Treating feline elimination disorders

Last month, I discussed how to identify which factors might be contributing to a cat's elimination problem, whether behavioral or medical. If the problem is behavioral, there are several options you can choose to help stop the frustrating behavior.

Treatment options

For purely behavioral elimination and litter box issues, a few key instructions will usually resolve the situation or provide more data about issues to be addressed. If friction between cats in a household is a possibility, the client should identify potential stressors or conflicts (e.g., intercat aggression) and redress them. Intercat aggression is a serious concern if a cat

• Is avoiding one or more other cats

• Consistently leaves the room or a preferred resting spot when another cat enters

• Does not eat or drink in the presence of others

• Frequently hides

• Is hyperreactive to noise or tactile stimuli.

If any of these conditions are identified, instruct the client to separate the cats when they're unsupervised. The more timid cat should have free-range, while the more aggressive cat should be confined to a space not highly contested or desirable (i.e., not the client's bedroom or the kitchen). If this isn't sufficient to resolve elimination concerns, a more complex behavioral work-up of the social situation in the house is warranted.

If anxiety or aggression is involved in any aspect of the litter box issue, a benzodiazepine, tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI) may be a useful treatment for an anxious or aggressive cat. Benzodiazepines are helpful primarily in behavior modification programs involving food reward (i.e., teaching cats to tolerate each other). TCAs and SSRIs can be extremely useful in helping to overcome aversions and address anxiety involved in marking behaviors and intercat aggression.

Specific therapies could include:

• Benzodiazepines: Alprazolam (0.1 to 0.25 mg/kg orally once or twice daily); oxazepam (0.2 to 0.4 mg/kg orally once or twice daily)

• TCAs: Amitriptyline or nortriptyline (0.5 to 1 mg/kg orally once or twice daily for 30 days minimum); clomipramine (0.5 mg/kg orally once daily for 60 days minimum)

• SSRIs: Fluoxetine or paroxetine (0.5 mg/kg orally once daily for 60 days minimum).

If the toileting issue is associated with intercat aggression and the victim needs to become more assertive, buspirone (0.5 to 1 mg/kg orally once daily for 60 days minimum) can be an effective treatment. But note it may act in part by rendering the afflicted cat sufficiently confident to engage in social interactions that could result in an actual physical fight, which clients should monitor for and address, if seen.

Before using any medication, conduct a laboratory evaluation (e.g., CBC, serum chemistry profile) and at least a lead II electrocardiogram, especially if considering TCA or SSRI use. Most of these medications are metabolized through renal and hepatic pathways, and clearance may be altered if renal or hepatic disease is a concern. Additionally, these medications will interact with other drugs that share the same cytochrome P450 system enzyme pathways, so obtaining a good medical history is important.

Pheromonal analogue products have been suggested to calm animals, but they, or their vehicles or dispensers, may make some animals more reactive. Their efficacy is in doubt, as most studies have been poorly designed and show, at best, a weak contributory effect. No controlled study on the use of pheromonal analogues has demonstrated efficacy to the extent seen when the underlying anxiety is treated with medication.

Advice for clients

Clients should be reminded of several other issues regarding this topic. For example, if more animals are added to the household, clients should expect social upheaval and ensuing changes in litter box behaviors. Litter box hygiene must be meticulous and lifelong. Finally, outdoor or visitor cats should be kept to a minimum or excluded.

If all else fails, the client should consider allowing the cat to be an indoor-outdoor cat. Several creative and safe cat enclosures and fences are available. Even if cats have little risk from vehicles and predators, enclosures and fences can help them be good neighbors by preventing them from sharing their elimination products and patterns with the entire neighborhood. In these ways, we can address specific feline welfare concerns that may have unappreciated but far-reaching consequences for us all.

Check in next month for a related article on specific steps clients can take to end behavioral elimination problems.

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.