INAPPROPRIATE ELIMINATION IN CATS

Dr. Kari Mundschenk

Board Member, American Association of Feline Practitioners

Inappropriate elimination encompasses periuria, commonly called inappropriate urination, and inappropriate defecation.  Together, they make up the number one reason for the surrender of cats in the United States.  Studies show that 10% of pet cats at some time exhibit an elimination problem and that incidence probability increases with the number of cats in the household.  Unfortunately, "inappropriate" elimination is only inappropriate when it is objectionable to humans.  Ancestral cats did not use plastic boxes filled with pelleted clay material to eliminate, nor did they eliminate in caves.  To make matters worse, many problems blamed on behavioral issues actually have a medical reason at the root of the problem.  On the flip side, the initial medical problem may have been solved long ago but the subsequent behavioral issues remained.  Multiple, blind studies exist demonstrating the role of stress (either from disease or environment) on the development of behavioral disorders.

In part one of this subject, we will delve into the factors which contribute to the behavior side of elimination disorders.  Next month, we will discuss some of the common, everyday, medical disorders which contribute to a problem that all of us will see at some point.  Hopefully, when we are done, you will have a better understanding of what is going on in the cat's mind and will be better able to manage the problems which may occur.

In order to understand urinary elimination problems, we need to try and determine if the cat is having an elimination problem, marking or a combination of the two.  From our previous talk on the cat, we remember that marking is a normal social behavior.  Common signs of marking include:  the cat still eliminates in the box, the cat targets areas of "behavioral significance", there is usually provoking stimuli such as a strange cat outside, a new arrival in the house, intercat issues, or general stress in the house, the cat usually stands and vertical surfaces are involved (but this is not always the case) the tail is up and twitching (beware of non-markers acting the part) and finally, there is usually a small amount of urine.

In contrast, elimination disorders usually encompass the following:  the cat stops using the box, the cat usually target an area of "suitable texture", there may be defecation problems also, the cat shows signs of aversion to the box and/or litter, they usually squat and involve horizontal surfaces (again, not always) and usually, there is a large amount of urine. 

It is important to remember that by the time the problem is recognized, there may be a combination of inappropriate elimination and marking, for example, a cat depositing a large amount of urine on vertical surfaces. 

In addressing inappropriate elimination, we must not ignore some of the physical and medical causes which may be present.  On the physical side, does the cat need a haircut?  Many times, cats may need a "sani-trim" to clean up the perianal/perineal areas.  Additionally, hair may grow between the toes which may change the tactile sensation when the cat gets into the litter box.  Medically, we will need to rule out diseases causing an increase or decrease in urination, diarrhea or constipation.  Neurological diseases can contribute to a lack of sensation or ability to control the timing of elimination.  Any condition which causes pain or discomfort while urinating or defecating can lead to a lack of desire to use the litter box.  Finally, elderly cats face the problem of arthritis (commonly overlooked in cats), sight, or more importantly, olfactory (smell) impairment, cognitive decline and hyperthyroidism.  As mentioned earlier, we will discuss some of the more common problems in our next talk.

If we find no cause of or we have addressed any medical or physical cause for the problem and we have eliminated a marking component, we must then turn to behavior.  Many times, a behavioral history will need to be taken and may appear daunting.  Rest assured, we are only trying to help you help your cat.  If we can determine the cause of the problem, then we can work with you to correct the situation which is upsetting your cat. 

A good behavioral history will involve the six basic questions of Who? What? Where? When? Why? And How?

The who is simply the culprit.  One must understand in a multicat household, there may be more than one culprit.  Occasionally, fluoroscein dye for urination or crayons for defecation may be necessary to assist with determining the suspect.  Don't forget that a dog in the household may also be contributing to the problem.  Special fluorescent lights may also assist in the search for urine in the house.

The what is simply, urine, feces, both and is there a marking component?

The when involves determining how long the problem has been present.  Additionally, was there any inciting event (ie- a urinary blockage, surgery, move to new house).  We must remember that the initial problem may no longer exist but the anxiety still persists.  Is the cat ever "good"?  For example, when confined or when the litter box is first cleaned? 

The where involves some thought.  It helps to draw out a floor plan and label the location of food and water bowls as well as the location of litter boxes.  Next, mark the location of soiled areas and differentiate between urine and feces.  Label the core area "where the cat lives or spends most of its time". 

The why starts to get personal.  It is broken down into the cat section of elimination (doesn't like the "toilet" provided or prefers another) and marking which encompasses an underlying anxiety.  It is interesting to note that a study by Schwartz in 2002 showed that inappropriate urination was the #1 symptom of separation anxiety in cats with the owner's bed being the primary, preferred location.  Remember, anxiety is not spite.  It is motivated by an underlying stress component. 

The second aspect of the why is the owner section.  Information will be gathered on litter boxes including how many, how old, the location, type, litter type (ie scented, unscented, is a liner used?).  Hygiene will be discussed and information will be needed to know when the boxes are scooped, the litter changed, is the box washed and with what.  A way to look at this section is to ask yourself "how often do you flush the toilet?"

Finally, the how.  It is important to examine the cat's behavior in the box.  Does the cat exhibit excessive digging or covering, a reluctance to get in or stay in the box, vocalization, does the cat run out of the box when done, stand on the side or run into the litter when it is fresh? 

From the above questions, it is easy to categorize the behavioral causes of elimination disorders to five main categories: 

1. substrate aversion
2. substrate preference
3. litter box aversion
4. location aversion
5. location preference

Your veterinarian will work with you to come up with a plan of treatment based on all of the above information.  Each plan is highly individualized and will include some general recommendations as to litter box hygiene, numbers, and environmental decontamination.  The AAFP guidelines on litter box care are an excellent way to start the process.  Another way to assist your veterinarian is to keep a log.  A log may contain such information as to which box(es) the cat is using and for what.  It also helps to assist with determining the cat's preferences because elimination orders really emphasize that it is ALL ABOUT THE CAT.  Most cases are treated and resolved with environmental modification simply by making the inappropriate area undesirable/aversive and the appropriate areas desirable. 

As to the topic of marking and spraying, remember that it is a normal behavior.  It is a normal way for the cat to communicate.  We need to determine if the cause is territorial, hormonal or part of an anxiety or stress situation.  Having your cat spayed or neutered can decrease the problem in 90% of cats.  Deny access to windows or install motion detectors (acts as diversion).  Cats love routine and schedule changes may bring on problems, interact with your cat, consider pheromone treatment and finally, some cats may require medication IN COMBINATION WITH environmental changes. 

Some cats improve with access to the outdoors (in a safe enclosure, of course).  Finally, it is very important to get rid of the source of the smell since cats use smell to communicate.  Products such as FON or urine off are made specifically for this problem and destroy the molecule versus just covering up the problem.

Don't get discouraged.  The way to manage the problem is to form a team between the veterinary staff, yourself and your cat to provide a situation in which everyone will be happy.