Approximately 1.5% of cats presented to veterinarians show lower urinary tract signs (LUTS), including hematuria, dysuria, pollakiuria, and inappropriate urination. A number of reports have found no identifiable cause for most cases. Some cats seem to be especially sensitive to their surroundings, and the indoor environment for some house cats may be stressful. Modifying the environment may be beneficial. In this study, the authors evaluated use of multimodal environmental modification (MEMO) in cats with LUTS. MEMO was defined as changing a cat's environment in an attempt to reduce LUTS by reducing activation of the stress response system. Detailed environmental histories were taken from 46 client-owned, indoor cats with idiopathic cystitis. The diagnosis of idiopathic cystitis was based on a history of recurrent LUTS in cats without urolithiasis or bacterial urinary tract infection. A MEMO plan was then developed with the objectives of empowering clients to understand how their efforts would contribute to the cat's recovery and remission of LUTS, helping the client manage the cat's environment, and helping reduce the cat's perception of environmental threat. From the suggestions made for reducing stressors, clients were encouraged to identify the changes they felt to be most relevant, and to make the changes sequentially and slowly to give the cat time to adapt. Follow-up was done every month for an average of 10 months. Aside from initial client education, the MEMO recommendations followed most commonly were reading additional client education materials provided, increasing time spent interacting with the cat, changing to a canned diet, and adding another litter box. During the time of follow-up, no signs of LUTS were observed in 70% to 75% of the cats and clients reported significant reductions in fearfulness, nervousness, and upper respiratory signs, as well as trends toward reduced aggression and lower intestinal tract signs. The authors concluded that this modification system shows promise as an adjunctive therapy for indoor cats with LUTS and that further prospective, controlled clinical trials are indicated.

COMMENTARY: Managing cats with LUTS is frustrating, and many cats are surrendered or euthanized because of this problem. The cats described here had received prior therapy, including combinations of individual environmental changes and medications, before being referred for this study. Previous studies have indicated that cats with interstitial cystitis (a subset of those with idiopathic cystitis) seem to have more active stress response systems and decreased adrenocortical function in response to stress. Other studies have documented improvement in animal health with environmental enrichment. The improvement in LUTS as well as other organ system signs after MEMO, as seen here, seems to support the possibility that stress reduction can play a role in treatment of some chronic disorders. One resource the authors referred clients to in this study,, provides a wealth of information for anyone interested in learning more about the authors' views on interstitial cystitis and stress in cats.

Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis. Buffington CAT, Westropp JL, Chew DJ, Bolus RR. J Feline Med Surg 8:261-268, 2006.