We treasure the bond we have with our feline friends. But discovering an odorous wet spot on our bed, clothing, or floor can make even the most devoted cat lover question their affection. House soiling may seem like a personal attack, but the cause can be complicated. Urinating outside the litter box may be due to medical, behavioral, or stress-related issues. Stress can even cause painful urinary tract disease in some cats.
Sorting out why a cat is missing the mark, and finding a solution, takes partnership between owner and veterinarian. A young tomcat urinating on the wall near a window is a very different scenario than an elderly cat urinating next to the litter box. Here we explore why cats urinate outside their litter boxes, and how veterinarians can help desperate owners to restore litter box harmony in their homes.
Scenario 1: That adorable kitten your neighbor rescued from under their porch has been a delight. You keep him indoors so he ‘s safe from cars, predators, and infections. But a feral cat has been lurking at the back door. You come home to find urine streaming down the wall under the window. Your conclusion might be that he’s angry you won’t let him outside.
Scenario 2: Your two-year-old indoor male neutered cat seems bored. You adopt another cat from the shelter. But you soon see that they are not instant buddies. There’s hissing and growling, and your sofa is now sprayed with urine. Your conclusion might be that he’s angry you are sharing your attention, and he’s getting revenge. You aren’t even certain which cat is the culprit.
These scenarios describe urine marking, a normal instinctive response to presence of a potential mate or to a perceived territorial threat inside or outside. It is most common in intact males, but can occur in neutered males and females. Cats usually back up to a vertical surface with tail held high and spray urine to send a scent message to another cat. They often twitch their tails while spraying. It’s their way of advertising for a mate, or putting a stake in the ground. Cats who engage in urine marking will still urinate normally in the litter box.
If you suspect your cat is urine marking, don’t pack their bags yet! First, neuter intact cats, as this dramatically reduces marking. If there’s an animal outdoors, keep the window covered. Motion sensing lights or sprinklers outdoors may deter feline visitors. Clean urine with an enzymatic cleaner and cover with a floral or citrus scented product to deter him. Place tin foil where he is marking, a surface he will neither enjoy walking on nor spraying against. There should also be plenty of places your cat can escape to. Elevated safe havens, such as a tall cat tower, perch, or bookshelf, can provide much-needed psychological distance. Always provide extra litter boxes (one more than the number of cats in the home), and make sure your cat feels secure at feeding time.
Pandora Syndrome (Feline Idiopathic Cystitis)
Cat owners often ask if urinating outside the box indicates a medical problem, or if their cat is just acting out in protest of stressful household changes. In many predisposed cats, painful lower urinary tract disease may actually be caused by stress. We call this Pandora syndrome, or feline idiopathic cystitis (FIC).
There may be a history of early adverse events in life, such as being orphaned or physical trauma. The stress response may be over-reactive to events that other cats take in stride. The stress hormones can trigger heightened pain perception and a thinning of the protective layer in the lower urinary tract that protects the lining from caustic urine. When this lining is breached, the cat experiences pain, inflammation, and sometimes even urinary blockage. No infection or other medical condition can be identified, yet sterile cystitis (bladder inflammation) is apparent. Signs may include bloody urine, straining, vocalizing during urination, hiding, and decreased appetite. Signs recur with stressors and improve with environmental enrichment. Middle-aged, less active, overweight neutered males on dry food tend to be at higher risk. They often have concurrent medical problems.
But why would they urinate outside the litter box? Cats are no dummies, if they experienced painful urination first in the litter box, they associate the box with pain. To the owner, this may look like revenge for working late, but the cat has a very different perspective.
Pandora syndrome is a medical diagnosis based on ruling out other problems. A veterinarian will perform bloodwork, urine tests, radiographs, ultrasound, and possibly cystoscopy. Managing Pandora syndrome requires immediate care and long-term plans to prevent recurrence. Pain relievers, fluids, and medications to relax the urethra may be indicated. Injections with polysulfated glycosaminoglycans (PSGAGs) have also been used to help restore the depleted protective film in the lower urinary tract.
At home, multimodal environmental modification (MEMO) can reduce recurrence of Pandora syndrome. Once stressors have been identified, a plan to modify your cat’s world should be implemented. Enrichment activities, toys, catnip, and hiding places can help relieve stress. Grooming, for cats who enjoy a gentle brushing, petting, and curling up together can feed both cats’ and owners’ souls. Activities that promote exercise and normal predatory behavior such as laser light pointers, walks on leash outside, fishing pole toys, or mechanical mice all can ease a stressed cat’s anxiety. Tailor enrichments to the individual cat, as one cat’s play may be another cat’s trigger!
MEMO must also address social dynamics in multi-cat homes where there is conflict. This may involve “special time” between owner and cat without other cats present. Some cats need enriched alone time away from other cats to reset their peace-meter. Ensuring an adequate number of litter boxes, food and water dishes, scratching and climbing posts, and secure elevated perches and hiding spots are available can relieve stress brought on by competition for resources.
It may take some time to see improvement. Special diets containing omega-3 fatty acids and anti-oxidants may help, as well as increasing water intake. This can be achieved through wet food, multiple water bowls, or offering a water fountain for cats. For cats whose urinary problems recur, a veterinarian may prescribe anti-anxiety medications or calming supplements. This is done in conjunction with environmental changes for the best outcome.
Underlying Medical Conditions
Some cats give up on the litter box due to chronic painful conditions such as arthritis. There is nothing wrong with their urinary tract, but climbing the stairs to reach the box, or stepping over a high side, causes pain. Much like people, middle-aged to older cats may develop arthritis. Even young cats with congenital conditions or physical trauma may find litter box visits difficult. Making the litter box more accessible is a simple solution. There should be at least one low-sided container on the level where the cat spends the most time. Cut down higher-sided boxes in front and tape over the sharp edges.
Medical conditions that cause increased urine volume may also lead to house-soiling. No self-respecting cat wants to hop into a fully clumped litter box. Kidney disease, diabetes mellitus, hyperthyroidism, and adrenal gland disease can all increase thirst and urination. They may also have to urinate so often that they tire of making the trip, or can’t hold their urine. Each of these conditions can be managed through diet, medication, or other interventions.
Urinary tract infections and bladder tumors are not common in young cats, but may occur as cats age. Bladder stones are another painful cause of house-soiling. These conditions cause straining, bloody urine, and pain, all leading to litter box avoidance. A veterinarian will perform a physical exam, run diagnostic tests, and determine treatment. Management involves prevention strategies in cases of bladder stones or infections. Increasing water intake through switching to wet prescription food can help.
Environmental Factors and Social Anxiety
Much as people have preferences for toilet paper, cats have their toileting preferences. Most cats prefer simple, unscented clumping litter in the box, but did you know they have a depth preference too? Keeping the depth to one to three inches keeps your kitty happy. The clean-up crew (that’s you) should scoop waste at least once daily, and wash litter boxes every one to three weeks. Provide one more litter box than the number of cats. The litter boxes should be easy to access, and escape from. If you have a multi-level home, make sure there are accessible litter boxes on each floor, away from noisy appliances, high-traffic areas, and small children.
Cats also have a preference for litter type. If you’ve recently switched from clay to recycled newspaper pellets, only to find that your cat prefers the tile floor, run back to the store. Try offering a few different types in separate boxes side-by-side to see which one wins.
The kind of litter box may be a factor as well. Most cats are fine with either uncovered or covered boxes, but size definitely matters. Try switching to a larger plastic storage bin. If you are using liners, consider packing those up for now. And although self-cleaning litter boxes are a modern convenience, your cat may not be as impressed with the mechanical upgrade.
Social factors in multi-cat homes can be critically important to keeping the “pee-pee peace.” If a cat feels unsafe or bullied when duty calls, they are not likely to revisit a vulnerable location. When an unsettling experience occurs during a litter box visit, there is a risk of subsequent box-avoidance. Recognizing what’s happening and mitigating social or environmental issues can restore proper litter box etiquette. Remember to provide vertical resting spaces, hiding places, and “me time” separated from other cats. If possible, this can last several hours each day. This doesn’t mean they should be isolated from the human family members. Playtime with family, feeding, and litter box time should all be combined in this safe space.
In order to reduce the use of preferred house-soiling sites, owners can apply double-sided tape, aluminum foil, motion sensing lights, strongly scented air freshener, or other unappealing elements. If possible, these areas can be blocked off all together. Synthetic pheromone-based products such as Feliway spray and diffuser often help reduce anxiety.
Although feline house-soiling can be distressing, there are well-defined steps to help curb or eliminate this unwelcome behavior. Don’t despair! By providing your veterinarian with an accurate history, they can help determine the cause, and work toward restoring both health and household harmony.
DC Academy Behavior Seminar “Keeping the Peace in Multi-Cat Households” by Lynne Seibert, DVM, MS, PhD, DACVB, Dec. 2, 2021