Marking cats: Are drugs the answer? (Proceedings)

Inappropriate elimination, both housesoiling and urine spraying (vertical marking) are the most common feline behavior problems seen at behavior referral practices. In a study of feline behavior cases referred to three different behavioral practices, 58% of 225 cats had a primary complaint of inappropriate elimination, with 70% housesoiling, 30% marking, and 13% exhibiting both behaviors. Marking is when a cat backs up to a vertical surface and directs a stream of urine toward an object or surface. Marking may be caused by territorial competition, anxiety-evoking situations, or arousing events, and it may be stimulated by novel sights, sounds, or odors, especially from other cats. Although sexually intact cats are most likely to spray, the problem is reported in 12% of neutered males and 4% of spayed females. Castration will reduce or eliminate spraying in up to 90% of intact males. Commonly sprayed sites include prominent objects such as plants and furniture, boundaries and exits and new objects in the home. Cats that spray generally use their litter for elimination of urine and feces, although some cats use the spraying posture even in their litter boxes. On rare occasions, cats that urinate or defecate on horizontal surfaces may also be marking. In order to effectively treat inappropriate elimination in cats, it is essential that the practitioner determine whether the problem is soiling or marking. If the cat indeed is marking then drugs may be the answer!

Diagnosis / cause

Housesoiling is often precipitated by medical problems. In a retrospective study of cats with problem elimination, 60% of the cats had a history of FUS/FLUTD. Inappropriate elimination can also be a sign of any medical problem that causes increased volume of urine or stool, increased discomfort during elimination, decreased control or problems that affect mentation, temperament or cortical control. Urinary tract disease is unlikely to be a factor in urine marking. On the other hand, systemic illnesses which might lead to alterations in behavior could contribute to marking by altering hormonal states or increasing anxiety. Assessment should therefore begin with a physical examination, blood and urine tests to rule out any abnormalities in health. Evidence of masculinization such as penile barbs or odorous urine might be indicative of a hormonal disorder.

History

Once medical problems have been ruled out, the behavioral history is the most critical diagnostic tool for determining the cause of the inappropriate elimination as well as to formulate an appropriate treatment plan. If the behavioral assessment does not include a housecall then details about the home should be evaluated by videotape or by having the owners make a diagram of the home. The history should include: Is the inappropriate elimination, urine, stool or both? Is the deposition vertical, horizontal or both? What percentage of the urine and stool is outside the box (i.e. does the cat also use its litter box)? Litter box information: size, covered vs. uncovered, litter type, number of boxes, frequency of cleaning. Diagram of home with locations of inappropriate elimination and litter box placement. Is there a substrate preference for soiling? Are there substrates or areas in which the cat does not eliminate? Frequency of elimination. When does soiling occur? What is the cat and owners daily routine (diarize) and does this correlate in any way to soiling. Any changes in routine at the time of onset. How many other cats and how do they get along: agonistic interactions between cats. Duration and progression of the problem. Previous treatment and outcomes.

For housesoiling, the substrate and location of elimination, the number and location of the boxes, litter type, location, cleanliness and how often the litter is used should all be evaluated to determine why the housesoiling may have started and how it might be resolved. Cats that entirely avoid using the box or its location may have a preference for other surfaces or areas in the home, or may have an aversion to returning to the box. On the other hand cats that intermittently use their litter box might give important clues by keeping a daily diary of litter use, changing and cleaning, feeding, soiling etc. and by placing a video camera in the area of the litter box or the area of the soiling or both. Litter cleanliness and situations that might induce the cat to intermittently avoid the box should be considered.

For marking behavior, territorial competition, conflict and anxiety evoking stimuli are most likely to be inciting factors. Therefore the history should focus on possible causes of conflict and anxiety that may have arisen at the time that marking began. Based on the cat's relationships with people and other pets and the location and timing of urine marking, it might be possible to determine the cause of the marking. For example, some cats will target new or novel objects, surfaces or odors. Cats that mark external walls, windows and doorways may be responding to outdoor stimuli. When there are multiple cats in the home and the marking is on internal doors, walls, or furniture, then the relationships between the cats in the home may be a problem. Cats that mark owner possessions or those of the family dog, may be anxious about these relationships, particularly if there are no other cats in the home. Changes in the environment can also lead to marking. In evaluating the history it might also be possible to determine if there are specific events that precede the marking (e.g. punishment, agonistic encounters with dogs or other cats).

Differential diagnosis

The major diagnostic categories for inappropriate elimination include location preference, substrate preference, litter aversion, location aversion and marking. When the cat eliminates on vertical surfaces, the diagnosis is urine marking. The problem arises as to whether a cat that is eliminating on horizontal surfaces might also be marking. This might be differentiated from other forms of housesoiling by the locations and surfaces used (i.e. are they similar to those that would be used for spraying), the volume of urine (usually small amounts when marking), whether the elimination is in response to specific stressors and whether the cat is also using its litter.

Treatment or urine marking

Treatment is likely to be most successful with an accurate diagnosis and determination of the originating cause. Something as simple as changing the litter more frequently, changing litters or boxes to ones that are more appealing, adding additional boxes or moving the litter to an area that is more appealing (or less aversive) may be all that is required in some cases. In fact, the first step in any case of inappropriate elimination should be to address litter box management. In a recent study, environmental management alone (i.e., using enzymatic cleansers on previously soiled surfaces; increasing the number of litter boxes to the number of cats in the household plus one; cleaning the box daily; changing the box weekly) led to improvement in a number of cats that were vertically marking. Owners were also advised to refrain from any form of punishment. Therefore, investigative history taking and therapeutic trials to assess response to therapy (e.g. odor eliminators, increased cleaning, different litter type, more boxes, and new locations) may be a practical starting point.

Should these suggestions fail to resolve the problem, then a more complete and comprehensive behavioral evaluation should be scheduled. If the primary cause cannot be identified or cannot be entirely addressed the problem may be difficult to improve or may recur. For example, cats that are marking because of outdoor cats entering the property and those that are marking or soiling due to competition and conflicts with other cats within the home may be difficult or impractical to resolve. In addition, over time new surface and area preferences can develop and conditioned avoidance of the litter box or area may arise, so that even if the initiating cause can be resolved these factors may lead to perpetuation and persistence of the problem. Therefore treatment is often a multimodal approach of a) environmental modification (e.g. to prevent or deter access to the soiled areas or the stimuli that lead to marking) b) behavioral modification (e.g. to reduce anxiety through desensitization and counterconditioning, to reinforce desirable elimination habits an perhaps to deter undesirable) as well as c) drugs or natural therapeutics when there is underlying anxiety or territorial marking as a cause.

Urine marking

Although treating all initiating factors is essential if the urine spraying problem is to be successfully resolved, eliminating such factors may not be practical when they involve stray cats on the property or multiple cats within the home. In some cases, environmental adjustments that reduce access to the most common target areas or that decrease exposure to the inciting stimuli may be effective. For example, if the stimulus for marking is the sight, sound or odors of outdoor cats, then efforts should be made to stop these cats from coming onto the property. This may be possible by placing booby traps in strategic locations outdoors (repellents, motion detectors) or by decreasing attraction to the area (e.g. keeping garbage in containers). It may also be helpful for the owner to house the spraying cat away from the outdoor cats by blocking access to windows (e.g. blinds, drapes) or by booby trapping the area (e.g. motion detectors). When cats mark due to conflict or anxiety with other cats within the home, the relationships between the cats will need to be improved (see notes on fighting between household cats).

To deter the use of areas where the cat is marking, booby trap devices could be placed in the sprayed areas; however, the cat may simply move its marking to another target. Cats that mark in one or two particular areas may cease if the function of the area is changed, such as to a feeding, sleeping, catnip or scratching area. For some cats, a good compromise might be to allow one or two sites for indoor marking. This might be accomplished with a covered or high sided litter box or by taking two plastic litter boxes and placing one inside the other to make an L-shape to catch the urine.

Drugs and natural therapy

Drugs and natural alternatives used in the treatment of urine marking likely act to reduce the cat's level of anxiety or arousal. Most drug and pheromone studies for urine marking have been careful to avoid any other concurrent therapy which might alter the outcome. Therefore, with concurrent behavioral management and environmental modifications and by combining both drugs and pheromones, an even greater level of improvement and lower recurrence might be achieved.

a) Clomipramine is effective for reducing or controlling urine marking in cats and is licensed in Australia for this use.7-9 In a study in which 25 urine marking cats were treated with clomipramine at a dose of approximately .5 mg/kg daily for a minimum of 30 days, 20 of 25 cats had •75% reduction in spraying within 4 weeks and spraying resolved or improved to a level of 90% or greater in 17 of the cats.7 After 6 months, 15 cats remained on the medication, many on a lower dose, and five cats been successfully withdrawn.7 Another study determined that a dose of .25 to .5 mg/kg was optimum dose for initiation of clomipramine therapy. Amitriptyline has been used but no studies have been published.

b) Fluoxetine is also an effective treatment for feline urine marking at a dose of 1 mg/kg.10 In a placebo controlled study of 17 cats, those treated with fluoxetine had a significant decrease in spraying by week 2 and continued to decrease through weeks 7 and 8. Two of the cats that did not improve to a level of 70% or greater were given an increased dose of 1.5 mg/kg in weeks 7 and 8. Recurrence after drug withdrawal was variable with cats marking the greatest at baseline most likely to recur.

c) A recent study compared the efficacy of clomipramine at .5 mg/kg per day and fluoxetine at 1 mg/kg per day in cats treated for 16 weeks. Efficacy was similar with treatment of longer than 8 weeks leading to increased efficacy. Return of marking occurred after abrupt drug withdrawal of fluoxetine in most cats but could be controlled if medication was reinstituted.

d) Diazepam has been reported to be effective at reducing spraying by 75% or greater in 55% to 74% of cats In one study higher success was achieved in neutered males (84% to 25%).12

e) Buspirone was effective in reducing urine spraying in 55% (64) of cats with 33% resolved. The relapse rate after 8 weeks of treatment upon withdrawal was 53% compared to over 75% with diazepam.

f) Progestins have been shown to improve about 30% of marking cats (50% of neutered males and 10% of spayed females). The potential adverse effects (immune suppression, breast tumors) are high.

g) Cyproheptadine may also be effective for the control of urine marking, especially in male cats. However, in one study clomipramine was found to be more effective than cyproheptadine.

h) In the geriatric cat, selegiline might be considered if soiling appears to be a component of cognitive dysfunction and some European behaviorists report success for emotional disorders including marking.

i) The feline facial pheromone, Feliway has been reported to reduce urine spraying in 74% to 97% of cats; but in one study, only 33.3% of treated households had a complete resolution of the spraying. A Feliway diffuser has been found to be effective at reducing urine marking. When marking is due to a recent change in the household, (new cat, renovations, moving) Feliway might be the primary option.

Refernces

1. Denenberg S, Landsberg GM, Horwitz D, Seksel K. A comparison of cases referred to behaviorists in three different countries. In: Mills D, Levine E, Landsberg G et al (eds). Current Issues and Research in Veterinary Behavioral Medicine. Purdue University Press, 56-62, 2005

2. Hart BL. Behavioral and pharmacologic approaches to problem urination in cats. Vet Clin N Am Sm Anim Pract 1996;26:651-658.

3. Hart BL and Cooper L. Factors related to urine spraying and fighting in prepubertally gonadectomized cats, JAVMA 184:1255-1258, 1984

4. Horwitz, D. Behavioral and environmental factors associated with elimination behavior problems in cats: a retrospective study, Appl Anim Behav Sci 1997; 52:129-137

5. Tynes VV, Hart BL, Pryor PA et al. Evaluation of the role of lower urinary tract disease in cats with urine marking behavior. JAVMA 2003; 223; 457-461

6. Pryor PA, Hart BL, Bain MJ, et al. Causes of urine marking in cats and effects of environmental management on frequency of marking. JAVMA 2001;219:1709-1713

7. Landsberg G, Wilson AL. Effects of clomipramine on cats presented for urine marking. JAAHA 2005:41,3-11

8. King JN, Steffan J, Heath SE et al. Determination of the dosage of clomipramine for the treatment of urine spraying in cats. JAVMA 2004, 225, 881-887

9. Hart BL, Cliff KD, Tynes VV, Bergman L. Control of urine marking by use of long-term treatment with fluoxetine or clomipramine in cats. JAVMA 226, 2005, 378-382

10. Pryor PA, Hart BL, Cliff KD, et al. Effects of a selective serotonin reuptake inhibitor on urine spraying behavior in cats. JAVMA 2001;219:1557-1561.

11. Hart BL, Eckstein RA, Powell KL, et al. Effectiveness of buspirone on urine spraying and inappropriate urination in cats. JAVMA 1993;203:254-258.

12. Marder A. Psychotropic drugs and behavioral therapy. Vet Clin N Am Sm Anim 1991, 21, 329-342

13. Hart BL. Objectionable urine spraying and urine marking in cats; evaluation of progestin treatment in gonadectomized males and females. JAVMA 1980;177:529-533

14. Kroll T, Houpt KA. A comparison of cyproheptadine and clomipramine for the treatment of spraying cats. Herts, UK: Pro, 3rd Int Congress Vet Behav Med, 2001:184-185.

15. Frank DF, Erb HN, Houpt KA. Urine spraying in cats: presence of concurrent disease and effects of a pheromone treatment. J Appl Anim Behav Sci 1999;61:263-272

16. Ogata N, Takeuchi Y. Clinical trial of a feline pheromone analogue for feline urine marking. J Vet Med Sci. 2001;63:157-61.

17. Mills DS, Mills CB: Evaluation of a novel method for delivering a synthetic analogue of feline facial pheromone to control urine spraying by cats. Vet. Record, 149: 197-199, 2001