My cat hates me, she’s peeing all over the house!

Cats are wonderful creatures, but for some reason we give them credit for some very human emotions to explain their behaviors.  When the cat urinates on your bed or your clothes, often it is assumed that you’ve done something to annoy the cat, like forgot her favorite treat, or left her home alone longer than she’d like.  While it’s nice to think our cats love us so much and hate us leaving them so fiercely that they do these things out of spite, rarely is this the case.  Often, owners will watch a cat who is urinating inappropriately for days, weeks, months, even years before calling the vet.  (I know that sounds crazy, but I wouldn’t say it if I hadn’t seen it.)  Often we get the call on the long term inappropriate urination cat when owners decide they are getting new carpet, new furniture, or a new house and they can’t tolerate the behavior anymore.  Cat owners need to look at a cat who was previously very good at using the litter box and starts urinating out of the box just like you would look at a house trained dog who starts urinating in the house.  Something is WRONG!

There are several reasons why cats will urinate outside of the litter box, and several methods to attempt to remedy the situation.

The number one reason a cat will start urinating outside of the litter box is a urinary tract infection.  Because cat’s have free access to the litter boxes, the other signs of a urinary tract infection often go unnoticed.  Frequent trips to the box, smaller amounts of urine produced per trip to the box, straining in the box, increased drinking, pain and discomfort while urinating (sometimes noted by vocalization, shifting weight back and forth while urinating, or sprinting out of the box after urinating), and blood in the urine are some of the signs of a urinary tract infection.

There are various causes for cats getting urinary tract infections.  Diet can alter the urine pH and make it a more favorable environment for bacteria to grow, overweight/obese cats can have issues with skin fold infections around the urethra which can cause urinary tract infections, stress can suppress the immune system and allow these to take off as well, and often, there isn’t a reason we can diagnose.  If a cat doesn’t like the box, it’s location, the litter, or was frightened in it, they will hold their urine longer and stagnant urine is a great place for bacteria to grow.  Also, the heavy cat who is drinking more and urinating more frequently (in or out of the box) is a candidate for diabetes and should not be overlooked.  Diabetics dump glucose (sugar) in their urine and bacteria love sugar.  When we diagnose a new diabetic, they almost always have a urinary tract infection.

Bladder stones can also be a contributor in inappropriate urination.  Other causes include overactive bladder syndrome (uncommon), endocrine disorders such as diabetes, Cushing’s, Addison’s, or hyperthyroidism, neurological problems, developmental problems of the bladder or urethra, and tumors of the bladder.

Bladder stones on radiographs

The first step in getting to the cause of your cat’s inappropriate urination behavior is to have a full medical exam.  This is a physical where we look for any signs of disease.  Next, we will want a urine sample.  The most accurate method for getting a urine sample is called a cystocentesis, where we palpate the bladder through the body wall, then isolate it and pass a sterile needle into the bladder to collect a clean urine sample.  This method ensures we are seeing what is truly going on in the bladder, not trying to decipher if what we are seeing is a contaminant from the urine passing through the hair or getting sucked up off the ground.  Also, this is a very fresh sample and samples that sit awhile (like on the car ride to the office) will start to deteriorate and grow bacteria that make the sample not a true representation of what is going on in your cat.  This process is relatively painless and quick.  We ask that you bring your cat in with a full bladder.  The easiest method to do this is to isolate them to a small area or cage without a litter box for several hours prior to their appointment.  If they don’t have a full bladder, we will often keep them in the clinic until they have a full bladder and we can get a sample.  The urine is then examined for color, turbidity, specific gravity (the kidney’s ability to concentrate the urine), pH, various metabolites in the urine, and a sediment examination.  To do a sediment examination we centrifuge the sample for 10 minutes, then remove the urine from the top of the sample and place the small amount at the bottom on a microscope slide.  We will stain this sediment to help in identification.  We look at the sediment for red blood cells, white blood cells, bacteria, crystal formation (number and type of crystals), casts, and any other cellular material that may indicate possible bladder tumors or other problems within the lower renal tract.  In some cases we will also take a radiograph of the abdomen to look for bladder and kidney stones, irregular shape to the bladder, or abnormal positioning.

If a urinary tract infection is diagnosed, the next step is treatment of the infection as well as evaluating the causes to hopefully prevent future episodes.  Most commonly an injection of antibiotics or oral antibiotics is used to treat the infection.  Diet changes may also be necessary, especially if there are stones present.  Stones are treated either surgically or medically with prescription diets to dissolve the stones.

Most cats don’t drink enough water.  The sound of running water tends to stimulate cats to drink.  An easy preventive measure is to get your cats a drinking fountain.  These fountains continuously circulate water to create the running water sound and filter it to keep it fresh for your kitties.  We like the Drinkwell Fountain and carry it in the clinic.

The best case scenario for a cat that is urinating out of the box is a urinary tract infection.  Once the infection is treated, most of these cats will readily go back to the box and the inappropriate urination ceases.

Once medical causes for inappropriate urination are ruled out, behavioral causes can be addressed.  Behavior causes are much more complicated than medical causes and can be significantly more challenging to treat.

Cats can be very particular about their litter box.  They will all have personal preferences to their box/litter and it is your job to figure them out.  The various particulars you need to evaluate are as follows:

• covered vs uncovered
• liner vs no liner
• scented litter vs unscented litter
• clumping vs non-clumping
• shallow vs deep litter
• traditional litter vs natural litter (corn cob, sand, recycled newspaper, ground corn, wood pellets, etc.)

** Remember that just because the litter is the same litter they’ve always used, doesn’t mean they can’t decide to not like it at any point!  They are cats!!!

Litter box number and placement is crucial as well.  A good rule of thumb is one box per cat in the household plus one.  This eliminates the odds of a box being in use when it’s needed.  Remember, nobody likes to wait in line for the bathroom!

Location is another fine point in keeping your cat happy with the box.  Cats feel very vulnerable when they use the litter box.  Placing a box someplace convenient for you may not be convenient for them.  The laundry room or basement near the furnace are not good locations.  These machines make loud noises and can startle a cat in the litter box.  If a cat gets scared or startled in the box, they may never return to it out of fear.  Placing the box in a hidden corner so it’s out of sight may not be the best idea either.  When cats are in the box, the last thing they want is someone or something (i.e. the dog or another cat) popping out of nowhere and interrupting them.  Placing the box in a corner opposite the doorway where the cat can get a good view of anything that is approaching helps to put them at ease in the box.

If your cat has selected a certain area in the house for urinating or defecating, there are some tricks to get them back in the box.

1. First, rule out the medical causes!
2. Then make sure the boxes are clean.  Cats are very fastidious creatures and don’t like to use an already soiled box!
3. Next, test for a litter preference.  The easiest method is to get several litter boxes and several types of litter (see above) and line them up to present your cat with a litter buffet to pick from.  The preferred litter will be obvious!
4. Once you have a litter that is liked, check the placement of the boxes.  Sometimes placing a box in the location the cat has chosen (under the table, in the corner, etc) is the fastest way to start this process.  If you can get the cat to use the box in that location (even if it’s not preferred by you), most cats will follow the box.  Once they are using it consistently, start slowly moving the box, about a foot a day, to a more desirable location.  I know this is tedious, but it’s better than the cat continuing to defecate under the dining room table!
5. There are also litter box additives, like Dr. Elsey’s Cat Attract, that can be added to the litter to help encourage the cat to get back in the box.
6. Cleaning the area where they have been going is also essential to eliminate the odor associated with it that may draw them back.  The best cleaning solution to use is an enzymatic cleaner that actually breaks down the smell.  There are several out there, but my favorite is called Got Pee?  We carry it at the clinic, it comes as a concentrate, and does an amazing job eliminating the odors.
7. Marking behavior is when male or female (intact or spayed/neutered) cats urinate on vertical surfaces.  This occurs as a scent marking behavior to alert other animals that this place is owned by your cat.  If your cat hasn’t been spayed or neutered yet, this is the first step to get this under control.  Pheromone sprays and diffusers like Feliway help to tell a cat that they are safe and secure in a certain area and there is no need to urine mark.  If marking is occurring near doors or windows, make sure there isn’t a neighborhood cat or other animal coming on to the property causing your cat frustration.
8. For the really challenging cases, eliminating access to the preferred area, setting booby traps around the area to keep them away from it, and going back to some remedial litter box training may be in order.  I will often recommend a cat be confined to a small room with the litter box until they are consistently using the box.  Once they’ve got this down, you can slowly start allowing them more room to roam.

There are also a few other medical conditions that owners often don’t think about when dealing with inappropriate elimination problems.  

• An obese cat may not be able to get into a small box and posture correctly and comfortably to eliminate.  Getting a bigger box may solve the problem.  I’ve had clients get big plastic storage boxes to use as litter boxes so it’s a little more roomy for those big kitties.

• An old cat may have arthritis and making a trip to the basement to eliminate may just cause too much pain.  Placing a box on each level of the house for easy access may help these kitties out.

• A cat with underlying diseases like kidney failure or diabetes, even though they are being treated, will produce more dilute urine and greater volumes.  A far away trek to the litter box several times a day may just be too much work.  Litter boxes close to the areas they spend the majority of their time may make the box more convenient.

I know I’ve covered a lot of information here, but I hope this helps you decipher what your cat is trying to tell you when they aren’t using the litter box.  I can guarantee it’s not that they hate you!  The biggest take away message I hope everyone who made it to the end of this blog gets is to not wait when your cat doesn’t use the litter box.  This isn’t likely to fix itself and the longer you wait, the bigger battle it is to fix, as well as the more cleaning up you’re going to have to do.  If you have specific questions, please contact me or your regular veterinarian for advice!