LitterBox Behavior Solutions

"Oh, no, I have got to go RIGHT NOW!"  That is what many cats feel when they have cystitis, the most common medical cause of urination outside the litter box. Most of these cats do not have a true bacterial infection, but they do have painful inflammation. This inflammation makes the cat feel an urgent need to urinate, even if there is only a small amount of urine in the bladder. If the litter box is not easily and quickly accessible, or if the cat associates the pain of voiding with the litterbox, the cat may urinate in a more convenient or attractive area. 

A medical examination and urinalysis by your veterinarian is critical to determine the cause of your cat's litter box issues. Targeted treament of issues like cystitis can make a dramatic difference both for your cat's comfort and health and your own quality of life.

Intestinal problems such as inflammatory bowel disease or constipation can cause pain and increase the urgency of reaching the litter box as well. Some cats, especially male cats, will develop a lower urinary tract blockage which fatal if left untreated. These cats may urinate or defecate outside the litter box or strain in the box in an effort to pass urine through the obstructed urethra.

X ray of cat with bladder stone- Wikipedia

Some cats develop bladder stones which cause chronic irritation of the bladder lining. These cats are frequently painful and urinating in multiple locations. Sometimes the urine may be pinkish or blood tinged on voiding. X rays and/or ultrasound  are needed to determine their presence. Magnesium based stones may dissolve with a change to prescription stone dissolution diet. Calcium and other mineral based stones usually require surgery.

Calcium oxalate stones- Wikipedia

Infrequently, a type of cancer called a transitional cell carcinoma can occur and cause blood in the urine, urgency to urinate, and pain on urination. These cats usually void small amounts of urine frequently. This type of tumor is usually seen in elderly cats rather than younger cats and may be treated surgically, medically with chemotherapy  or palliatively (supportively) with an anti-inflammatory agent called piroxicam.

Help- I can't believe how much urine I am producing!"  Does your cat seem to be 'flooding' the litter box? Do you scoop out more than 2-3 egg size urine soaked clumps a day from the litter pan? The three most common diseases that cause increased volume of urine produced are kidney disease, diabetes, and hyperthyroidism. These are common metabolic diseases in older cats, and will occasionally occur in younger cats as well. Often increased urine production is the first sign of one of these treatable and occasionally curable diseases. Your cat needs to be seen by your veterinarian for an examination and a routine urinalysis and screening blood panel. It is not normal for a cat to urinate large volumes. Sometimes these high volumes overwhelm the strength of the urinary sphincter and cause overflow urination, especially where a cat is sleeping.  In addition, dilute urine is much more hospitable to bacteria than concentrated urine, so some of these cats may have a bacterial urinary tract infection occuring as well which will also  cause pain and voiding outside the box in some cats.

Constipation- how hard are those stools?

Constipation can occur at any age in the cat, but it is most common in older cats and cats that have inflammatory bowel or kidney disease. Obese cats are also more likely to develop constipation. Constipation can cause the cat to defecate outside of the box. As they strain to defecate, the stool can move partially through the anus and get stuck. When the cat walks around outside the box, the stool can work its way out and fall to the ground.

Most cat stools have a "tootsie roll" shape and firm but pliable texture. Small hard round stools or narrow ribbons of stool, or large hard stools indicate constipation. Some cats will eventually develop "obstipation", constipation so severe that the cat requires multiple enemas and significant medical care to resolve the condition. Some of these cats actually pass diarrhea uncontrollably around the fecal impaction (called a fecolith). This diarrhea may be the only change that the owner has noticed. Megacolon occurs when the wall of the colon becomes very thin and stretched out and is unable to contract to move the stool through the colon. These cats usually require surgery eventually to help correct the condition.

Constipation is treated by correcting the cause of the condition when possible, and using stool softeners and other medications as needed to keep the stoool moving and the cat comfortable.

Arthritis- any human with arthritis will tell you that normal every day activities are made painful, awkward, and sometimes impossible when arthritis symptoms are flaring. Cats have arthritis too. Joint pain can make traveling up and down stairs difficult, and sometimes cats will seek out more easily accessible areas for elimination of wastes. In addition, assuming normal postures for passing stool and urine can be very painful in cats with lower back and hip arthritis, and consequently the cat  may urinate over the edge of the litter box or defecate next to the box.  Covered litter boxes can prevent less flexible cats from assuming normal postures, and when they bump aching joints in the box they may develop an aversion to the covered box.

Fortunately, there are a number of prescription pain medications now available that can make cats much more comfortable. (Note-these medications are used off label in cats and need to be prescribed and monitored by your veterinarian).

Putting additional food and water stations and  extra litter boxes in favorite cat areas can improve easy access for aged cats. Soft clumping litters are easier on arthritic feet and encourage burial of solid wastes.

Obesity- " Sorry, Mom, I just don't fit into this box! Although fat cats may be well loved and enjoy their extra food, the extra weight they carry make getting into and out of the litter box difficult. The bigger the cat, the bigger the box that the cat needs. In addition, it may be a big effort for an obese cat to get up and down stairs to reach basement litter boxes, and they may choose to eliminate in a more accessible location. 

Your overweight cat will benefit by a gradual weight loss plan developed for you by your veterinarian. Note- do not try to have your cat lose more than 1/2 pound per month, as a more rapid weight loss can trigger hepatic lipidosis, a potentially fatal liver disease.

Diarrhea- can be chronic or acute, that is, a problem occurring for a long time or one having a sudden onset. Either type can result in such an urgency to defecate that the cat literally cannot make it to the litter box in time. In addition, there may be such pain and discomfort that the cat associates the pain with the litter box and finds other locations to pass stool, especially with chronic diarrhea. Treatment for acute diarrhea may be symptomatic with antidiarrheals, bland food, and intestinal antibiotics.

Chronic diarrhea usually requires diagnostics such as fecal examinations, blood tests to evaluate the cat's general health, and sometimes evaluation of the pancreas and intestinal tract with blood tests or biopsies. These cats may require long term medication depending on the cause of the chronic diarrhea.