If young adult or mature cats are presented with lower urinary tract signs, such as pollakiuria, hematuria, or periuria, feline idiopathic cystitis (FIC) is the most likely differential.⁷⁹ Although this is currently a diagnosis of exclusion, this disease can be exacerbated by a variety of stressors perceived by the cat. Notably, there is evidence that complex interactions exist between “susceptible” cats and “provocative” environments in the development of chronic lower urinary tract signs.⁶⁰ A study evaluating multimodal environmental modification suggested that this form of therapy can be beneficial for helping manage cats with FIC.⁸⁰ Affected cats were followed for 10 months, primarily by phone contact, and significant (P < 0.05) reductions in lower urinary tract signs were noted.

Although urine-marking behavior and FIC are different conditions, the environmental management of both of these elimination problems is similar. Tailoring an environment that is optimal for the indoor cat to reduce urinemarking could also help prevent the onset or reduce the severity of FIC.⁸¹ Not all cats will require intense multimodal environmental modification therapy, giving practitioners scope to adapt environmental change recommendations based on the cat’s needs and owner’s desire and commitment to this process.