Helping veterinary clients understand and treat cats with elimination disorders

The steps below are designed to help cat owners resolve substrate and location preferences and aversions.* They are intended to help reinforce what clients will consider appropriate litter box use, while also meeting cats' social and personal hygiene needs. Also inform clients that the feline social system may be having an effect on the behavior of a cat that is not using its litter box. In fact, social interactions might be compounding the problem. They should watch for changes in relationships among the cats in the household. Keep in mind that changes in the canine and human relationships, schedules and composition are all destabilizing influences on cats that like some degree of predictability. Accordingly, alterations of some social situations may be necessary to fully resolve an elimination problem.

*Adapted from Overall KL. Manual of clinical behaviorial medicine for dogs and cats. St. Louis, Mo: Elsevier, 2011.

How you can help correct elimination problems in your cat

1 Identify the problem. Follow your cat around and see what it chooses in terms of the area and substance on which it eliminates. If this doesn't work, videotape your cat while it is at the litter box. If the video camera is on a tripod, most cats will ignore it, and you will be able to see what behaviors your cat uses when it explores the litter box. You can then view this video with your veterinarian and identify normal and promising behaviors and ones that indicate a problem. Also, consider videotaping your cat's normal daily activities and its interactions with anyone else—feline or not—in the household. This lets you see your cat through new eyes and, with the assistance of your veterinarian, helps you learn about both the problem and what you can do to fix it.

2 Clean, clean and clean again. Because cats are so good at smelling and identifying scent, you need to take this step immediately. First cleanings should involve soaking the area with plain water (club soda or seltzer can also be used and may help urine that has sunken deep into carpets bubble to the surface). After soaking, blot the area. Repeat this until you can no longer detect even a trace of the scent of urine or feces on the towels that are used to blot the wet area. You'll go through a lot of towels, so consider using rags, disposable sponges or paper towels. Remember, this is the baseline cleaning—repeat it more often if possible because, although you cannot smell the urine or feces, the cat will be able to do so. Once you think you are done, use a small black light to go over all relevant areas since urine fluoresces. Continue to clean until you cannot detect it.

3 Clean all affected areas with a good odor eliminator. The best odor eliminators have enzymatic capabilities to breakdown or degrade the substances in the urine and make it harder for the scents to aerosolize when the cat sniffs the area. Ask your veterinarian for recommendations on specific products you can use.

4 Cover affected areas. After cleaning, cover problem areas with heavy gauge plastic to alter the tactile sensation for the cat and to prevent further penetration in the event of elimination.

5 Make litter boxes appealing. Here are some tips:

• Get multiple litter boxes—generally you should have one more than there are cats in the house. If you have more than five cats, see how many boxes the cats are willing to use and adjust your household to accommodate this number. Given the chance, the cats will tell you what they need.

• Place the litter boxes in a variety of locations. You should be guided in this by the choices your cat has already made. The places your cat chooses contain information about what it needs. Meet these needs. If the box is in a particularly awkward spot from your viewpoint, you can gradually move it (1 cm/day) to a more preferable location once your cat has routinely used it for weeks. If you need to move the box for a party, both the cat and the box can be temporarily placed in a room in the house in which the cat is comfortable.

• Choose litter boxes of a style your cat likes. While you may like covered and small litter boxes because they keep down dust and odor, this is not what cats like. Cats prefer larger boxes—research shows that cats prefer a box that is 1.5 times the length of the cat. Additionally, only very shy cats may prefer closed boxes—most cats don't like them because they enclose smells. Also consider the depth of the box. Cats that are small or arthritic need easy access, so large, shallow boxes may be the best overall choice. Few, if any, commercial litter boxes meet these needs, so consider using unlidded sweater boxes as litter boxes.

• Throw out the box and get a new one as soon as there are scratches in the bottom of the box. These scratches are hiding holes for odor. Cats have reputations for being fastidious. They don't want to use a smelly litter box any more than you would want to use a smelly toilet.

• Wash the litter boxes at least weekly in very hot water. If you wish, you can use a mild detergent if you rinse well. If you choose to use a disinfectant such as bleach you must rinse and rinse and rinse. Cats dislike strong chemical smells, and given their sense of smell, even a small odor will smell strong.

• Choose a litter that your cat likes. How do you know what it will like? Mimic the texture of the objects chosen. If the cat is choosing soft fabrics, use a litter that feels soft (e.g., potting soil; No. 3 blasting sand; soft, clumpable litters; litters made from puffed up, recycled paper or wood; plant-based litters). Some cats will use the commercially available chucks, or soft paper fabric pads that are lined in plastic. These have the advantage over litters of not having any components that can adhere to a cat's fur, which may be very important for long-haired cats. However, if your cat is choosing smooth, cool, well-drained substrates that reflect light, either put a small amount of litter in the box, use a cookie sheet or gardening tray as a box or line the box with ceramic tiles and use no litter. If the cat restricts elimination to a shower or sink, you may just decide to clean these multiple times a day rather than have the cat sample and learn about areas that are not so easy to clean. In the wild, cats prefer open, well-drained, reflective surfaces such as clear sand, and they may not cover their urine or feces. Not covering elimination products is often a normal behavior. You should only be concerned if there has been a dramatic change.

Remember that cats like soft, clean-smelling substances. This means that cats will not like litter that holds onto odor.

Studies have shown that clumpable, recyclable litters may be terrific for owners but are not always so good for cats. By reusing these litters, you are stirring around and redistributing microscopic pieces of feces that come to coat the silicaceous grains. From your cat's perspective, these litter grains stink, even if there are clean grains interspersed among them.

6 Scoop the litter daily (at least). Most litters should be dumped totally at least every other day. The clumpable litters must also be scooped multiple times a day but can be topped up and stirred. Still, given the findings about microscopic feces adhering to the grains, these litters should be dumped and replaced considerably more often than is discussed on their labels. Dump them every few days, and more often if more than one cat is using the box.

7 Scrutinize the litter depth. Some cats like to dig in deeper areas, but some don't like to bury their paws. Learn what your cat likes. One hint is that cats dig more in litters they like, whether or not they cover their urine or feces.

8 Use mechanized litter boxes with caution. Some cats will use these litter boxes and other novel formats.But these boxes are not for fearful cats or those that easily startle. While they are appealing because of the ease of clean-up, remember that the point of a litter box is actually to meet your cat's needs.

9 Remember that cats are not truly trained to use litter boxes. This is true at least in the sense of how we think of housetraining a dog. Seeking out a preferred substrate, digging and covering urine or feces if the cat chooses to do so are behaviors that develop in kittens in the absence of human intervention. Accordingly, we cannot train cats with an elimination problem to use a litter box; however, they can be encouraged to do so by taking them to the litter box frequently, waiting with them and praising them whenever they use the box.

10 Avoid punishment for accidents. If you see your cat squat outside the box, most forms of punishment or extreme startle will only make your cat more secretive about where or when it eliminates. If you use a gentle interruption just as your cat is beginning to eliminate (e.g., when it sniffs, circles), it may stop your cat from eliminating in the undesired spot. This will only work if you can then take your cat to a preferred spot, have your cat use it and praise your cat. Frankly, this sequence of behaviors is not highly likely. Given the amount of damage you can do by scaring a cat, you may wish to abandon this and related tactics. Regardless, punishment after the fact is useless. Physical punishment, including rubbing your cat's nose in the soiled area, should be avoided at all costs since it teaches your cat to avoid people and may also lead to physical or behavioral injury.

11 Consider confining your cat to a restricted area at first. If you do this, make sure that your cat has the same choice of litters and litter boxes mentioned above and that you pay lots of attention to it during its confinement. If your cat was very social before confinement, arrange the confinement to meet the cat's social needs. If the behavior of the other cats in the household changes when one is isolated, this hints at a social problem that may need to be addressed as part of the therapy for the elimination disorder. Access to the rest of the house can be expanded once your cat is using the litter box appropriately in the confined area. Be sure to closely supervise the expanded access because of the potential for relapse and because of potential social problems that may not have been previously recognized. A bell attached to a break-away collar can act as a reminder that supervision is necessary. Access should be gradually expanded. Don't give your cat free access to the entire house all at once after six weeks of confinement. If your cat has truly learned and demonstrated a preference for a litter or litter box style, this will generalize to the rest of the house only if the reintroductions are gradual.

12 Take into account the way cats perceive scent.

• Do not use plastic liners. Whether or not they are scented, they smell different to cats. Cats also usually do not like the additional texture.

• Do not use scented litters. Consider your cat's needs first. Scents that mask the scent of elimination products for you may be upsetting to cats.

• Try placing a mint-scented bar of soap in an area your cat has soiled. Some cats will avoid it, while others won't, but you have done no harm.

13 Take precautions when handling litter boxes. Good hygiene for litter boxes can also contribute to good hygiene and healthcare for people. Immunocompromised and other at-risk individuals need to take care in handling cat feces. See the following websites for more information: http://petsandparasites.org./cat-owners; http://cdc.gov/parasites/toxoplasmosis/gen_info/pregnant.html.

14 Consider drug therapy. Anti-anxiety medications may help some cats that are otherwise unable to succeed with this program. But keep in mind that if your veterinarian decides that your pet could benefit from anti-anxiety medication, you will need to use it in addition to the behavioral and environmental modifications outlined in this column. Anti-anxiety medication should be used judiciously and only after a thorough physical examination has been performed and laboratory tests have determined that your cat is not unduly at risk from side effects of the drugs.

Dr. Overall, faculty member at the University of Pennsylvania, is a diplomate of the American College of Veterinary Behavior (ACVB) and is board-certified by the Animal Behavior Society (ABS) as an Applied Animal Behaviorist.