A common presenting complaint for cats is the issue of urinating outside the litter box. This can be a very frustrating problem for owners to deal with. It can disrupt a household and put a strain on the human-feline relationship. Determining the underlying reason can be a complex puzzle with multiple pieces.
Obtaining a Urine Sample
A clean sample of the patient’s urine must be collected and analyzed for the presence bacteria, crystals, WBCs, RBCs, and other important values. Obtaining that sample has its challenges. We often employ a urine collection kit with non-absorbent plastic litter in a clean litter box. This may take some time as the patient is not accustomed to this setup and often holds their urine. If this method is unsuccessful, we may need to retrieve a sample via cystocentesis, carefully sticking a needle directly into the bladder, often guided by ultrasound, to extract an uncontaminated sample.
Urinary Tract Infection
The first thing to rule out with urinary issues is a urinary tract infection. UTIs are regularly treated with antibiotics, but isolating which bacteria is present in the urine indicates which antibiotic is needed. This is why a culture of the urine is often recommended.
Bladder stones develop when the pH of the urine is unbalanced, and an overabundance of minerals start to merge and harden. This problem can be diagnosed by taking a radiograph or ultrasound of the bladder. They are usually treated with surgical removal or diets specially formulated to dissolve the particular compound.
Another value that is measured in a urinalysis is the presence of glucose in the urine. This can clue us in that diabetes may be on the differential. Glucose in the urine can be due to stress, so more testing is required to definitively diagnose the disease. A symptom of diabetes is frequent urination, which may lead the patient needing to go when a litter box is not convenient.
Kidney disease and hyperthyroidism are common ailments in cats. Both have symptoms of frequent urination. The frequency or urgency leaves them little time to make it to the box and instead turning to the nearest available location. A low specific gravity of the urine may indicate the need to run blood work to check kidney function.
The urethra is a small tube leading from the bladder to the outside world. It can become plugged with mucous and/or crystals, blocking the flow of urine. Since the kidneys filter toxins from the body and eliminate them through the bladder, the inability to urinate can cause a build up of toxins in the body. This is a serious and life-threatening condition.
FIC- Feline Idiopathic Cystitis
Idiopathic means that we do not know the cause of inflammation in the bladder. This diagnosis is reached when other conditions have been eliminated. Treatment options may include anti-inflammatory pain medication, diet change, and environmental enrichment. Since cats are notorious for not drinking enough, encouraging increased water intake can help flush out the bladder.
Behavioral problems can be the most challenging to diagnose and resolve. Cats are creatures of habit and do not like variations to their routine. Even something small like moving the furniture around in the living room can stress them out. A larger change like a new human or animal in the household or moving can be even more upsetting.
With the invention of new products that relieve stress, we have more tools in our toolbox. Here are some examples:
- Specialized Diets- Hill’s Feline c/d stress management or Royal Canin Urinary SO + Calm
- Probiotics- Purina Calming Care®
- Pheromone- Feliway® Spray or Plug-in
- Pharmaceuticals- Fluoxetine, Gabapentin, etc.
Litter Box Aversion
Even after symptoms of a UTI or other issue have resolved, the patient may still associate the litter box with the pain caused from that issue. Moving their litter box to a new spot or offering them a new one may help them overcome this aversion.
Felines prefer a quiet, private place to do their business. If the litter box is in an area of high traffic or noisy area of your house, your cat may just need a change of scenery. If they are frequently eliminating in a specific spot in the house, move their litter box to that spot as it just may be where they feel most comfortable. The type of litter you use can be unfavorable to a cat.
If a senior cat is having urinary issues and medical conditions have been ruled out, we investigate age related issues. Cognitive dysfunction may mean the cat is forgetting where to go or even getting lost in your house and unable to find the box. Try offering more litter boxes and placing them in areas around the house they most frequent. Arthritis can also play a role. They may be having difficulty getting in and out of the box. Consider a box with shorter sides or one that is wider allowing easier movement in and around. Make sure they have a box available on each level of the house in case they are unable to navigate the stairs.
In summary, inappropriate urination may just be the cat’s way of telling you that there is something wrong. There are other issues not on this list that could be the underlying problem. The important part is to observe the cat’s behaviors or reactions to treatment and communicate your findings with your veterinarian. Together, we can add up the pieces to the puzzle to paint the complete picture.