Pawsitively Humane

Friday, February 15, 2013

Urinating Outside the Litter Box

One of the top four reasons cat owners become frustrated and want to turn in their cat at a shelter is when the cat exhibits bad behavior.  Often in cats that behavior is urinating outside the litter box. There is hope!

The below article by Cindy Hewitt explains that misbehavior is the cat's way of communicating that something is wrong either in the environment or medically. Please be patient and observe all the signs in order to assess and take the appropriate steps to help your cat.
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by Cindy Hewitt

Inappropriate elimination is the leading cause when cats are relinquished to shelters, and urinary issues are one of the most common health problems for which cat guardians seek veterinary assistance.  

Cats naturally seek somewhere to eliminate that will allow them to bury their waste.  When cats don’t use the litterbox, there is usually a reason:

  • There is a medical issue.
  • The litterbox is unattractive.
  • There is a behavioral issue.

Medical issues: “Knowledge regarding feline urinary tract issues is evolving in terms of diagnostics, causes and treatments, and this can be both confusing and controversial. The current thinking is that the majority of Feline Lower Urinary Tract Disease (FLUTD) cases has no clear cause and is lumped into idiopathic cystitis or interstitial cystitis (borrowed from human medicine).  Since the exact cause is unknown, the perfect therapy eludes us.  To make matters worse, this syndrome of idiopathic cystitis can produce urinalysis results that sometimes yield either bacteria or crystals, obscuring the true process initially.  This frustrates owners and vets alike.  Often, idiopathic cystitis is finally diagnosed once a trend or repeated pattern is detected” explains Dr. Jim Dugan of Pinecrest Veterinary Hospital.

Cats frequently attempt to get our attention and let us know they are having problems by eliminating outside the litterbox.  When this occurs, cats should be examined by a veterinarian to insure there is no medical basis for the issue. A urinalysis should be performed to determine Ph and specific gravity, and to look for crystals, bacteria and blood in your cat's urine.  If there are no significant findings in the urinalysis, but this is a repeat or chronic issue, a radiograph should be performed. If there are still no findings, an Ultrasound is helpful in more thoroughly visualizing the bladder and bladder wall to evaluate for possible calculi.  If US isn't available, a radiograph with contrast (usually air is used to inflate the bladder) may be useful.

If a cat is going in and out of the litterbox, or appears to be straining but not producing urine, it is CRITICAL to monitor carefully and if the cat cannot urinate, it is a medical EMERGENCY.  A blocked urethra can be fatal and must be treated immediately.  If you are unsure, segregate the cat with a clean litterbox and observe carefully to determine if it is actually urinating.

Some studies have shown that in cats under 10 years of age, the vast majority of urinary tract infections (UTI) have no bacterial component, so treatment with antibiotics may not be necessary.  If there is blood in the urine, most veterinarians prescribe antibiotics to prevent infection.  In addition, studies have shown that most UTIs in young cats clear in 3-5 days, with or without antibiotics, fluid therapy, both or nothing.  Providing COMFORT to the cat by using medication to relieve pain and/or reduce inflammation should be discussed with your veterinarian.

Diet appears to play a role in many cases.  If the cat is producing crystals, modifying the Ph of the urine (with diet or drugs) can help prevent formation and even dissolve some existing crystals.  Fluid intake also makes a difference, as larger fluid intake can help flush out any small crystals that may form.  Providing a fresh flowing fountain, or giving your cat very low-sodium chicken broth (such as Pacific low sodium, free range, organic broth with about 70mg sodium/8 oz) can help increase fluid intake.

Many cats improve if fed a prescription diet such as Hill's Rx CD Multicare, Royal Canin Urinary SO and Purina UR.  If the cat improves on a prescription diet, then dietary modification is probably appropriate.  If the cat improves and is stable on a prescription diet for an extended period of time, but cost is a factor, ask your vet if you can try an over-the-counter (OTC) urinary formula food such as Purina Pro Plan Urinary Formula.  If your vet approves, slowly add in the OTC urinary formula food (no more than 10% at a time) over several weeks, and if the cat does well both from a digestive and urinary perspective, see if you can maintain him on the OTC urinary formula.

Additionally, if the cat has experienced painful elimination (such as with a bladder infection), it may associate this pain with the litterbox and be hesitant to use the box again.  If your cat had an infection which has been successfully treated and is still hesitant to use the box, try a different type of box in a different location in an attempt to break the association.

Cat Professionals, Ltd. has produced a great booklet on FLUTD, which thoroughly outlines the diverse things that can impact your cat.  It is available in print or download formats at

Unattractive litterbox:  Cats can be very particular, and a variety of issues affect their willingness to use a litterbox. 
  • Location:  should be in a quiet, peaceful location away from noise and traffic.
  • Type of box:  some cats are hesitant to use a hooded litterbox; other cats prefer the privacy.
  • Size of litterbox. Box should be at least 1.5 times the length and width of the cat; bigger boxes are usually better.
  • Litterbox entrance: Be aware of height of entrance, as older cats may have difficulty getting into high litterboxes and larger cats may not want to enter through a small opening.
  • Type of litter: 
o   Most cats prefer a small grain litter such as scoopable litter. Dr. Elsey’s Cat Attract Litter is formulated to encourage cats to use the litterbox, and may be helpful in retraining your cat.
o   Scented litters can be very offensive to cats.  Try an unscented plain clay or scoopable litter. 
o   Dust from litter may bother the animal; use a low dust brand.
o   Try different types of litter (scoopable, clay, etc.) in different boxes (open vs. hooded) at the same time, preferably in the same location, to control for all variables. If your cat has a preference for one type of litter, use that litter in different boxes and locations to further understand your cat’s needs. 

  • Litter box liners:  some cats dislike liners; when they dig their claws get caught, and they don’t like the feel of the plastic.
  • Number of boxes vs. number of cats:  most animal behaviorists recommend at least one box per cat plus a spare; if there are litterbox problems, they recommend two boxes per cat because some cats won’t urinate and defecate in the same location
  • Frequency of cleaning:  cats don’t want to step into a landmine (theirs or another animal’s).  If the box is dirty, they will seek another location.  Clean boxes at least once daily, more often if possible.  Hint:  make cleaning litterboxes as convenient as possible.  If using flushable litter, place in bathroom near toilet.  Consider having an old-fashioned diaper pail for easy disposal of waste, and containment of odor.  There are automatic boxes that will keep at least one box clean even if you aren't home.   
Behavioral problems:  When cats are stressed or unhappy, they may “mark” with urine.  This can be vertical spraying or horizontal urinating.  Behavioral urination is frequently associated with the introduction of additional animal or person (even a new baby) in the household, or some other type of change to the cat’s environment.  Multicat households have a much greater risk that one or more of the cats will urine mark. 

Try to determine the source of stress, and eliminate or minimize causes of stress if possible.  Do not punish a cat for urine marking; this will only encourage the cat to mark when you are not around.  NEVER hit a cat or try to rub its nose in excrement; this type of response only further stresses the animal and makes it afraid of the guardian.

Try to give the animal extra attention and even “private” space if possible; it is not cruel to segregate a cat in an office or bedroom if that is what the cat prefers.  Sometimes environmental enrichment can help reduce stress.  Cats like vertical hideaways, and you can dramatically increase their options by adding cat perches, walkways and tall furniture.  In addition, some cats really enjoy having access to safe, outdoor enclosures.  There are several commercial products available that allow your pet to be outside without the normal risks faced by free-roaming felines.

Thorough cleaning of any surfaces marked with urine is critical to minimize the chance the cat will be drawn back to the same area by residual scent.  First remove as much urine or other organic material as possible using just water; use a steam cleaner/extractor on carpets and upholstery.  Then thoroughly saturate the area to be cleaned with an enzymatic cleaner such as Nature’s Miracle, Urine Off, etc.  The enzymes break down the urine to remove all odor.  Do not use soap or detergent when cleaning, as these will leave residue that will inactivate enzymatic cleaners.  Reapplying the enzymatic cleaner for several days will help minimize the chance that there will be any lingering odor that your cat can detect, even if you can’t.

If urine marking cannot be eliminated, discuss possible segregation, pheromone therapy and/or medication with your veterinarian. Ultimately, if a thorough medical workup has ruled out any physiological cause, and the spraying behavior cannot be controlled, it may be better to allow the cat to go outdoors than to surrender it to a shelter or have it euthanized.  

Conclusion: Recurrent urinary issues are one of the most common health and behavioral problems among cats.  Resolving these issues requires patience, perseverance, a bit of detective work and flexibility on the part of caretakers and veterinarians.   People regularly make significant concessions to address the medical or behavioral issues of family members.  Hopefully more and more pet guardians will make the same commitment to their furchildren.

Thanks to Dr. Jim Dugan of Pinecrest Veterinary Hospital for contributing to this article.


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