What is “Pandora Syndrome” in our feline patients?

Post by Dr. Kris Johnson

Post by Dr. Kris Johnson

One of the most common problems we see in veterinary medicine, and one of the most frustrating for owners, is when cats have problems with their urination.  This could show up as straining to urinate, pain while urinating, or urinating in places other than their litterbox (this last clinical sign is particularly annoying to owners!)  When no reason for this can be found (i.e. no bladder infection, no bladder stones), the problem is called “idiopathic feline lower urinary tract disease” (FLUTD) or “feline interstitial cystitis” (FIC) and is thought to be similar to interstitial cystitis in humans.  Since the actual cause for this frequently seen problem is still unknown, despite decades of research, it makes treatment difficult.

However, there is an emerging theory that seems to have promise in developing successful treatments for these poor kitties.  It has been found that these cats with FIC often have other problems (called “comorbidities”) such as behavior problems, or problems pertaining to their skin, heart, endocrine, or GI systems.

Dr. C.A. Tony Buffington coined the term “Pandora Syndrome” to illustrate that all these “bad” things coming out of the affected cats might stem from a single source.  In the case of the Greek myth of Pandora’s Box, the source was Pandora’s curiosity.  But in this case, it isn’t the cat’s curiosity that gets him in trouble!

Research has proven that cats with FIC have abnormal sensory nervous systems, so they perceive things differently than other cats.  They have an increased “acoustic startle response” (a protective reflex located in the brain stem), which means they startle more easily when they hear a loud noise.  However, they not only perceive things differently, they react to things differently, too.  The area of their brainstem that produces norepinephrine is too active, and they can’t control their vigilance, alertness, or pain perception like other cats.  They are in a constant state of “fight or flight”, can never relax, and have a maladaptive, exaggerated pain response.   The typical personality of a cat with Pandora Syndrome is fearful, nervous, sensitive, and prefer being alone.

But what causes a cat to have this abnormal nervous system?  One theory is genetic, as it is often seen in littermates, or in the mother of the affected cat.  Another theory is that the mother may have experienced significant stress while carrying the kittens, and this increased stress while in utero led to abnormal responses to cortisol from their adrenal glands when the kittens grow up.  Many cats with FIC also have a history of being abandoned or orphaned, so stress at an early age may play a role in the development of Pandora’s Syndrome.

So stress definitely makes this problem worse in cats that have a genetic predisposition to it.  But what we perceive as stressful or not stressful is not necessarily what your cat does.  Although it is commonly thought that it is easier to keep a cat as a pet than a dog because they require less time and attention, when you list all the things that are important to cats, they suddenly look very high-maintenance!

Cats are very territorial creatures and they need their SPACE!  Sharing perches, sleeping areas, food bowls, water sources, and litterboxes are all unpleasant to cats, and stressful to cats with Pandora’s Syndrome.  Cats need scratching posts in their preferred location and of their preferred substrate, and need to play with toys that simulate stalking prey.  They also need their owner’s attention and affection (and did I mention they don’t like to share?)  Too barren of an environment is stressful for cats and too chaotic of an environment is stressful for cats.  Having to SEE another cat is stressful to cats.

And this stress manifests as urinary problems in cats with FIC.  In addition to other problems in cats with Pandora’s Syndrome such as overgrooming, chronic diarrhea, constipation, vomiting, etc.  They can’t control their fear or arousal systems and on top of that, they have a maladaptive, exaggerated pain response!  So pain control is a significant aspect of treatment.   But so is changing the environment to suit the cat’s individual needs.  This might mean allowing more time outdoors, or adding a food bowl in a quieter place, or changing the shape of the waterbowl so that their whiskers don’t touch the sides.  Yes – these are high maintenance cats!!!  These cats should never be forced to share food, water, or space with unrelated cats and they need to know that their resources will be provided to them at all times.

Along with “multimodal environmental modification” (MEMO) tailored to the individual affected cat, the synthetic facial pheromone product “Feliway” can help reduce stress, as can certain foods like Hill’s Science Diet “c/d-stress formula”.  However, first it is important to see your veterinarian to rule out all the possible other reasons for your cat’s clinical signs.  Every cat with signs of diarrhea and overgrooming doesn’t have Pandora Syndrome – it might have an allergy!  And every cat that urinates outside its litterbox doesn’t have Pandora Syndrome or FIC – it might have bladder stones!

But what we are learning is that not all serious problems that cats have can be “fixed” with a pill or an injection.  With Pandora Syndrome, we are learning to “think outside the box”!