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Understand Inappropriate Elimination, Then Treat It

By Gary D. Norsworthy, DVM, Dipl. ABVP (Feline)

Posted: April 7, 2009

Inappropriate elimination, the most common feline behavioral problem, can cause pet owners to take drastic measures: ban the cat to the outdoors, abandon it, surrender it to a shelter or euthanize it.

It is important that a simple cookbook answer not be used for these cats as illustrated by the approach I use.

Underlying Causes
Though many cats present with behavior-driven IE, the behavior may originate with one of several physical abnormalities. Address these before proceeding to behavior modification techniques. History is sufficient for some; specific tests are needed for others.  

Cystitis
Bladder inflammation, whether sterile or bacterial cystitis, frequently results in inappropriate urination. These cats typically have one or more clinical signs of dysuria, pollakiuria, increased frequency of urination and hematuria. However, these may be present and missed by owners.

Urinalysis usually reveals bacturia, hematuria and crystalluria, though some affected cats will have a normal urinalysis. A urine culture is the most sensitive way of detecting bacturia. Bladder ultrasound can detect chronic cystitis—thickened, irregular bladder walls—as well as uroliths.

Pain
Certain types of pain may be manifested when the cat goes to the litter box and positions to urinate or defecate. Most notable is pain from the lumbar spine, lumbosacral junction, hips and knees. Uroliths in the bladder can create pain that is manifested when the cat urinates. The discomfort associated with constipation also can be litter-box related.

These cats’ histories may include lameness, reluctance to jump or run, failure to raise the tail when petted, increased sedentary lifestyle, hiding, personality change (especially aggression), reluctance to be picked up, sitting or lying down slowly, a hunched posture of the back and protecting a body part. Radiographs of these areas are diagnostic. Impacted or infected anal sacs will become painful when the cat defecates, sometimes resulting in a litter-box-pain association. Anal sac palpation or expression is diagnostic.

Polyuria
Polyuria may cause a cat to urinate inappropriately. Common causes of polyuria in cats include diabetes mellitus, renal disease and hyperthyroidism. Blood panels that include glucose, creatinine, BUN and total T4 are diagnostic.

To-Do List
The ideal workup consists of directed history taking, physical examination, a blood chemistry panel including total T4, bladder ultrasound, urinalysis, urine culture, anal sac palpation/expression, and radiographs of the abdomen, lumbar spine, hips and knees.

When possible, the minimal workup should consist of directed history taking, physical examination, anal sac palpation/expression, radiographs and urinalysis. Your clinical judgment and the owner’s motivation and finances will direct how extensive your workup can be.

Litter Box Issues
Cats will avoid litter boxes under various situations:

  • Too few litter boxes for the number of cats in the household. The official recommendation is one more litter box than the number of cats. This is not practical for many cat owners, but it is a rule that should be imposed or at least discussed.
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  • Hooded litter boxes. Though these have many advantages (for owners, at least), odors are trapped inside, making the hooded litter box undesirable to many cats. Hoods should be removed, at least until the problem is resolved. Using CatAttract Litter Additive can make odors attractive to a cat instead of offensive.
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  • Type of litter. Clumping litter best simulates sand or soil and is preferred by most cats. It is my litter choice unless it is heavily scented or deodorized. When IE is occurring, avoid clumping litters for multiple cats because of the odors. If the owner objects to dusty clumping litter, recommend a higher quality product. Litters made from wheat, newspaper, etc., can cause substrate aversion. Though they are well accepted by many cats, I recommend avoiding them in IE situations.
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  • Recent change of litter type. Cats are creatures of habit. A change in the litter type can result in IE.
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  • Dirty litter box. The box should be scooped each day, or several times a day if used by multiple cats, and emptied and scrubbed once a month.
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  • Location. Cats often avoid litter boxes in walkways and prefer those in somewhat secluded locations.
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  • Litter box liners. Some cats do not like them, so remove them when IE occurs.
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  • Side height. Arthritic cats can have difficulty climbing in or out of litter boxes with sides that are 4 inches high or more.

Household Issues
The smell of urine will attract a cat, so it is imperative that urine be removed from carpet, other flooring, furniture and bedding. If the item is washable, do so with hot water and bleach, if possible. Use a black light to find all soiled carpet areas. Treating the carpet pad is paramount. To do so, pour a half cup of water on the area and spray with Zero Odor. This is the most effective odor-removal product I have used. Zero Odor also can be used in and around the litter box to remove lingering odors.

The pheromone Feliway can be used to mark the cat’s “good zones.” As a rule, cats will not urinate or defecate in these areas. It should be sprayed on the IE locations. Alternatively, the Feliway Diffuser can be used when many areas need to be treated in the same room.

Behavior Aspects
Inappropriate elimination may be a primary or secondary behavioral disorder. Obviously, if a primary disease is present, it must be addressed. However, specific measures must be taken to address the behavioral component. Situations that cause stress and insecurity need to be explored. Common causes include:

  • A new pet, especially a puppy or kitten, or a new person in the household.
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  • A pet or person leaving the household.
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  • New carpet, drapes or furniture.
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  • Rearrangement of furniture.
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  • A new home.
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  • Harassment by dogs, children or other cats. Too many cats in the household. Each additional cat means a 10 percent increase in the likelihood that IE will occur.

Solutions
Piecemealing the treatment protocol is much less effective than using all your tools at once. 

  1. Diagnose and treat underlying diseases.
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  2. Identify stress- or insecurity-producing situations. Eliminating any of these situations is very beneficial.
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  3. Correct litter box issues.
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  4. Use a black light to find all IE areas. Remove the odor with Zero Odor.
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  5. Create “good zones” with Feliway to discourage the cat from returning to previously soiled areas.
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  6. Put the cat on a psychoactive drug. My first choice is buspirone (BuSpar). If it is used with all the above for two weeks without response, I change to clomipramine (Clomicalm). If unsuccessful, try fluoxetine (Prozac).

Prognosis
Identifying and eliminating stress- or insecurity-producing situations improves the prognosis significantly. Duration is also extremely important. If I begin working with an IE cat in the first month, I give a good prognosis. If IE has been present for more than six months, the prognosis is poor. If it has been occurring for more than one year, I do not recommend treatment. <HOME>

Dr. Gary D. Norsworthy practices at Alamo Feline Health Center in San Antonio, Texas.

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Understand Inappropriate Elimination, Then Treat It

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Reader Comments
hi Dr Gary, Please include some front declaws with distal P2 osteochondritis, digital hyperflexion and flexor tendonitis. It is enough to put any older cat in a bad mood and not use the litterbox! Yes publication is coming....
Ron, Shakopee, MN
Posted: 8/30/2011 11:04:36 AM
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