Urine Trouble (or: When The Poop Hits The Floor)

[Examining urine and feces under the microscope is a huge (if gross) part of my job. It’s important to figure out whether Fluffy is peeing outside the box because they’re angry, or because they’ve got an infection!]

I love the smell of cat pee in the morning…said no one ever. Feline inappropriate elimination (peeing and pooping outside the box) is one of the number-one reasons we see cats at the vet. There are a few things which may cause Fluffy to mistake your linen cupboard for the great outdoors — read on for a quick overview of what might be behind your kitty’s toileting issues (and what we can do to help!)

Those of us with cats know the smell of cat urine. It’s a sharp, gag-worthy ammonia scent that gets up inside your nose and doesn’t want to leave. We’re also acquainted with the horror that is cat feces, which occasionally will make even the cat flee from the litter box in terror. And many of us know what’s even worse than the litter box: when that urine or that feces ends up somewhere else.

There are so many reasons why a cat might go outside the litter box that it would take at least a day to discuss all of them in detail. That’s why I’d like to focus on the two main reasons for what your vet probably calls ‘inappropriate elimination’ (which always sounds a bit like something the Borg would do) and what I like to call: peeing and pooping somewhere other than outside or the cat litter.

Reason number one: FLUTD/FUS and FIC

Feline lower urinary tract disease (formally known as feline urologic syndrome) and feline interstitial cystitis is my number two main reason for a cat urinating somewhere they’re not supposed to. FLUTD is a nice broad term used to refer to several different conditions affecting the cat’s bladder and urethra (the pee tube). FIC is one of these conditions but it’s important enough to talk about on its own.

One of the major conditions described under FLUTD is urolithiasis, or bladder stones. Your vet might tell you that your cat has crystalluria, or crystals in their urine. These crystals are what gather together and form stones inside your cat’s bladder. There are many different reasons for stone formation but typically it’s either diet-related or or due to an infection. There are also some diseases of other organs which encourage crystal growth in the urine. It’s very important that your vet be able to take a sample of your cat’s urine to see what kind of crystals are forming, as this will tell them how to treat it!

Bladder stones and crystals cause inappropriate urination in a number of ways. The bladder will often be taken up by a stone, making less space for the urine and making your cat need to pee more often and more urgently — sometimes so fast that they can’t make it to the box. These conditions are also painful (imagine having sharp little crystals in your urine scraping every time you pee’d), and cats will frequently pee outside the litter box when they have pain, possibly because they associate the box itself with the discomfort and hope to find a place where the discomfort is less. The urine will often be tinged pink or red and may look very cloudy. In extreme cases, it may sparkle when held up to the light or if it dries on a smooth surface. If the cat has a urinary tract infection at the same time, it may smell very strong and strange. Your cat will likely try to urinate frequently and may cry out when they are urinating.

Bladder stones and crystals are treated in a number of ways. Often, a veterinary food is prescribed to change the pH of the urine to a level where the crystals cannot continue to form. Some veterinary foods are also able to dissolve crystals and occasionally small-to-medium sized stones. Some cats will need this food for the rest of their lives if they are prone to forming crystals. It is important to encourage the cat to drink lots of water to dilute the urine and flush out the bladder. If an infection is present, the cat will be treated with antibiotics to clear the infection and then have their urine rechecked to see if  crystals are still forming.

If there are stones, surgery is recommended. If these stones are small they may get stuck in the urethra and cause a life-threatening urinary blockage. If your cat is straining to urinate and cannot get any urine out, this is an emergency and should be seen immediately. During surgery the bladder is opened, the stones are removed, and the bladder is flushed out to remove any tiny stones that may still be present. The stone should then be sent away for analysis; a veterinary lab will examine the stone, determine what kind of stone it is, and offer treatment recommendations.

FIC is an inflammation of the bladder, caused by damage to the lining of the bladder wall. When the lining is damaged the urine will damage the tissue underneath, causing pain and sometimes bloody urine. It is frequently an ideopathic condition, meaning we don’t know what caused the damage to the bladder wall. It is, however, strongly associated with stress! Stressed cats are much more likely to have an episode and cats who have had one episode will frequently have more.

Cats with FIC will try to urinate frequently many times a day, and may strain and cry out while trying. They often urinate outside the litter box in several places rather than return to the same place over and over. Their urine may be pink or red and may smell very strong. They may not want to be touched on their abdomen, lower back, or pelvis. It’s very important for the vet to examine a sample of your cat’s urine in order to rule out any infection or crystals.

FIC is usually treated with a multimodal approach. Pain control, usually opioids and anti-inflammatories (if kidney function and hydration are OK) will be given for some time. Anti-spasmodic medication may be given to help the cat urinate without their urethra spasming shut. Sometimes a medication called Cerenia (maripotent) is given; this is usually given for nausea but it also has pain controlling effects and may help the bladder lining repair itself. Sometimes injectable joint medication is given as well, again to try and help the bladder lining repair itself. The cat should be encouraged to drink lots of water to flush out their bladder. Anti-anxiety medication and pheromones such as Feliway are often used to control stress during the episode, especially if it can’t be changed e.g. a family renovating or a new baby. Which brings us to…

Reason number two: STRESS

Cats are creatures of routine. They’re easily stressed, especially with changes like moving, new additions to the household (human or animal), deaths, births, or family members being away…or just a new settee in the living room. When cats are stressed, they frequently show this stress by urinating or defecating outside their litter box.

It’s important to remember that what seems to us like a deliberate flaunting of the rules of hygiene may in fact be a cry for help. While some instances may seem to be more ‘spiteful’ than others (my parent’s cat would poop in their shoes every time they went away), any time a cat misses the box should be seen as a wake-up call to look for what’s making them unhappy in their home. After all, they rely on us for their well-being!

New additions to the household can cause marking behaviours, in which a cat sprays or urinates in many different places, frequently on walls and furniture. This is a territorial behaviour; the cat is worried they may lose their territory and is making sure you know it belongs to them! Cats who return over and over to the same spot may be stressed about their litter box and are trying to make a new one. Did you switch litter? Is it dirty? Is it in a busy spot? Too small? Covered? Open? As a general rule there should be a litter box for each cat in the household plus one. Once you’ve remedied any litter box issues, use an enzymatic cleaner on the spot the cat has been peeing and try to block it for a short time to encourage the cat back to their box.

Dealing with a stressed-out cat can be difficult. The first step is identifying the stressor. Think back to just before your cat started peeing or pooping outside the box, and try to think of any changes. If they can be changed back e.g. furniture rearranging, buying a new brand of litter, it’s not a bad idea to do so. If it can’t be changed or fixed, other options are available. Pheromones such as Feliway mimic a calming scent (the one a mother cat uses with her kittens) and can be used as a spray or a diffuser. Sometimes, your vet may recommend anti-anxiety medication if your cat is really stressed. Supplements for calming are available but have varying efficacy. Veterinary calming diets are available and may be recommended, especially if the cat is having health issues related to their anxiety.

The number-one thing to remember when dealing with a cat who is urinating and/or defecating outside the litter box is that they should be seen by a vet. Cats are fastidious animals who hate mess and dislike the sight and smell of their own ‘leavings’…if they’re leaving them for you, they’re trying to tell you something! It’s so important to rule out pain or illness before trying behavior modification; what you think is Fluffy being rude might actually be Fluffy trying to tell you that they’re hurting.

Talk to your vet about feline inappropriate elimination today!