Feline Housesoiling

Thinking Inside the Box: A Refresher on Feline Housesoiling
Beth L. Strickler, MS, DVM, DACVB

“Doc, Fluffy urinated yesterday on my finest Persian rug!” or “Doc, Mittens urinated right on my husband’s pillow!” Does this sound familiar? Do you struggle with helping clients whose cats are urinating outside the box? Feline housesoiling is one of the most common behavioral complaints presented to the primary care clinician. It is estimated that approximately 10% of all households with one or more cats have at least one cat with elimination problems. In a recent survey conducted by the author, 37% of cat owners visiting veterinary clinics for yearly wellness visits reported that their cat eliminated inappropriately, and only half of those owners had discussed the problem with their veterinarian. Cats should be screened at every wellness visit for elimination issues in the home as this may place the cat at risk for relinquishment or euthanasia.

The initial approach to a complaint of housesoiling is to obtain a full database – both medical and behavioral. If a screening urinalysis is normal, the minimum medical database for a housesoiling cat consists of a full physical exam (including examining the genitalia for structural abnormalities and checking the anal sacs), complete blood cell count, chemistry profile, thyroid test, urinalysis by cystocentesis with culture and sensitivity, and fecal examination. Radiographs, ultrasonography and cystography may also be necessary.

Once the medical contributions have been eliminated or identified, a behavioral history should be evaluated. The more information that is obtained during behavioral history gathering, the more likely the clinician is to sort out causes of housesoiling and establish an effective treatment plan. It is best if a clinician obtains a behavioral history using a standard behavior questionnaire so that contributing details are not overlooked.

Diagnosis of the motivation for the inappropriate elimination starts with identifying whether the cat is marking or inappropriately toileting. Marking (i.e., spraying) behavior occurs when the cat is standing and moving its back feet with the tail quivering while depositing a small amount of urine. The urine is deposited onto a vertical location, several inches off the ground. Most commonly the area where the urine is located has some social significance, such as doors, windows or new objects. Cats usually continue to use the litter box for both urination and defecation. Male, female, intact and neutered animals may engage in this behavior (10% of reports are neutered males and 5% are spayed females). Urinalyses are typically normal in spraying cats.

When a cat is “toileting” (i.e. inappropriately urinating), urine is typically deposited on a horizontal surface. Normal to large volumes of urine are deposited, and the cat often reduces its use of the litter box. Urine may be found in a variety of areas such as the edges of rooms, rugs, beds, bathtubs or just outside the litter box. A cat who is depositing feces in appropriate locations may also be motivated by toileting issues. Feces may also be used for marking if it is placed in socially significant locations, but this is less common.

Surgical neutering as a treatment for marking behaviors may be 90% effective in intact males (regardless of age) and 95% effective in intact females. Beyond surgical intervention, it is important to identify and control the eliciting stimulus. Marking is a normal feline behavior. It serves a communicative function and may be associated with competition, conflict or territorial issues. Pheromones may be used to change the marking behavior from spraying to bunting (reports of success are up to 95% improvement, and some improve in 7-14 days). Psychotropic drugs can be useful if there is an anxiety component when used in conjunction with behavioral therapy. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has been shown to be greater than 90% effective in reducing feline marking behaviors. Other SSRIs or tri-cyclic antidepressants (TCAs) may also be beneficial.

Although clinicians often find inappropriate elimination secondary to toileting issues as one of the more challenging behavioral problems, it can be rewarding when the puzzle is solved. The treatment protocol for cats with this behavioral disorder is dependent on the identified cause and consists of environmental and behavioral modification. Possible behavioral causes may include: litter box cleanliness, litter aversion, litter box aversion, location aversion, location preference, learned aversions, substrate preferences, social influences, environmental stressors, cognitive dysfunction and other miscellaneous causes. Referral to a veterinary behaviorist is often beneficial for these patients as the process of identifying causes and developing a treatment plan can be time-consuming and challenging.

Treatment may involve improving the cleanliness of the box, the size of the box, the location of the box, the type of litter, the depth of the litter, etc. What is most important is to determine what this individual cat prefers. If there are complicating factors secondary to anxiety, medications may be used in conjunction with behavior modification for toileting issues. Prognosis for toileting issues in many cases depends not on duration or cause but on an owner’s ability and willingness to manipulate the environment.