Yes, litter box problems can be resolved (Proceedings)

Housesoiling is the most common behavior problem for which cat owners seek help.1,2,3,4 The typical cat's convenient, welcome habit of disposing of urine and stool in a litterbox help make it a popular indoor pet. On the other hand, the indiscriminate elimination habits of some cats have contributed to their demise. It's very frustrating for owners who have to cope with the disagreeable problem of housesoiling by an otherwise loving, wonderful pet.

Once underlying medical problems have been ruled out, the first step in working up a housesoiling problem is to find out whether the cat is spraying a vertical surface or eliminating inappropriately on horizontal surfaces. Spraying occurs when a cat backs up to an upright surface and directs a stream of urine toward it. The amount is typically smaller than what is voided when a cat empties its bladder during normal urination.1,5 This is a marking behavior that is typically caused by territorial or stressful situations.

The density of cats in the home contributes to the incidence of spraying. Spraying increases from 25% in single-cat households to 100% in households with more than ten cats.1 Intact males or females in heat are the individuals most likely to engage in this type of behavior,6 although some neutered cats will spray. In fact, studies have shown that as many as 10% of prepubertally castrated male cats and 5% of prepubertally spayed female cats take up spraying on a frequent basis as adults.7 Objects that are commonly sprayed include doors, walls by doors or windows, new objects in the house and furniture.

When taking the history, close attention must be given to anything that might make the pet anxious or elicit a territorial response. The tendency to spray is influenced by factors pertaining to the individual (hormones, temperament), environmental stimuli that are upsetting to the cat (new roommate, new cat in the neighborhood, remodeling, moving) and its relationship with the owners (change in the work schedule, absences from home, spending less time with the pet, inappropriate punishment).

Inappropriate elimination can been defined as the act of squatting to defecate or urinate on horizontal surfaces outside the litterbox that are unacceptable to the owner.6 Housesoiling that occurs as a squatting behavior occurs with an almost equal incidence in females and males.3 There are many causes of inappropriate elimination. If the cat suddenly starts urinating and defecating outside the box, then it's highly likely that something about the litterbox is aversive to the cat. The physical accumulation of waste, organic odor, disinfectant odor, unacceptable litter or a negative experience associated with the litterbox may cause the pet to avoid it. The box may be in an area the cat does not like. There may be too much traffic through the area, or the area may be associated with something aversive that happened to the cat. Perhaps it was medicated, disciplined or frightened in the vicinity of the box. If the pet has been severely punished for any reason, it may start eliminating in secluded areas in order to avoid family members. Some cats will eliminate outside the litterbox simply because they have found another area or surface that is preferable.

If the cat consistently defecates in the box, but urinates elsewhere, or vice versa, then the problem probably isn't caused by an undesirable litterbox, substrate or box location. Likely causes are medical problems, new surface preferences or new location preferences. Other causes of inappropriate elimination include a need for privacy and medical problems (cystitis, constipation, diarrhea, diabetes, renal disease, arthritis, senility6 ). Be suspicious of constipation or colitis if an older pet suddenly stops defecating in the litterbox, but continues to use it for urination.

In some cats, the act of eliminating on horizontal surfaces can be a marking behavior caused by the same stimuli that cause spraying. This will result in a puddle if the cat squats or a linear wet area if the cat sprays in the middle of a room or bed, but not near an upright object. As mentioned earlier, the most common cause is increased cat density. Emotional problems, such as a stressful relationship with a family member, separation anxiety or fear can trigger housesoiling.1,3 If the cat is urinating on top of specific items, such as the owner's clothing, bed or favorite chair, you will want to be sure to explore an anxiety-related problem. If emotional factors are maintaining the housesoiling, you may expect to see related changes occurring, such as hiding, avoidance, aggression or an alteration in the pet's general temperament or behavior.1 Keeping a diary may help the owner identify the stimuli that trigger intermittent marking episodes.

History

Diagnosing the early causes of a long-standing housesoiling problem can be very difficult. Even with the best efforts, the initial reasons for not using the litterbox may not become evident. Be sure the cat presented for the problem is actually the one that is housesoiling. In a multi-cat household, separation may be necessary to find the culprit. Another method is to give fluorescein orally (0.5 ml of a 10% solution) or by injection (0.3 ml of a 10% solution SQ) in order to trace urine stains to the individual with the problem.6,8,9 Urine-soiled spots retain fluorescence for at least 24 hours.6

You'll need to know the signalment and medical history of the patient. Relevant lab tests and a physical exam should be performed. You'll also want to find out when and where the problem began; if there were any changes in the cat's environment that were associated with the beginning of the problem; whether the soiling involves urine, stool or both; what surfaces are being soiled; how frequently the problem occurs; if the appearance of the problem has changed; and what has been done to try to correct the problem.

If you do not do a housecall consultation, ask the owner to diagram the house with litterbox placement and soiled areas noted. If the cat is urinating in the house in response to visits by neighborhood cats, you may discover clusters of soiled areas around windows or doors in the house near the areas where outdoor cats visit.

You need to keep in mind that the factors that contributed to the initiation of the housesoiling may be different than the factors that are maintaining the behavior.1,5 For example, a sudden change to a brand of litter that was unaccep-table to the pet may have caused it to avoid the box and eliminate on the living room carpet. After a certain amount of time, the cat may develop new surface or location preferences. It will continue to eliminate in the living room even though the owner switches back to an acceptable brand of litter. In this case, the initiating factor was a litter brand change, the maintaining factors are new elimination preferences.

Treatment of Urine Marking

The two main approaches to eliminating urine marking involve altering the cat's exposure to the stimulus and altering the cat's normal response to the stimulus.10 If outdoor cats are the stimulus for spraying, then the owner should consider discouraging their visits with a water hose or booby traps, or have the cats humanely removed from the property. Anything in the yard that might attract roaming cats should be removed (bird feeders, garbage, food, etc.). Besides removing the stimuli, the owner can remove access to the stimuli. The spraying cat should be kept away from windows or out of rooms that permit it to view outdoor cats. Drapes can be closed. Window sills can be modified so that the cat can no longer sit on them. Chairs near windows on which the cat perches can be moved. Urine odor should be cleaned from around doors and windows. If other cats in the household are contributing to the problem, they should be separated. In some cases, the number of cats in the home may need to be reduced. Some individuals will spray less indoors if they have more access to the outdoors. Others do better if kept inside more.

Neutering is very successful in curbing spraying behavior at any age and, in most cases, should be done as soon as possible. Efficacy has been reported at 90% for males and 95% for females.7 Although rarely used, olfactory tractotomy11 and ischiocavernosus myectomy12 have been successfully used to control urine marking.

A recent approach to the treatment of urine spraying involves the use of the environmental application of facial pheromones. Work done by Dr. Patrick Pageat in France has appraised the use of feline facial pheromones to curb spraying behavior. He demonstrated a significant reduction in the incidence of spraying by cats when their own facial pheromones were collected on gauze pads and applied to areas in their environment that were being sprayed.19 His work was the basis for the development of a spray containing synthetic analogues of naturally occurring feline facial pheromones (Feliway®, VPL). Studies have demonstrated the pheromone spray is up to 95% successful in stopping reactional-type urine spraying in cats (triggered by changes in the cat's surroundings such as moving, new occupants of the home, stress, remodeling, etc.).21,22 The product also shows promise in helping cats settle into new surroundings. Information provided by the company details a study of 56 cats in which the pheromone product was successful in significantly decreasing the time interval between introduction into a new environment and the exhibition of feeding and exploratory behavior. A heat-activated diffuser is now available in the United States which appears to be as effective as the spray and is much easier to use.

Medication is often necessary to control urine spraying. Since individual responses to psychoactive drugs may vary considerably, owners should give the initial dose when they can be at home to observe the cat's behavior. If the pet responds to treatment, then a decrease in marking behavior usually occurs within two to four month. Owners should be informed of all potential side effects and that none of these drugs are approved for behavior modification in cats. Progestins, benzodiazepines, tricyclic antidepressants, azapirones and selective serotonin reuptake inhibitors have all been used with varying degrees of success. The drug that I use most frequently is fluoxetine (Prozac™, 2.5-5.0 mg per cat q 24 hours). It is available in a small size tablet and is tolerated in food by most cats. Paroxetine (Paxil™, 2.5-5.0 mg per cat q 24 hours) is another SSRI that is frequently successful. Another drug I have used successfully is clomipramine (2.5-5.0 mg per cat q 24 hours). In a recent Belgium study, 80% of the cats (n=26) given clomipra-mine demonstrated at least a 75% reduction in spraying behavior.18 Buspirone (Buspar™, 2.5-7.5 mg per cat q 12 hours) is another good choice for spraying with a reported efficacy of 55+ %.14 Buspirone is effective within the same range as diazepam and greater than that for the progestins. Buspirone does not cause the adverse effects of sedation and ataxia, commonly seen with most benzodiazepines.13 Because of its wide margin of safety, buspirone is a good drug to consider for geriatric animals or pets with realized or potential health problems. Diazepam (Valium™) is an effective drug in a significant number of cats at a dosage of 1-2 mg/cat PO q 12 hours.3 Studies have shown that after cessation of diazepam, however, 90% of cats resumed spraying while only 50% resumed spraying when buspirone was discontinued. A small number of cats will become hyperactive when given diazepam, but the hyperactivity will usually decrease within three days.14 Another, more serious, side effect that has recently been reported is acute, fatal hepatopathy.20 This problem has been documented in a very small number of cats. Pretreatment lab work was not done on most of the reported cases and the pathophysiology of this problem is not well understood. Amitriptyline (Elavil™, 5-10 mg per cat PO q 24 hr) or alprazolam (Xanax™, 0.125-0.25 mg per cat PO q 12 hr) have also been reported to be effective for treating urine marking.15 Progestins are not as effective as the abovementioned medications for decreasing spraying behavior and have more side effects.3 They may be considered for cats that do not respond to other treatments.

Treatment of Inappropriate Elimination

Treatment of inappropriate elimination problems involves three major considerations: remove the cause, reestablish the habit of litterbox use and prevent the cat from returning to previously soiled areas.16

Remove the Cause

If the housesoiling is due to litterbox or location aversion, the box may need to be moved, medical problems must be treated, an acceptable brand of litter must be found and the box may need to be cleaned more often. Aversive handling in the box must be stopped. Changing the depth of the litter or removing a plastic litterbox liner may help in some cases. Switching to a sand/potting soil mix or one of the fine-textured clumping litters may also be helpful. Any new substrate should be introduced in an additional box in case it happens to be one the pet dislikes. As a rule of thumb, you should recommend at least one box per cat be available.3 The boxes should be scooped once or twice daily and emptied at least once each week.17

Reestablish Litter Box Use

To reestablish a consistent habit of using the litterbox, the cat should be confined to a small area with the box and only allowed out when it can be supervised 100% of the time. When confined to a relatively small area, most cats seem to prefer to eliminate in the box rather than soiling the floor.6 It's then a matter of confining the cat long enough for a consistent habit to become established. As a rule of thumb, one week of confinement is usually re-commended for every month of soiling. The ratio may be decreased for soiling problems in existence for more than six months. Total confinement time should generally not exceed eight weeks. Food rewards may help when given immediately after the cat finishes eliminating in the box. If the cat becomes anxious about being confined, anxiolytic medication or Feliway® should be considered.

If the cat refuses to use the litterbox when confined to a small room, the confinement area should be changed to a large cage. If it still won't use the box, a perch or shelf should be added inside the cage. The floor should be covered with litter, forcing the pet to use it for elimination. The litter should gradually be removed and replaced with a litter-box. Once the cat has used the litterbox in a confined area for an appropriate amount of time, the owner can begin to gradually allow it to have more freedom in the home.

Prevent Further Soiling

Previously soiled areas can be safeguarded by placing booby traps, food bowls, bedding or toys in the areas. Lemon-scented room deodorant, perfume or cologne will deter some cats.5 Plastic carpet runners can be placed upside down with the "feet" facing up. Plastic, foil or double-stick carpet tape can be used to protect specific areas.

Removing urine and stool odor is important. Products that are specifically formulated to work on these types of odors should be used. These products need to make contact with the organic material. In most cases, an ample amount should be poured on carpeting and porous surfaces to allow penetration into deeper layers rather than just spraying the surface. A 50:50 mixture of white vinegar and warm water will do a satisfactory job if nothing else is available.

Some cats are extremely sensitive to changes in their environment. They housesoil in response to minor changes. Owners need to realize this and do their best to keep things constant, although this is not always possible. When situations occur that are likely to upset the cat, the owner should confine, supervise and use anxiolytic medications. Desensitization and counterconditioning may help reduce undesirable responses to anxiety producing stimuli.

Punishment

Punishment is the least effective tool for controlling housesoiling. Under no circumstances should the owner swat or physically punish the pet. If the owner catches the pet in the act of eliminating in an inappropriate area, the owner can make a sharp noise, the cat can be squirted with a water gun or an object can be tossed near the cat to interrupt the behavior. This should be done without saying anything or looking at the cat. Any type of interruption must only be given during the behavior or within one second after the behavior ceases. It is very important that the cat not associate the interruptive stimulus with the owner or the bond between the pet and the owner will quickly deteriorate. A proper interruption should stop the behavior and slightly startle the cat without causing it to become fearful or avoid the owner. Care must be taken when using anything that might be aversive to the cat if anxiety or fear is an significant component of the problem.

References

1. Borchelt, P. and Voith, V.L. "Diagnosis and Treatment of Elimination Behavior Problems in Cats," Vet Clin North Am Small Anim Pract 12 (4): 673-680 (1982).

2. Beaver, B.V. "Housesoiling by Cats: A Retrospective Study of 120 Cases," J Am Anim Hosp Assoc 25 (6): 631-637 (1989).

3. Borchelt, P.L. and Voith, V.L. "Elimination Behavior Problems in Cats," Comp Cont Educ Pract Vet 8: 197-205 (1986).

4. Borchelt, P.L. and Voith, V.L. "Elimination Behavior Problems in Cats," Comp Cont Educ Pract Vet 3 (8):730-738 (1981).

5. Marder, A. "Feline Housesoiling," Pet Veterinarian, Sept-Oct: 11-15 (1989).

6. Hart, B. and Hart, L. Canine and Feline Behavioral Therapy. Lee & Febiger, 1985.

7. Hart, B.L. and Cooper, L. "Factors Related to Urine Spraying and Fighting in Prepubertally Gonadectomized Cats," JAVMA 184: 1255-1258 (1984).

8. Hart, B.L. "Urine Spraying and Marking in Cats." In Textbook of Small Animal Surgery, edited by S.H. Slatter. Philadelphia: W.B. Saunders Co., 1985.

9. Hart, B.L. and Leedy, M. "Identification of Source of Urine Stains in Multi-cat Households," J Am Vet Med Assoc 180: 77 (1982).

10. Beaver, B.V. Feline Behavior: A Guide for Veterinarians. Philadelphia: W.B. Saunders, 1992.

11. Hart, B.L. "Olfactory Tractotomy to Control Objectionable Urine Spraying and Urine Marking in Cats," J Am Vet Med Assoc 179: 231 (1981).

12. Komtebedde, J. and Haupman, J. "Bilateral Ischiocavernosus Myectomy for Chronic Urine Spraying in Castrated Cats," Veterinary Surgery 19: 293-296 (1990).

13. Hart, B.L.; Eckstein, R.A.; Powell, K.L.; and Dodman, N.H. "Effectiveness of Buspirone on Urine Spraying and Inappropriate Urination in Cats," JAVMA 203 (2): 254-258 (1993).

14. Cooper, L.L. "Feline Inappropriate Elimination," Vet Clin North Am Small Anim Pract 27 (3): 595 (1997).

15. Marder, A.R. "Psychotropic Drugs and Behavioral Therapy," Vet Clin North Am 21 (2): 329 (1991).

16. Hunthausen, W. "Dealing with Feline Housesoiling: A Practitioner's Guide," Veterinary Medicine, 726-735 (Aug. 1993).

17. Crowell-Davis, S. "Elimination Behavior Problem of Cats I," Vet Forum 10 (Nov. 1986).

18. Dehasse, J. "Feline Urine Spraying," Applied Animal Behaviour Science 52: 365-371 (1997).

19. Pageat, P. "Functions and Use of the Facial Pheromones in the Treatment of Urine Marking in the Cat. Interest of a Structural Analogue," XXI Congress of the World Small Animal Veterinary Association, Jerusalem, 197-198 (1996).

20. Center, S.A.; Elston, T.H.; Rowland, P.H. et al. "Hepatotoxicity Associated with Oral Diazepam in 12 Cats," Proc. ACVIM, Lake Buena Vista, Fla., 13: 1009 (1995).

21. White, J.C. and Mills, D.S. "Efficacy of Synthetic Feline Facial Pheromone (F3) Analogue (Feliway) for the Treatment of Chronic Non-sexual Urine Spraying by the Domestic Cat." Proc of First Internat Conf on Vet Behav Med, Birmingham, U.K. (eds: D.S. Mills, S.E. Heath, L.J. Harrington) Universities Federation for Animal Welfare, Potters Bar, U.K., p. 242, 1997.

22. Hunthausen, W. "Evaluating a Feline Facial Pheromone Analogue to Control Urine Spraying," Veterinary Medicine, 151-155 (Feb. 2000).

Additional reading:

Horwitz,D. House soiling by cats, BSAVA Manual of Canine and Feline Behavioural Medicine (eds: Horwitz, D Mills & Sarah Heath),BSAVA pub., Gloucester, Eng, 97-99, 2002

Neilson, JC, Feline House Soiling: Elimination and Marking Behaviors, Vet Clin No Amer,, Vol 33, No. 2, March, Saunders, Philadelphia, 287-302, 2003

Pageat, P Current Research in Canine and Feline Pheromones, Vet Clin No Amer,, Vol 33, No. 2, March, Saunders, Philadelphia, 187-212, 2003