WVC Conference 2021

(Session SA007) Feline Housesoiling: Who Says It’s Inappropriate?

WVC Conference 2021

Margaret E. Gruen, DVM, PhD, DACVB

College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA

Learning Objectives

At the conclusion of this lecture, attendees will be able to:

1. Describe the main points in the work-up and diagnosis of feline housesoiling

2. Describe the similarities and differences in the treatment of feline toileting (urine) and feline urine marking

3. Explain the use of environmental management and medication in the treatment of feline urine marking, including expected results

Introduction

Feline housesoiling problems are the most common behavioral complaints by cat owners to primary veterinarians. In addition, elimination problems involve 33–59% of referred feline behavioral problems. If not resolved, housesoiling problems can lead to rehoming, relegation outside the home, abandonment, or euthanasia of the offending cat. These behavior problems impact feline/human relationships ranging from the bond between the owner and the pet to the cat’s tenure as a veterinary patient.

Feline housesoiling problems can be divided into problems relating to elimination outside the litter box, including toileting (urination and/or defecation), and problems related to marking behavior, involving either urine or feces. In all cases, it is imperative that medical differential diagnoses be eliminated prior to behavioral therapy. Even when a medical diagnosis is made, behavioral therapy may be needed concomitant with medical treatment since behavioral problems can arise as a result of negative conditioning (when I use the litterbox, it hurts, so I am not going there anymore!). So, a cat experiencing urethritis may associate pain with the litter box location and seek alternate sites for urination. A behavior modification program may be required to reestablish satisfactory litter box use. As a second example, adversarial or stressful situations may become “flare factors,” which contribute to recurrence of feline interstitial cystitis and subsequent inappropriate elimination (Seawright et al. 2008). A behavioral program may be necessary to mitigate the stressful situations, including agonistic relationships with household or outside cats, that lead to these flare ups.

A thorough behavioral history is critical to the diagnosis and effective treatment of feline elimination problems. Factors that are important to elucidate include correct identification of the offending cat, the location and temporal pattern of eliminations, and careful examination of whether simple elimination, marking, or both are present, as this will affect treatment (see Table below). Environmental modifications are beneficial in the treatment whether the problem is simple elimination or marking. General recommendations for environmental modifications are based on studies of cat preferences and include increased number of available litter boxes (# boxes = # cats +1), increased size of litter boxes (Guy et al. 2014) (1.5 x length of cat), preferred litter type (unscented, fine grain, clumping litter generally preferred, but may vary by individual cat), uncovered litter box, and no litter box liner. One study suggested that the use of a deodorant (Zero Odor) increased the attractiveness of the litter box to cats, and decreased incidents of unwanted (outside the box) eliminations (Cottam, Dodman 2007). It must be noted that individual preferences exist for cats for litter type, covered vs. uncovered litter boxes (Grigg et al. 2013), and other litter box features.

Table 1. Toileting vs. marking

Behavioral signs	Toileting	Marking
Posture	Normal elimination posture (squatting)	Standing, backed up to object, tail raised
Litterbox use	Partial to complete cessation of litterbox use	Generally, continue to use the litterbox for normal elimination
Target areas	Preferred substrate or location—may develop individual preferences	Generally vertical, maybe socially significant (near doors, windows, prominent objects)
What owners find	Puddles of urine on horizontal areas	Urine marks on vertical objects, at cat’s standing height. May see small puddle on the floor at the edge (if urinated on the wall and dripped down)
Early signs/predisposing conditions	May see signs such as straddling box, not covering eliminations, urination/defecation close to box	Agonistic relationships among cats, outside cats present
Sex of cats	Males = Females	Males>>Females Intact>>Neutered

Approach to Feline Toileting and Urine Marking

Rule Out Medical Etiologies

Perform a complete physical examination and medical history for all cases of housesoiling.

Laboratory tests are needed for baseline information including a CBC, Chemistry Panel, UA; if indicated, this may include abdominal radiographs, ultrasound, contrast study, or other tests.

Medical causes are more common in squat urination/defecation outside the litterbox, but must be ruled out in marking cases as well. Some medical conditions that cause cats to experience pain during elimination may lead to a conditioned litterbox aversion (avoid the place where pain occurred). It may be necessary to re-establish litterbox use in these cats, even after the medical condition has resolved.

Make a Behavioral Diagnosis (Required for Effective Treatment)

Take a complete history including questions regarding the Who? (Especially important in a multicat household); When? Describe frequency and duration of the behavior; Where? Location in the home may be important, and may provide a clue to the reason for the behavior; Why? This may not be able to be determined, but investigate social relationships between the cats, the presence of outdoor cats, etc.; and How? Marking vs. toileting and posture, antecedent behaviors.

For Simple Urination (Squat Urination, Inappropriate Urination)

Cat will squat to urinate, normal posture and often occurs in vicinity of litter box or in a few areas. Cats may develop a substrate preference. The causes of this behavior include: Response to dissatisfaction with feature(s) of litterbox—especially consider this cause if the cat is not using the litterbox for urination or defecation; Environmental change or stress such as a new pet, home renovation, etc.; Change in litterbox location—consider how easily the cat can get to the litterbox, and what the surrounding of the box is. There is evidence that cats may wish to have their litterboxes within their “core area’ (where they spend >75% of their time); Interference from another household member (pet or human); separation related—this is less often considered, but there is increasing evidence that cats can also suffer from separation anxiety.

Treatment for Simple Urination Often Involves Multimodal Approaches

Tiered treatment includes environmental modification, behavioral modification, and (as needed) pharmacotherapy. Environmental modification/manipulation includes: Clean litter box daily; Change other features of litterbox (if cats are using the box at all, keep at least one box the same) including the size, number of boxes, type of litter, type of box, presence of liner, etc.; Options for changing the decreasing housesoiling at a given site include changing the context of the area, restriction of the cat, or gradual relocation of a litterbox in that area. Behavior modification is often targeted toward the owner and decreasing punishment. Where possible, owners can reward cats for use of the box, though this often is not feasible. However, punishment rarely works, can only be used if catching the cat in the act, and is not generally recommended. Pharmacotherapy is not usually indicated but may be necessary if there is an underlying anxiety component.

For Urine Marking (Spraying)

Cats will orient to a vertical surface (generally), raise and quiver its tail, and direct a stream of urine caudally. The amount of urine is usually small, but varies by individual. Typically, this behavior is identified by characteristic posture or urine on vertical surface. Urine marking is seen most commonly in intact males, then castrates, then females and is indicative of high level of arousal, often associated with presence of other cats (inside or outside house), other stressors. The probability of having a cat that sprays increases as cat density increases.

Treatment for Marking Also Involves a Multimodal Approach

Environmental management (Pryor et al. 2001a) includes all litterbox management strategies from simple urination treatment above. Other modifications include restriction of cat's access from areas where spraying occurs, use of odor deterrents (citrus and others), pheromone treatment (Feliway©), repellents outside house, reduce cat numbers outside or inside house, and correct other factors if indicated. Behavior modification again centers on decreasing punishment. This behavior is often highly motivated and punishment is not usually effective and may serve to make the cat more anxious. Pharmacotherapy is frequently used and often effective (in combination with environmental and behavior modification). Treatment is often for several months, but at least 2 months past resolution or satisfactory reduction in clinical signs, with a gradual taper to lowest effective dose. Intact cats may also be neutered; this is curative in many cases, however 5% of spayed females and 10% of neutered males spray urine.

Approach to Feline Inappropriate Defecation/Marking

The approach to feline inappropriate defecation is the same as for urination. Dissatisfaction with litter box is common. Digging and covering feces requires sufficient litter depth and some cats may urinate in one litter box and defecate in another. Although there are individual differences, the normal behavioral sequence for defecation involves choosing a site with loose substrate (such as a litter box), digging a shallow depression, defecating at the site, and then covering the feces with raking movements. The latter behavior is stimulated by the odor of feces and may be attempted when defecations occur on the floor. Fecal marking (middening) has been described. The occurrence of fecal marking has not been well documented, but patterns of fecal deposition in feral cats suggest it occurs. These cases should be evaluated as in urine spraying, with similar treatment recommendations.

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