While FIC remains a diagnosis of exclusion, studies over the last two decades suggest that it results from complex interactions between the urinary bladder, neuroendocrine system and environmental factors, and stress appears to play a role in the pathogenesis. The self-limiting nature of FIC and importance of environmental factors on recurrence of clinical signs emphasize the need for controlled, prospective, double-blinded clinical studies to determine the best management options. Current best evidence for initial management of acute, non-obstructive FIC supports a specific nutritional recommendation for a therapeutic urinary food proven to reduce recurrent episodes, environmental enrichment and feeding moist food.