Canine housesoiling (Proceedings)

Overview

For the young puppy, the purpose of micturition and defecation is to rid the body of wastes. Elimination by adult canids can serve other functions including social communication. It also may occur as a component of fear, submissive responses, separation anxiety, and excitement.

Eliminating in the home can be due to a variety of reasons. The most common causes in young dogs are inadequate training, submissive urination and excitement. During adulthood, marking and separation anxiety can result in inappropriate elimination in the home. Medical problems can occur at any age, but tend to be more frequent in the older pet. Occasionally, you will see a housesoiling problem that occurs rather spontaneously and may be due to situations such as an abrupt change in the owner's schedule, failure of the owner to allow the pet access to the elimination area in a timely fashion, a change in the pet's feeding schedule or a change in the pet's diet. When the problem is allowed to persist, it is likely that the pet will develop strong, new location or surface preferences for eliminating within the home.

Table 1. Differential Diagnoses for Housesoiling

• Inadequate training

• Submissive urination

• Excitement urination

• Marking

• Separation anxiety

• Medical problems

• Management-related problems

Medical causes of fecal housesoiling

Before working up and treating any behavior problem, it is always important to rule out underlying medical conditions. This is particularly true when working with older pets that have a relatively high incidence of medical problems. Conditions that result in an increased frequency of defecation or cause inflammation and pain to be associated with the act can lead to housesoiling. Diarrhea, maldigestion, malabsorption and colitis are all problems that can result in the pet defecating in the home. Anything that compromises the neurological control of elimination can cause incontinence and result in housesoiling. Neurologic causes of defecation in the home include peripheral nerve damage, spinal cord disease, and cephalic problems including tumors, trauma, infection, inflammation, and age-related degenerative disorders. Impaired cognitive function in some elderly pets can cause confusion, disorientation and poor perception, which can lead to housesoiling.

Medical causes of urinary housesoiling

Urinary problems that cause polyuria, increased frequency or irritation can trigger housesoiling problems. Housesoiling is often one of the first signs noticed by owners of dogs that have polyuria due to conditions such as renal disease, hyperadrenal disease, diabetes or pyometra. Lower urinary tract infections or inflammation, and irritation caused by cystic calculi typically lead to an urge to urinate more frequently. Anything that decreases the volume of the urinary bladder can also increase the need to urinate more frequently. Problems such as urinary bladder tumors, large calculi or abdominal masses can result in a decrease in bladder volume and an increased frequency of urination. An increased frequency of urine voiding usually will cause housesoiling if the pet's access to its elimination area is not concurrently increased.

Anything that compromises the neurological control of elimination can contribute to housesoiling problems, including peripheral nerve damage, spinal cord disease, and cephalic problems, including tumors, trauma, infection, inflammation and age-related degenerative disorders. Urethral incompetence that results in incontinence can be another cause of housesoiling. As with fecal housesoiling, impaired cognitive function in some elderly pets can cause confusion, disorientation and poor perception, which can result in housesoiling.

Table 2. Medical Causes of Fecal Housesoiling

Problems that cause increased volume of feces

• Maldigestion disorders
• Malabsorption disorders
• High fiber diets

Problems that cause increased frequency of voiding

• Colitis
• Diarrhea

Problems that influence control

• Compromised neurologic function
• - Peripheral nerve impairment
• - Spinal cord impairment
• - Cranial disease (tumors, encephalitis, infection, degenerative disorders)

Medical Causes of Urinary Housesoiling

Problems that cause polyuria

• Renal failure

• Hyperadrenalcorticism

• Diabetes

• Pyometra

• Hepatic disease

Problems that cause increased frequency

• Lower urinary tract infection or inflammation

• Urinary calculi

• Urinary bladder tumors

• Prostatitis

• Abdominal masses

Problems that influence control

• Compromised neurologic function

• - Peripheral nerve impairment

• - Spinal cord impairment

• - Cranial disease (tumors, encephalitis, infection, degenerative disorders)

• Urethral incompetence

• Cognitive dysfunction

Miscellaneous medical causes of housesoiling

Anything that makes it difficult for the pet to get to its elimination area can result in it voiding in the home. Arthritis or weakness can cause the pet to avoid using stairs to the outdoors. Sensory loss can make ambulation difficult, lead to confusion and cause the dog to urinate and defecate indoors. Intolerance to extremes in heat (obesity) or cold (hypothyroidism) may make the pet reluctant to leave the comfort indoors to eliminate outdoors.

Medical workup

The housesoiling patient should receive a thorough physical and neurologic exam including attention to the pet's state of mental awareness. Special attention should be paid to the gastrointestinal and urinary systems. Lab tests may include a fecal exam for parasites, urinalysis, serum chemistry panel, CBC and thyroid function evaluation. Ancillary testing and procedures might include radiographs, adrenal function tests, trypsin-like immunoreactivity and water deprivation testing.

Behavioral history

Once underlying medical problems have been ruled out or treated, some time must be spent gathering sufficiently detailed historical information in order to formulate a diagnosis, prognosis and treatment plan. You will want to know where the pet is housesoiling, whether it is urine, stool or both, as well as a description of the act of elimination. Any information the owner can provide concerning the initial appearance of the problem may prove to be helpful in understanding the cause of the housesoiling as well as deciding what to do to prevent recurrence.2 You will want to find out if there were any major changes in the pet's environment, in the owner's schedule, or in its relationship with the owner preceding the appearance of the housesoiling. Some pets are relatively intolerant of diet changes, so switching to a rich diet can cause diarrhea, increased frequency of defecation and housesoiling. Changing an obese dog to a high fiber diet can cause an increase in the volume of stool produced and a need to defecate more frequently. If the pet is not allowed outdoors more often, it may subsequently defecate in the home.

Information about the home environment, family members' schedules and individual relationships with the pet will be helpful. If the family schedule results in the pet being left alone for longer than it is able to control elimination, a doggie door or paper training may be important considerations. Confinement, supervision and reinforcement of desired behaviors are important parts of the correction program and should be assigned to individuals depending upon availability and dedication to the pet. Another reason to explore the relationship between the pet and family members is to investigate the possibility of separation anxiety triggering a housesoiling problem. A history of housesoiling that started after an abrupt decrease in the amount of time spent with the pet by an owner who has a very close relationship with it may suggest an underlying separation anxiety problem. Anxious behavior when the owner departs and the absence of housesoiling when the pet has access to the owner are typical accompanying signs.

If there are specific territorial or anxiety-provoking stimuli that typically precede incidents of urination by a male pet, marking should be a strong consideration. Visits by other pets, visits by owners of pets or visits that are disruptive, such as overnight visits by guests and holiday celebrations, may trigger marking behavior.

It is always important to ask if the housesoiling has taken place in front of a family member. In most cases, you will find that the pet eliminates out of sight of the owner. If the pet is housesoiling directly in front of the owner, there are several possibilities: the owner has never provided a sufficiently aversive correction during the behavior; the pet tried to signal, but the owner was distracted; a medical problem has compromised the pet's control; or senile changes resulting in disorientation and mental confusion have compromised voluntary control. Another important consideration is what medication the pet is currently taking, since some medications can cause polyuria or changes in the characteristics of the stool.

Prognosis

Knowing the duration of the problem, frequency of housesoiling, number of sites soiled and the mental state of the pet is important in deciding upon the prognosis for successful treatment of the dog with a housesoiling problem. The best prognosis is for a pet with an alert mental status that has no untreatable medical conditions, and a problem that is short in duration that occurs infrequently in a limited number of locations in the home. The prognosis is also improved if the dog has already been accustomed to a confinement room or crate and the owner is available to frequently take the pet outdoors to eliminate.

General principles for treating housesoiling problems

Elimination behavior changes considerably during the initial weeks of the dog's life. The infantile puppy must be stimulated to eliminate by having its urogenital area licked by the bitch. Immediately upon eliminating the mother will ingest the puppy's feces and urine. By three weeks of age, most puppies have begun eliminating on their own, away from their nesting area.6,7 At about five weeks of age, puppies have chosen general areas for elimination and by nine weeks the area for elimination becomes rather specific.8 The rationale behind housetraining involves taking advantage of the dog's innate proclivity to avoid eliminating in its nesting area and combining this idiosyncrasy with classical and operant conditioning. The main techniques involve shaping and rewarding desired behavior, controlling the feeding schedules and controlling the pet's environment in order to prevent elimination in undesirable areas. With patience and consistency, most owners are able to train the pet to eliminate outdoors and avoid eliminating indoors within a couple months.

Teach the desired behavior: Treating the housesoiling dog involves reinforcing the desired behavior and preventing or discouraging the undesired behavior. The first step is to teach the pet where it is acceptable to eliminate. To accomplish this, the owner must frequently accompany the pet to the chosen elimination area, mildly praise any sniffing or other pre-elimination behaviors and heartily praise it as it eliminates. Giving a food reward immediately following elimination will further strengthen the recurrence of the behavior in the desired location.

Feeding schedule: Controlling the feeding schedule will provide some control over the pet's elimination schedule. Most dogs will eliminate within a somewhat predictable time postprandial. While young puppies tend to eliminate within the first hour after eating, the interval between eating and eliminating tends to be somewhat longer for adults, as well as more variable. Food should be offered at the same time each day for no longer than 30 minutes. The last meal should be finished three to five hours prior to bedtime. The time during which most of the housesoiling occurs will have some bearing on the feeding schedule that is established. If the pet is more likely to housesoil during the day, the morning meal should be very small, or feeding should be limited only to the early evening. Feeding the pet a low fiber diet will reduce the amount of stool produced and may help in some situations. In most cases, water should be available all day, but, unless there are medical reasons not to restrict water intake, water should be taken up just prior to bedtime.

Confinement/Supervision: Probably the most important consideration is to provide close supervision or confinement for a long enough period of time that eliminating in an appropriate area has been adequately reinforced and the habit of eliminating in inappropriate areas has become extinct. This may take anywhere from several weeks to many months depending on the duration of the problem, the consistency of the family and whether or not the pet was ever housetrained. In general, the pet should not be considered housetrained until it has gone for at least four to eight consecutive weeks without eliminating in an inappropriate area. Until this has been accomplished, it should be within eyesight of a family member 100% of the time. When it can't be watched, it should be confined to a small area or placed outdoors. A leash can be a handy tool to keep the pet within eyesight when the owner might be distracted.

A wire or plastic crate provides an excellent area in which to confine the pet when it cannot be observed, but it has some limitations. It should not be used for longer than the pet can physically control elimination or for more than four to five hours during the day on a continuous schedule. Older pets sometimes have difficulty adapting to a small confinement area if this was never used when they were younger. These dogs should be introduced to confinement very gradually. Feeding in the crate, tossing toys in the crate and hiding treats for it to find in the crate should all help adjust the pet to confinement. If the confinement area will be a small room or run in the home, the same techniques can be used, and the owner may also spend some time in the area playing with the pet or simply reading or doing paperwork as the pet rests in the area. If the pet eliminates in inappropriate areas while the family sleeps, but wakes the family if they attempt to crate it at night, they might try tying the pet to a leg of the bed on a short leash during the night.

Another consideration is to provide a doggie door so that the pet has access to the outdoors when the owner is not home. For dogs that soil indoors even when a doggie door is available, the owner should build a small confinement pen around the inside door flap that is just large enough for the pet to rest. Most dogs will then use the door to go outside in order to avoid soiling the sleeping area.

Prevent resoiling: Urine and feces odor must be removed with an effective commercial product. Carpeting should be soaked, since merely spraying the surface is not likely to be efficacious. Access to previously soiled areas can be controlled by closing doors or moving furniture over those areas. The pet can be taught to avoid an area by using environmental punishment. Booby traps such as upside-down mousetraps, balloons set to pop when disturbed and motion-activated alarms are often successful in conditioning a pet to avoid an area. Most pets prefer to avoid eliminating in areas where they eat, sleep or play. Therefore, food, water bowls, bedding or toys can be placed in previously soiled areas in order to discourage elimination at those spots.

Punishment: This is the least important and most overused approach to correcting housesoiling. Punishment must be discussed because most owners use it excessively or inappropriately. Punishment should involve nothing more than a startling distraction. A quick stomp of the foot, a loud handclap, a sharp tap on a tabletop or an abrupt "No" given with enough intensity to stop the behavior and elicit a mild startle response without frightening the pet is all that is necessary. The correction must be given during the behavior or within a second afterwards. A longer delay will be ineffective and may create anxiety-related problems. Physical punishment, harsh scolding and rubbing the pet's nose in urine or feces must be prohibited.

Table 3

Treatment of Housesoiling Problems

Reinforce the desired behavior

Control the feeding schedule

Confinement / Supervision

Prevent resoiling

• Odor elimination

• Prevent access to areas

• Change the behavioral function of the area

• Avoidance conditioning

Punishment

• Avoid physical, harsh or delayed punishment

• Use a mild auditory interruption

Submissive urination

Submissive urination is most commonly seen in puppies, although it may occur at any age. The problem occurs when the pet is confronted with certain gestures or body postures by a person that it perceives to be threatening or socially dominant. Triggers for urination include approaching, standing over, reaching for the pet or attempts to punish the pet. The pet urinates as it shows signs of submissive signaling, such as ears back, horizontal retraction of lips, avoidance of eye contact, and cowering. Sometimes the pet will roll onto its side or back while urinating. The pet that urinates submissively may be perfectly housebroken with no other history of having urinated inappropriately in the home.

The first step in treating submissive urination is to identify all initiating stimuli. The owner then must do whatever is necessary to discontinue these actions so that all urination-eliciting stimuli are removed. The pet must be approached in a calm, less dominant manner. When greeting a very submissive dog, the owner may initially need to ignore it, even to the extent of avoiding eye contact. Asking the pet to sit for a treat or fetch a toy during greetings can be very helpful.

Excitement urination

This problem is similar to submissive urination but accompanying submissive behaviors are absent or less prominent. Treatment is basically the same as for submissive urination. Stimuli for excitement must be removed or changed. The pet should be ignored until it is calm, then should be asked to sit/stay for a treat or toy.

Marking

In most cases, this type of problem involves an intact male urinating on an upright object. The volume of urine voided is usually less than what is typically voided to empty the bladder. Marking is most likely to occur on or near pheromones left by other canines. The diagnosis can be confirmed when specific territorial or anxiety-eliciting stimuli are associated with the act. For example, the owner may have noticed that immediately after barking at a stray dog in the yard, the pet went to the corner of a couch or side of a plant, lifted its leg and voided a small amount of urine.

Consideration should be given to neutering the intact male9 and preventing exposure to stimuli that elicit urine marking. A stake can be driven into an appropriate area of the yard and marking reinforced at this site. If stray dogs have been marking around doors or windows, all urine residue must be removed from those areas. Preventing the pet from watching other dogs through windows in the home may be helpful. If the male pet marks when another pet is in estrus, spaying the female may be helpful. New upright objects that are brought into the home should not be placed on the floor until the pet is familiar with them. Setups involving remote punishment may be attempted. An object, such as a suitcase or grocery sack, can be placed in an area where the owner can observe from out of sight. When the pet attempts to mark, the owner can remotely punish it by setting off an electronic alarm or tossing a tin can containing pebbles near the pet, the noise of which should be aversive enough to stop the behavior. During training, the owner should closely supervise the pet and confine it when it can't be watched.

Separation anxiety

A pet with a very close relationship with its owner may become anxious when it suddenly loses access to the owner. Situations such as returning to work after a long stay at home or changes in the owner's work schedule can lead to this type of problem. As the owner prepares to leave, the pet may show signs of either increased activity and anxiety (pacing, restlessness, whining) or depression (lying around, reluctance to move or eat). These behaviors occur as the pet becomes aware of predeparture cues, such as putting on a coat, reaching for keys or picking up a briefcase. When the owner returns, the dog usually becomes extremely active and may exhibit exaggerated greeting behaviors. Separation anxiety can also occur when the owner becomes involved in a relationship or activity that takes a significant amount of attention away from the pet at home. The anxiety becomes the driving force for destructive behavior, selfmutilation, excessive vocalization or housesoiling. Anxiety-based problems, including separation anxiety, tend to occur with increased frequency and intensity in the older adult and geriatric pet dog populations.

Treatment involves gradually accustoming the pet to absences by the owner and desensitization to predeparture cues. A dramatic increase in daily exercise will usually have a calming effect. Enriching the pet's environment (rubber toys stuffed with treats) or distractions (another pet, radio) may be helpful, although some pets become so anxious that food and distractions are ignored. During the early stages of treatment, a small confinement area, a pet sitter or boarding may be necessary and general principles of housetraining should be followed. Benzodiazepines (clorazepate, alprazolam, diazepam), selective serotonin reuptake inhibitors (fluoxetine, paroxetine) or tricyclic antidepressants (amitriptyline, clomipramine) may be helpful when the anxiety is severe.

The geriatric dog

In general, geriatric dogs require access to an elimination area more frequently than younger dogs. Access to a doggie door, a pet sitter or closer observation by the owner may help prevent housesoiling problems from occurring. Problems in older pets, such as arthritis, muscle atrophy and weakness make navigation of stairs more difficult. Ramps and carpeted stairs should make the dog less reluctant to take a trip outdoors. Medication may be necessary to reduce pain and stiffness and make it easier for the pet to get to its elimination area.

Housetraining requires voluntary control of the detrussor reflex at a cortical level.3 As the dog ages, physical and physiologic changes occur in the central nervous system that result in a general decrease in cerebral function.4 Impaired cerebral function can affect the geriatric pet's housetraining by influencing voluntary control of the emptying reflex and by reducing awareness. Loss of voluntary control can result in urge incontinence (the dog has a warning that micturition is about to occur but can't stop it) or unconscious urination (there is no awareness or control).5 Reduced awareness may also result in the pet being less cognizant of its external environment making it less likely to signal to the owner when it has to eliminate.

Establishing a frequent, regular schedule of guiding the dog to its elimination area will help ensure that the pet voids in a timely manner. A fixed diet and feeding schedule can also be helpful in preventing problems. Stress should be kept to a minimum, and when the owner expects a schedule change or an extended absence from the pet, steps should be taken to gradually prepare the dog. This will help prevent problems such as separation anxiety. Cold intolerance can be a problem for some older pets. Those dogs should be checked for underlying circulatory problems and hypothyroidism. For the pet with extensive mental deterioration, confinement to a safe, easily cleaned area may be the only way to manage the housesoiling problem.

Miscellaneous causes of housesoiling problems

Changes in the feeding schedule such that the pet has to eliminate when no one will be available to let it out (moving the meal closer to bedtime or confinement) may lead to housesoiling. Fear of the owner (inappropriate punishment) may cause the pet to avoid approaching the owner to signal when it needs to eliminate. A frightening event that occurred in the pet's elimination area (abuse by a neighbor) or intolerance of inclement weather (rain, wind, snow) may make the pet hesitant to go outdoors and lead to elimination indoors. Failure to allow the pet to eliminate just prior to confinement can cause a well housetrained pet to suddenly eliminate indoors. For example, if the owner was not observant when the pet was allowed in the yard to eliminate prior to bedtime and the pet spent the allotted time chasing squirrels instead of eliminating, it will likely eliminate in the home during the night.

Summary

Medical reasons for a break in housetraining should always be considered when working up the dog that is housesoiling. Unresolved medical problems will cause any attempts to correct the behavior problem to fail. The basic approach to treatment involves correcting the factors that initiated the problem, rewarding the desired behavior and preventing the undesirable behavior from occurring for a long enough period of time until the habit of eliminating in a desired location is well established. Treatment of pets with housesoiling problems that have no underlying organic problems generally has a high rate of success. Housesoiling due to untreatable problems, such as advanced renal failure or senile mental changes that result in cognitive impairment, are not likely to be corrected, but merely managed.

References

1. Hunthausen W. Identifying and treating behavior problems in geriatric dogs. Vet Med, 1994, 89 (9), 688-700

2. Hunthausen W. Collecting the history of a pet with a behavior problem. Vet Med, 1994, 89 (10), 954-959

3. Oliver JE, Lorenz MD. Handbook of Veterinary Neurology. W. B. Saunders Co., Philadelphia, 1993. 74-75

4. Mosier JE. Effect of Aging on Body Systems of the Dog. Vet Clin No Amer: Sm Anim Pract. 1989, 19 (1) 1-12

5. O'Brien D. Neurogenic Disorders of Micturition. Vet Clin No Amer: Sm Anim Pract. 1988, 18(3):535

6. Ross S. Some observations on the lair dwelling behavior of dogs. 1950;2:144-162

7. Scott JP, Fuller JL. Genetics and the Social Behavior of the Dog. The University of Chicago Press, 1965

8. Voith VL, Borchelt PL. Elimination Behavior and Related Problems in Dogs. Compend Cont Educ Pract Vet. 1985, 7 (7), 538

9. Hopkins SG, Schubert TA, Hart BL. Castration of adult male dogs: Effects on roaming, aggression, urine marking and mounting. J Am Vet Med Assoc 1976;168:1108-1110

Additional Reading

Landsberg G, Hunthausen W, Ackerman L, Handbook of Behavior Problems of the Dog and Cat, 2nd Edition, Butterworth-Heinemann, Jordan Hill, Oxford, England. 2003