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Diagnosing Cat Litter Box Issues:
A Focus on Disease and the Aging Feline
by Cynthia Jones
Fall 2004
Introduction
House soiling or elimination outside of the litter box
is the most common reason cats
are turned in to shelters by their caregivers
(Salman, Hutchinson, Ruch-Gallie et al., 2000).
Older cat caregivers sometimes choose to euthanize the cat
when cleaning a soiled house becomes too taxing
and there seems to be no solution to the problem.
Appropriate diagnosis and treatment of house soiling problems
is of great importance for this reason.
Understanding what constitutes natural feline elimination behaviors
is also vital.
This paper examines recent data
from veterinary medical journals and publications
in the hopes of offering caregivers who have older cats
a better understanding of their litter box issues and treatment options.
Differentiating between behavioral and medical causes of house soiling
is discussed as well as two success cases
involving small populations of older, arthritic cats
that will hopefully offer frustrated caregivers
a good alternative to relinquishing their cat to a shelter or euthanasia.
Natural Feline Elimination Behaviors
First we must understand that behaviors we humans may find repulsive
appear to be normal communication between cats.
Cats use scent marking via urine and anal secretions
to communicate with one another (Neilson, 2000).
Spaying or neutering cats greatly reduces
and usually even eliminates these marking behaviors.
Research has revealed that ninety percent of intact males
significantly decreased marking after castration
and that female cats in estrus (in heat and therefore not spayed)
show an increase in marking (Neilson, 2003).
Regardless of the cat's spay/neuter status,
natural elimination behaviors include
investigating a potential spot,
digging a hole,
squatting to pass urine or feces,
and covering the area of elimination.
The cat's choice of where to eliminate is only a problem
if we perceive it to be.
In fact, some studies have shown a significant association
between caregivers' perceptions of treatment outcome
and the percentage reduction in frequency
of inappropriate elimination (Marder & Engel, 2002).
Elimination behaviors perceived as problematic by some caregivers
might not be perceived as problematic by others.
Despite what the children may think,
an uncovered sandbox or garden looks like an ideal giant litter box
to a cat and it's perfectly normal for a cat
to urinate or defecate in such areas.
Identifying norms is key
and it's obvious that the majority of cats have a natural inclination
to eliminate in a clean, safe area where they can observe a spot,
squat, and cover their waste.
There are many factors that can deter a cat from this "norm"
of litter box use that must be ruled out
before determining that the problem is medical or behavioral.
What to Rule Out Before Consulting A Veterinarian
Getting rid of the problem and not the cat is the goal.
Sometimes it's human behavior that needs changing.
It shouldn't come as a surprise that cats might have problems
with a dirty litter box, too few litter boxes
or litter boxes placed in a stressful location.
Any combination of these may be contributing
to the house soiling problem (Marder & Engel, 2002).
Experiment with different types of litter
(crystal versus clay for example),
litter box designs
(enclosed versus open or puppy pads versus walled box),
and try placing the litter box
in different easily accessible locations
while paying attention to which box
is used the most frequently
if you keep more than one litter box available.
It is a good idea to have more than one litter box
especially if there are multiple cats in the household.
Most importantly, keep the litter box clean
by scooping several times daily
and replacing the old litter with new at least once a week.
Whether we think like our cats or not,
some cats might consider a litter box dirty
if it has been soiled only once.
If multiple cats live in the household,
consider setting up a video camera to monitor the litter boxes
and what goes on in that general area
(visit
www.litterboxcam.com
for a preview).
This is useful to see if a particular cat
is intimidating or cornering another cat in the litter box
frightening him or her from the area.
A cat may be avoiding the litter box due to anxiety
from being attacked or cornered (Neilson, 2004).
If the house soiling problem persists,
you can probably rule out cleanliness, location,
and most stress related factors.
The Medical Versus Behavioral Debate
A necessary initial step in addressing the house soiling issue
is attempting to discern if the problem is medical or behavioral.
This can be complicated work as the two
are usually not mutually exclusive.
House soiling may initially be the result of a medical problem
and even after that problem is resolved,
the house soiling may continue for behavioral reasons
(Neilson, 2003).
For instance, the discomfort associated with a medical problem
leads to the litter box becoming aversive
and the cat's choosing an inappropriate place to eliminate.
The use of this new location becomes habitual and reinforcing
and therefore the behavior is maintained (Marder & Engel, 2002).
Identifying the Culprit
In multiple cat households,
the first step involves determining
which cat or cats are the culprits.
Veterinary expert Jacqui Neilson, DVM,
whose writings and observations appear
to dominate this area of study,
offers some advice in her article
"Thinking Outside the Box: Feline Elimination."
She suggests three methods for identifying the correct cat.
Which one to use depends on whether the problem
is urination or defecation outside of the litter box.
Confinement is the first (self-expanatory) option
that works for both urination and defecation problems
but doesn't always produce immediate results.
The flourescein dye test is an option for determining
which cat is urinating outside of the litter box.
The dye strips can be administered orally within a gel capsule.
Twenty-four hours after administration
the cat will eliminate bright yellow-green fluorescent urine
when viewed under a black light.
Neilson notes that untreated urine will also fluoresce
so the caregiver must become familiar with the difference
between normal and enhanced fluorescence.
If inappropriate defecation is the problem,
she suggests using non-toxic green crayon shavings
mixed with Cat X's food while Cat Y gets the non-toxic purple shavings.
The color that shows up on the living room rug
will identify the culprit.
Better yet, if you have access to a video recorder or camcorder,
simply set it up to record the area that is being soiled
and catch the culprit on camera.
Once the caregiver has identified the problem cat(s),
and ruled out factors such as a dirty litter box
or too few litter boxes,
the cat should be taken to a veterinarian
for a thorough history and medical evaluation.
Diagnostics
A systematic (versus random treatment application) approach
to managing cats with elimination issues
should help veterinarians achieve treatment success (Neilson, 2003).
This systematic approach begins with proper diagnosis.
There are three differential diagnoses
for urination or defecation outside of the litter box
and they are:
Disease, marking, and inappropriate elimination (Marder & Engel, 2002).
This paper discusses the disease diagnosis
as it is more prevalent in older cats.
Discomfort associated with medical problems
is often the initiating factor for an older cat
with house soiling issues.
The list of diseases that cause polyuria
and other elimination problems is endless,
but frequently mentioned in the research literature are:
arthritis, diabetes mellitus, urinary tract problems
such as stones or cystitis, hyperthyroidism,
drugs such as steroids or diuretics,
infections such as feline leukemia virus (FeLV)
or feline immunodeficiency virus (FIV),
seizures, and any pathology of the bladder,
gastrointestinal tract, endocrine system,
and musculo-skeletal system (Neilson, 2004)
(www.vetmedcenter.com, 2000).
Diseases that cause polyuria lead to urination
outside of the litter box due to the frequency
or urgency associated with elimination (Neilson, 2000).
Arthritis and degenerative joint disease
in particular can lead to house soiling issues.
Degenerative joint disease (DJD) has been found
at incidences as high as ninety percent
in cats older than twelve (Hardie, Roe, & Martin, 2002).
Due to the design of most litter boxes,
an arthritic or DJD geriatric cat
is going to have a difficult time stepping in and out
of a typical litter box.
If the litter box is located upstairs,
in a basement, or an area the cat has to jump to reach,
the cat is going to have a difficult time
traveling to or accessing the box
and may choose an alternative location to eliminate.
Veterinarian and feline house soiling expert Jacqui Neilson (2004)
recommends several diagnostic tests as part
of a comprehensive physical examination.
But first a complete history is essential
for proper diagnosis and treatment.
Make sure your veterinarian knows the frequency
and pattern of elimination, diet history, etc.
in addition to your cat's complete medical history.
As the caregiver you are largely responsible
for providing the veterinarian
with detailed and accurate descriptions
of your cat’s behaviors and history.
Your veterinarian should also be asking you questions
about how often you scoop, wash, and replace the litter
in the litter box with fresh new litter.
If the cat is urinating inappropriately,
the diagnostic work-up should include the following:
- urinalysis via cystocentesis
- urine culture and sensitivity
- CBC and chemistry panel (plus thyroid in older cats)
- Imaging (radiographs, ultrasound)
- Endoscopy to evaluate lower urinary tract when indicated
If the cat is defecating inappropriately,
the diagnostic work-up should include the following:
- CBC and chemistry panel (plus thyroid in older cats)
- rectal exam with anal gland evaluation
- fecal flotation
- additional tests on feces as indicated
- radiographs when indicated
- colonoscopy when indicated
Appropriate medical treatment of the diagnosed medical condition
may solve the house soiling problem.
However, there is a risk that even with the medical condition
resolved the cat has developed a habit or aversion to the litter box
that still needs to be addressed with behavioral treatment.
We can make changes in the cat's environment
that work with the medical diagnosis.
The following section describes one such treatment plan.
A Successful Behavioral Treatment
Even though the initiating factors
of a house soiling problem
may start out as medical,
the next step in treatment
after the medical issues have been addressed
is behavior focused.
This usually means making the litter box situation
as pleasant as possible by tailoring the litter box
to the individual needs of the cat. (Marder & Engel, 2002).
For the past four years,
the Zimmer Foundation has housed and hospiced
two groups of 'retired' elderly cats
at separate cage-free facilities
in the area of Ann Arbor, Michigan.
The majority of cats in this geriatric group
have medical problems ranging from arthritis to hyperthyroidism.
Staff at the foundation's life care centers
were asked to log each event of elimination
outside of the litter box on a computer database
detailing the type of event (urination or defecation),
location, and identification of the cat if known.
At one point it was not uncommon for house soiling events
to occur on a daily basis usually in the same
two or three different areas at each facility.
Zimmer Foundation Vice-President Kitty Zimmer
experimented with every type of cat litter on the market
and different types of litter boxes.
The boxes were scooped several times daily
and were also cleaned and replaced with fresh litter
at least once a week.
Litter boxes were placed in all corners of the house
and were easily accessible,
yet the problem of house soiling continued.
After much trial and error
and sampling everything available for cats
that the market had to offer,
she discovered a product intended for dogs.
These "puppy pads" are much like a diaper
that is placed over a flat rectangular tray.
These puppy versions of a litter box were placed
in the corners of the living areas
that were regularly being soiled.
They were an instant hit with the cats
and have stood the test of time.
For the entire year the puppy pads have been in use
the frequency of house soiling has been reduced
by almost one hundred percent at both life care facilities.
Why are the puppy pads a success
for this particular population of cats?
First of all they are flat
and rise only about an inch off the ground,
allowing arthritic or DJD cats
to easily step into and out of them
versus having to climb over the edge
of a typical high-sided litter box.
Because the puppy pads are litter free,
aversions to a particular type of litter are not an issue.
The trays are easily accessible
and the disposable "diapers" can be replaced
as frequently as needed allowing for a high level of cleanliness.
To implement such a "treatment" plan in one's own home
usually requires some compromise.
Some caregivers may not be willing to use the puppy pads
for aesthetic reasons and prefer scooping litter
rather than changing a diaper on a daily basis.
Because the puppy pads are not covered with a lid
to keep waste out of sight,
some caregivers may find them undesirable.
Once again the success of such treatments
greatly depends on the cat caregiver's willingness
to change his or her own behavior
to accommodate the needs of an aging feline.
Conclusion
When an older cat develops a house soiling problem,
the cause is often initially medical rather than behavioral.
When an elimination problem continues
after a medical problem has been remedied or ruled out,
a behavioral diagnosis should be sought (Neilson, 2004).
Cats are very sensitive to the cleanliness of their environment
and instinctively choose certain areas to eliminate.
Once the cat doing the house soiling is identified
and factors such as cleanliness, location,
and intimidation by other cats are ruled out,
a visit to the veterinarian is recommended
for a thorough history and physical evaluation.
This paper lists many of the diagnostic tests
appropriate to the type of house soiling problem.
Once a medical diagnosis has been issued and treated,
caregivers often still need to make changes
in the cat's environment to accommodate the cat.
Much as a person in a wheelchair requires a ramp
or other specified surface to easily access an area,
an older cat often needs the same consideration
concerning litter box design and placement in the home.
The Zimmer Foundation's two groups of geriatric cats
offer an example of successful implementation
of a behavioral program that accommodates the needs
of older, arthritic and otherwise medically challenged felines.
References
Hardie, E.M., Roe, S.C., and Martin, F.R.
(2002).
Radiographic Evidence of Degenerative Joint Disease in Geriatric Cats:
100 cases (1994-1997).
JAVMA.
220: 628-32
Marder, Amy and Engel, Joan.
(2002).
Long-Term Outcome After Treatment of Feline Inapporpriate Elimination.
Journal of Applied Animal Welfare Science.
5(4): 299-308.
Neilson, Jacqui.
(2003).
Feline House Soiling: Elimination and Marking Behaviors.
The Veterinary Clinics Small Animal Practice.
33:287-301.
Neilson, Jacqui.
(2000).
Friskies Behavior Companion:
A Clinical Reference Guide for Veterinarians.
Friskies PetCare Company.
Neilson, Jacqui.
(2004).
Thinking Outside the box: Feline Elimination.
Journal of Feline Medicine and Surgery.
6:5-11.
Salman, M.D, Hutchinson, J., Ruch-Gallie, R., et al.
(2000).
Behavioral Reasons for Relinquishment of Dogs and Cats to 12 Shelters.
Journal of Applied Animal Welfare Science.
3:93-106.
www.vetmedcenter.com.
(2000).
Understanding Your Pet's Medical Diagnosis.
"Inappropriate Urination in Cats."
Question and Answer.
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