Many of the problem behaviors for which cats present are actually normal behaviors that are unacceptable to their human companions. Inappropriate elimination - urinating and/or defecating in inappropriate places - may be a medical or a behavioral problem, or it may contain elements of both, making it somewhat of a challenge diagnostically. Certainly the behavior may first bring the medical problem to our attention, and medical causes should first be ruled out before looking for behavioral causes. Any disease that causes diarrhea, polyuria (increased urination) or polydipsia (increased drinking) may catch the cat away from his box. Pain or discomfort while urinating or defecating may cause the cat to avoid the litter box, associating it with his pain. The pain does not have to be the result of urinary or gastrointestinal disease. Cats recovering from castration, abdominal or claw removal surgeries are liable to blame their pain on the litter box. Incontinence for any reason is another medical rule-out. This is particularly a problem with Manx kittens. In the geriatric cat in particular arthritis, visual and olfactory deficits and cognitive dysfunction may all explain failure to use the litter-box. Constipation produces discomfort which may be associated with the litter-box, or may produce a mixed medical/behavioral scenario, where the longer time required to defecate leaves the cat in what appears to him a vulnerable situation on an exposed litter-box, so he may seek a more private location. In a similar case reported by Leslie Cooper, a Siamese cat fled from his litter-box leaving a trail of fecal balls behind him. Examination showed that amid the hard dry feces were strands of the owner’s long hair. Like many Siamese in particular, the cat groomed the owner’s hair excessively. The hair remained in the rectum, feces banged against the cat’s legs, he ran away from this, and gradually as the hair passed he left the fecal trail.
Ruling out medical causes, and treating them, is the first priority. Particularly in the case of urinary tract disease, this isn’t always as easy as it sounds, and it may be necessary to repeat urinalysis and culture several times, and even then the cause may remain elusive. Owners may feel certain the cat is out to get them, and is doing this out of spite for some perceived misdemeanor, and it is sometimes easy to overlook the physical cause of the problem. Sometimes the behavior may persist even when the inciting physical cause has been addressed.
Sometimes the separation of physical from behavioral cause may become blurred. A condition called idiopathic feline lower urinary tract disease appears to be associated with stress. It results in self-limiting bouts of painful, bloody, frequent urination lasting 5 to 7 days. The condition likely has more than one cause, although a virus may often cause it. The condition has been treated using the tricyclic antidepressant amitriptyline - Elavil – that is used to treat many behavioral problems. In these cats, however, the drug acts on mast cells to reduce histamine release and, by its anticholinergic effect, increases bladder capacity.
Assuming that medical causes have been ruled out or addressed, and the case is behavioral, the first order of business is to take a thorough behavioral history. We look for patterns. When and where is the cat urinating or defecating? Have there been changes in its routine or that of the family? Have there been new animals or humans joining the family group, or have former members left? Has there been a move, workman or painters in the house? Is there new furniture, or has the furniture been rearranged? Have there been changes in eating or drinking habits? We also need detailed information about litter boxes, their type, size and location, as well as the kind of litter used. In the multi-cat house it may not even be clear who is actually missing the litter box.
Who is usually relatively easy to determine. Sodium fluorescein can either be injected (0.3ml of 10% solution), given orally (0.5ml 10% solution) or you can make your own solution using 9 of the ophthalmic strips and given first to the most likely candidate. Owners then check new marks with either an ultra-violet lamp or a loaned Wood’s lamp for fluorescence. If the first cat is not the culprit, sodium fluorescein is administered to the next most likely cat etc, allowing a 2 day interval between cats. The responsible party may, of course, not be the cat. Toddlers may regress in their toileting, particularly under the stress of a new sibling, and other family pets may also be to blame. Cats may also start to mark over the urine left by other species as well as their own further complicating the issue!
It is also important to find out what the cat is doing. Is it urinating and/or defecating? If urinating is it spraying - backing up and marking vertical surfaces, or squatting and urinating pools of urine on horizontal surfaces or both? To this end, it is helpful if the owner can describe the most recent episodes, whether they were witnessed or not, they can at least say whether walls or floor were involved. (If even this is impossible, use of an ultraviolet light around the house will show if urine is on walls floor or both.) This may also establish when the cat is marking. Is it related to activities inside the house, or those outside, for example other cats or dogs crossing its yard? It is useful to know whether there is a cat door. In more than one case, a cat has refused to use its litter box after a stray cat entered through a cat flap, and used the resident cat’s litter box! Does the cat never use the litter box, or just sometimes avoid it? Although it may be hard to elicit the information, some cats will only misbehave if voices are raised in family arguments, literally scaring the poop out of them. If the cat is fine when the owner is home, but not when they are gone, confining it in an easily cleaned area during owner absence may be the simplest, and sometimes the only solution. This is really a case of separation anxiety, which can affect cats as well as dogs and horses.
A floor plan noting location of litter box(es), food and water, as well as owner perceived cat territories in multicat households, and location(s) cat(s) is using other than litter boxes, may provide a key to understanding the problem. It may be that the dominant cat has forbidden the problem cat access to the litter box!
Observing the cat in its litter box may be extremely informative. Some cats stand in the box, but eliminate over the side. Litter box size may or may not be a factor in this case. I will always remember an early case, where I visited the owner’s home, and watched as her 25lb castrated cat tried desperately to use his “litter-box” - which proved to be an aluminum roasting pan - not even a turkey sized one. No wonder he often escaped to the more spacious accommodations of her bathtub! In general, cats prefer the new clumping litters, but this is not always the case. Experimenting with litter type is certainly a good first step in solving the problem. Similarly, most cats prefer an out of the way location for their litter box, but do not appreciate the confinement of a hooded box. If you can observe the cat using its box, you may have clues as to whether either preference is a factor for a particular cat.
In general, inappropriate elimination can be divided into two separate behavioral problems. One is marking behavior, where the cat is delineating his territory. While more common in multi-cat households, marking may be seen in indoor cats particularly those which can see cats outside through windows or have other marking species in the house. The other problem, often referred to as inappropriate urination and/or defecation, indicates elimination where the purpose is voiding urine and feces.
Marking
As we have already observed, marking is a normal communicative behavior of free roaming cats, but one that is unacceptable in the confines of the human home. Cats may mark either when they are dominant or when they are insecure. To mark cats will either back up to a vertical surface, and standing emit a stream of urine - this is accompanied by treading with the hind feet and quivering of the tail - or they will perform basically the same movements, but from a squatting position. The quantity of urine involved is generally small when compared to that produced when the cat urinates to void its bladder. Before marking, cats may sniff the area first often for long periods, but do not sniff once they have marked. In contrast, urine that has been voided and buried rarely evokes more than a cursory sniff from another cat. Studies have shown that cats can determine the age of the mark, as well as the identity (sex, and whether it of the same group, an adjacent group or an unknown cat). Having sniffed, cats may mark over the mark, but do not retreat from it. In general, it is felt that marking enables cats to “time-share” an area, as well as being a sexual billboard. Marking increases dramatically during the breeding season. Unlike some species, cats not only mark the borders of their territory, but also the areas in between. It has been suggested they do so, as a form of comfort, surrounding themselves with their own scent, and that this explains why indoor cats are more likely to mark when anxious or stressed. Cats do not mark before they reach puberty. While marking occurs less frequently in castrated cats it can still be a problem. One study showed no difference in the occurrence between males castrated before reaching puberty and those castrated as adults.
Given what we know about the importance of urine marking in free-ranging cats, it is perhaps more surprising that not all cats mark or restrict their activity to the great outdoors. It has been suggested that these non-markers feel totally secure and comfortable in the home, and therefore do not feel the need to mark. Marking tends to occur on doorways and in halls, frequently traveled locations. Other areas seem more bizarre. Many cats target stove tops, electrical appliances and clothes dryers, much to their owners’ displeasure, as the misdeed is frequently not discovered until the appliance has been turned on. Whether this is a response to the particular odor of the appliance or the associated heat has been debated. It has even been suggested that cats are responding to their own reflections in mirror like appliances as if they were seeing another cat. Spraying into electrical outlets has caused more than one fire. Cats will often target their owners’ most intimate possessions including their beds and clothes. The motivation again is open to much speculation - mingling scents with a loved one, over marking an unloved intruder on the cat’s relationship with its owner, a need to reestablish closeness with an owner who is more frequently absent from the home etc etc. The latter might even be perceived as success by the cat. Even if the owner is screaming at the cat, at least she is paying it attention! While far less common, some cats do mark with feces - “middening”. As these tend to be left openly in doorways, halls, beds, chairs and often on the refrigerator they tend to be poorly received by owners.
Inappropriate Urination and/or Defecation
It is important to establish whether the cat was once completely litter-trained and is backsliding or whether appropriate behavior has never been established. The latter cases are usually more difficult to treat. In general, these cats either dislike something about the box provided or like somewhere else better.
A good place to start is to look at the litter substrate. This may be clay, clumping or not; paper; wood; ground corncobs; grass; gravel; peanut hulls or just about anything else that’s loose. Interestingly, many feral cats and even indoor/outdoor cats may have adapted so well to using concrete or hard packed earth, that they no longer associate “loose” with “toilet” and will use just about anywhere else in preference to their litter box. Scents applied to mask litter-box odor for the owners, may be aversive to cats. Many for example will avoid areas sprayed with citrus scents. Aversion to the litter may be expressed by shaking of the paws to get rid of it when leaving the box, rushing out of the box, crying, minimal scratching in the box, perching on the edge to avoid contact etc. If the problem began when the litter brand changed, substrate preference is to be suspected.
If pain triggered the problem, changing substrates may also break the false association with the litter box. (Shredded newspaper is often recommended for cats whose claws have been removed or which have been castrated, as it is less irritating to their wounds.) Cats that choose a particular surface type for their indiscretions, such as carpeting, linoleum or tile, may be giving you a message that this is their preference. A small area of the surface set aside for the cat or placed in its litter box may solve the problem.
The location of the box may be problematic. Owners often place the cat’s box, food and water in close proximity in an out of the way location, such as the laundry room or bathroom. Too open a location may also cause a cat to seek more privacy under the furniture. Cats should not be snatched from their litter boxes or otherwise disturbed thereon, as it is liable to cause them to avoid the box in future. Odor from rarely cleaned boxes also disturbs some cats and causes them to seek a new spot. As already mentioned, a dominant cat may guard the box. The number of boxes should always exceed the number of cats by one. These should be distributed round the house in such a way that each cat has access to at least one in his normal territory within the house. Cats that only use one or two spots in the house may be indicating this is the location they have chosen for their box instead of indicating a preference for a particular surface. Where possible, the easiest solution is to provide a box in the preferred location. If this is not acceptable, closing off the chosen area from the cat is also a possibility that may work.
Treatment:
We have already discussed some ideas that may help. However, each case is unique, and treatment often involves trying many different approaches before hitting something that works for a particular situation. Having a handout with possible solutions for owners, is definitely a starting point, and saves them trying to keep notes, and forgetting most of what you’ve suggested before they get home. In many cases, cats may be marking and voiding inappropriately, or the owner is not a good enough observer to distinguish the two, and so trying approaches which might seem more appropriate to the unobserved condition may also be helpful. In general, the sooner owner’s address the problem the better chance they have of correcting it. Cats which start out marking, may decide to add a marked area as a supplemental toilet area in time - it being less trouble than seeking out the litter pan two flights of stairs below.
The first step is to thoroughly clean the areas that have been soiled. For this only enzymatic cleaners are effective. While the area may smell clean to the owner, or they feel they have masked the odor with vinegar, chlorine bleach or whatever “secret” combination they have concocted, only the enzymatic cleaners remove the odor for the cat. Each indiscretion should be cleaned up whenever the owner discovers it. We have already addressed the topics of litter type, and box type and location.
For marking behaviors limiting access if only certain areas are being used is certainly a good idea. If this is not possible, using the areas the cat has marked as feeding stations or play areas, may also discourage marking behavior. If the cat is marking near outside doors and windows, it’s a good bet that it’s doing so because it sees cats in its yard. Blocking off visual input from outside may be helpful. Commercial scent aversives in my experience aren’t very good at keeping cats off window sills, but other options include electric scat mats - not my first choice, or inverted mouse traps under aluminum foil or newspaper - one company manufactures mouse traps in rubber for this purpose, but the added bang of the aluminum is rather effective. Solid deodorizers placed at intervals may also discourage the cat. Keeping stray cats out of the yard (fence toppers sold to keep cats in will keep others out) may be feasible in a particular situation. If it is possible that strays have used the cat door and entered the house, block the cat door.
If the cat marks after a move, furniture rearrangement or the introduction of new objects into its environment it may be suffering sensory overload. If a complete move or overhaul of the environment has occurred (or if it’s planned) limit the cat to one small area initially, and gradually introduce it to more areas as each is accepted. If there is a particular piece of furniture, or single room which has undergone adjustment, either limit access to the area, or allow the cat access only in the owner’s presence for several days, engage the cat in play or feed it in the area of concern until it seems comfortable there, but continue to monitor even after all seems well.
If the cat marks only during the owner’s absence - or voids for that matter - it indicates separation anxiety. Desensitization may be helpful. Confining the cat to a small area or boarding if the owner is gone for extended periods may be helpful while retraining the cat. The use of anxiolytics may help during this process. These techniques may also be useful if the cat responds by marking or voiding in response to family tension including the screaming of a newborn infant. Some cats spray their owners when they are reprimanded or as an attention seeking device. If the owners really feel they must reprimand the cat, suggest that they use long distance techniques, water pistols, foghorns etc. In the meantime, encourage them to engage the cat in play/ fun training sessions when he is being good - even if it means waking him up from his nap.
If the cat marks or voids on the owner’s possessions it may indicate a surface preference, separation anxiety or just plain marking. Given that the drugs used for marking and separation anxiety are often the same, the cause may remain moot. Owners are least likely to tolerate this behavior, and drugs tend to be in the forefront of treatment!
Multicat households are usually those in which marking is a problem. Marder has shown that in 100% of houses where there are 10 or more cats there will be marking. It may be that removal of the prime offender may ultimately be the only solution that works. All may be well, until the latest arrival just proves to be one too many. Feuds occur between particular cats, which we will be discussed further under aggression. Certainly cats have different tolerance when it comes to sharing. As well as providing an appropriate number of suitably located litter boxes, it is important that other stresses aren’t placed on the cats. Ensure that feeding areas in particular are also well spaced, and that no cat risks being chased off food all the time. If floor space is limited, adding the commercial cat trees, padding shelves etc to make use of vertical space may help. It is also appropriate to give cats hiding places where they can get a way from it all. These don’t have to be fancy, cardboard boxes with small entry holes are perfectly adequate. If a smaller cat is being kept from the box by a larger one, placing a litter box within a large cardboard box in which a door large enough to admit the persecuted cat but too small for its tormentor may provide effective relief.
It is particularly important that care is taken when introducing a new cat. Introductions should be made slowly. Move the new cat around from room to room excluding the established resident(s) and vice versa. Let the cats observe each other without being able to touch via screens, crates etc. Try feeding the cats separately in the same room, with the owners present to act as referee, although only in so far as separating the cats if things get out of hand. (If trouble is anticipated, having the cats on harnesses to which strong light twine has been attached will facilitate separation.)
Inappropriate voiding behaviors require that the attractiveness of the litter box must be increased for the cat, while that of the sites it has been using is diminished. Again making the areas he has been using feeding stations, play areas or simply keeping them off limits may all be helpful. While some cats do not like being observed using their litter box, if it can be done discretely, and the cat rewarded for appropriate littering this should be helpful. If the cat has never been properly litter box trained, it may be necessary to confine him in a small area (cat cage), with a litter box and no inappropriate areas for littering. Once he is using the litter box successfully, gradually broaden his horizons, until he will seek out the litter box in increasingly larger areas. If the cat gets in the box, but voids over the sides, look for a larger box, or one with higher sides or a cover. If he sprays from the box, fitting another box vertically in his target area or simply placing the box in a tiled or easily cleaned area, may be acceptable provided he is not spraying elsewhere. If the cat shows preferences for certain surfaces - carpeting, linoleum etc, place two boxes near to each other, in one put regular litter, and in the other a piece of the desirable surfacing. At each box change, add a handful of litter on top of the “surface”. If the cat has chosen the bathtub or sink as its litter area, you may need to start with a litter box in the tub/sink. Once the cat is using this, move the box to an area beside the tub/sink, and fill these with an inch or two of water to discourage him going back to his bad old ways. Even if the cat doesn’t mind getting its feet wet, it is unlikely to persist in urinating and defecating there. However, given its penchant for porcelain, this may be a cat that you can train to use the human toilet. If the cat uses plant pots as litter boxes, covering the soil surface with chicken wire or even decorative rocks can often discourage him.
If a cat returns to the site where its box was, and avoids the new site, it may be necessary to move the box back to the original location. Once the cat is again using it, start to move it in small increments towards the new location, while making the old location unattractive to the cat. Some things you can try include using lemon scents, putting down aluminum foil, plastic etc, as well as turning the old area into a feed station, bed or play area. It may be possible to shut off the old area, and start retraining from the entrance into the old area.
If arthritis restricts the cat’s ability to get in and out of the litter box, it may be replaced with a shallow tray, or even litter on a paper sheet, or one of the disposable puppy whelping box liners or puppy house breaking pads. For the geriatric cat with cognitive dysfunction consider selegiline. Confining the cat may also make it possible for the owner and cat to share some more time together. Hyperthyroid cats sometimes present with inappropriate defecation and less frequently urination. Once the thyroid problem has been addressed however, the problem usually resolves.
How and how often the litter box is cleaned may be important. As previously mentioned, cats may avoid a box which is too odiferous, soggy from underfoot urine or full of feces, but some owners go too far in the other direction, and scrub out the cat box with cleaners - sometimes even the enzymatic ones. As well as the possibility that these cleaners may be toxic, or burn the cat’s feet it not scrupulously washed out, the box may now be just too clean. Some odor serves to identify the box as the place to go. How much the box should be cleaned clearly depends on the number of cats using it, whether they go out or are confined indoors, the number of alternate boxes etc. Scooping once a day, and changing once a week has been suggested, although may be more than is strictly necessary in most cases.
Eventually, most owners would hope to be able to give the cat the run of the house again, even if it is helpful to exclude the cat from areas of indiscretion during re-training. It is also important to note, that simply restricting access, without making other changes to make the litter area more attractive usually result in the cat finding another inappropriate spot. Belling the cat, or keeping track of it by tying string to its harness may enable owners to catch it before it has a chance to reestablish old unacceptable habits.
Some owners put spraying cats (especially males at stud, which they cannot castrate) in diapers, cloth pants with leg and tail holes fastened with Velcro. There are two major problems with this approach. Cats generally loathe them, although the more confident cats tend to adapt to them with time. The other problem is that feces cling to the cat’s hair. One option is to keep the cat in an area where it is all right for him to spray, and only put the diapers on when he comes into other parts of the house.
The use of direct owner punishment when they see the cat engaged in inappropriate elimination serves little purpose, whether it is simply yelling at the cat or hitting it. In general, the only result is that the cat avoids the owner. Using indirect aversives, booby traps etc as described earlier, is generally only effective as long as they are present. Once they are removed, the cat will usually return to the previously protected area.
One of the newest, and highly touted treatments for feline urine marking is the pheromone analogue Feliway developed by Sanofi Animal Health. It contains an analogue of the feline facial pheromone - which has been described as an appeaser - and a cat attractant. Most research has shown that there is a reduction in the number of times a cat sprays in a period of time. However, more recent investigators have found that the success rate is not as dramatic as initially reported from studies funded by the manufacturer. Wayne Hunthausen reported results from 123 households through 18 vet clinics. Of 61 vertical sprayers, 14 stopped and 29 showed significant reduction, while of 18 horizontal sprayers 3 stopped and 6 showed significant reduction. He found no significant differences based on the animal’s sex, age, and the duration of spraying or number of cats in the household. In general, if the product was going to be effective it proved itself within the first week of trial. Few cats relapsed once they had stopped spraying. Some cats would no longer spray on treated areas, but found new areas to mark. The alcohol in the product can attract cats to spray, and the cat should be excluded from treated areas until the product has completely dried! Certainly, Feliway may be useful if only as an adjunctive treatment.
Drug therapy is generally most appropriate in cases where anxiety plays a significant role in the inappropriate eliminative behavior. The drugs used are not approved for feline use, although few significant side effects have occurred over years of use. It is important that correct doses are given, and that the cat gets the medicine. It is also important that a sufficient length of trial is made, because most of the more effective drugs do not produce a significant effect until they have been given for 3 - 4 weeks. If they are effective, without significant environmental modification, the cat may revert to its old ways if the drugs are withdrawn. Even with environmental change, many owners don’t want to risk taking the cat off the drug and having a return to the previous behavior, and chose to keep the cat on them for life.
Probably the safest and most effective drug for this problem is buspirone. Eckstein and Hart reported >75% reduction in spraying in 55% of the cats in their study. Male and female cats were equally likely to respond. When the drug was withdrawn after 2 months, only half the cats resumed spraying compared to more than 90% of the cats in a similar study using diazepam. Increasing the dose may be effective in some cats that do not respond initially. Cats maintained on the drug do not regress over several years of treatment. Response is usually seen within a week, although further improvement may occur over the next few weeks. Side effects are rare, agitation after pilling, or even in rare cases for longer periods has been reported. Some cats may seem a bit sleepy after pilling, but this is usually transient, as are g/i disturbances, which rarely last through more than the first 2-3 weeks of treatment. Tachycardia had also been reported. Cats usually become friendlier with their owners, but as their confidence increases, their increased assertiveness may manifest as aggression towards other cats.
Diazepam has fallen from favor as a behavioral drug since the report of fulminant hepatic failure in 11 cats given the drug orally at the established dosage level. However, it has been reported to be between 55-75% effective in treating spraying behavior, and to be equally effective in males and females. Increased friendliness to owners, sedation, ataxia, increased appetite and associated weight gain have all been reported. It is probable that oxazepram and alprazolam, which are metabolized differently and given to human patients with compromised liver function, would be safer and equally effective in cats. At this point though, there appears to be little or no advantage in giving any of the benzodiazepams over buspirone. If buspirone is ineffective, or if aggression to other cats is a potential problem, fluoxetine or one of the TCAs may prove effective. Because of their serious side effects, synthetic progestins are no longer recommended for treatment of inappropriate elimination. Castration will generally reduce or eliminate spraying in intact males. Other surgeries to create lesions in the medial preoptic hypothalamus (males), olfactory tracheotomy (females) while apparently successful in some cases have fallen out of favor in the light of newer drug therapies.
If therapy fails, is too expensive or not practical, giving the cat access to the outdoors, creating an easily cleaned indoor environment (or screened porch) or rehoming it may all be solutions that may preclude euthanasia. Some cats will continue to spray in the new home, while others do not.