Published by: Ingrid King. Last Updated on: October 31, 2022 by Crystal Uys

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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.

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