Why is My Cat Peeing Out of the Litterbox?

One of the most common complaints I get from my clients about their cats is inappropriate elimination. One of the biggest misconceptions they bring to the table is “My cat is mad at me so she peed on the rug.” Inappropriate elimination is complicated and can have several reasons. Cats do not get mad at us and make a mess in retaliation — cats don’t have the ability to think like that.

Inappropriate elimination is often a combination of medical and behavioral factors. Determining the root of it can be expensive, time consuming and frustrating. Before we can attribute going to the bathroom in the wrong place as behavioral in nature, multiple tests must be done to rule out any medical conditions.

Evaluating Your Cat’s Health

A minimum database must be compiled consisting of urinalysis and chemistry, and a complete blood count. These must be run to evaluate the overall health of the cat, any urinary abnormalities such as crystals, excessive protein, inflammation, or renal disease. A urine culture must be run to evaluate for infection. Ninety percent of cats with cystitis (inflamed bladder), are negative for infection. For too long we have been attributing straining to urinate and urinating out of the box to the “UTI” or urinary tract infection. We have been overusing antibiotics where they weren’t needed and potentially creating other problems with disrupting the bacterial flora of the body (good bacteria that naturally occurs in the respiratory tract and intestinal tract) as well as creating stronger bacteria that become resistant to antibiotics. Over time it has been determined that these cats do not have infection but do have very severe inflammation of the bladder wall. Antibiotics will not help cats with these clinical signs. This is why doing a urine culture, in addition to the baseline labs is so important. You cannot diagnose infection based on urinalysis alone.

Imaging studies are also important diagnostic tools. X-rays are needed to rule out the presence of kidney and/or bladder stones. Some stones, such as strives or calcium oxalates, are readily visible on these radiographs; however there are other types of stones that do not show up, such as stones composed of urates and cysteine crystals. This is where the ultrasound becomes part of the diagnostic tool box. The ultrasound allows us to evaluate the inside of the bladder. We can see stones on ultrasound that may not show up on radiographs. The ultrasound also allows us to visualize the wall of the bladder. We can assess if it is thickened, indicating inflammation, or identify even more dangerous problems such as cancer.

If we fail to do appropriate diagnostics, and do not address a medical issue first, this condition can never be resolved with behavioral modification and behavioral drug therapy alone, and we will be spinning our wheels in vain.

Once all these tests have been run, and a medical condition has been completely ruled out, then we can attribute this condition to behavioral attributes and address it as such. Treating for behavioral problems requires commitment and discipline on the part of the owner. It requires teamwork between the owners, the doctors, and technicians. Sometimes this condition can be treated with behavioral modification alone. Sometimes it’s something simple, like adding another litter box. Sometimes changing the type of litter, the location of the litter box in the home, or substituting another type of litter box can be a huge help. How often do we purchase the covered litter boxes for ourselves because we don’t like the look or smell of the box?  Asking our feline friends to use those boxes is the equivalent to asking our children to use a port-a-potty. Sometimes just removing the cover can solve the problem.

Often times trying to fix the problem can get a lot more complicated. A thorough history needs to be obtained, as well as pictures of the layout of the home to assess for any triggers that is causing the unwanted behavior. Any change in the environment can trigger stress to your cat and medication may be needed to lower anxiety levels. High anxiety will contribute to inappropriate elimination. Anger and retaliation will not. Again, I reiterate, cats do not get angry and vengeful. Cats get anxious and stressed.

Identifying the source of your cat’s stress can be a huge help in fixing the problem. Sometimes it is difficult to identify stressors as cats are very sensitive to stress, and often it will be to small for us to identify. Strange new smells or sounds may be occurring that we cannot easily perceive. In that case we often can use environmental enrichment tools to try to relieve the cat’s stress. New toys, special treats, kitty pheromone room refreshers, cat nip, cat grass and other such items can make a cat’s environment a little more relaxing and enjoyable.

Just to muddy the waters a bit, most cases of feline inappropriate elimination are both medical and behavioral. More often than not, it stems from a medical condition, and then a behavioral component develops. It is important to not get frustrated, but instead work closely with your veterinarian to help make life easier for your cat, which in turn will make life easier for you.