Does your cat need help finding the litter box?

House soiling is the number one behavior problem of domestic cats.  Many cats are placed in shelters, turned outside or even euthanized for this behavior. 

To help correct this behavior, it is important to determine whether the problem is medical or behavioral in nature.

Why do cats urinate in unusual places?

1.   To mark their territory.  

2.   Litter box aversion.

3.   Due to pain or discomfort associated with a disease known as idiopathic cystitis or feline lower urinary tract disease.

4.   To get their owner’s attention if they are not feeling well.

How do we determine why the cat is urinating outside the litter box?

-  Urinalysis: The physical, chemical and microscopic analysis of urine to detect changes in important characteristics and values that may indicate disease or disorders.  These include protein, sugar, relative acidity or alkalinity, presence of blood and microorganisms, bilirubin and an increased number of white blood cells.

-  Radiographs:  Imaging can help evaluate kidney size/shape, bladder size/shape as well as the presence of stones within the urinary tract.  Stones may be present within the kidneys themselves, ureters, bladder or the urethra.

-  Bloodwork: A complete blood count and chemistry may help determine underlying metabolic disease.  There are a number of diseases that cause cats to drink frequently and urinate often which may contribute to inappropriate urination.

-  History: Many factors can contribute to inappropriate urination including spay/neuter status, the number of cats in the household, litter box maintenance, recent changes in the household, traveling family members, and any other possible stressors. 

Feline Lower Urinary Tract Disease (FLUTD)

-  Signs of this syndrome include straining to urinate, frequent licking/grooming of genitals, bloody urine, and often inappropriate urination.

-  50% of cats with this condition will not have an identifiable cause (This is true feline idiopathic cystitis or bladder inflammation of unknown cause)

-  20% will have bladder stones

-  20% will have urethral blockage

-  1-5% will have a true infection

-  1-5% will have had trauma to the urinary tract

-  1-5% will have a combination of a bladder stone and an infection

Feline Idiopathic Cystitis (FIC)

As the name implies, the cause of FIC is unknown.  However, there are several theories as well as several treatments all of which have varying degrees of success.

THEORIES

-  Environmental Stress Theory:  There appears to be a link between environmental stress and FIC.  Manipulating the cat’s environment and attempting to determine the cause of the animal’s stress can be the mainstay of treatment.  Anxiolytic medications may also be helpful.

-  Defective Mucous Lining Theory: The urinary bladder is lined with a type of proteins called PSGAGs (Polysulfated Glycosaminoglycans).  This material acts as a protective barrier for bladder tissue from the urine it contains.  The pH of urine can vary greatly and contain abrasive crystals in addition to various toxins and irritants that the kidneys have removed from the bloodstream and concentrated.  If the lining of the bladder is destroyed, the bladder tissue is then exposed to the urine and inflammation results.  According to this theory, treatment centers around replenishing the PSGAGs that line the bladder, or periodically distending the bladder in an effort to deplete the painful inflammatory chemicals the bladder tissue has to release.

-  Dietary/Urinary pH Theory:  There is a link between diet, urinary pH and crystal formation.  This becomes especially important in male cats where crystal plugs can actually lead to complete urinary obstruction.  Special diets can help modify urine pH, dissolve crystals and prevent the formation of crystals in the future.

TREATMENT

Anti-spasmodics and tranquilizers - These medications can help the painful urethral spasms that occur with the inflammation associated with the episode.  They also help the urethra dilate so that urine can pass.  Some medications include acepromazine, phenoxybenzamine, prazosin or diazepam.

Antibiotics - A true infection is not typically involved in FIC, though antibiotics are commonly prescribed.  Controversy exists over antibiotic use and they may be unnecessary and contribute to antibiotic resistance.  Some believe that antibiotics have anti-inflammatory properties separate from their antibacterial properties

Urine acidifiers - This has become a less common treatment since we are now aware that certain types of crystals can form in the presence of very acidic urine.  If it is clear that struvite crystals are present in the urine, the treatment may be useful.

Narcotic analgesics - These medications are pain relieving but have no anti-inflammatory properties.  Medications include fentanyl, buprenorphine, and tramadol.

Anti-anxiety medications - These medications are meant to address the stress component of FIC.  The difficulty with such medications is that it often takes several weeks to reach maximal effect in most patients and often the FIC episode has resolved on its own prior to that.  These medications may be better for preventing such episodes rather than curtailing an active episode.  On the other hand, many patients appear to respond very quickly to such therapy.  Medications include amitryiptyline, clomipramine, and fluoxetine.

Elmiron and Adequan - These medications may strengthen and thicken the mucous lining the bladder.

Subcutaneous fluids - Fluids administered under the skin will help to distend the bladder.  It is believed that as the bladder wall stretches, inflammatory chemicals are released into the urine.  By depleting the bladder wall of its inflammatory chemicals, there should be less on-going pain.  Extra fluids also help to dilute the urine making irritants in the urine less noxious.

PREVENTION

-  Feeding primarily canned food/increasing water consumption

-  Environmental enrichment/relieving environmental stress (All treatments described below for urine marking and litter box aversion apply to cats suffering from FIC)

Urine Marking/Territorial Anxiety

It is normal cat behavior to use urination and defecation as a means of communicating with other cats.  Certain environmental stressors (addition of a new pet/family member, a prolonged absence of the owner, remodeling within the home) may create the need for a cat to reassert its territorial claim.  Certain signs can help differentiate such urine marking from inappropriate urination related to a medical condition.  These include:

-  spraying on an upright surface

-  occasionally using the litter box as well as other surfaces

-  using the litter box to defecate, but urinating elsewhere

-  urinating in the same location each time

-  urinating on the owner’s bed or laundry

-  urinating in response to punishment for other behavior

-  urinating near a door or window

-  inappropriate urination that began when furniture had been added or rearranged

-  a major change has recently occurred in the home (new baby, new pet, etc.)

- the cat is not spayed/neutered

TREATMENT

The mainstay of treatment for such behavior is to identify and eliminate the source of stress for the cat.

 If the cat has not been neutered, this should be the first step in addressing this problem.  Hormonal motivations to mark territory are very potent and need to be eliminated.

 Cleaning the marked area effectively with an enzymatic cleaner is extremely important in correcting this problem.  It has also been found that peppermint oil can help deter animals from marking territory.  After the area is cleaned well, spraying with peppermint oil may aid in repelling the animal from returning.

 Anti-anxiety medications can be very helpful if it is impossible to completely eliminate the source of stress.

Some medications that have been used successfully include Buspar, Clomipramine, Fluoxetine, Amitriptyline, and Valium.

Rescue Remedy is a Bach flower remedy containing 5 different flower extracts including Rock Rose, Impatiens, Clematis, Star of Bethlehem and Cherry Plum.  These flowers have anxiolytic effects in both people and animals and can be easily administered simply by adding a few drops to the cats water dish each day.

Lavender oil has anxiolytic properties.  Applying lavender oil to the animal’s bedding or toys may provide sufficient stress relief.

 Feliway Spray - This spray contains feline pheromones that cats deposit when engaging in facial marking.  Such pheromones can have a calming effect that should help reduce the urge to mark.  This product is available as a spray as well as a plug-in diffuser that spreads pheromones throughout the room.

Litter Box Aversion

Some cats are inappropriately urinating simply because their litter box is unacceptable to them.  Clues that inappropriate urination is occurring as a result of litter box aversion include:

-  urinating and defecating outside of the box

-  urine is not sprayed on a vertical surface

-  litter brand has recently been changed

-  multiple cats are using one litter box

-  the box is not scooped frequently

-  a dog, cat, or child bothers the cat while in the box

-  the litter box is located near a noisy appliance

-  the litter box is covered (most cats do not prefer a covered litter box as it tends to trap odors/dust and has poor lighting)

 TREATMENT

Cats with litter box aversion may require re-training to the box.

A new box should be provided in a new location.

There should be one litter box per cat plus one available.

It should be determined whether a child, dog, or another cat is bothering the cat while it is attempting to use the litter box.  The cat needs to know that nothing unpleasant will happen while in the litter box.

Older cats may be arthritic (reluctant to jump, stiff walking).  Providing a litter box with a more shallow entrance will prevent that cat from having to jump or climb into the box.

Litter boxes must be scooped daily or even twice daily and kept as clean as possible.  Clumping litter should be changed at least once/month and non-clumping litter should be changed twice weekly.  The box should be washed with soapy water but no strong smelling disinfectants.

Cat Attract is a litter additive which is an herbal product designed to entice the cat  to return to the box.  Many people have had excellent results with this product.

Litter box length should be at least one and a half times the length of the cat so the cat has adequate space to maneuver.

A different type of litter as well as a different type of litter box (covered/uncovered) may be tried.

If a cat continues inappropriate urination, the cat should be confined to a small kennel with a litter box.  Once the cat starts using the box, you may gradually increase the space the cat is allotted.  First only allow the cat in one small room.  If he continues to use the box, continue to increase the space he is allowed to roam in the home.

References

1.  Brooks, Wendy C. "Feline House Soiling" 01 VeterinaryPartner Home Page - VeterinaryPartner.com - a VIN Company! Veterinary Information Network, Inc., 02 July 2009. Web. 15 Sept. 2011. <http://www.VeterinaryPartner.com/Content.plx?P=A>.

2.  Landsberg GM, Wilson A. Effects of clomipramine on cats presented for urine marking. J Am Anim Hosp Assoc 41[1]:3-11 2005

3.  Neilson JC. Feline house soiling: elimination and marking behaviors. Vet Clin North Am Small Anim Pract 33[2]:287-301 2003

4.  Neilson J. Thinking Outside The Box: Feline Elimination. J Feline Med Surg 6[1]:5-11 2004

5.  Overall KL. Treating Feline Elimination Disorders. Vet Med 93[4]:367-382 1998

6.   Pryor PA, Hart BL, Bain MJ, Cliff KD. Causes of Urine Marking in Cats and Effects of Environmental Management on Frequency of Marking. J Am Vet Med Assoc 219[12]:1709-1713 2001