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Basics ⬇

Basics

Definition

  • Deposition of urine or feces outside the litter box.
  • Urine housesoiling (also called periuria) includes inappropriate urination, a toileting behavior in which urine is typically found on horizontal surfaces outside the litter box, and urine marking, in which urine is sprayed on vertical surfaces as part of a ritualistic tail-up display.
  • Fecal housesoiling includes both inappropriate defecation, a toileting behavior characterized by feces deposited outside the litter box, and fecal marking, called middening, characterized by feces deposited in prominent locations.
  • Marking behavior serves a normal communicative function in cats.
  • Housesoiling will negatively impact the human-animal bond and can lead to relegation outside, rehoming, relinquishment, or euthanasia.

Pathophysiology

  • Inappropriate urination/defecation-may be a response to dissatisfaction with the litter box environment or preference for an alternative location or substrate, or may reflect an underlying pathophysiologic state such as a negative (pain) association with the litter box secondary to uroliths, constipation, or orthopedic pain.
  • Urine marking-a normal behavior observed in free-ranging and confined cats; significant individual differences in the propensity to urine mark in a given environment. Cat density is correlated to probability of urine marking. Cats that urine mark also commonly use a litter box for toileting.
  • Fecal marking (middening) is rarely observed; it should be a diagnosis of exclusion.
  • Social or environmental stressors may contribute to housesoiling, primarily marking.

Systems Affected

  • Behavioral
  • Endocrine
  • Gastrointestinal
  • Renal/Urologic

Genetics

  • Not specifically identified.
  • Persians and Himalayans that exhibit inappropriate urination should be DNA tested for the genetic disorder polycystic kidney disease.

Incidence/Prevalence

  • Housesoiling is the most common behavioral problem for which cat owners seek veterinary advice and the second most common reason for relinquishment of cats to animal shelters.
  • Inappropriate urination/defecation: in one survey, 11% of indoor cat owners reported inappropriate elimination as a problem.
  • Urine marking: exhibited by approximately 10% of castrated male and 5% of ovariectomized female house cats.

Geographic Distribution

Housesoiling may be more problematic where cats are commonly restricted indoors.

Signalment

Species

Cat

Breed Predilections

Housesoiling may occur in any breed, although Persians, Himalayans, and relatives are overrepresented in some studies.

Mean Age and Range

Inappropriate urination/defecation can occur at any age. Marking behaviors are typically seen in cats >6 months.

Predominant Sex

  • Housesoiling can occur in either sex, intact or altered.
  • Urine marking is more common in males (intact and neutered) than females (intact and neutered).

Signs

General Comments

Identify the Affected Cat in a Multi-Cat Household

  • Direct observation, although if punished, cats may become secretive.
  • Videotaping or video monitoring.
  • Separate the cats to identify the culprit. Note that this protocol may alter the social milieu sufficiently to inhibit inappropriate elimination.

  • Add a urine indicator. If urine is alkaline, administer the dye fluorescein (6 fluorescein test strips in a gel capsule PO or 10 mg/cat) sequentially to each cat. Urine outside the litter box will fluoresce under a Wood's light for approximately 24 hours; if negative after 36 hours, the test can be repeated on another cat. Negative results are common in households in which the frequency of urine housesoiling is low. Fluorescein may stain fabrics.

Identify the Locations of Housesoiling within the House

The owner should generate a map of the home, indicating the locations of urine and fecal housesoiling and locations of litter boxes. Location of the housesoiling can provide insight into the type of housesoiling and etiology.

Historical Findings

Inappropriate Urination/Defecation

  • Abnormal pattern of urination (incontinence, polyuria, hematuria, dysuria) suggests an underlying congenital or medical problem.
  • History of straining to defecate; vocalizing or running away when defecating; hard, dry, or bulky feces suggest painful defecations that may lead to conditioned avoidance of the litter box for defecation.
  • History of polydipsia, anorexia, vomiting, or diarrhea suggest an underlying medical etiology.

Urine Marking

  • History of displacement, aggression, or avoidance behavior between cats in a multi-cat household.
  • Observation of the posture of spraying urine: the cat orients caudally to a vertical surface, stiffens its posture, raises and quivers its tail, and directs a small burst of urine caudally.
  • Observation of urine marks on vertical surfaces or puddled at the bottom of a wall.
  • Urine marks can be found on prominent furniture or other objects, or urine sprayed on new objects brought into the house.
  • Horizontal urine marks may be found on clothing or bedding associated with a particular person or in response to visitors or novel objects.

Fecal Marking

Feces deposited on prominent, conspicuous locations.

Physical Examination Findings

  • Presence of abnormal physical findings depends on whether problem is pathophysiologic or behavioral.
  • If strictly behavioral, physical examination will be normal.
  • Apparently-neutered males that urine mark should be examined for the presence of penile spines, indicating the presence of endogenous testosterone, or quantify serum testosterone.

Causes

Medical Causes

  • Any metabolic or GI condition that causes polyuria, diarrhea, or constipation
  • Lower urinary tract disease, including idiopathic interstitial cystitis (may be associated with environmental stressors)
  • Urolithiasis
  • Diabetes mellitus
  • Hyperthyroidism
  • FeLV
  • FIV
  • Liver disease
  • CNS disease/cognitive dysfunction (senility)
  • Iatrogenic-administration of fluids, corticosteroids, diuretics
  • Musculoskeletal pain that make entry/exit from the litter box or elimination postures difficult, can contribute to litterbox aversion
  • Hormonal influences may contribute to urine marking

Behavioral Causes

Inappropriate Urination/Defecation

  • Soiled litter box.
  • Inadequate number of boxes or locations (one box per cat plus one is recommended).
  • Box located in remote or unpleasant surroundings or subject to interference by dogs or children.
  • Inappropriate type of box-a covered litter box, box too small to allow large cats to move around comfortably; or allows other cats, pet dogs, and young children to target the cat as it exits.
  • Time factors-daily or weekly temporal patterns of inappropriate urination suggest an environmental cause; acute onset in a cat that has previously used the litter box suggests a medical or social problem.
  • Substrate-unacceptable litter type; preference tests indicate that most cats prefer unscented, fine-grained (clumping) litter but individual variability; coincident change in litter box habits with new litter type suggests an association; a sudden shift from one substrate (e.g., litter) to an unusual substrate (e.g., porcelain sink) suggests a lower urinary tract disorder.
  • Location-urination outside the litter box may suggest a location preference or influential social factors. Urination in the vicinity of the litter box may suggest dissatisfaction with qualities of the litter box, including litter box hygiene.
  • Social dynamics-consider social conflicts between cats at the time the problem started (e.g., addition of a new cat).

Marking

  • Marking is associated with arousal, anxiety, or territorial behavior.
  • The probability of urine marking is directly proportional to the number of cats in the household.
  • Marking can be a response to household disruption or another cat(s) in or outside the home. Urine marks around windows and doors to the outside suggest a response to the presence of an outdoor cat.
  • Urine marking grocery bags or new furniture suggests arousal in response to new stimuli.

Risk Factors

Inappropriate Urination/Defecation

  • Inadequate litter box hygiene
  • Litter box features (litter type or scent, box size or style)

Urine Marking

  • Male
  • Sexually intact
  • Multiple-cat household
  • History of urine marking by a parent

Diagnosis ⬆ ⬇

Diagnosis

Differential Diagnosis

  • Must identify if a medical problem underlies the behavioral problem.
  • If behavioral, must differentiate inappropriate urination from urine marking.

CBC/Biochemistry/Urinalysis

Usually normal when urine marking and inappropriate urination are strictly behavioral; urinalysis via cystocentesis is the minimum database in any cat examined because of inappropriate urination; collect serial samples from cats whose behavioral signs wax and wane; CBC and biochemistry are recommended prior to administration of medication and to evaluate medical status.

Other Laboratory Tests

Cats with refractory inappropriate urination or progressive signs should be tested for hyperthyroidism, FeLV, and FIV.

Imaging

Abdominal ultrasonography, abdominal radiographs, and contrast studies if indicated to rule out urolithiasis as an underlying cause for inappropriate urination.

Diagnostic Procedures

Helpful historical information: map of the house, with litter boxes and urine/fecal housesoiling identified; behavioral diary with daily frequency of urinations/defecations inside each litter box and outside the litter boxes. Requires daily household monitoring.

Pathologic Findings

None, unless an underlying medical etiology.

Treatment ⬆ ⬇

Treatment

Appropriate Health Care

  • Treat any underlying medical condition.
  • Use environmental and behavioral therapies before or concomitant with pharmacologic treatment.
  • The environment for indoor cats should include safe resting places, separated resources, and positive and predictable human-cat interactions.
  • Restrict the cat from rooms in which urine housesoiling occurs.
  • For immediate management and in cases of agonistic relationships between cats in a multi-cat household, it may be necessary to confine the cat to one room in the owner's absence. Provide a litter box (see specifications below), water, food, and resting sites. The cat can be let out of the room when the owner returns and is available for strict supervision of the cat. Initiate other, more permanent treatments.
  • Clean urine “accidents” with an enzymatic cleaner specific for this purpose.

Inappropriate Urination

  • Scoop out the litter boxes daily. Clean out and wash litter box and refill regularly.
  • Avoid deodorizers, scented litters, or other strong odors in the vicinity of the litter box.
  • Move food bowls away from litter boxes.
  • Provide one litter box per cat, plus one, distributed in more than one location; positioned away from high traffic or noisy areas.
  • If the litter box is covered, provide an additional large, plain, uncovered litter box filled with unscented, fine-grained, clumping litter, with no liner and quantify cat use on a behavioral diary. Additional boxes may be provided (“litter box buffet”) to reveal cat preference for litter box type and substrate.
  • If one site in the home is preferred for inappropriate urination, place another litter box over this site. After it is in regular use, move it 2.5 cm per day to a site more acceptable to the owner.

Urine Marking

  • If there are signs that the cat is marking in response to cats outside the home, use mechanical or olfactory products to deter outside animals, or trap and remove.
  • Reduce cat numbers to reduce conflicts if possible.
  • Synthesized feline facial pheromone (Feliway, Ceva Animal Health) is commercially available as a treatment for urine marking. The product is sprayed regularly or diffused in the environment and may reduce urine marking up to 75%.
  • Litter box management, as described above, has been shown to decrease urine marking.
  • Pharmacotherapy plays an important role in the control of urine marking.

Nursing Care

N/A

Activity

Opportunities for active play that incorporate behavioral patterns of predatory stalking and pouncing should be provided daily.

Diet

No specific diet unless suggested by an underlying medical etiology, such as urolithiasis or constipation.

Client Education

  • Cats do not housesoil to be spiteful.
  • Scolding and punishment are contraindicated, they may increase cat anxiety and will cause the cat to avoid the owner.
  • Understanding the underlying motivation for housesoiling behavior is critical for treatment success.
  • Creating a predictable environment will decrease anxiety and arousal that may contribute to housesoiling.
  • Work to resolve cat conflicts within the home (see Aggression, Intercat Aggression).
  • Meet cat needs for exercise, play, and safe elevated resting sites.

Surgical Considerations

Castration reduces urine marking in up to 90% of males and 95% of females.

Medications ⬆ ⬇

Medications

Drug(s) Of Choice

Inappropriate Urination

Psychotropic medication not usually indicated, except in treatment-resistant cases or when associated with generalized anxiety or heightened arousal.

Urine Marking

  • Medication to decrease arousal is often needed for treatment success.

  • Drugs from a number of drug classes may be used. All have the general effect of decreasing arousal and anxiety. Side effects can be sedation and/or altered social behavior (see Table 1). Drugs commonly used include fluoxetine, paroxetine, clomipramine, amitriptyline, buspirone.

Fecal Marking

Medication may be needed to decrease the arousal that drives this behavior.

Contraindications

  • Benzodiazepines-use cautiously or avoid because of rare reported cases of fatal idiopathic hepatic necrosis in cats receiving diazepam.
  • Tricyclic antidepressants-cats with a history of cardiac conduction disturbances, urinary or fecal retention, megacolon, lower urinary tract blockages, seizures, and glaucoma.
  • Transdermal route does not appear to consistently produce satisfactory drug levels.

Precautions

All drugs listed are extra-label. Inform the client of extra-label use and potential side effects; document the discussion in the medical record or use a release form. Start psychotropic drugs when the owner is present to monitor the patient.

Possible Interactions

Do not use monoamine oxidase inhibitors (e.g. selegiline) concurrently with TCAs or SSRIs.

Alternative Drug(s)

  • Synthetic progestins-the risk of serious side effects, including blood dyscrasias, pyometra, mammary hyperplasia, mammary carcinoma, diabetes mellitus, and obesity, has diminished their once-common use.
  • Pheromone therapy (Feliway, Ceva Animal Health) may reduce urine spraying.
  • L-theanine (Anxitane, Virbac Animal Health) or alpha-casozepine may reduce cat anxiety.

Follow-Up ⬆ ⬇

Follow-Up

Patient Monitoring

  • Regular follow-up is essential.
  • The owner should keep a daily log of elimination patterns so that treatment success can be evaluated and appropriate adjustments in therapy can be made. Number the litter boxes and request that client count and record the number of urinations/defecations in each box and outside the litter boxes each day.
  • For marking behavior, after 2 months of successful medication management, medication might be withdrawn gradually over 2 weeks. However, if the social features that underlie the behavior are still present, medication may need to be continued for treatment success.
  • For medication monitoring, an annual CBC, chemistry profile, urinalysis, and physical examination are recommended at a minimum.

Prevention/Avoidance

  • Neuter cats.
  • Restrict cat numbers to decrease the probability of urine marking.
  • Counsel clients on appropriate litter box selection, location, and hygiene.
  • Veterinary practitioners should inquire about housesoiling at each veterinary visit. Early identification and treatment optimize treatment success.

Possible Complications

Client expectations must be realistic. Immediate control of a long-standing problem of housesoiling is unlikely; the goal is gradual improvement over time.

Expected Course and Prognosis

  • Prognosis for improvement is good if underlying etiology is identified and managed.
  • Housesoiling is destructive to household belongings and erosive to the human-animal bond, which if not successfully controlled can lead to abandonment, relegation outside, relinquishment to an animal shelter, and euthanasia.

Miscellaneous ⬆

Miscellaneous

Associated Conditions

Aggression between cats may be associated with urine marking.

Age-Related Factors

  • Older cats might find litter box access difficult and seek alternative locations. Low-rise litter boxes can provide better access for these cats.
  • Failure to use the litter box could be associated with age-related cognitive decline.

Zoonotic Potential

Pregnant women should avoid or take appropriate precautions when cleaning cat feces because of the risk of toxoplasmosis.

Pregnancy/Fertility/Breeding

Tricyclic antidepressants are contraindicated in animals used for breeding.

Synonyms

  • General: feline housesoiling.
  • Urine: feline inappropriate elimination, squat urination outside the litter box, urine marking, urine spraying, periuria.
  • Feces: feline inappropriate defecation, defecation outside the litter box, fecal marking, middening.

Abbreviations

  • FeLV = feline leukemia virus
  • FIV = feline immunodeficiency virus
  • SSRI = selective serotonin reuptake inhibitor
  • TCA = tricyclic antidepressant

Internet Resources

Author Margaret E. Gruen and Barbara L. Sherman

Consulting Editor Gary M. Landsberg

Client Education Handout Available Online

Suggested Reading

Herron ME.Advances in understanding and treatment of feline inappropriate elimination. Top Companion Anim Med 2010, 25(4):281–295.

Landsberg G.Feline housesoiling. In: Landsberg G, Hunthausen W, Ackerman L.Behavior Problems of the Dog and Cat, 3rd ed. New York: Saunders/Elsevier, 2013, pp. 281–295.

Neilson JC.House soiling by cats. In: Horwitz DF, Mills D, eds. BSAVA Manual of Canine and Feline Behavioural Medicine, 2nd ed. Gloucestershire, UK: BSAVA, 2009, pp. 117–126.

Pryor PA, Hart BL, Bain MJ, Cliff CK. Causes of urine marking in cats and the effects of environmental management on the frequency of marking. J Am Vet Med Assoc 2001, 219:1709–1713.

Tynes VV, Hart BL, Pryor PA, et al. Evaluation of the role of lower urinary tract disease in cats with urine-marking behavior. J Am Vet Med Assoc 2003, 223:457–461.