How to identify inappropriate feline elimination

The most common concern expressed by clients about their cats' behavior involves inappropriate elimination. In fact, it's the single biggest reason cats are relinquished or euthanized. But the cause of litter box problems can usually be identified, prevented and treated successfully.

Simple observation

At each veterinary visit, encourage clients to observe their cats' behaviors at home. Using a history checklist not only enables you to assess behavior in a consistent manner at each visit and note potentially worrisome changes, but it also teaches clients which behaviors to monitor. (Download a short questionnaire clients can complete when they arrive at the clinic at dvm360.com/behaviorquestionnaire.)

Also encourage clients to take short videos of their cats' basic behaviors so when something changes, they can show the veterinarian videos of the cat and environment before and after the change. Remember, in veterinary behavioral medicine, behaviors are the data. Once we can see them, we're best able to understand what they mean.

Litter box issues: Taking the time to work through factors contributing to inappropriate elimination is a critical part of diagnosis and treatment.(GK HART/VIKKI HART/GETTY IMAGES)

To help facilitate this client discussion, here are a few sample questions:

• Does the cat leave urine or feces outside the litter box? If yes, where?

• Does the cat spray? If yes, where?

• Do you have concerns, complaints or problems with urination or defecation in the house? If yes, what location? How frequent is the inappropriate urination or defecation? What is the approximate time of day the event(s) occur (i.e., are you at home or away)?

• Does the cat exhibit vocalization about which you're concerned? If yes, what types of vocalization (e.g., yowling, growling, meowing, hissing), and when does the vocalization typically occur?

• Is the cat aggressive to people or other cats?

Feline welfare issues

The key to resolving elimination concerns is to identify a pattern in the choices the cat makes. Unfortunately, before relinquishing or euthanizing a cat with inappropriate elimination problems, few people ask if the cat's behavior is reasonable or if its elimination and litter-box-related behaviors are true behavior problems for this particular cat. Given the risk factors for not using the litter box and for marking, we should be prepared to discern the well-being of a cat as part of any assessment of elimination complaints.

Complaints about feline elimination patterns can involve those associated with litter boxes and with marking. Concerns about litter box use generally involve one or more of the following—specifically, the cat:

• Doesn't use the box at all

• Uses the box for either urine or feces, but not both

• Eliminates right next to or on the box, but not in it

• Uses the box, but doesn't cover urine or feces.

Three classes of problems

Inappropriate elimination, in general, encompasses three classes of problems from which client complaints are derived:

1. Substrate preferences or aversions involve deposition of normal amounts of urine or feces. Substrate (texture/surface) preferences and aversions are linked by texture but not by location. The preferred substrates chosen have a shared tactile association that becomes clearer to clients on thoughtful examination. Examples of common classes of substrate preferences include soft materials (e.g., clothing, bath mats, fireplace ashes) and smooth, reflective, cool surfaces (e.g., tile floors, sinks, granite countertops). Conversely, cats that prefer cool surfaces may avoid soft ones. Preferences can develop innately because the cat truly prefers a substrate other than the litter in its box. Or they can develop after the cat learns to dislike its litter or box.

2. True aversions develop when the accustomed substrate changes in a way that is repugnant to the cat. The usual reason is hygiene; litter feels different when soiled, and soiled litter creates a very different olfactory and chemical environment from that which the cat is accustomed. We've done a poor job of evaluating the olfactory effects of altered or soiled substrates, but given the sensitivity of the feline nose and how quickly olfactory associations are consolidated in the frontal cortex, it's logical to think olfactory concerns are important. Cats that find their litter aversive undergo a process of sampling and will find another substrate they consider acceptable. Clients usually don't find these new substrates acceptable.

3. Location preferences or aversions involve deposition of normal amounts of urine or feces in places linked by region. Changing substrates appears to have little effect on the behavior of these cats, but if a location preference is suspected and a litter box is placed in the chosen spot, a cat usually uses it. Conversely, cats can learn to loathe certain areas no matter how wonderful the box, the litter or the hygiene routine. Aversions to locations usually develop because of a stimulus the cat associates with threatening, disruptive or injurious stimuli (e.g., the box is behind an entry door that crashes into the cat and box when opened).

Marking behaviors

Problematic elimination behaviors include spraying and non-spraying marking; both can be part of the normal signaling repertoire in cats.

Non-spraying marking involves the deposition pattern of urine or feces, which distinguishes this behavior from substrate or location aversions or preferences. When non-spraying marking is a consideration, the amounts of urine or feces are small and distributed over areas associated with social stimuli, not with substrates or locations.

In marking behavior involving sprayed urine, the cat treads on its front feet, raises its tail, quivering the tip, and sprays urine vertically. If the cat is not backed against a vertical surface, sprayed urine makes a linear pattern on horizontal surfaces. Both male and female cats can and will spray, as will those that have been neutered (castrated or spayed). Neutering can decrease or stop spraying if it's been occurring for only a short while or is related solely to estrous cycles or responses to them. Moreover, neutered cats spray less than intact cats.

Risk factors

As with all behavior problems, the key to intervention lies in understanding the cat's perspective, which can be discerned by watching for correlated behavioral patterns. If we identify potential risk factors and assess these with clients at every appointment, we are likely to make considerable progress in addressing the cat's needs.

Factors that contribute to inappropriate elimination preferences and aversions include:

• Frequently dirty litter or litter boxes

• Litter boxes that are too small and discourage active digging and exploration

• Litter boxes that are too high for cats to enter readily

• Styles (e.g., covered) and placement (e.g., in closets) that allow the cat using the litter box to be trapped by a child, another cat, a dog, etc.

• Placement of boxes in locations the cat can't reach because of pain (e.g., arthritis), access or social factors (e.g., being chased by a puppy)

• Odor entrapment by lids of covered boxes placed in areas without adequate ventilation

• Illness of another cat in the household that causes changes in bladder and bowel function.

Factors that contribute to marking behaviors generally are based on stressors such as:

• Addition or loss of another pet in the household

• Change in the composition of the human household

• Change in the stress level of the household (e.g., illness, job change)

• Visitation by an outside cat

• Illness or change of relationships between cats in the household (e.g., concomitant with social maturity)

• True intercat aggression.

Potential medical complications

If the cat is eliminating in a pattern that doesn't seem to be associated with how something feels or where it's located, and the social environment appears to contain minimal stressors, a medical problem may be involved. The most common medical conditions associated with elimination are feline lower urinary tract signs or disease, bacterial cystitis, urethral obstruction, diabetes mellitus, cognitive dysfunction, hyperthyroidism, lower motor neuron disease, enteritis or colitis and parasitemia.

The standard work-up for inappropriate urination includes a physical examination, complete blood count, serum chemistry profile, urinalysis with culture and thyroid profile (if the cat is older than 6 years). For complaints involving defection, fecal flotation and direct smear should be included.

Aging can cause cats to change their litter box usage. In addition to an increasing probability of bladder and bowel disorders, aging can cause mobility changes. For example, doors that were easy for young cats to open may be difficult for older cats. Stairs may now be an impediment for litter box access. For cats with hip or shoulder pain, litter boxes may have prohibitively high walls requiring they be re-engineered or replaced with short boxes or baking sheets. If long-haired cats develop balance problems, their hair may need to be washed or trimmed so they don't develop an aversion to litter. In short, a little forethought can provide much needed help for life-stage changes that affect feline patients.

Next month, I'll address treatment options and recommendations for clients with cats experiencing elimination issues.

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.