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What is Painful Bladder Syndrome?

It is thought that in some cats, urine begins to irritate the inside of the bladder to the point that it becomes so inflamed that ulcers and other tissue damage forms. There is reason to believe that the central nervous system and the adrenal glands also play a part in the inflammatory response. In severe cases, the irritation may cause the muscles of the urethra to spasm, which can lead to swelling and blockage of the urinary tract. Reports of cats under ten years of age with painful bladder syndrome are more common, and indoor cats seem to be most susceptible. Often the syndrome will become cyclical and return more frequently after each flare-up. 

Cats are prone to developing a chronic and painful inflammation of the bladder. This inflammation is not paired with any type of infection, nor is an obvious cause of urinary tract issues present. While this circumstance is commonly referred to as painful bladder syndrome (PBS), it may also be called feline idiopathic chronic cystitis, feline lower urinary tract disease (FLUTD), feline interstitial cystitis or feline urologic syndrome (FUS). Both the bladder and the urethra may be affected by this syndrome. 

Symptoms of Painful Bladder Syndrome in Cats

The same symptoms tend to be seen in all affected cats. Cats suffering from painful bladder syndrome are often suffering from other inflammatory issues of the skin, gastrointestinal tract or the respiratory system. Symptoms to watch for include:

  • Stranguria (difficulty urinating)
  • Pollakiuria (frequent urination of small amounts)
  • Blood in the urine
  • Urinating in unusual places
  • Crying while urinating
  • Excessive grooming of the genital area

Causes of Painful Bladder Syndrome in Cats

As of yet, painful bladder syndrome has no single, identifiable cause. It is thought that a combination of scenarios and conditions lead to the issue. The syndrome seems to occur more often in indoor cats who only eat dry food. Possible causes include:

  • Defective bladder lining
  • Obesity
  • Mild dehydration
  • Inappropriate diet
  • Abnormal stress response
  • Hormonal imbalances
  • Inflammation of the nervous system

Diagnosis of Painful Bladder Syndrome in Cats

Diagnosing a cat with painful bladder syndrome involves an eliminatory process to rule out all other possibilities. It is necessary to provide your veterinarian with the cat’s full medical history to assist in the process. The vet will perform a complete physical examination of the cat which may involve abdominal palpation to test for tenderness and identify thick bladder walls or unusually small bladder size. You will be asked about your cat’s diet and elimination patterns. 

There is no test that confirms painful bladder syndrome. All tests will be run to see if any other issue is present, and if all tests return negative, a diagnosis of PBS may be made. Urinalysis may reveal microscopic amounts of blood in the urine, along with small struvite and calcium oxalate crystals. The pH of the urine will most likely be quite high. A bacterial culture should be performed on the urine to rule out any organism presence that would cause irritation or infection. X-rays and ultrasounds may be needed to confirm that no abnormalities or growths are found on the bladder, urethra, or surrounding areas.

Treatment of Painful Bladder Syndrome in Cats

At first, the only treatment may be to alleviate painful symptoms. Most other treatments involve lifestyle changes for the cat, to reduce any possible triggers of inflammation. Mild dehydration seems to exacerbate the problem, so proper fluid intake should be monitored.

Increase Water 

In general, cats have a low thirst drive due to centuries of gaining most of their water from fresh meat consumption. This tendency can aggravate a PBS flare up. Providing your cat with fresh water multiple times a day can help to decrease inflammation. Investing in a fountain water dish has proven very effective in a lot of cases.

Diet Changes 

To increase hydration, it may be best to switch your cat from dry to wet food. Ensure that the quality and ingredients of the food are species appropriate.

Identify Allergies 

An allergic response can trigger PBS. Eliminating foods commonly associated with allergies in cats can help the flare ups from occurring. This often means switching the protein source of the cat’s diet for a minimum of three months.


Certain supplements have been known to reduce inflammation internally. Glucosamine or injectable Adequan may be used on an ongoing basis to help prevent flare-ups. 


As a last resort, medication may be prescribed if the cat is not responding to other treatments, or if symptoms are too severe for the cat to function. Antidepressants or GAG replacers may be prescribed. Adverse side effects are common with these medications and should be watched for.

Recovery of Painful Bladder Syndrome in Cats

Follow any new diet guidelines as set out by your veterinarian. Focus on anti-inflammatory foods and avoid all “filler” foods. Provide fresh water for your cat in multiple locations around the home to encourage drinking. Place a minimum of one litter box per cat around the home, and clean them daily. It is best to keep a low-stress environment for the cat to prevent an abnormal stress response from triggering a flare up of PBS. If conflict is arising between two cats, it may be best to look for new living arrangements for one of the felines. 

Positive stimulation and exercise have proven to be very effective at eliminating painful bladder syndrome flare ups. Play with your cat on a daily basis. Provide cat toys and scratch posts to prevent boredom in your cat. Make sure the cat has ample space to explore. If you have an indoor-only cat, it may be best to build an enclosed outdoor area that the cat can access. Spontaneous improvement can happen in cats who suffer from PBS. The aging process seems to affect the syndrome positively, with less cats showing symptoms as they age.

Painful Bladder Syndrome Questions and Advice from Veterinary Professionals

Domestic long hair, I'm not really sure of breed
3 Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

Bloody Urine
Bloody Urine muscle spasams in bladder

Pls I need help with my 3 year old male fixed and we rescued bout a year ago this whole year he's been on natural balance salmon mix...and just a week ago was showing symptoms of what I thought was bladder crystals cus the next day he started peeing a couple days later a pee supsided and he was peeing more we took him to the vet and they had a cathitar hooked up over night all they found was blood and no crystals...all the vet told me was they seen that he was having bad muscle spasams in his now there saying he might be on meds for the rest of his life for this pls help! And there is no indication of infection or bacterial disease and idek what this is apparently they also didn't check his ph balance of pee ugh

Dr. Callum Turner, DVM
Dr. Callum Turner, DVM
3320 Recommendations
Without examining Kuro myself, it is difficult to say what the underlying cause of this issue is; bladder sphincter disorders, transitional cell carcinoma, neurological conditions among other causes may lead to problems. You should see how he responds to the treatment prescribed and return to your Veterinarian if there is no improvement and have and x-ray or ultrasound performed. Regards Dr Callum Turner DVM

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Polydactyl Black mid length fur
20 Years
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

hungry, thirsty, diarrhea, blood

My male cat just turned 20yrs old, neutered. More than a year ago he was diagnosed with congestive heart failure, due to constant sneezing & rattle in his chest & has been taking Enacard & Furosemide twice daily. January 27, 2018 I found 2 ticks on him & he seemed congested with green snot from his nose, they put him on Doxycycline, causing severe diarrhea I did not finished the round of medication. In March, blood in the urine showed up, April 10, 2018 they put him on Orbax. 5 Days into it the blood disappeared. 2 nights ago was the final dose & dark blood in the urine this morning. The diarrhea has never gone away & is still a melted chocolate mess. I’m beginning to think that he should’ve never been put on any of these meds, I’m not even convinced that he has a heart problem. Twice since January they’ve run blood work & tell me that he’s healthy, just has old age. Eats mainly canned food with some dry food, same brand all his life. Drinks lots of water, probably due to the Furosemide & urinates frequently. Sometimes he pees over the edge, we use piddle pads around the boxes for the accidents, that’s how I know the urine has blood in it. No other cats in the house are sick, including his sister from the same litter.

Dr. Michele King, DVM
Dr. Michele King, DVM
1611 Recommendations
Without seeing Ricky and having more information about his general health and lab work, I have a hard time commenting on his diagnoses, but things do start to happen as cats age. Since you are not sure of his diagnoses, and he is having this diarrhea and bloody urine, it might be a good idea to seek a second opinion. Your veterinarian sounds like they are doing a good job managing these conditions, but if you are not sure, a second opinion never hurts. He may need an ultrasound to evaluate his bladder since the blood has not resolved, which is another option.

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