Environmental Enrichment Resources and References

Converging evidence from a variety of studies (available below) suggests that idiopathic cystitis (IC) in some cats is more likely to be a systemic disorder affecting the bladder than an intrinsic bladder disease. In these patients, IC may be more comparable to the effects on the bladder of diabetes or spinal cord injury than of a urinary tract infection or bladder tumor. That the clinical signs of all these (and other) conditions are similar may be related more to the limited number of responses the bladder is capable of mounting than to the location of the insult.

Cats with IC seem to have variably severe involvement of their stress response system (internal factors), and are exposed to a range of environmental stimuli (external factors). Given the current state of our knowledge, we have limited capacity to treat the internal factors, and so have focused on modification of external factors pending development of drugs to modulate the activity or output of the stress response system.

Although many indoor housed cats appear to accommodate to a wide range of surroundings, the neuroendocrine abnormalities in the cats we treat do not seem to permit them the adaptive capacity that healthy cats have. Moreover, since external factors have been shown to unmask susceptibility to many common chronic diseases in cats, we recommend environmental enrichment as preventative health care for all cats, just as we recommend appropriate vaccination and provision of satisfactory nutrition.

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Forms and Documents

Optimal housing and handling of cats

Learning to safely house and handle cats in cages improves the experience for both the cats and the caretaker. This training will help you better understand cats and how they interact with their cages, their environment and the humans they encounter. Click HERE to begin the interactive training.


  • Environmental Enrichment for Indoor - Part 1
    • Recommendations to cat owners to house their cats indoors confer the responsibility to provide conditions that ensure good health and welfare.  Cats maintain their natural behaviors, such as scratching, chewing, and elimination, whike living indoors, and they may develop health and behavior problems when deprived of appropriate outlets for theys behaviors. This article divides the environment into five basic "systems" to enable identification of features that may benefit from improvement.  It also addresses practical means of meeting cats' needs in each of these systems.  Posted with permission through the courtesy of Compendium: Continuing Education for Veterinarians®

  • Environmental Enrichment for Indoor Cats - Part 2 - Implementing Enrichment

    • Part 2 discusses the imporatnce of effective client communications for implementing enrichment, including identifying factors to enrich in the environment, creating SMARTr goals, and follow-up to coach the client through the change process. Posted with permission through the courtesy of Compendium: Continuing Education for Veterinarians®

  • Idiopathic Cystitis in Domestic Cats-Beyond the Lower Urinary Tract

    • Signs of lower urinary tract (LUT) disease in domestic cats can be acute or chronic, and can result from variable combinations of abnormalities within the lumen of the LUT, the parenchyma of the LUT itself, or other organ system(s) that then lead to LUT dysfunction. In the majority of cats with chronic signs of LUT dysfunction, no specific underlying cause can be confirmed after standard clinical evaluation of the LUT, so these cats typically are classified as having idiopathic cystitis. A syndrome in human beings commonly known as interstitial cystitis (IC) shares many features in common with these cats, permitting comparisons between the two species.  A wide range of similarities in abnormalities has been identified between these syndromes outside as well as inside the LUT. A variety of potential familial and developmental risk factors also have been identified. These results have permitted generation of the hypothesis that some of these people have a disorder affecting the LUT rather than a disorder of the LUT. This perspective has suggested alternative diagnostic strategies and novel approaches to treatment, at least in cats.  The purpose of this review is to summarize research investigations into the various abnormalities present in cats, to compare some of these findings with those identified in human beings, and to discuss how they might modify perceptions about the etiopathogenesis, diagnosis, and treatment of cats with this disease.
      Dedication: I dedicate this contribution to Professor Dennis J. Chew, whose collaboration, patience, and support made it all possible.

  • Clinical evaluation of multimodal environmental modification (MEMO) in the management of cats with idiopathic cystitis

    • Abstract - This prospective observational study evaluated client-reported recurrence of lower urinary tract signs (LUTS) and other signs of abnormalities in cats with idiopathic cystitis after institution of multimodal environmental modification (MEMO). Forty-six client-owned indoor-housed cats with idiopathic cystitis, diagnosed based on a history of recurrent LUTS and evidence of absence of urolithiasis or bacterial urinary tract infection were studied. In addition to their usual care, clients were offered recommendations for MEMO based on a detailed environmental history. Cases were followed for 10 months by client contact to determine the effect of MEMO on LUTS and other signs. Significant (P < 0.05) reductions in LUTS, fearfulness, nervousness, signs referable to the respiratory tract, and a trend (P < 0.1) toward reduced aggressive behavior and signs referable to the lower intestinal tract were identified. These results suggest that MEMO is a promising adjunctive therapy for indoor-housed cats with LUTS, and should be followed up with prospective controlled clinical trials.

  • Posted through the courtesy of the Journal of Feline Medicine and Surgery

  • Westropp JL, Buffington CAT. Feline idiopathic cystitis: current understanding of pathophysiology and management. Veterinary Clinics of North America-Small Animal Practice 2004;34:1043-1055.

    • Abstract - Many indoor-housed cats seem to survive perfectly well by accommodating to less than perfect surroundings. Neuroendocrine abnormalities in the cats we treat, however, do not seem to permit adaptive capacity of healthy cats, so these cats may be considered a separate population with greater needs. Moreover, veterinarians are concerned more with optimizing environments of indoor cats than with identifying minimal requirements for indoor survival.

  • Buffington CAT. Comorbidity of Interstitial Cystitis with other Unexplained Clinical Conditions. Journal of Urology 2004;172:1242-1248.

    • Abstract - The aims of this review are 1) to consider the hypothesis that interstitial cystitis (IC) is not a single disease entity in all patients by reviewing the evidence for the presence of IC subtypes and for the comorbidity of various unexplained clinical conditions in some patients with IC, and 2) to describe recent results obtained in humans and in cats with severe feline IC (FIC) that suggest the presence of an underlying neuroendocrine abnormality.
      The IC literature concerning comorbidity with other disorders was reviewed and these findings were compared with those of investigators studying the comorbid disorders and comparable data on cats with FIC.
      A significant overlap of symptoms exists among a number of unexplained clinical conditions and a common stress response pattern of increased sympathetic nervous system function in the absence of comparable activation of the hypothalamic-pituitary-adrenal axis occurs in a subset of patients with many of these conditions. A comparable pattern exists in cats with FIC, which also includes increased corticotropin releasing factor activity and decreased adrenocortical reserve. Further investigation of the stress response system of patients with IC seems merited, which may provide novel approaches to therapy in some patients.

  • Westropp JL, Welk KA, Buffington CAT. Small Adrenal Glands in Cats with Feline Interstitial Cystitis. Journal of Urology 2003;170:2494-2497.

    • Abstract - We documented the uncoupling of sympathetic nervous system activity from the hypothalamic-pituitary-adrenal axis in cats with feline interstitial cystitis (FIC). Altered hypothalamic-pituitary-adrenal activity was recently suggested in some humans with interstitial cystitis (IC) but to our knowledge no information exists on adrenal gland size and histopathology in this disease. To investigate further adrenal function in cats with FIC we determined cortisol responses to 125 µg synthetic adrenocorticotropic hormone (ACTH) as well as adrenal size and histology. Methods: ACTH stimulation studies were performed in 11 healthy cats and 20 with FIC. Adrenal glands obtained at autopsy in 8 healthy cats and 13 with FIC were weighed, measured and examined histologically. Results: Cats with FIC had significantly decreased responses to ACTH (2-way repeated measures ANOVA p <0.05). Mean weight ± SD (158 ± 50 vs. 241 ± 60 mg) and volume (264 ± 72 vs. 410 ± 115 mm3) of adrenal glands were significantly smaller in cats with FIC than in healthy cats (p <0.05). Conclusions: These results suggest that cats with FIC may have mild primary adrenal insufficiency. Decreased adrenal size has been observed in patients with chronic fatigue syndrome, which can be a co-morbid condition in some patients with IC. If these abnormalities are confirmed in humans with IC, hormone replacement therapy may be indicated in select patients.