Bailey, a 4 year old male neutered Domestic Shorthair, is presented for inappropriate urination. Bailey lives with three other cats. They share two litter boxes, which are scooped daily and cleaned weekly.

This has always worked well, but Bailey’s owner recently began noticing small puddles of urine on the rug in the upstairs guest bathroom. After a week of careful observation, the owner has determined that Bailey is the culprit.

Inappropriate elimination is a common, and potentially frustrating, presentation. Let’s first walk through the basic approach to these cases, then apply this approach to Bailey’s case. 

The Basic Approach to Inappropriate Elimination

Owners often assume that inappropriate elimination is behavioral, but it’s important to rule out medical causes, such a lower urinary tract disease and gastrointestinal disease. A thorough medical workup (bloodwork, urinalysis, fecal parasite testing, and GI diagnostics as indicated) is required before assuming that the issue is behavioral.

Once medical causes for inappropriate elimination have been ruled out, a more thorough behavioral history should be collected. 

• Have there been any recent changes in the home? 
• How do the cats in the home get along with each other? 
• Are they friendly (cuddling and mutual grooming) or do they avoid each other?
• Where are your litter boxes located? 
• If there are multiple boxes, are they in a single room or separated?
• Are they in a quiet area or in a loud area (such as the laundry room)?
• Where are the food/water bowls in relation to litter boxes?
• What is your litter box setup?
• Litter box size, covered vs. uncovered
• What type of litter?
• What is your cleaning routine?

The answers to these questions may give you an easy solution. For example, owners should have one more litter box than they have cats. Having an inadequate number of litter boxes can cause issues, especially if the cats in the home do not get along well. Litter boxes in noisy areas, or that are cleaned inconsistently, may also be unappealing to many cats. 

Inappropriate elimination can be categorized by one of the following diagnoses: 

• Aversion: substrate or location
• Preference: substrate or location
• Marking 

In an aversion, the cat dislikes the litter box or its location. A substrate aversion may be caused by a cat disliking the particular litter that is used in the box or the cleanliness of the box. Cats may also develop an aversion if they had a previous painful experience in the litter box (for example, feline lower urinary tract disease). Location aversion is caused by unpleasant experiences in the area where the box is located. This may occur if a cat is bullied upon approaching the litter box, if the litter box is located in a loud area, or if the cat has previously been startled in this area.

Some cats develop a preference for a specific substrate or location. A cat with substrate preference may prefer an alternative surface for elimination (such as fabric) or may simply not like the type of litter that the owner is providing. A cat with a location preference prefers to eliminate in a different area than where the litter box is currently located. These cats may prefer an area that is more quiet or that is free of social conflict. 

Finally, some inappropriate elimination takes the form of marking. Marking can involve urine or feces, but it is typically deposited at areas of social significance (for example, near doors and windows if an indoor cat is responding to cats outdoors). Spraying is a form of marking, but marking can also involve depositing urine on horizontal surfaces. 

Determining the underlying cause of a cat’s inappropriate elimination is essential, in order to develop an appropriate treatment plan. 

First, the owners should thoroughly clean all surfaces with an effective enzymatic cleaner. Flooring should be replaced or resealed, if possible; every effort must be made to remove all odors. After cleaning, the cat’s access to the area should be eliminated. Remove rugs or secure heavy tarps over the area to make it less appealing. 

Next, offer the cat options for elimination - a “litter box buffet.” The client’s goal is to overcome any aversions the cat has developed and provide a litter box that is in line with the cat’s preferences. The client should offer a variety of litter box styles and different litters, placed in various locations throughout the home, in order to allow the cat to determine which litter box configuration it prefers. If the cat has expressed a preference for a new location, place at least one litter box in that room. Ensure that litter boxes are scooped daily and fully changed and cleaned once weekly, to make the litter box as appealing as possible. 

Medication may also be used to treat inappropriate elimination. Pheromones like Feliway^® can help restore a cat’s sense of well-being. Selective serotonin reuptake inhibitors and tricyclic antidepressants can also be helpful in helping cats overcome litter box aversions or adjust their litter box preferences. It’s important for clients to understand, however, that these treatments are intended as an adjunct to behavioral/environmental modification. They are not intended to replace these efforts. 

Bailey’s Case

On physical exam, Bailey appears healthy. He has a body condition score of 3/5, mild dental calculus, and no apparent abnormalities on thoracic auscultation or on abdominal palpation. There is no evidence of overgrooming on his belly (which could indicate abdominal discomfort due to cystitis) and no other abnormalities are detected. A complete blood cell count, serum biochemistry, and urinalysis are all within normal limits. Therefore, a medical cause for Bailey’s inappropriate urination was ruled out. 

As you obtain a behavioral history, you learn that Bailey does not get along well with one of the other cats in the home. They don’t fight, but Bailey goes out of his way to avoid that cat when possible. You also learn that both litter boxes are located in the laundry room and the only cat tree in the house, which is where Bailey’s “enemy” typically hangs out, is right outside the door to this room. When Bailey urinates inappropriately, he does so on the rug of the guest bathroom. This is upstairs, in an area that the human owners and the other cats rarely enter. 

Based on this information, you suspect that Bailey has developed a location aversion to the laundry room. The presence of his “enemy” is likely causing Bailey anxiety about entering this area. Therefore, you recommend that Bailey’s owner add a litter box in the quiet guest bathroom where Bailey is currently eliminating. Additionally, you ask Bailey’s owner to remove the bathroom rug, to remove temptation.

You also suggest that the owner add two more litter boxes in other areas of the house, to limit resource competition between cats. She doesn’t feel this is realistic, but said that she will try to add at least one more box. You also suggest adding more cat trees, to minimize competition between the cats. 

You tell the owner to try these changes without medication and make plans to revisit the need for medication if improvement is not noted. When you contact Bailey’s owner to check in two weeks later, you learn that these simple changes have completely resolved the issue. 

Challenging but not impossible! 

This case was relatively simple, for a number of reasons. First, Bailey’s owner sought help promptly. Second, she was willing to make positive changes. Finally, Bailey responded well to those changes. 

In some cases, however, things won’t be as easy. 

If you encounter a frustrating case, keep in mind that a systematic approach is still best. Rule out medical conditions, collect a thorough behavioral history, arrive at a diagnosis, and then devise a treatment plan. If owners seek help promptly, and you can convince them to follow your recommendations and have realistic expectations, many of these cases can be successfully addressed.