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.
- 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.
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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