INAPPROPRIATE ELIMINATION, CAT

About the Diagnosis

A cat that urinates or defecates outside the litter box is described as exhibiting a soiling problem or "inappropriate elimination" of urine and/or stool. Depending on the reason for this behavior, the problem may be consistent, or the cat may only occasionally use another part of the house for toileting needs.

Cause: There are many reasons why cats urinate and defecate outside of the litter box. Correcting the problem requires understanding its underlying cause, and the underlying causes fall into one of 2 categories: medical problems (where the urination problem is a symptom of illness) and behavioral problems. Medical problems include a urinary tract infection, arthritis causing inability to physically get to the litter box, and declining mental capacity seen in some geriatric cats. Behavioral causes often involve situations in the cat's environment that unintentionally discourage normal use of the litter box. For example, cats can develop aversions to the texture, size, or odor of the litter, the box itself, and/or the location of the litter box. A very common cause for urination or defecation outside the litter box is that the litter is not scooped frequently enough and the boxes are not cleaned often enough.

Environmental stressors can cause anxiety and inappropriate elimination. For example, if the location of the box is noisy or in an area of high traffic, the cat may choose to not use it. If there are many cats sharing only a few litter boxes, inappropriate elimination may result.

Diagnosis: It is essential that the cat's complete medical history and behavioral and environmental profile be shared with your veterinarian to help determine if the fundamental problem is a medical one or a behavioral one. This history must include any changes in the cat's environment, including diet changes, the addition of new family members and other pets, the type and location of litter used, the frequency and pattern of elimination, methods used to clean the litter box, and how you or others in the household respond to these incidents. The veterinarian needs to know if the cat has ever been diagnosed with a medical disorder and is currently taking medications.

Your veterinarian will perform a thorough physical exam. A urine and/or fecal sample may be analyzed to screen for possible causes of inability to withhold urinating or defecating, that is, medical disorders such as diabetes, intestinal diseases, or kidney disease. A small blood sample may be taken to assess various potential causes of this problem. Depending on the results of these tests, the veterinarian may recommend that x-rays be taken or that an ultrasound exam be performed, again, to identify any medical condition that could be causing the urination or defecation problem. These tests are important because making a diagnosis of a behavioral cause for elimination problems means that no further illness is being sought out; if a disease that causes excessive urination or defecation were present, it could be missed and allowed to worsen, if the proper tests are not performed.

A problem that is behavioral in origin and that is very similar to inappropriate elimination is urine marking. It is important to distinguish inappropriate elimination from urine marking. Urine marking (commonly called spraying) is a form of communication between cats. Marking is a way for cats to indicate their territories and sexual status to other cats. It usually involves the cat's spraying urine onto a vertical surface such as a wall, door frame, or vents, and only a small amount of urine (or rarely feces) is sprayed. Occasionally, cats mark on clothing or bedding. This behavior may represent a conflict with the person. Distinguishing between inappropriate elimination and urine marking is one of the goals of the thorough medical and environmental history your veterinarian asks. This is a good example of the importance of describing the circumstances of the urination or defecation problem in detail because the causes of urine marking and, therefore, the ways to manage the problem and try to bring about a resolution also are different from those of inappropriate elimination.

Living with the Diagnosis

Cats diagnosed with inappropriate elimination require time and patience from the owner while the cause is being determined. Specific strategies are needed to figure out why the cat is behaving this way, and they are presented under Treatment.

Treatment

If a medical problem is determined to be the cause, it must be treated. There are dozens of types of diseases that may make cats unable to withhold urine or feces, and it is essential to identify these rather than wrongly believe the cause is behavioral. If no medical problem is diagnosed, several options are available to make the litter box more attractive and to make the areas of elimination less attractive. This is the cornerstone of successful management of elimination problems.

To determine which kind of litter the cat prefers, several different types can be offered in several different boxes. Scented litter should not be used. Litter should be scooped daily. Clay litter should be changed entirely at least weekly, and scoopable litter should be changed every other week. The box should be washed with warm water at every complete change.

The number of litter boxes in a house should equal the number of cats, plus one additional litter box (e.g., a three-cat household should have four clean, accessible litter boxes at all times). Some cats will not use a litter box if it is covered, if it is too small, or if it has a plastic liner.

The location of the litter boxes may need to be changed. Closets may be preferred over the basement or laundry room, especially if the children play in the basement or if the cat is arthritic.

Soiled areas in the house can be cleaned with an enzymatic cleanser. These areas can be made unattractive by covering them with contact paper (sticky side up), aluminum foil, or plastic runners with the points up. It may even be necessary to keep this part of the house entirely off limits to the cat.

Some owners have had success placing the clean litter box at the location of inappropriate elimination. If the cat begins to use the box in this location, it can be gradually moved (a few inches each day) toward the new location if desired.

Very rarely, cats with inappropriate elimination will need to be given medication to control anxiety.

DOs

• If you are giving your cat medication, give it exactly as directed by your veterinarian, and if you are concerned about possible negative effects, discuss them with your veterinarian immediately rather than just giving up on the medication.

• Keep a log of when and where your cat eliminates; this can be very helpful when reviewing efficacy (or lack thereof) of treatments and approaches.

DON'Ts

• Do not lose your temper and punish the cat. This behavior can make correcting the problem even more difficult.

• If you are giving medication to your cat, do not stop without discussing it with your veterinarian. Suddenly discontinuing some medications can cause serious side effects.

When to Call Your Veterinarian

• If you cannot keep a scheduled appointment.

• If you are unable to give medication as directed.

• If your cat appears to be straining or uncomfortable when urinating or defecating, is unproductive when trying to urinate or defecate, or attempts to eliminate more frequently than usual (symptoms of diseases of the bladder or other organs).

Signs to Watch For

• Weakness, lethargy, vomiting, diarrhea, constipation, weight loss, decreased appetite, abnormal behavior (especially hiding more than usual), excessive drooling/salivation, seizures, etc.

Routine Follow-Up

• A follow-up visit may be scheduled, depending on the cause of the cat's inappropriate elimination and the treatment.