Veterinary Behavior Consultations, LLC and TEAM Education in Animal Behavior, LLC, Spicewood, TX, USA
Feline inappropriate elimination (FIE) is defined as urination and/or defecation in areas that are considered inappropriate by human counterparts. The condition may include medical, behavioral, and environmental components. FIE is the most common behavioral problem of house cats with approximately 1/3 of cats house soiling, spraying, or marking. In the order of which presentation is the most common, 52% of cats deposit urine alone (32% on vertical surfaces and 20% on horizontal surfaces), 28% of cats deposit both urine and feces, and 20% of cats deposit feces alone.1 There is no gender effect for house soiling, but spraying/marking is twice as common in male cats. In one retrospective study, Persian cats were overrepresented for eliminating outside of the box.2 Problem cats often do not cover urine or feces with litter. In one study of inappropriate elimination in cats, they spent less time digging prior to elimination.3 Cats spent an increased amount of time sniffing the closer the box was located to the core area.3
A diagnosis of FIE is based on a thorough history and physical exam. Medical work-up is important to rule out contributing factors. For simplicity, the primary behavioral diagnosis will either be one of house soiling, or urine spraying/marking, yet motivational factors for the behavior may vary.
House soiling usually consists of a large volume of urine being deposited on horizontal surfaces. Usually this is a full void of the bladder deposited by squatting (toileting behavior). Soiled areas may consist of one or a few centrally located areas of the home. Elimination often may occur near the litter box, but not inside the litter box. Feces are seen on occasion with house soiling. The most common cause of house soiling in cats is medical disease. Diet, litter box factors, the smell of soiled areas, and stress may contribute to the condition.
Differential diagnosis for house soiling should include medical disease, urine spraying/marking, separation anxiety, lack of training, cognitive dysfunction, or other age related changes such as incontinence, or arthritis.
The minimum data base for FIE should include a FeLV and FIV screening, a complete blood count, general chemistry, and urinalysis. Pending the clinical presentation, further testing may include urine culture, abdominal radiographs or ultrasound, screening for hyperthyroidism, and fecal screening for parasites. Any disease that causes polyuria or polydipsia and/or an increase or decrease in the frequency of defecation may lead to FIE.
Behavioral causes of house soiling may include a litter box aversion, substrate aversion or preference, a location aversion or preference, associated with litter box management, the number of litter boxes, or the smell of soiled areas. Litter box aversion may be due to the use of hooded litter boxes which retain odor. Lack of cleanliness in terms of scooping the box or the use of strong smelling detergents when cleaning the box can be a cause of aversion. Most cats do not like plastic bag lined litter boxes. A frightening or painful medical event in the litter box can be a causative factor. Larger litter boxes that are easily accessible are preferred for most cats. Large size litterboxes should be 22 in x 16 in x 6.5 in or approximately 1.5x the body length of the cat.4
Cats may have a substrate preference such as carpet rather than litter. Generally, finely granular sand-like material is preferred for feline elimination.5 One study suggest clumping litter is preferred verses silica or crystal type litters.6 Changes in type of litter may lead to an aversion. One study suggests that Fresh Step Scoopable Litter is preferable to Arm & Hammer Super Scoop.7,8 Generally, use a fine unscented clumping litter of at least 3 inches depth is advised.
Locations that are not preferred for elimination include basements and/or laundry rooms. In multi-level residencies, a litter box should be located on each floor. Litter boxes should be located in or just adjacent to feline lived in areas of the home such as a hallway or closet. Core areas in multi-cat households should include a litter box. Some cats have a greater requirement for litter box management than others. Boxes should be scooped daily and not cleaned with strong smelling detergents. The number of litter boxes should be one plus the number of cats in the home when one or more cats are eliminating inappropriately. Soiled areas should be cleaned with an enzymatic cleaner to biologically remove pet odor. Previously soiled areas may be made attractive in a manner that decreases elimination through the use of Feliway spray (cheek pheromones). Cats may be less likely to eliminate in areas where they eat, sleep, or play. Addition of catnip, cat treats, or interactive play near or on soiled items may change the association. Previously soiled areas may be made aversive though a malodorous compound (naphthalene, citronella) or a scented chemical cleaner (citrus of pine scents). Ammonia containing cleaning products are not recommended for cleaning soiled items. Treatment of house soiling may include retraining the cat to a litter box through confinement and supervision. This may allow the change of a substrate preference from carpet to litter over the course of several weeks. Owners should reward elimination in appropriate areas and block access to or remove items from the environment that are typically soiled. Drug therapy is usually not indicated in house soiling cases unless stress is a causative factor. Stress is more likely to be a causative factor in multi-cat households where one cat may block access to litterboxes. Of most importance is the addressing and correcting of litter box factors. Factors to consider include litter box accessibility, the number of boxes, type of litter, litter box hygiene, and the type of litter box. Soiled areas should be made inaccessible or unattractive.
Spraying or marking usually consists of a small volume of urine with the exception of soiled personal items. Vertical surfaces are sprayed by the cat backing up, standing tall in the rea, and twitching the tail while depositing urine. Typically the outskirts of the territory are sprayed or specific areas such as windows or doors with threats to the territory. Horizontal surfaces are marked less frequently and generally have a concentration of human scent, such as bath mats or personal articles. Marking with feces (middening) is rare. The most common cause of spraying or marking is the stress of other cats living inside the home or the visualization of cats outside the home. Marking is a normal social and sexual behavior of cats. The smell of soiled areas attracts the cat to eliminate in the same area.
The prevalence of urine spraying/marking has been suggested to be as high as 25% of single cat households. Probability may approach 100% that one cat is spraying in households ≥10 cats. Ten percent of castrated males continue to spray and five percent of spayed females continue to spray.9 Intact cats mark greater than gonadectomized cats.
Differential behavioral diagnoses for marking include house soiling, a generalized anxiety, or separation anxiety. The condition is unlikely related to medical disease; there is no difference in the urinalysis between voided or sprayed urine samples.10 Urine spraying/marking is a normal form of territorial communication. Stress or anxiety associated with other cats in the home or outside of the home is the most likely behavioral cause. Inter-cat aggression in the home may be present therefore active or passive aggression should be screened for in multi-cat homes. Males spray and fight more often in household with female cats than with males.11 Changes in the environment or schedule can result in stress. Conflict may be related to a person in the home or stress may be associated with the absence of a preferred attachment figure.
Surgical spaying or neutering is highly effective in reducing or preventing the behavior. Castration is 90% effective in eliminating/markedly reducing spraying behavior and ovariohysterectomy is 95% effective in eliminating/markedly reducing spraying behavior.12 Behavioral treatment of urine spraying/marking is similar to that of house soiling with the one major difference being the addition of psychopharmacotherapy. Veterinarians who correctly diagnose and differentiate urine spraying/marking from house soiling are more likely to recommend environmental management and medication for treatment.13 Litter box factors are addressed and improved when treating spraying and marking. Using an enzymatic cleaner, scoop the box daily, and cleaning and replacing all litter weekly was noted to improve urine marking (71% ♀, 36% ♂) responded with ≥50% decrease in marking).14 Stress factors should be identified and avoided or treated concurrently.
Anxiolytic medications are highly effective in eliminating or markedly reducing the behavior. Pharmacotherapy and supportive therapy will be discussed in detail.
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