June 12, 2025, 3:46 pm | Read time: 6 minutes
Cats with bladder issues often suffer from recurring problems—but why are some more affected than others? A study suggests that fear of strangers might be an underestimated risk factor for relapses. The findings indicate that behavior matters—and could help better protect affected animals in the future.
Urinary tract infections in cats are not only painful but also more common than one might assume. In fact, urinary tract issues, collectively known as FLUTD (Feline Lower Urinary Tract Disease), are among the most frequent reasons for a vet visit. A urinary tract infection—also called cystitis—usually occurs due to bladder stones that injure the cat’s bladder lining. These can become inflamed and cause pain. Owners often notice that the cat passes only small amounts of urine and frequently visits the litter box.1
Often, reduced water intake is the cause of urinary tract diseases in cats. However, the behavior of the animals might play a larger role than previously thought, as a new study suggests. 2
Clear Link Between Anxiety Behavior and Urinary Tract Infections in Cats
Researchers at the veterinary faculty of the Centre Hospitalier Universitaire Vétérinaire (CHUV) in Canada investigated whether there are behavioral patterns that promote relapses in cats with Feline Idiopathic Cystitis (FIC)—the technical term for urinary tract infection in cats. The study was conducted from March 2019 to February 2022. It was based on feedback from cat owners who were surveyed through an online questionnaire system. The results were analyzed using statistical methods and show a clear link between certain anxiety behaviors and the recurrence of the disease.
Exact Causes of Urinary Tract Infections in Cats Still Unclear
Feline idiopathic cystitis (FIC) is the most common form of urinary tract disease in cats, affecting about 55 to 65 percent of all FLUTD cases. It manifests as pain during urination, blood in the urine, and unusual urination behavior. The exact causes are still unclear, but current research suggests a psychoneuroendocrine component: Stress activates the sympathetic nervous system and disrupts hormone regulation—both of which can make the bladder lining vulnerable.
The bladder wall loses protection due to lower amounts of glycosaminoglycans (GAGs), and this promotes inflammation. Studies suggest that environmental factors like stress or anxiety behavior play a role. However, little is known about which specific behavioral traits are associated with an increased risk of relapse—this is where the current study comes in.
Owners Received Standardized Questionnaire
The aim of the study was to investigate the link between certain behaviors and the relapse rate of urinary tract infections. Included were 33 cats (23 neutered males, 10 neutered females) treated for urinary tract infections at the CHUV clinic between March 2019 and February 2022. The condition was that no other diseases explained the symptoms.
After diagnosis, the owners received a standardized questionnaire. They were asked to provide information on anxiety behavior, aggression, environmental changes, feeding methods, and any relapses. Additionally, they were asked whether and to what extent recommended adjustments were implemented.
94 Percent of Cats with Recurrent Urinary Tract Infections Showed Fear of Strangers
Overall, 16 out of 33 cats (48 percent) experienced a relapse. The key difference between the groups with and without relapse was their behavior towards strangers. According to their owners, 94 percent of the cats with a relapse showed fear of strangers. In the group without relapse, only 59 percent of the animals did. Fear of familiar people also occurred more frequently in the relapse group (81 percent compared to 53 percent), although without statistical significance.
Other factors—such as aggression towards people or animals, urine marking, being a victim of aggression, implementation of environmental measures, or feeding methods—did not differ significantly between the groups. The relapse rate remained constant even with longer observation periods, indicating a stable trend. Additionally, there was no link between relapse and weight, age, or breed.
Urinary Tract Infections in Cats Are Also a Psychologically Induced Condition
The study provides an important indication of the influence of anxiety behavior on the risk of relapse in urinary tract infections. While it is already known that stress promotes the disease, it was shown for the first time that specifically fear of strangers is a measurable risk factor for relapses.
This finding supports the hypothesis that urinary tract infections in cats are not only a physical but also a psychologically induced condition. The lack of connection with environmental adjustments suggests that general recommendations alone may not be sufficient. Instead, targeted behavior training or individualized therapy, possibly through veterinary behavior experts, could be more promising.
Additionally, the study shows that many affected animals may suffer from chronic stress. This condition not only promotes relapses but also affects the overall well-being of the animals.
Study Provides No Proof, Only Indications
The results should be interpreted with caution due to several methodological limitations. Firstly, it is a study with a relatively small sample size of only 33 cats, which limits its significance. Secondly, the diagnosis was based on clinical assessment and ultrasound—a urine culture was not performed if cytology was unremarkable.
Data collection relied on self-reports from pet owners, which means subjective misjudgments cannot be ruled out. The questionnaire was also not validated, and behavioral categories like “anxiety” or “aggression” were not clearly operationalized.
Furthermore, all data were collected from a single veterinary clinic, which may introduce some selection bias. Finally, the described associations do not represent causal evidence but merely statistical correlations.
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Results Emphasize the Importance of Individual Behavior Therapy
Despite these limitations, the study suggests that fear of strangers can significantly increase the risk of relapses in urinary tract infections for cats. Other factors like aggression, housing conditions, or feeding played no measurable role. The results emphasize the importance of individual behavior therapy. They suggest that an integrated approach—considering both physical and mental health—could be the best long-term strategy to prevent recurring urinary tract infections and improve the quality of life for affected cats.
My Experience with Relapse in Urinary Tract Infections
“In my work as a cat sitter, I have noticed the connection investigated in this study before. I was looking after two young male cats, one of whom had already struggled with bladder issues. His owners had put him on ‘urinary’ special food—but there was no known physical cause for his bloody urine, except perhaps a bit of stress because his social partner sometimes acted like a little bully.
I was also warned in advance that he might have blood in his urine. I found the cat to be very shy, while the other young cat demanded all my attention. Additionally, his urine was indeed very bloody in the first few days, and he groomed himself noticeably often and thoroughly in the genital area after using the litter box.
However, after a while, his shyness subsided, and after three days, there was no more blood in the litter box. At that point, he would nuzzle me when I came in and rub against my legs when it was feeding time. During all subsequent visits—I regularly sat for the two from then on—he always recognized me and became increasingly affectionate. I believe this was truly a case of stress and fear of strangers.”