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Urination or defecation out of the litter box is the most common feline behavior problem for which owners seek advice.
1. Medical problems need to be ruled out before behavioral issues are addressed.
These include: urinary tract disease, other disease causing increased urine production, neurological or musculoskeletal disease making access to box difficult, intestinal disease or other disease causing diarrhea, or constipation.
2. Aversions or preferences: A cat may dislike the litter (too dusty, perfumed, used), the box (too high, enclosed, previous painful experience), or the location (too far, difficult to reach, near loud appliance, accessible to the dog). Or it may prefer some feature of the area it has chosen for urination or defecation (texture, smell, location, habit).
3. Stress related behavior: This is NOT spiteful behavior; the cat has no malicious intent. However, changes in household environment (new people/pets, new schedules, new furniture, even new neighborhood dogs or cats) are often associated with behavior problems. Do not punish the cat for this behavior—punishment may actually make the problem worse.
4. Territorial Marking: This is usually limited to un-neutered male cats, often beginning between 6 and 12 months of age. Urination is almost always sprayed on a vertical surface (wall or furniture) and in a prominent location (near doorway or high-traffic pathway).
First, we collect a detailed history of the problem: when it started, urine/stool/both, time of day, location of problem, constant/intermittent, other pets, any changes in environment, changes in food or water consumption, or any other problems.
Next, a complete physical examination is done to identify diseases that may contribute to the problem, and laboratory tests are performed to confirm or rule out medical causes of the behavior. This may include blood and urine tests, X-rays, stool examination, or others as needed.
Usually, a suggestive history along with normal physical exam and urinalysis is sufficient to diagnose the problem as behavioral.
Any medical causes must be treated first, such as urinary tract infections or stones. Resolving these problems often resolves the behavior.
Territorial marking often resolves with neutering. If the problem is long-standing, neutering alone may not be curative. Feliway is a facial pheromone, or scent-marking hormone, that is effective in inhibiting urine-marking behavior. Sometimes anti-anxiety medications such as buspirone are helpful.
Aversions are best treated by using an alternate type of litter, such as scent-free clumping or pelleted paper; having two boxes per cat; keeping the boxes in accessible but quiet locations; and keeping the boxes fresh and clean.
Preferences are best addressed by changing the problem area so it is less attractive to the cat as a litter area. Some options are: making the area inaccessible (closing the door); covering the area with foil, furniture, potted plant, etc.; using an enzyme-based odor remover such as Nature’s Miracle or Febreeze; keeping laundry in a hamper or closet; placing food/water dishes, catnip toys, or a scratching post in the area; or spring-loaded booby-traps to deter the cat (this is usually a last resort). Sometimes placing a litter box at the problem site and gradually moving it to a more appropriate location will work.
Stress induced problems often require medications as well as some of the above aversion/preference measures. Buspirone and amitriptyline are often effective. Treatment usually continues for two to six months, and occasionally must be life-long. In multiple cat households, feeding cats separately and providing multiple litter boxes can reduce cat-to-cat conflict, which sometimes helps.