Having your cat not use the litter box is not only frustrating, it can even be life threatening. At the Animal Clinic at Thorndale, we work with you and your cat to determine if there are underlying medical or behavioral problems. We will work with you to develop a treatment plan specific to your cat’s needs.

Inappropriate Elimination Disorders

The term “elimination disorder” is used to describe cats that do not use their litter boxes for urination and/or defecation; instead, these cats eliminate somewhere in the house. Elimination disorders are the most common behavioral problem of cats. Because most owners take pride in their homes, house soiling by the cat can strain the owner-pet relationship to the breaking point. Unfortunately, in some cases, frustrated owners give up their cat to an animal shelter or elect euthanasia.

Urinary Tract Obstruction – a True Emergency

If your cat is seen straining to urinate, whether in or out of the litter box, and little to no urine is being produced, it is very important to seek veterinary care immediately. Some cats will plug their urinary outflow tract with mucus plugs or crystals and be unable to pass urine. When this happens, the bladder continues to fill but cannot be relieved. The pressure builds up in the bladder and eventually backs up to the kidneys. This results in the kidneys no longer being able to filter the blood. The everyday waste products the kidneys are supposed to clear from the blood stream now build up in the body. This is an extremely nauseating and painful condition and the ensuing kidney failure and toxins will eventually cause the cat to die. This entire process can happen very quickly; and within 12- 24 hours of not being able to urinate, many cats will be extremely ill and need intensive medical care.

Contributing Factors to House Soiling

Medical Problems

In some cases, a medical problem can be related to inappropriate elimination. Diabetes, bladder infections or stones, kidney disease, diarrhea from any number of causes, and arthritis may all contribute to your cat needing to urinate or defect more frequently and/or being unable to make it into the litter box. When a medical problem can be identified, improvement can be expected if it can be successfully managed.

Feline Lower Urinary Tract Disease or FLUTD

These cats are straining to urinate, producing small amounts of urine very frequently, and have a painful sense of urgency. Some of these cats can have a urinary tract obstruction, as discussed above, and are true emergencies. Many are urinating small drips and drabs around the house. Their bladders are being emptied frequently in small amounts so it is difficult for an owner to actually determine if they are urinating or obstructed. For this reason, all cats straining to urinate need to be checked by a veterinarian to be certain they are not obstructed.

1. Feline Idiopathic Cystitis or FIC

Feline Idiopathic Cystitis, or inflammation of the bladder, is the most typical cause of FLUTD. This means the cause cannot be found (hence the term idiopathic). The inflammation is not due to a bacterial or viral infection or a true structural defect. Cystitis is an inflammation of the bladder, not necessarily due to infection. The lining appears raw and irritated and there may not be enough of the correct type of protective layer over the inner lining of the bladder. Interstitial Cystitis is a human condition with many similarities. Behavioral modification, especially stress reduction, is important in controlling FIC. Recent studies have shown that many cats will successfully respond to what we term “environmental enrichment”. This includes giving the cat activities which keep it active and engaged. Playing with you cat, giving it cat puzzles or interactive toys and setting up ways for it to “hunt” for its food can entertain both you and your cat. There may be some benefit to supplements such as Cosequin for Cats to help provide a more protective bladder lining and reduce the irritation.

2. Other Causes of FLUTD

Certainly, some cats with FLUTD do have bacterial and perhaps viral infections of the bladder. Urine culture can help diagnose a bacterial infection. Viruses cannot be cultured and are difficult to diagnose. Bladder stones can be diagnosed by radiographs and/or ultrasound. Dietary modification and potentially surgery to remove the bladder stones will help these cats.

Feline Behavior

In many cases, however, inappropriate housesoiling is primarily a behavioral problem. Numerous factors may be involved, most of which you can control and correct. Litter box placement, type of box and litter, social enrichment, and stressors to your cat are often things in the cat’s environment that we as owners can improve.

Prevalence

An animal behaviorist at the University of Pennsylvania reported that 40 to 75% of all cats presented with behavior problems had an elimination disorder. It appears that longhaired cats are over-represented as compared to shorthaired cats. This has not been completely evaluated but may be related to adherence of certain types of litter to the longer fur.

Behavioral Causes

A complete physical examination, urinalysis, and complete blood count and blood chemistry will rule in or out most medical problems. Radiographs and Ultrasound, urine culture, and other special tests may be warranted if a medical cause is suspected. As mentioned above, after medical causes of these problems have been ruled out, the source of the problem is considered a behavioral disorder. Behavioral causes of inappropriate elimination fall into two general categories:

1. A dislike of the litter box. One of the main reasons for the cat avoiding the litterbox is because the box has somehow become objectionable to the cat. This usually occurs because it is not cleaned frequently enough or because the cat objects to the type of litter used; this is called substrate aversion. Sometimes, the cat dislikes the location of the litterbox (avoidance of location). Substrate aversion is by far more common than avoidance of the box because of its location.
2. Stress-related misbehavior. There are many possible related causes. Some of these can include the following:

• A new person (especially a baby) in the house
• A person that has recently left the house (permanently or temporarily)
• Several new pieces of furniture or rearrangement of existing furniture
• New drapes or carpet
• Moving to a new house
• A new pet in the house
• A pet that has recently left the house
• A new cat in the neighborhood that can be seen by the indoor cat
• A cat in heat in the neighborhood
• A new dog in the neighborhood that can be heard by the indoor cat
• Construction or loud noises in the house, especially near the litter box location

Therapy or How Do I Fix This

Most successful treatments rely on a combination of behavior modification techniques and drug therapy.

A. Behavior Modification

Behavior therapy involves a dual approach involving (1) Aversion Therapy and (2) Attraction Therapy. The former repels the cat from the inappropriate location, and the latter encourages the cat to choose an appropriate location.

The purpose of Aversion Therapy is to make the area of inappropriate urination or defecation undesirable for the cat. There are many ways to do this, but the following steps have proven successful in a high percentage of cases.

1. A product to neutralize the odor of urine or stool should be used in places where inappropriate urination or defecation has occurred. Although many of the available products do a good job, none of them will undo months or years or repeated soiling. The sooner the affected area is treated, the better. If the objectionable location is on carpet, it is necessary to treat the carpet and the pad below because most of the odor will be in the pad. This usually means soaking the carpet with the neutralizing product so it penetrates into the pad. Test an inconspicuous piece of carpet for staining before using any odor neutralizing product. In some cases the subfloor will also be affected, requiring more extensive treatment. White vinegar may help as an initial cleaning neutralizer. Ammonia products are similar to urine so do not use these.
2. If the soil in potted plants is being used, place a lemon-scented air freshener at the base of the plant. This will usually repel the cat. In some cases, the plant may need to be removed. You can cover the soil around the plant with aluminum foil to prevent access.
3. Citrus odors may help repel some cats. Black pepper can also be tried.
4. Cover the area(s) with aluminum foil and secure it to the carpet or furniture with masking tape. Aluminum foil is a surface on which most cats will not walk. Large plastic trash bags may work for some cats.
5. Block access to the area by closing off doors if possible. Scat mats (producing a mild shock or a loud sound) can be used, but keep in mind these are stressors and may cause your cat to seek out a new location.

The purpose of Attraction Therapy is to make the litter box more desirable than the inappropriate site. The following are usually successful:

1. Purchase a new litter box; even well-cleaned litter boxes have odor deep in the plastic.
2. Have at least one more litter box than you have number of cats so there are options
3. Be certain the box sides are low enough that an arthritic cat can move in and out freely
4. Be certain the boxes are in easily accessible places in the house. This is especially important if you have a cat who cannot readily climb stairs.
5. Although we like our privacy, most cats find a hooded litter box undesirable presumably because it traps odors inside. Occasionally, a very shy or timid cat will prefer a covered litterbox.
6. Purchase non-scented clumping litter. If your cat has not been using this type of litter, it will usually find it more desirable than the clay types. In general, most cats seem to prefer these newer litters because they are softer. Some behaviorists theorize that these new litters are more reminiscent to the cat’s ancestral elimination substrate – desert sand.
7. Place the new litter box near the area of inappropriate urination until it is used for several days, then move it 2-3 feet (0.7-1 m) per day back to the desired location.
8. Be certain you litter box is in a quiet area. If it is next to a noisy furnace or clothes dryer, your cat may be startled and avoid the box.
9. Keep the existing litter box in the normal location in case the aversion therapy causes your cat to return to it.

Other things you can do:

1. Realize that multiple cats in a household can be stressful to some. Some cats will prefer to have their own room or area (e.g. upstairs and downstairs cats) or may only do well as solitary cats.
2. Closing drapes so your cat cannot readily see other cats rooming outside may help
3. Make certain all cats have free access to fresh water at all times. Feed small frequent meals. Newer diets are designed to help prevent certain bladder crystals and stone and even help with stress. Be certain to ask your veterinarian about diet changes that would be appropriate.
4. Be certain food and water sources are not near the litter box.
5. Providing appropriate play time (a.k.a. social enrichment) has also been shown to be beneficial
6. In some cases, confining the cat to a smaller area may help “reacquaint” the cat with the box
7. Scoop the box, scoop, the box, scoop the box! And wash it frequently
8. Calming phermones in a spray or plug in can be helpful. Feliway is a synthetic pheromone that can be used to help reduce stress in cats.
9. Environmental enrichment such as interactive toys and puzzles. Feeding systems that require the cat to “hunt” for the kibble.

B. Medical Therapy

This usually involves one of three types of medications.

1. Anti-depressants, including amitriptyline, fluoxetine, clomipramine, buspirone
2. Tranquilizers, including diazepam and phenobarbital
3. Hormones, including megestrol acetate and medroxyprogesterone acetate (rarely used today)

While none of the oral medications have been approved for use on cats, most have been in use long enough to give us reason to believe that they are very safe. Most require long term therapy, with an eventual reduction in dose or elimination of the medication once behavioral training is completed. It is important to consider these medications as an adjunct to behavioral modification, not a sole solution to the problem.

Prognosis

The prognosis for improvement is more likely if several of the following are true:

1. The duration is less than 1 month when treatment begins.
2. There are only one or two locations in the house that the cat uses for inappropriate elimination.
3. It is possible to identify and relieve the stress-causing situation.
4. It is possible to neutralize the odor caused by the urine or stool.
5. You have only one cat.
6. You are willing to commit to the behavior modification

For additional information, we recommend the Cornell Feline Health Center