“I’m at the end of my rope!” This is a common sentiment among cat owners who are tired of cleaning up after their cat who has stopped using the litter box.
Eliminating outside of the litter box is one of the most common behavioral and health problems that bring our feline patients in to see us. There are four main categories that causes fall into for feline house soiling: Feline Idiopathic Cystitis; Medical Causes; Marking Behavior; Problematic Primary Enviromental or Social Factors. Feline Idiopathic Cystitis is caused by both a physiological problem and environmental stress and is considered both a medical and behavior problem. Other medical problems that can cause house soiling are a urinary tract infection, increased urine production (diseases like diabetes, and many others, cause this), urinary pain from crystals/stones, and other primary urinary problems. The problem can be defecating outside the box, and it may be a sign of bowel discomfort due to constipation or diarrhea. For cats with urine marking, the problem may be a sign of anxiety or stress in the cat, and respond to medication for anxiety. For cats with inappropriate elimination which is neither marking nor medical, improving the nature of the litter box and retraining their habits is key. For some of these cats, anxiety is also a component. In older cats, especially over the age of 12, arthritis may make travelling to or entering the box uncomfortable, motivating the cat to go in other places.
The first step in evaluating this disorder is to take a detailed history about what the cat is doing, where, and how often, and including any changes in the household (such as changes in family members or pets living at home, changes in where the cat lives, home construction projects, etc.). We have a feline house soiling questionnaire you can download from our home page in the far lower right hand corner. This is a detailed questionnaire that can help us pinpoint the problem and find the best solution.
Next, a full physical exam and urinalysis is performed to help determine whether there is a medical cause for the signs. If there is a medical cause, it is critical to treat it. This may require medication for a short time, or for life if the cat has a chronic disease. In most cases, the cats do best on a canned food which helps them have good nutrition, more water intake, and a healthy weight. We may prescribe a specific canned food if your cat has a urinary tract problem.
If your cat has no urinary infections, crystals or other abnormalities, the most common cause (behavior sometimes in conjunction with anxiety/stress) is likely the culprit. For these cats, behavioral modification using confinement so that they only have one place to eliminate (the litter box) is highly effective in getting the cat to resume consistent litter box use. This may also require making changes to reduce the availability of other places your cat is currently using (picking up throw rugs, putting laundry in closed bins, etc) to help change the cats habits. For some cats, especially those in which we can identify that anxiety is definitely the cause, we may also use a medication to reduce their anxiety, since treating the underlying cause is the best way to solve the problem. However, even if your cat is on anti-anxiety medication, it will work best in conjunction with the behavior modification plan.
We do not know why some cats become stressed by what may seem like small changes in their household, especially since other people and cats in the house may not show similar signs of stress. However, we do know that cats which show this pattern of inappropriate elimination as a response to anxiety may do so repeatedly.
Further, once a cat starts using an inappropriate place to urinate or defecate, it may become habit, or attract other cats to use that place inappropriately also. Therefore, if any of your cats start to have inappropriate elimination, contact us promptly so we can start treatment and minimize the risk of ongoing property damage or bad habits developing.
Help Your Cat Like To Use The Box
Cats can be finicky about their litter boxes. Here are some things you can do to help ensure your litter boxes are attractive and not off-putting to your cats. We want to put the boxes some place the cat wants to go, rather than a place the cat avoids.
1. Plenty of boxes. Have one more box than you have cats: if you have 3 cats, have 4 boxes. Cats often want to go all at the same time, first thing in the morning. If all the boxes are occupied, someone may end up going outside the box.
2. Clean boxes. Make sure all boxes are cleaned every day. No one wants to use a dirty box. Cleaning the litter box is as necessary as flushing a toilet after a human uses it.
3. Consistent litter substrate. Some cats dont like change. If youre not sure what litter your cat likes, you can line up a row of boxes with different types of litter and see which one the cat uses. If your cats have been consistently using a specific litter type, dont change it. Change in litter type (particle size, substance, smell, etc.) can make the box unattractive and make a cat stop using the box.
4. Boxes nearby. If you have multiple levels, have a box on every floor/story of your house. If your house is large, make sure there are boxes at each end of the house so that cats dont have to travel really far to use one.
5. Easy to access. Make sure at least some boxes are easy to access. If a box is behind a closed bathroom or bedroom door, the cat cant get to it. Upstairs, downstairs, over/under baby gates, and otherwise hard to access boxes may deter a cat which is tired, sore, or needs to go urgently. If you have an older cat or a cat recovering from injury, low-sided boxes that are easy to step into, or ramps leading into higher-sided boxes, can make it easier to use the box even with sore legs. Boxes should be 1.5 times the length of the cat. You can use plastic storage bins or other items that are adequate in size and shape if commercial boxes are too small.
6. No scary things nearby. If the box is next to the laundry machines, and they are noisily running, it may scare off a cat. High traffic areas, places near dogs, or ones requiring the cat to go past an aggressive cat housemate may all keep the cat from feeling comfortable going to, and sitting in, the box. Try to place the boxes where they are peaceful to enter and use.
7. Privacy. Try using covered, top-entry, or other box styles (without removing the old style boxes) to see if your cat is more comfortable using a box that gives the cat more privacy.
8. Humor preferences. If you arent sure what your cat likes, offer a litter box buffet a row of different boxes (covered, open, automatic; clumping, clay, other litter types, etc.) so you can find out what your cat prefers to use. Sometimes finding the right combination does the trick.
Litter Box Boot Camp: Behavioral Modification for Inappropriate Elimination
All cats who start using non-litter-box places to eliminate need to be encouraged to use the box as the one, and only, suitable place to go. The best way to do this is to give the cat a very simple, routine life where the only attractive place to eliminate is the litter box.
Create a studio apartmen for your cat. Start with a large dog crate. These are typically made of thick wire and have a removable plastic tray in the bottom. Place in the crate a litter box with litter, a food and water bowl, and an empty plastic cat carrier (the cats bed). This gives the cat a place to eat, drink, sleep and eliminate. Its no-frills but it provides all the cats needs.
The cat should stay in this studio apartment until he/she has used the litter box consistently with no mistakes for 2 weeks.
Each level or phase will last two or more weeks, until the cat has been successful using the box for 2 weeks. If the cat fails, then go back to level one.
Level One: Confined to studio apartment unless on a leash or in your arms.
Level Two: Confined to studio apartment unless within eyesight in same room with you and only out while you are awake/paying attention.
Level Three: Confined to studio apartment unless within the same room, or one room away (but still within eyesight) and only out while you are awake/paying attention.
Level Four: Confined to studio apartment unless you are at home and only out while you are awake/paying attention.
Level Five: Confined to studio apartment while you are at work or asleep. Loose in house when you are home, even if you are not paying direct attention, and while you run short errands (less than a few hours).
Level Six/regular life: Loose in house at all times even when you are not home for more than a few hours/overnight.
This Boot Camp may seem like its a lot to do. However, it really takes less effort than you think, especially when you realize you wont have to spend a significant time every day cleaning the messes your cat was leaving in your house. Also, Level One is a great time to thoroughly clean places where your cat previously eliminated, and brainstorm ways to keep them from being used again once you reach the next level.
Eliminate attractive places to go. Pick up bathmats and throw rugs. Place clean and dirty laundry in closed closets, baskets with lids, or other inaccessible areas. Use of scatmats and other deterrents can also help keep cats off of places they used to go.
Husbandry and Management for Inappropriate Elimination
In addition to the already discussed changes in the litterboxes themselves, there are household or environmental management changes that can help reduce the cats anxiety and significantly improve behavior.
Visit the Indoor Cat Initiative for helpful tips on making your indoor cats life as enriched as possible.
Some helpful things you can do include:
- Place Feliway diffusers in all rooms (see package for details). If unable to put them in all spaces, put them in places where the cat eliminates to help reduce the cats stress in these areas.
- Offer high perches such as cat trees, empty shelves, etc. for your cat to enjoy
- Ensure each of your cats have one-on-one play and quality time with you; even 10 minutes twice a day can really help relax your cat and help your cat feel less stress.
- Give your cat a room of his/her own an entire room, a closet, bathroom, or large crate where your pet can retreat when desiring alone time.
- Have night lights where cats sleep in multi-cat households so no one gets startled by other cats moving around in the dark.
- Try to keep to a similar daily routine in which events, such as meals, happen at consistent times.
- Try to avoid having heavily scented items near the cats favorite hangouts, litter box, and food. Heavy scents in these areas may deter the cat from using them or make the cat uncomfortable when she/he does use them.
Medication for Urine Marking and Anxiety in Cats
There are many medications available to help treat anxiety in cats. Depending on the severity of the case, we use pheromones (Feliway), amitriptyline, clomipramine, fluoxetine, alprazolam, and/or other medications.
Amitriptyline is a TCA (tricyclic antidepressant) that acts to inhibit the uptake of serotonin and other transmitters at presynaptic nerve terminals. It is not FDA labeled for cats and is used off label. Many veterinary behaviorists have documented success with this drug for both Feline Idiopathic cystitis and behavioral causes of house soiling. It can be given orally in pill or compounded liquid or it can be applied transdermally for cats who do not accept oral medications. Although it works transdermally the dose may need to be increased because it is not absorbed through the skin as efficiently as it is through the GI tract.
Studies have shown that Clomipramine can be effective for urine marking in cats. This medication is FDA approved for use in dogs as the brand name Clomicalm. This medication is available as a tablet or capsule.
As with any medication which has desired effects (reducing urine marking), there is a chance it has effects which may be less desired. In cats, the most common undesired effects are sedation and dry mouth. Obviously we are giving this medication to change behavior and elimination in a good way. There is a low risk this medication can make your cat uninhibited and it may become more or less friendly, more or less aggressive, more or less active, or more or less well-behaved.
In cats that have serious anxiety issues, we may use a medication called Fluoxetine to reduce anxiety and other behavior problems, such as urine marking. This medication is FDA approved for use in dogs as the brand name Reconcile. Since most cats are smaller than most dogs, and often do not take pills well, we usually use a liquid form of the medication.
As with any medication which has desired effects, there is a chance it has effects which may be less desired. In cats, the most common undesired effects are reduced appetite, behavior change, and change in elimination patterns. Obviously we are giving this medication to change behavior and elimination in a good way. There is a low risk this medication can make your cat uninhibited and it may become more or less friendly, more or less aggressive, more or less active, or more or less well-behaved.
Fluoxetine should not be stopped abruptly. When you cat is ready to stop taking Fluoxetine, please slowly taper your cat off the medication over the course of about 2 weeks by decreasing the dose by a small amount every day.
In cats that have serious anxiety issues, we may use a medication called Alprazolam to reduce anxiety and other behavior problems, such as urine marking. This medication is FDA approved for use in humans as the brand name Xanax. This medication is available in a liquid and a pill form (the pill form is available as a generic).
As with any medication which has desired effects, there is a chance it has effects which may be less desired. In cats, the most common undesired effects are sedation, behavior change, and change in elimination patterns. Obviously we are giving this medication to change behavior and elimination in a good way. There is a low risk this medication can make your cat uninhibited and it may become more or less friendly, more or less aggressive, more or less active, or more or less well-behaved.
Most cats starting any of the above medications are otherwise healthy and not on medications. If your cat is on any other medication when starting any new medication, make sure your vet is aware of all of your pet’s medications. The use of this medication may need to be altered if used in conjunction with other behavior-altering medication (such as tricyclic antidepressants, SSRIs and MAOIs) and you need to discuss with your veterinarian before giving this medication with cimetidine, cisapride, certain sedatives, dextrometorphan, rifampin, and certain other medications.