Treatments for sterile cystitis include:
pain medication
increasing water consumption with a canned food diet, etc.
decrease the patient's stress - not always easy since cats can be very 'silent' in their stress and we may not always be aware of what is bothering them
glucosamine/chondroitin sulfate/hyaluronic acid products such as injectable Adequan, or oral products such as Cosequin, Dasequin, or Trixsyn may help but studies have not supported them as being beneficial. That said, they don't seem to have any downsides and may be worth a try.
Tricks used to increase water consumption:
water fountain
flavored waters such as tuna water, chicken or beef broth, clam juice, lactose-free cat milk (CatSip), etc. - can be kept in covered (to prolong fresh smell and taste) ice cube trays
add plain water to canned food - ~1 TBS per meal - or whatever amount your cat likes
You can make your own tuna water by taking a can of tuna and adding 3 cups of water. Break up the tuna and let it sit for awhile (~15 minutes, give or take) and then pour the tuna water into covered ice cube trays.
3 cups of water fills two 16-cube trays.
After warming the flavored ice cubes to 'mouse body' temperature you can:
add to canned food
set out as a separate drink of water
Subcutaneous fluids may also need to be administered at home by the owner in order to increase urine flow. However, this can be stressful and is usually reserved only for severe cystitis cases involving dry food addicts that are on their way to transitioning to canned food.
To repeat a very important point: Bladder infections are not a common cause of cystitis. Sadly, the rampant abuse of antibiotics when addressing feline urinary tract issues in cats shows that this fact is being ignored. The most important 'treatments' are increasing water consumption and lowering stress.
Cats, unlike other species including humans, have a natural defense mechanism in which they produce a more highly concentrated urine. (USG >1.040) Few self-respecting bacteria want to float around in concentrated cat urine.
Before considering the use of antibiotics in cystitis patients, a culture and sensitivity (C & S), in addition to a standard urinalysis, should be run on urine obtained via cystocentesis. This involves a needle going through the abdominal wall, directly into the bladder. This sounds much worse than it really is. The patient does not feel the needle going in but, instead, may simply object to being held on his or her back.
'Free-catch' urine samples (urine voided onto an exam table or into a litter box) should not be used for a C & S due to the issue of contamination which will often give a false positive result. In other words, bacteria will grow on the culture that may not even be in the patient's bladder or kidney.
The 'culture' part of this test shows if an infection exists or not. The 'sensitivity' part of the test is run only if a bacterial colony grows. This half of the test tells us which antibiotic is the best one to choose for the type of bacteria that was grown.
One difficulty that we run into when trying to get a 'clean' sample (via cystocentesis) from a cystitis patient is that most of these patients present with an empty bladder. Or, they void all of their urine once the veterinarian starts to palpate (feel) the bladder through the abdominal wall.
To get around this, the patient can be given a dose of pain medication and a dose of subcutaneous fluids and placed in a cage without a litter box for 1-3 hours. This should result in the patient's bladder filling up enough to obtain a sample for a urinalysis and a C & S.
A note about cost: Many veterinarians do not run a C & S on their cystitis patients because they are worried about running up a client's bill. However, I cannot stress strongly enough that this is often a 'pay me now or pay me later' issue.
I have seen countless cases where both the veterinarian and the client are 'chasing their tail' by pouring needless antibiotics into their sterile cystitis patients. This not only results in added expense and stress for the client, but please also consider the added stress to the patient's mind and body and the significant potential for promoting bacterial resistance. Most cats are not happy about taking medications and all medications have negative side-effects.
This "tail chasing" often results in far more cost to the client than would have been incurred if a C & S would have been run when the patient first presented with clinical signs.
