Feline Urination Issues
The seasons are changing, and I know winter is in full swing when I start to see the appointments for cats urinating ‘inappropriately’ as we call it in the veterinary industry. (Of course, at home, it generally goes by the name ‘The !@^%#$^$ cat is peeing everywhere!!’ ) Though it can occur at any time of year, fall and winter truly seem to bring on an increase in feline urinary problems.
I know how infuriating and frustrating this problem can be! Growing up, the cat we begged my father to allow us to have, urinated all over the basement and kitchen counters, and one of the first cats I got after becoming a veterinarian struggled with inappropriate urination for years. The expense of replacing furniture and flooring, the seemingly futile attempts to eliminate urine smell from your belongings, pressure from other family members to get rid of your beloved but infuriating cat have an impact on our quality of life.
Sometimes these problems can be very easy to fix (ie neutering an intact male cat, and ensuring the litterbox is clean and accessible). However, most of the time it’s not that simple! First, you really need to get your cat into the veterinarian as quickly as you can when this problem starts. There are many possible reasons why your cat may be urinating inappropriately. One of these problems may be an initiating event that makes them urinate outside of the box (usually due to pain or increased urgency to urinate), and then they continue to do so. I frequently see cats that have already been urinating around the house for weeks if not months, their owners getting more and more frustrated and feeling that they have tried everything they can think of or read about on the internet, before their cat comes to see me. Problem is, there is very often a medical problem, and the longer your cat is urinating inappropriately, the lower the chances of being able to completely fix the problem.
You need a good veterinarian who will take the time to:
- gather a full detailed history about the problem which includes your cat’s lifestyle and home environment,
- perform a thorough physical examination to gather more clues,
- perform the necessary diagnostics and 4) ensure you fully understand the treatment plan since you will be the one treating your cat!
First your cat needs a diagnosis. Inappropriate urination is only one of several urinary tract or other body system signs your cat may be showing. Here are some of the causes for inappropriate urination:
- Urinary tract infection. Often the first thing cat owners think of, this actually accounts for a mere 2% of lower urinary tract signs in cats under 8 yrs of age, but becomes more common in cats over 10 yrs of age.
- Bladder stones. Bladder stones account for about 20% of cases of lower urinary tract signs.
- Bladder mass. Polyps as well as cancerous tumours can grow from the bladder wall, but this is uncommon.
- Cats who have experienced pain while in the litterbox may start to develop an aversion to the litterbox. Most of the other causes in this list can lead to painful urination. Cats can also experience painful defecation if they have constipation, anal sac problems, or anal or rectal masses. Orthopedic pain definitely affects the ability of your cat to use the litterbox.
- Urinating larger volumes of urine can be caused by kidney disease, hyperthyroidism or diabetes mellitus.
- Idiopathic cystitis. This is by far the most common cause of lower urinary tract signs in cats, especially young cats. It is usually diagnosed by ruling out all the other causes of lower urinary tract signs (infection, stones and masses. Current research is looking into the causes and treatments for this condition. The most widely accepted theory at this time is that there is an abnormal interaction between stress hormones, nerves and the bladder. Cats with this disease often have signs that come and go, often appearing during or after changes in the household or other stressful events. There are urination problems, with or without other signs like vomiting, diarrhea, hair loss from licking excessively, and fearfulness/aggression. Treatment is primarily something called multimodal environmental modification (MEMO), which basically make the home cat-friendlier and reduce stress. More on MEMO below. Special diet, pain relief, and antianxiety medication may be needed as well.
- Urethral Obstruction or Blockage. This is a problem that can be caused by any other cause of bladder inflammation, and causes your cat to be unable to urinate. This requires immediate treatment, because your cat could die within 3 days without treatment.
Treatment and management:
Specific problems like urinary tract infections, pain etc. must be treated. However, when inappropriate urination continues after treatment, or when idiopathic cystitis is diagnosed, there will be more work to do to stop or reduce the inappropriate urination. It is best to do as much as possible right away to try to correct the problem, rather than trying one thing at a time. This is because usually multiple treatment/management techniques are needed for each patient, and the more time goes by the less chance we have to correct the problem. The following is a very brief summary of treatment methods:
An obvious place to start! You want your cat to have the best possible experience with the litterbox. You will need to address the number, type, and location of litterboxes, the type of and cleanliness of the litter. Cat Attract or Litter Magnet products can help.
Treat the household:
Find and effectively treat (Zero Odor or Urine Erase) every urine location. Discourage your car from urinating there by placing tinfoil, plastic sheeting, and/or a litterbox in the location, and using Feliway spray. Feliway (www.feliway.com) is a synthetic cat facial pheromone, that has been proven to decrease inappropriate urination when sprayed daily on urine locations. It is also available in a plug-in diffuser.
Identify and then eliminate or minimize stressors:
Any change to the social or physical environment or routine, can be a stressor, even if it seems insignificant to us humans. Too many cats are a common trigger (every cat in the household increases the chances of inappropriate urination by 10%).
If you cannot eliminate the stressor, try to minimize it. For example, give your cat time and space away from people or pets that are a problem.
Be proactive with changes: The best way to make any change is to either do it gradually, or offer your cat a choice and follow through with the option he/she seems to prefer. If the change that is stressing the cat is relatively recent (<1 month), try to change it back to the way it was before and then gradually reintroduce it. It is vital to provide a safe refuge and not to change anything else at the same time, if possible.
Treatments that reduce stress:
This includes Feliway, natural calming dietary supplements like Zylkene or a cat food containing the supplements like Royal Canin Calm diet, and antianxiety medication (clomipramine, amitriptylline). The supplements and medications help by changing brain chemistry (via neurotransmitters, which are body chemicals that communicate between nerve cells), to help improve mood.
Multimodal Environmental Enrichment (MEMO):
This is likely the most important and least expensive part of managing the inappropriately urinating cat. However, it requires some thought and effort on your part, and sometimes some sacrifices to execute it. Dr Buffington, a veterinarian who is an expert on idiopathic cystitis in cats, is currently studying the effects of MEMO and results so far seem promising. In a nutshell, MEMO means making your home as cat-friendly as possible. A wealth of information is available on Dr Buffington’s Indoor Pet Initiative website – indoorpet.osu.edu. (There is no specific reference to MEMO on the site, the entire site is about MEMO.)
The following is a very brief overview:
Refuge – a quiet and calm area for your cat to be alone.
Litterboxes – see above information.
Food/water resources – always provide multiple food and water stations especially if you have multiple cats. These need to be in different areas of the house, and there should be one in your cat’s refuge area.
Perches – cats naturally prefer to be up high, so they need cat trees, shelves or other places to perch.
Outdoor viewing or access – Watching outdoors can be entertaining for many cats. Some get frustrated by not being able to catch prey they see, or dislike seeing other cats – these cats need windows to be blocked off. Allowing your cat to go outdoors can provide MEMO, but your cat can get lost, injured or killed outdoors so this decision should not be made lightly. Check with your vet to ensure your cat receives the preventative care necessary to be an outdoor cat. For some cats, access to the outdoors causes more stress than it relieves.
Toys and play – exercise and fun reduce stress for us and the same goes for cats. Indoor Hunting – beyond playtime, you can allow your cat to express her hunting instincts by hiding treats or food around the house or in a treat-dispensing toy like a Slimcat ball.
You must allow at least a month to give treatments a chance to help. Keeping track of instances of inappropriate urination on a calendar is the best way to monitor response to treatment.
The prognosis varies greatly for inappropriate urination. Prognosis improves if the problem has been going on for a shorter time, the initiating factor(s) can be eliminated, if you follow through with all the instructions, and if your cat responds well to treatment. There are no guarantees of success or failure, no matter what you do. But that is why it is always worth it to try.
If nothing works:
Rehoming can be difficult but a cat may do better in a different home with no kids or other pets for example.
Euthanasia may unfortunately be necessary if there are no other options, and no response to exhaustive treatment efforts.
Another option is for your cat to join Dr Buffington’s colony of research cats at Ohio State University, to help contribute to research that will help other cats in the future.
Inappropriate urination can be infuriating and frustrating. However, by seeing your veterinarian quickly, having a thorough workup done, and using the many tools available to help there is hope for your home to return to its normal urine-free state soon.
Dr. Linda Johnson, DVM