Pandora syndrome: Rethinking our approach to idiopathic cystitis in cats - Veterinary Medicine
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Pandora syndrome: Rethinking our approach to idiopathic cystitis in cats
Cats with idiopathic cystitis often have multisystemic comorbidities, so look outside the urinary tract—as well as in the cat's environment—for diagnostic and therapeutic answers.



A novel aspect of environmental enrichment that has become available is the application of pheromones to the living space. Pheromones are chemical substances that transmit highly specific information between animals of the same species. Although the exact mechanism of action is unknown, pheromones appear to effect changes in the function of both the limbic system and the hypothalamus to alter the emotional status of the animals.

Feliway (Ceva Animal Health), a synthetic analogue of naturally occurring feline facial pheromone and valerian, was developed to decrease anxiety-related behaviors in cats. Use of this product has been reported to reduce the amount of anxiety experienced by cats in unfamiliar circumstances, a response that may be helpful to these patients and their owners. Decreased spraying in multicat households, decreased marking, and a significant decrease in scratching behavior have also been reported subsequent to its use.18 Pheromones are not a panacea for unwanted cat behaviors, however, and were found to be no better than placebo in one study.19 Their effectiveness may be improved by combining them with environmental enrichment or drug therapies, but, to date, the clinical effectiveness of these combinations has not been thoroughly investigated.


One of the critical keys to any successful therapy program is to follow the patient's progress. I tell clients what our follow-up schedule is and ask them to agree to a preferred method and time to be contacted. Our first contact with the client occurs by telephone within a week after initial recommendations are made, followed by repeat check-ins at three to six weeks, three months, six months, and a year in uncomplicated cases that need less follow-up. (Referral may be necessary for more complicated cases.) This schedule allows technicians (under veterinary supervision) to monitor the patient's progress, make adjustments as needed, and continue to support and motivate the client. It also helps us determine when an owner is becoming frustrated or is having problems with the plan, and we can then offer encouragement or suggestions.

Technicians are an important part of the team in the process of empowering clients to make changes and implement new enrichment strategies deemed likely to be most helpful if they are provided enough support and guidance. Veterinarians alone may not be able to cost effectively provide the time and energy for these efforts on their own, but may be able to provide effective training and supervision of motivated technicians.


Many indoor-housed cats appear to survive perfectly well by accommodating to less than perfect surroundings. However, the neuroendocrine-immune abnormalities of some cats do not seem to permit the adaptive capacity to stress that healthy cats enjoy, so these cats may be considered a separate population with greater needs, as they have a greater risk of developing disease in response to stress. (See Tiger's tale: A successful outcome in a cat with Pandora syndrome.) Moreover, I believe that we as veterinarians are concerned more with optimizing the environments of indoor cats than with identifying minimum requirements for indoor survival. My approach is to let clients choose the most appropriate intervention for their particular situation and to let trained technicians do the enrichment implementation and follow-up.

Finally, the question of the relative merits of indoor housing to promote the welfare of cats—and the different opinions on what constitutes animal welfare in general—is beyond the scope of this article and is a subject of controversy among experts. I hope to encourage extension of the welfare efforts of individuals working in zoos—who have recognized the effects of housing quality on the health of animals in their care and have worked to enrich the environments of these animals—to all captive animals in our care. I think that idiopathic cystitis and a variety of related disorders are better prevented than treated and that we have a great opportunity to encourage this husbandry approach in veterinary clinical practice. Further information about environmental enrichment for indoor-housed cats is available at

C.A. Tony Buffington, DVM, PhD, DACVN
Department of Veterinary Clinical Sciences
College of Veterinary Medicine
The Ohio State University
Columbus, OH 43210


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