Treating feline urine marking - It's not just a pill (Proceedings)

Despite the fact that cats are known for their fastidious eliminative behavior, problem elimination, especially urination, is the most frequent category of behavioral problems in feline practice. In fact, urine trouble is probably the most puzzling behavior problem in the entire field of veterinary behavior and the topic upon which the most focused research has been done (especially at UC Davis). The causes of house soiling can be due to lower urinary tract disorders, intestinal disorders or may stem from behavioral causes. This lecture covers inappropriate elimination and urine marking that have behavioral causes and behavioral solutions.

One of the concepts that plays a role in feline problem urination is that cats are attracted to use a spot that has some fecal odor, because this indicates in nature a toilet area where feces, possibly containing intestinal parasite larvae, are deposited. However, too high a concentration of odor drives away the cat because this indicates a "parasite mine field." In the home we want appropriate toilet areas to have a small bit of fecal odor (which we cannot smell), but not a strong odor that drives away the cat.

This topic is discussed extensively in Hart, Hart and Bain, Canine and Feline Behavior Therapy, 2nd edition, 2006, Blackwell Press.

Inappropriate Urination and Defecation

Typical History

In inappropriate elimination, the cat changes its toilet area to another part (or parts) of the house. The litter box is no longer used some or all of the time. The problem may be with urine, feces or both.

Diagnosis

This problem could stem from aversion to the litter box or, for outside cats, inclement weather or harassing dogs or other cats. The problem could also result from attraction to inappropriate places or substrates such as a carpet. The cat may use a litter box for defecation, but urinate in other places, or vice versa, or both urinate and defecate outside the box. Aversion to the litter box may be indicated by the cat not covering feces, straddling the box to avoid touching the litter, shaking its paws after touching litter, digging outside the box on the floor of the room, and/or running from the box after elimination. Such aversion-related behavior is a predictor that a cat that currently uses the box may later eliminate outside it. Aversions can be related to infrequent cleaning (common), introduction of new litter (deodorized, dusty), use of a liner, and use of an electric self-cleaning box or changing the depth of the litter. The following table is useful in differentiating between inappropriate urination and urine marking.

Treatment Guidelines

Household Hygiene

Clean litterbox daily and change all soiled litter.

Perform a Litter and Litter Box Preference Test

Find out what the cat prefers. Use a selection of 3-5 or so litter boxes in a preference test. Use current litter, sand, plain clay litter, sand-like clumping litter, treated litter, tray liners, no liners, etc. Cardboard trays cut down from boxes are useful temporary litter boxes. The latest information indicates that cats mostly prefer finely-granulated clumping litter, and that sand is the next most preferred. Wood chips and treated newspaper plugs are rarely preferred.

Eliminate Aversive Aspects

One should removing feces and urine spots daily and completely change all litter each week. Clean the box with mild, unscented detergent. Avoid bleach, ammonia, pine oil cleaners and other strongly smelling agents. Prevent harassment by dog or children. Avoid all physical and harsh verbal punishment.

Increase Appeal and Accessibility of Litter Box or Outdoor Area

Provide a sufficient number of litter boxes for the household. Different cats may prefer different types of litter. A rule of thumb is one more box than there are number of cats, positioned to try to provide easy access by all cats. Increase the appeal of outdoor areas by eliminating aversive elements such as harassing dogs and effects of inclement weather. Provide shelter over area for weather protection. Make a sandy litter area with commercial sand in a sheltered area and clean frequently as you would an indoor litterbox.

Clean Soiled Areas

Find soiled areas with careful observation and use a cleaner to decrease attraction of soiled areas as established toilet places.

Confinement

As a last resort it may be necessary to confine the cat in a small space where there is a high probability it will use the litter box (large crate, bathroom, utility room with tile or vinyl floor). Once the cat is regularly using the litter box, gradually allow it access to the rest of the house. Confinement can be aversive to cats, so this procedure should be instituted as a last resort.

Urine Marking (Spraying)

Typical History

Urine spraying on vertical surfaces (most common), or on horizontal surfaces, is a form of urine marking. Although often thought of as normal for intact toms and possibly females in estrus, this problem occurs in about 10% of castrated male cats and less than 5% of spayed female cats. Age at time of castration makes no difference with regard to predisposition to urine mark. Selected targets often have particular olfactory characteristics such as the owner's clothes. Stereo speakers and electrical appliances may be targets, possibly because they give off volatiles from electrical insulation that evokes marking. Target areas are hit repeatedly. Urine marking may also be performed on a horizontal surface using the squatting position and directed to olfactory significant targets such as the caretaker's bed.

Diagnosis

This topic is covered in the table. The precipitating factors are: agonistic interactions with other cats, either in the same household or with an outside cat; moving to a new home; making an outdoor cat an indoor cat; owners leaving or returning from a trip; a major change in household schedule; onset of the cat breeding season.

Treatment Guidelines

Castrate Males

Age of castration is not correlated to resolution of problem behavior. Also spay females.

Behavioral Management

Give attention to environmental and litter box hygiene, this will may urine marking frequency especially in females.

Make Previously Marked Areas Aversive

Use upside down carpet runner, double-sided sticky tape, aluminum foil, upside down mouse traps. Alternatively, make these areas an area where pleasurable things happen (get fed, get played with).

Reduce Predisposing Factors

Arrange household to reduce inter-cat aggression between cats in the household if this seems to be a contributing factor.

Anxiolytic Drugs

Depending upon desires of the client, one might first attempt behavioral approaches and, if not successful, add the drug. Most clients feel the situation is more urgent and wish to combine the behavioral approaches and drug treatment concomitantly. Clomipramine (0.5 mg/kg/q24hr) and fluoxetine (1 mg/kg/q24hr) seem to be most effective. More recent results with fluoxetine revealed that achieving the 90% reduction in marking frequency may take 16 or even 32 weeks of treatment in some cats. Eventually almost all cats seem to respond.

There is recurrence of marking to 50% or more of baseline in most cats, even after as long as 32 weeks of treatment remains the main challenge. Some cats may have to be kept on treatment indefinitely, requiring regular health evaluations (e.g. every 6 months).

Both fluoxetine and clomipramine seem to involve few side effects with long-term treatment, but regular monitoring is recommended (CBC, serum chemistry panel). Recurrence of marking after drug withdrawal may be less likely if the provoking factors causing the marking are carefully controlled during drug withdrawal. Cats seem to respond to a second series of fluoxetine treatment as well as the initial series and thus clinicians may take a cat off treatment to test for recurrence with confidence that, if the marking reoccurs, it is likely to be controlled again. Also, cats do not seem to become refractory to the dose as initially used, even after several months of treatment.