Urinary tract disease is one of the most frustrating conditions to diagnose and treat in cats. It’s not always possible to identify the exact cause, since most of the affected cats have more than just one single problem.

The history of feline urinary tract disease

Urinary tract issues used to be lumped together under the term FLUTD (Feline Lower Urinary Tract Disease) or FIC (Feline Idiopathic Cystitis, “idiopathic” meaning that the cause is not known.) In the 1990’s, veterinarians began to make a connection between feline urinary tract problems and interstitial cystitis in women, a chronic condition in which affected women experience increased urge to urinate and bladder pain, ranging from mild to severe.

Finally, in 2011, a study conducted at the Ohio State University on 32 cats over a three year period found that stress had a significant impact on lower urinary tract health. Dr. Tony Buffington, a professor at Ohio State University’s College of Veterinary Medicine and leader of the study, coined the term Pandora Syndrome. Usually, diseases are named after the cause, and he felt that in this case, it was important to get away from assuming that this particular condition is all about the bladder.

Urinary tract disease is seen in male and female cats. Cats who are fed a dry diet, are overweight, get little exercise and experience stress are more prone to this condition. In male cats, urinary tract disease can lead to a complete blockage of the urinary tract, which is a life-threatening emergency that requires immediate treatment.

The stress connection

The vast majority of cats who present with Pandora Syndrome have concurrent problems ranging from behavior issues and stress to heart disease and vomiting. The condition may come and go, and may sometimes be triggered by a stressful event in the cat’s life, such as the addition of a new cat to the family, home remodeling or a move.

Cats who present with this problem tend to be more fearful and nervous. They have a higher startle response than normal cats, even in a normal environment. Veterinarians now believe that these cats may be wired differently than other cats and that the issue may actually be caused by abnormal sensory neuron function.

Some of the affected cats may have concurrent mild adrenal insufficiency and a lower cortisol response, which means that they can’t mount a balanced response to stress and are slower to recover from stressful events. There may be a genetic component as well.

Diagnosis of Pandora Syndrome

Since there is no one single cause of Pandora Syndrome, diagnosis can be frustrating. Your vet will perform a thorough physical exam, urinalysis and bloodwork. The vast majority of cats only show blood in their urine. They will not show urinary crystals, which would indicate the presence of bladder stones, or have elevated white blood cell counts, which would indicate infection. ” ‘Definitely maybe’ may be the closest you’ll come to diagnosing Pandora Syndrome,” says Dr. Elizabeth Colleran, a feline veterinarian and owner of two cat hospitals.

Treatment of Pandora Syndrome

The goal of treatment is to reduce stress and provide pain relief as needed. Your vet will treat acute flare ups with medication tailored to your cat’s specific condition. This may include pain medication, anti-spasmodic medication to help the bladder relax, and anti-inflammatory medication.

Stress Reduction and Environmental Enrichment

In chronic cases, environmental enrichment will be an important part of the solution. Ensure that there are enough litter boxes, and that they are kept scrupulously clean. Reduce territorial aggression in multi-cat households by providing plenty of vertical space in the form of cat trees and shelves, and hiding places in the form of cat cubes, tunnels and covered beds. It’s also important that cat guardians reduce their own stress levels as human stress can actually make cats sick.

Spending more time with affected cats can also help lower their stress level. Petting, grooming and interactive play session will all contribute to enhancing the cat’s well-being. “These cats respond to soft voices and praise,” says Dr. Colleran.

Consistency in the cat’s routine is important. The Ohio State study found that cats even reacted to small changes such as a change in caretakers with flare ups. Cat parents who are planning major changes in the household, such as remodeling, moving, or the addition of a new human or feline family member, should be aware that the added stress will often cause flare ups.

Calming remedies

Holistic remedies such as Spirit Essences Stress Stopper can make a big difference for these cats. Feliway Plug-in Diffusers can also help. Some cats respond well to calming treats. Energy therapies such as Reiki may be beneficial to reduce the cat’s overall stress response.

43 Comments on Does Your Cat Have Pandora Syndrome?

  1. This condition is what my friend’s cat had. He would squat and pee randomly throughout the house, though she had a litter box in each room for him. She initially thought he was retaliating for not getting his way. But when he has a UTI, I told her about Cantharis, a homeopathic remedy for UTIs. She gave him 1 Cantharis 30c from Boiron, daily and he never peed outside of the litter box from that day forth. He was only a year old when this started. Also, another friend, in animal rescue, shared with me the benefit of apple cider vinegar (ACV) to dissolve bladder crystals.

  2. Yes, my vet told me Cosequin strengthens the bladder. I was never told it stops crystals. The glucosamine should be paired with chondroitin for absorption. Cosequin has both.

    • Very interesting. Must be the chondroitin, being a substance that occurs in the connective tissue of people and animals, that does the job. I learned something! Thanks.

  3. My vet recommended distilled water only. She has had a cat Hosp for over 40 years. I have complete confidence in her. She says he gets the nutrition he needs from his food. I believe avoiding all the minerals in spring water is to avoid the formation of crystals in my cat, which cause blockage to urination. Thankfully, my cat has had no more flare ups and is very healthy and happy :).

      • Thanks Gloria!! Best to yours, too :). Of course, I’m not sure exactly why his flare ups stopped. I think the Cosequin is important. I used to stop it now & then, and sure enough, 3 days without it, a flare up would start! The vet says he’s in remission. It’s possible they could start again. But, so far, so good!! 🙂

        • Well, my goodness! I never heard of Cosequin being useful in stopping urinary crystals. Please tell me how you came across that info. Did your vet recommend it? Thanks.

          • Glucosamine is thought to help protect the bladder’s lining. I’m not aware of any studies that prove that it actually does that, but many veterinarians have found it helpful for cats with urinary issues.

  4. I commented over a year ago regarding my 4 year old having Pandora’s Syndrome. He was a rescue at 6months (or so) from outside. He was starving and traumatized from mean people I had witnessed him encounter. To make a long story short, his flare ups seem to have stopped. No incidences for over a year!! I renew his Rxs as they expire, just to have them on hand in case of recurrence. It’s as if he made a decision that he is safe now. He is more friendly and purrs often. I swear by the gabapentin, Prazosin, Cosequin & Rx food ( which is his food main stay). A peaceful, loving and gentle play environment including places for privacy and climbing helped him a lot. He loves his 2 clean litter boxes. He hates fireworks though! That’s when the gabapentin still helps him :). There is hope!! Don’t give up!!

      • Why only distilled water? Did the vet recommend it? it is lacking in essential minerals and is sometimes called “hungry water” because it is lacking. I give my cat spring water. It is more natural and closer to what he would have access to if he were living in the wild.

  5. Great Posts!! I have a Kitty, now 8yo, that had what was dx’d as Feline Interstitial Cystitis! Horrible disorder
    but she just would not pee! I think because it “hurt!” She would just “hold it!” Took her to several Vets, that all tried to treat w/abx’s, for no reason, and finally to Holistic Vet, & Voila, SUCCESS!! Accupuncture did it! 1st time. She loved it, totally relaxed, and pee’d a TON the minute we got home! What Angels we have with our wonderful Holistic Vets. She also put her on some “drops” orally, no bad taste, to take 2-3 times/day. Everything just disappeared…she was cured! On rare occasion if she was stressed about seeing a cat outside, I would take her back in for Accupuncture, with instant results! It’s a miracle!!! I love it myself as well. Halle has been symptom free for 4 years now without accu. or drops!!
    I always feed her Canned Wellness Grain Free Turkey or Duck or at times a good raw diet! Good luck…it can be handled!!!! The drops were an Herbal mix with out a noxious taste, which she readily took an eyedropper 1/2 full b4 meals
    It all was just miraculous, and soooo simple.

  6. My little cat had chronic urinary issues before she passed away… Wow it’s been 18 months since I lost her.

  7. I think Miss Gracie has this condition – she is a very nervous girl, and definitely marches to the beat of her own band! We recently had our kitchen renovated and I have to admit I was expecting to have to factor in a trip to the vet at some point for treatment for her. Touch wood, she got through the renovations like a little trooper. I am an anxious person myself, so I will have to try and remember that my anxiety can also affect her. Great article, Ingrid. Thanks!

  8. I have a foster cat that has been diagnosed with this. It is very frustrating because how can I get a cat adopted that has a bathroom issue and could be expensive in the future? I already have 10 cats of my own but adopting him isn’t really an option as I believe he needs a quiet home. I have tried the Sentry Calming collar and it does work wonders. I also feed him wet foot daily much to the dismay of the other cats. However, for some reason, lately a couple of my resident cats have started picking on him…ugh!!! I don’t know what else to do.

    • Some vets and shelters have been given donations to cover the cost of meds for low income or foster cats. Donations may be in the form of unopened meds that a past patient didn’t use (got well or died or a different med worked better) or cash. I have donated many meds back to my vet for just that, to help others who can’t afford meds.

    • I have been successfully managing my kitty’s Pandora Syndrome for 2years. I give him Gabapentin for calming and for the pain that accompanies cystitis. For acute cystitis flare ups he also gets an antispasmodic drug (Prazosin). Always wet Rx stress/urinary chicken & Veggie stew ( no fish ever!) He also gets Rx dry urinary food. Both wet & dry Rx food triggers more water consumption & prevents crystals. I agree that your kitty should be mercifully rehomed away from other cats. I had to rehome his sister to solve his problem. It broke my heart, but now we all live in healthy & usually calm peace. The only time meds are used are to prevent a flare up during stressful noise or strange people in the environment, vet visits or travel. A compassionate vet won’t make you rush to their Hosp for each flare up ; better to dose at home with oral syringe. A couple hours after the Prazosin, the trips to the litter box subside. My cat never pees outside the box anymore. Always be cautious that male cat isn’t obstructed. If cat can’t pee at all, call vet immediately. Stress relief is SO important. Find a quiet loving home with means to buy Rx’s. It is possible. Don’t give up 🙂

  9. Our Pirate lost an eye as a kitten and has been skiddish ever since. We never had behavioral problems, though, until our pipes burst in our home in 2012. With contractors banging around in and around the house, he and our other furbabies were quarantined to the guest bedroom, where they managed to re-open a temporary crawlspace into the attic. He had peed outside the litterbox in the room and trying to catch him and the others to relocate them was terrifying, I’m sure.

    Since then, we have had nothing but trouble. He has marked every doorway leading into and out of the house, as well as anything leading into a different room, and each of the windows he has access to.

    We tried the amitriptyline gel on the ears, because pilling him is not a realistic option.

    However, over the last six months, we have noticed red-tinged urine in these areas. He has chronic cystitis. And, last week, he completely blocked. We nearly lost him. As a matter of fact, had he not tried to come out to eat for the evening meal, I am certain we would have.

    Now, we must pill him. And I can tell you it is not pleasant for any of us. He is on prazosin and amitriptyline. We will start the injections soon to help combat the chronic inflammation.

    We were about to start a homemade cat food trial with our babies because the food we had been feeding them had been discontinued. But now we must use the FLUTD prescription foods which are outrageously expensive. And we are switching all of our babies to it, because feeding only one this diet would be impossible.

    As it is now, we will just have to cut the human costs and focus on our furbabies. We don’t want another episode of this. ever.

    Feliway and calming collars did not help, but I am hopeful Jackson Galaxy’s Spirit Essences will.

    We have put up a GoFundMe page to help deal with the unexpected costs of the ER and hospital stay. My husband lost his job in April and I am disabled. Our kids are grown and gone, so our rescues are our babies. If you see it, the Save Pirate the Cat! page, any assistance will be greatly appreciated.

    • I’m so sorry about Pirate and everything you’re going through, Donna. As for the diet, I know budget is a consideration, but you may want to consider consulting with a holistic veterinarian on formulating a homemade diet specifically formulated to help with and prevent future urinary tract issues. It may be less expensive in the long run, and in terms of ingredients, it will be a better nutritional choice than the “prescription” diet.

  10. My cat is a classic scaredy cat and had chronic FLUTD episodes where he would pee 20 times in one day. I changed to grain free canned food and i add water to it to increase his fluid intake. It has helped significantly.

  11. We have a kitty with this diagnosis. She’s on amitriptyline for anxiety, which helps greatly. Without the medication, her symptoms present like feline hyperesthesia, another illness that is essentially diagnosed via process of elimination. We use Feliway and Jackson Galaxy’s Spirit Essences, but they aren’t quite enough. After her last bout, our vet suggested she take glucosamine daily, and it works wonders. For anyone with a cat with FLUTD, I’d recommend trying glucosamine. There are chewable treats that are easy to administer.

    • Glucosamine helps protect the bladder’s lining. Even though studies about its effects are inconclusive, I’ve heard a lot of anecdotal evidence such as yours that it does help.

        • Hi Olivia, I’m wondering how the surgery went? Did your kitty do ok? Recovery? Etc. I have a rescue cat that must have this syndrome and is in a 24 hour clinic today due to a blockage. This is his second blockage and the last one he needed a catheter for days for it to pass and several beginnings of a episode of the blockage since that we were able to get him thru with medicine (prazazoin and buprenorphine),

          Wondering if surgery is the way to prevent him from getting into a condition that seems to repeat for him.

          Thanks for any info.

        • My cat had constant peeing problems that required many expensive trips to the vets until i bought an electric water fountain. This encouraged her to drink more…since then she is ‘cured” and hasn’t had any bladder trouble since!

  12. My cat was diagnosed with cystitis. Sounds more like Pandora syndrome. She’s been on Paxil for awhile now, and I’m feeding her more wet, grain-free food. She’s doing quite well, but is still a bit of a jumpy cat.

  13. Intriguing article. The Pandora of this disease can also extend to the problem that not all pet parents are willing to seek treatment for these special cases. Working in a shelter I have seen many felines abandoned due to the fact that peeing other than in the box is not acceptable and some don’t even consider treatment. I appauld the pet owner that adopts a feline with really any issue. It takes resources, not only medical but also a commitment to work with the feline. I have a cat who from time to time will over shoot the litter box. He has been checked out by our vet and has been given a clean bill of health. Curiously, I believe from reading this article that perhaps stress is playing a factor in his behaviour. Benny, Dr. Benny, as we have renamed him due to his role in being a therapy cat to our unwell feline perhaps is feeling stressed when his patient is not having a good day. I will treat Dr. Benny with some Rescue Remedy in light of this. Thank you Ingrid. A guardian angel to felines everywhere.

    • Aww, thanks, Robyn! You are absolutely right that sadly, cats do end up in shelters because not everyone is willing to hang in there and get the problem figured out and treated. It sounds like Dr. Benny (I love it!) is a very sensitive soul, and I wouldn’t be surprised at all if he reacted to what his “patients” are dealing with.

      • Dr. Benny was a feral stray in my neighbourhood. Even though I have a full house there’s always room for one more. Goes to show you there’s potential in every cat. Dr. Benny will get extra care now that I know what’s bothering him.

  14. The title of your article intrigued me today, but I didn’t realize it had to do with urinary tract issues – something both my cats have. This is very interesting. I know that stress can aggravate urinary conditions, and Sentry calming collars have worked well for us. The Feliway diffusers have also done well for us in the past.

    Thank you for sharing this!

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