to cystitis. This is her second occurrence we know of. Last time was about 3 months ago and we might not have recognised precious bouts if any.

We caught it early, it started yesterday and she was in and out of her litter tray many times. So the vet says it could be an infection, but there's no thickening he can feel (I think he said that!) and he thinks it probably isn't due to infection. He says it is more likely to be from stress or (irritating) crystals.

We think he is probably right. She didn't have an easy time for most of her life, and was essentially a rescue some years ago. She can be friendly and plays at times, but has never shaken off suspicion and defensiveness against humans, and "rowls" and hisses, and readily claws and bites at times, if annoyed or disturbed. (She does understand moderation, she paw bats, stares, flees or rolls over as well, so it's not like she is completely feral, and does at times come up to us for attention, if we are sleeping or she wants something).

We're used to this and understand it's her way, but the upshot is that it's rare for a day to pass without her showing signs of experiencing a lot of stress.

She doesn't seem to have ever really developed more than tentative and very fragile trust, or any usual degree of stress coping mechanisms, so although it's been a stable home for years, ordinary things stress her which wouldn't stress other cats: the door is shut, food is late, people make noise, people exist, people aren't playing with string for her when she wants it, a comb of any kind is nearby (she's long hair and needs daily combing to avoid hairballs), humans might be going to grab her for unknown reasons when treats are on offer, then chair she's on or place she's lying is needed by humans, and a hundred other things.

We live in a quiet apartment without children and without ,amy raised voices, and no other cats are around. She has a lot of leeway to "live and let live", but she feels stress at a lot of things, so the vet's suggestion that it could well be stress related makes a lot of sense. We do try to give her a stable routine and "safe" places, but that only goes so far.

We have used a "Feliway" calming plugin for a long time. Her usual routine for meals is a bowl of hard granules she can eat any time, chunks in jelly from a sachet twice daily, and if hungry a sachet of cat soup at lunchtime. We time her meals to ensure she isn't left hungry later on. Her appetite is good and she often asks for meals before it's time. The chunks and soup meals go fairly quickly after they are put out. Occasional treats (a few daily) include hairball and bladder treats, cat milk, and dried or fresh fish. She has fresh water out always, and a bowl of an appropriate kind of grass which she sometimes nibbles.

The first time she had cystitis the vet used antibiotic injection, metacam (a NSAID), and encouraged a much more liquid diet to dilute her urine. We stopped feeding her granules, added milk to her chunks and gave her soup daily. This time he has said the same but added "Cystaid Plus", a product said to help the bladder resist caustic urine and crystals and help manage the condition and reduce the incidence/discomfort. He says that anti-anxiety meds are available but would very much be a last resort. She doesn't need them right how and may not need them in future.

My question is, is there anything else we can do to help her, if this is a chronic condition and will recur? Is there anything that we can do either to improve things for her, or reduce her stress further, and reduce future vet visits or upset for her?

Helping would include anything that might cut down future incidents - even cutting it to once or twice a year if it's going to be regular, would help a lot.

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It sounds like your vet has recommended all the major treatments for this frustrating condition.

Diet

One thing you did not mention in detail is diet. This is a cat I would put on a prescription urinary diet. Hill's c/d is a good choice, as well as Purina ProPlan UR or Royal Canin Urinary SO. These urinary diets are formulated to keep the urine pH low to prevent crystals and bacterial infections, and contain low levels of crystallogenic substances such as magnesium and phosphate. Veterinary diets are more expensive but in the long run you might be able save money by preventing additional vet bills if you can prevent boughts of cystitis.

There are also excellent combination diets now. For example, Hill's c/d Stress and Royal Canin Urinary + Calm. The Royal Canin combination product is very popular, and contains tryptophan and hydrolysed milk protein which can help to manage stress in addition to the urinary benefits.

Water

As your vet says, increasing water intake by upping the amount of wet food fed can be helpful. This helps keep the urine more dilute. Also provide plenty of water sources throughout the house. Some cats like water fountains and it encourages them to drink more, others hate them.

Glucosamine

It sounds like she may already be getting glucosamine supplements. Apart from managing joint disease, glucosamine can help to protect and fortify the bladder lining.

Anti-anxiety products/medications

There are many products out to help with feline stress – Feliway you mentioned, also Zylkene, Solliquin, etc. Though I prefer to avoid it, in some cases when cats have severe anxiety and resulting cystitis, then I have to turn to antidepressants such as fluoxetine (Prozac) or clomipramine (Clomicalm). These drugs are not without side effects so the pros/cons of starting them has to be considered.

Other pets

You mention no other cats, but make sure there are not other cats roaming outside the windows that are causing her stress. Obviously, any dogs in or near the house can be a source of stress in these cats as well.

Making the house cat-friendly

Last thing is to do everything you can to alleviate stress in the house. This means putting your cat's food and water in a quiet private corner. Include multiple (at least 3) litter boxes in quiet locations throughout the house. Allow plenty of hiding places and beds where she might sleep without being disturbed. Cats like vertical space more than horizontal space; that is, they like to climb and view from a height. She may feel more relaxed if you can put up high shelves around your house for her to climb up and observe from a safe height.

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