FELINE HOUSE-SOILING: SOLVE, NOT SURRENDER Jacqueline C. Neilson, DVM, DACVB Portland, Oregon Introduction: While cats are the most popular pet in the United States, their most common behavioral problem, house-soiling with urine (periura) and/or feces (perichezia) is very unpopular with their owners. In fact, house-soiling may lead to outdoor banishment, relinquishment or euthanasia. Studies support this regrettable outcome, with behavioral problems, primarily house-soiling, being a leading cause of relinquishment of cats to shelters. 1 In one study, over 23% of the cats relinquished to a shelter had daily or weekly incidents of house-soiling. 2 A recent study by Marder found that the most common problem identified post adoption of a cat from a shelter was house-soiling with 9% of the cats in her study exhibiting this behavior within three months post adoption. 3 Understanding the true underlying motivations for house-soiling and making a definitive diagnosis is critical to treatment success since it allows us to design a targeted treatment plan. Terminology: Unfortunately, universally accepted diagnostic terminology does not exist to describe feline house-soiling. For the purposes of this paper and presentation, the inappropriate deposition of urine (periuria) or feces (perichezia) with the intent of evacuation of the bladder/bowels will be called inappropirate toileting and periuria/perichezia deposited with the intent of communication will be called marking. The term house-soiling will encompass both inappropriate toileting and marking behaviors. Diagnosis: There are three main diagnostic categories for periuria: primary medical disease, toileting or marking. Toileting and marking are both behavioral diagnosis and are considered as diagnosis of exclusion therefore primary medical causes must be ruled out before arriving at a behavioral diagnosis. The most common medical diagnosis for cats between the ages of 1-7 years that demonstrate periuria are feline idiopathic cystitis and uroliths. 21 Diagnostic testing should be aimed at the most likely conditions, thus a physical examination, urinalysis and imaging studies are recommended. Less than two percent of these adult cats with periuria suffer from bacterial bladder infections. 21 Once medical problems have either been ruled out or treated, the behavioral aspects of the housesoiling should be addressed. These generally fall into one of two categories: inappropriate toileting due to aversions/ preferences or marking as a communication tool. Behavioral Diagnosis: Urine marking is a form of communication. About 10% of prepubertally castrated male cats and 5% of prepubertally spayed female cats show problem urine marking. 4 Marking may be associated with spatial organization and/or arousal. Territorial marking behavior may be stimulated by multiple cats sharing a common living area, breeding season or the arrival of new cats into a territory. Situations that evoke anxiety or stress in a cat such as the addition of a new family member or a dramatic change in work schedules, may also lead to urine marking. Regardless of the underlying motivator, urine marking is a considered a normal behavior that is usually unacceptable in our homes. Toileting problems are often triggered by medical causes, aversions, preferences or anxiety. Litterbox aversion is a common cause of inappropriate toileting. Litterbox cleanliness, location, style and litter type/brand can all impact acceptance/rejection of the litterbox. A negative experience accessing or in the litterbox (e.g. ambushed by a person/another animal when in the box) can create a litterbox aversion. Preferences may involve substrate preferences and location preferences. When a cat
develops a substrate preference it is selecting a substrate (e.g. carpet) that is more pleasing to the cat than the substrate that the owner is providing in the litterbox. The author has found that the following four questions are helpful for discerning toileting from marking: 1. Location of periura? Vertical = Marking; Horizontal= Marking or Toileting 2. Concurrent perichezia? Yes= Toileting; No= Marking or Toileting 3. Substrate pattern to periuria? Yes= Toileting; No=Marking 4. Litterbox Set-Up? Good= Marking; Poor= Toileting Marking involves urine sprayed on vertical surfaces or puddles of urine deposited on horizontal surfaces with special social significance. One tends not to see a particular pattern of substrate use, in fact the periuria is often found in areas with different substrates underfoot. Inappropriate defecation is rarely involved. The cat continues to use the litterbox for both urination and defecation and there is no evidence of litterbox avoidance. In contrast, the cat with inappropriate toileting usually deposits urine and/or feces on horizontal surfaces. A substrate-use pattern is often identified: for example, the cat always targets a certain type of carpet. The cat shows decreased or absent usage of the litterbox. Historical collection may reveal a pattern of inappropriate litterbox cleaning, box type, litter type or box placement. The estimated volume of the urine deposit(s) is not particularly helpful at discerning marking from toileting. And while intercat tension or aggression may certainly be a causative factor of periuria and will need to be addressed in the treatment plan if it exists, it is not particularly helpful in the diagnostic portion as intercat tension/aggression can result in marking or toileting problems. Treatment of Inappropriate Toileting: The treatment for inappropriate toileting should focus on providing a very attractive litterbox while reducing the attractiveness or accessibility of inappropriate target spots. The most attractive litterbox set up for the majority of cats includes the ABC s of the best box: A= Accessible B= Big C = Cafeteria, Clumping Clay, Clean To find the ultimate litterbox for an individual cat, a cafeteria of different options is the best strategy; the cat is given a variety of options and then preference is determined by usage. Most cats like boxes that follow the ABC s listed above which are discussed in greater detail below. Accessible: Placement of the litterbox (location) has been hypothesized to contribute to litterbox rejection;if the box is located in an area that is too noisy, too far away, too trapped, etc. the cat may seek an alternative toileting site. It is generally recommended to avoid dead ends (where there is only one exit point for the cat) in litterbox placement. This may be especially critical in multiple cat households with intercat tension/aggression. Since covered litterboxes only provide one exit option, this may be an issue with their use. Big: It has been hypothesized that one cause of feline toileting problems is a litterbox aversion secondary to small box size. Some experts recommend that litterboxes should be 1.5 times the body length of the cat, however, to the author s knowledge, there is a lack of evidence to support this specific claim. A study where cats were provided a regular sized box (56x38x14cm) versus an over-sized box
(86x39x14 cm) demonstrated a statistically significant increased use of the larger box. 23 One value of larger boxes is that there will be more clean real estate within the box between scooping events. Excrement build up may be a barrier to use. Clay Clumping/Cafeteria: Studies have established that, when given a variety of litter options, cats preferentially use finely particulate sand-like ( clumping or scoopable ) litter for elimination. 17,18 A reasonable strategy for figuring out an individual cat s litterbox preference is to set up a cafeteria of different options, allowing the cat to select which set up s/he prefers. Clean: Although regular box scooping is regularly advocated by behaviorists a study by Sung that examined 20 cats with inappropriate toileting vs. 20 cats without inappropriate toileting did not find box cleaning frequency to be a risk factor for inappropriate toileting. 19 Eleven cats without house-soiling had their boxes only scooped 1-3 times per week while 10 cats with inappropriate toileting had the same cleaning schedule. This data could reflect individual differences between cats with the more fastidious cats developing the inappropriate toileting. Another possible explanation is that the critical level of soiling that makes a cat reject its litterbox is scooping less than once weekly; this particular study had no households with that infrequent a scooping schedule. Treatment for Urine Marking: Marking animals should be neutered. Ninety percent of intact males show a significant decrease in marking behavior after castration. 5 Once neutered, marking treatment should follow the D,E,F,Gs: D= Drugs E = Environmental Enrichment F = Feliway G = Get Rid of Triggers Drug therapy has been long used to help control urine marking, however, to date, no drugs have been licensed by the FDA to treat urine marking in cats. The two drugs that have the most information published regarding their efficacy in the treatment of urine marking are clomipramine and fluoxetine. 11,12,13 The relative treatment success for both of these drugs is statistically significant. A meta-analysis showed that when fluoxetine was administered (1 mg/kg PO SID), the cessation rate (at least a 90% reduction in spraying) was 13 times higher than in control cats; that same meta-analysis demonstrated that clomipramine s (0.25-0.5 mg/kg PO SID) cessation rate was 4 times higher than control cats. 22 Response to treatment can be rapid, within days of initiating treatment, but continued treatment shows a steady incremental increase in efficacy. Studies have evaluated cases on drug therapy (fluoxetine) up to 32 weeks and found that urine marking is controlled over these prolonged treatment durations. 14 Side effects are usually mild and self limiting but may include lethargy, gastrointestinal upset and paradoxical anxiety. Severe or persistent side effects may warrant dose reduction or termination of treatment. Other drugs such as amitriptyline, buspirone and paroxetine have been used clinically to treat urine marking however the published evidence of their efficacy is either lacking or weak. Environmental Enrichment: An environment of plenty should be created in multiple cat households. This involves creating multiple feeding areas, multiple elimination areas and multiple single cat sleeping perches at different vertical heights throughout the home. Adequate environmental management of soiled areas and litterboxes may help to reduce marking. A study examined the effects
of environmental management on the frequency of vertical urine marking. 6 The owner cleaned urine marked spots with an enzymatic cleanser, provided one litterbox per cat plus one additional, scooped the box daily and changed the box weekly. These four steps significantly reduced the number of urine marks. Feliway: Other forms of marking such as bunting (facial marking) and scratch marking should be encouraged. To encourage scratch marking, scratching posts and/or pads should be placed around the home, with the highest concentration in areas where the marking is occurring. Feliway is a synthetic analog of the feline facial pheromone. Three proposed principal functions of the facial pheromone are: 1)spatial organization 2)relationships with other cats and 3)emotional stabilization. It is proposed that by increasing emotional stabilization Feliway results in the resolution or decrease of urine marking. Several studies support Feliway s efficacy in the treatment of urine marking 7,8,9,10 although a meta-analysis did not demonstrate significance over controls. 22 Get Rid of Triggers: To treat urine marking the clinician should be trying to reduce or remove conflict and stress in the environment, whenever possible. Conclusion In conclusion it is critical that the veterinarian establish a definitive diagnosis for cats with periuria and consider that it will either be medical, toileting or marking. By establishing a definitive diagnosis they can provide a targeted treatment plan which will increase treatment success and ultimately preserve the human-animal bond. References: 1. Salman MD, Hutchison J, Ruch-Gallie R et al. Behavioral Reasons for Relinquishment of Dogs and Cats to 12 Shelters. J of Appl Anim Wel Sci 3(2), 93-106, 2000 2. Patronek GJ et al. Risk factors for relinquishment of cats to an animal shelter. JAVMA 209, 582-588, 1996. 3. Marder AR, Engel JM, Hekman JP. Feline Behaviour Problems Reported by Owners after Adoption from an Animal Shelter. In Proceedings of the 6 th International Veterinary Behaviour Meeting and European College of Veterinary Behavioural Medicine- Companion Animals European Society of Veterinary Clinical Ethology. Riccione, Italy, pp. 138-139, 2007. 4. Hart BL, Cooper LC: Factors relating to urine spraying and fighting in pre-pubertally gonadectomized cats. JAVMA 184: pp. 1255-1258, 1984. 5. Hart BL, Barrett RE: Effects of castration on fighting, roaming and urine spraying in adult male cats. JAVMA 163: pp.290-292, 1973. 6. Pryor PA, Hart BL, Bain, MJ, Cliff KD. Causes of urine marking in cats and effects of environmental management on frequency of marking. JAVMA ; 219 (12): pp. 1709-1713, 2001 7. Frank DF, Erb HN, Houpt KA. Urine spraying in cats: presence of concurrent disease and effects of a pheromone treatment. Applied Animal Behaviour Science 61: 263-272, 1999 8. Mills DS and Mills CB. Evaluation of a novel method of delivering a synthetic analogue of feline facial pheromone to control urine spraying by cats. The Veterinary Record, vol. 149, 197-199 2001 9. Hunthausen, W. Evaluating a feline facial pheromone analogue to control urine spraying. Veterinary Medicine, 151-156, 2000.
10. Pageat, P. Functions and use of the facial phermones in the treatment of urine marking in the cat, interest of a structural analogue. In: Hohnson D, Waner T (Eds) Proceedings and Abstracts of the 21 st Congressof the World Small Animal Veterinary Association. Jerusalem, Israel 197-198, 1996 11. Dehasse J. Feline Urine Spraying. Applied Animal Behavior Science 52: 365-371 1997 12. Landsberg GM, Wilson AL Effects of Clomipramine on Cats presented for Urine Marking JAAHA 41: 3-11 2005 13. Pryor PA, Hart, BL, Cliff KD et al. Effects of a selective serotonin reuptake inhibitor on urine spraying behavior in cats. JAVMA; 219: 1557-1561, 2001 14. Hart BL, Cliff KD, Tynes VV, Bergman L Control of urine marking by use of long-term treatment with fluoxetine or clomipramine in cats. JAVMA 226: 378-382 2005 15. Salman MD, Hutchison J, Ruch-Gallie R et al. Behavioral Reasons for Relinquishment of Dogs and Cats to 12 Shelters. J of Appl Anim Wel Sci 3(2), 93-106, 2000 16. Patronek GJ et al. Risk factors for relinquishment of cats to an animal shelter. JAVMA 209, 582-588, 1996. 17. Borchelt PL: Cat elimination behavior problems. Veterinary Clinics of North America Small Animal Practice 21(2): 257-264, 1991. 18. Neilson JC. Pearl vs. Clumping: Litter preference in a population of shelter cats. In Abstracts from the American Veterinary Society of Animal Behavior. Boston, p. 14, 2001 19. Sung W., Crowell-Davis SL. (2006) Elimination behaviors patterns of domestic cats with and without elimination behavior problems. American Journal of Veterinary Research 67 (9), 1500-1504. 20. Neilson JC. The Latest Scoop on Litter. Veterinary Medicine March 2009 pp. 140-144. 21. Buffington CAT, Chew DJ, Kendall MS, et. al. Clinical evaluation of cats with nonobstructive urinary tract diseases. JAVMA 210 (1) 1997 46-50. 22. Mills DS, Redgate SE, Landsberg GM. A meta-analysis of studies of treatments for feline urine spraying. PLoS One 2011, 6(4): e18448 23. Guy NC, Hopson M, Vanderstichel. Litterbox size preference in domestic cats (Felius catus). J of Vet Behav 2014, 9: 78-82.