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Wednesday, March 30, 2011

Cats That Pee On The Floor

I love cats. I have three at my house! Having said that, for some animal-lovers, the point of choosing a cat instead of a dog is to avoid dealing with the whole housebreaking thing. Cats use litter boxes, therefore no one needs to be home to let them outside to "do their business." Ah, but as with so many things in life, the cat doesn't always stick to the plan. At our hospital we see several cats a week for what we term "litter box avoidance."

We can generally classify the causes of litter box avoidance as either due to bladder pain (physiologic), or due to environmental factors (behavioral). Most of us who have ever had a UTI can relate to the bladder pain issue. These cats feel pain which they associate with urination, which they associate with the litter box. So they avoid the litter box. They also may feel like they have to "go" all the time, and they just can't make it to the box. We can usually tell which cats fall in this category based on the history (frequent, small-volume urination; vocalizing when urinating), and urinalysis results which show evidence of inflammation in the urine (usually increased red or white blood cells).

Once we determine that a cat has a bladder problem, we can bet that it's one of four things: an infection (UTI), a stone, a tumor, or "interstitial cystitis" (IC). You all know what the first three are, but probably haven't heard of interstitial cystitis. "IC" goes by many other names (Feline Urologic Syndrome, Feline Lower Urinary Tract Disease, Idiopathic Cystitis) which usually means, as in this case, that not much is known about it. The disease causes pain and inflammation in the bladder (including the presence of blood, crystals, or other substances), and in male cats can lead to urethral obstruction and the life-threatening inability to urinate.

Current thinking is that IC is a stress-associated condition which only occurs in certain predisposed cats. But we really don't know. There is no good treatment, but the symptoms often run their course, sometimes to reoccur later. The best therapy in my hands is feeding canned food exclusively (preferably Science Diet C/D --I really think it helps!) and the anti-anxiety drug amitriptylline. Encouraging a cat's natural predatory instincts (hunting, stalking prey) also seems to help. This can be accomplished by letting the cat chase a string, toy mouse, etc...

Diagnosing IC is also challenging. Here are my guidelines for diagnosing/treating cats with bladder inflammation. First of all, I know that UTI's and IC are far more common than stones and tumors; furthermore, UTI's are more common in old cats (and diabetic cats), while IC is more common in young cats. So if the cat is old or diabetic, I will try antibiotics first and see if things get better. If the cat is young, I will treat for IC first. If treatment is not successful (in either case), I will take an X-Ray to look for a stone. If there is no stone, I might do a urine culture to verify the presence or absence of bacteria (UTI). If all tests and treatments are unsuccessful, and the cat still has blood (or other stuff!) in the urine, I will recommend an ultrasound to look for a tumor. Again, with IC, all tests will be normal.

One thing that bothers me is when vets automatically put all cats with blood in the urine on antibiotics. If the cat is young, it probably does not have a UTI. When the cat is rechecked a few weeks after the antibiotic, it may be better. This is not due to the antibiotic, but because of the waxing-waning nature of IC. Even though antibiotics are generally safe, their indiscriminate use can lead to the development of resistant strains of bacteria. And that is becoming a big problem in our country.

As I mentioned at the beginning, some cats who have "litter box avoidance" have normal results on their urinalysis. I generally classify these cases as behavioral. They may be avoiding the box because they don't like the box (it's not clean enough, they don't like the cat litter, they don't like sharing it with other cats, it is not in a "private" enough location, etc...), or something else has upset them and they are showing their displeasure by urinating in inappropriate places. This might be due to a new pet or person in the house, a strange cat in the yard (cats love to look out the window), or some other change in their routine. It could also be due to the cat not feeling well. Sometimes the first sign of serious illness in a cat is litter box avoidance. For this reason, these cats should always be checked out by a vet.

Believe it or not, litter box avoidance is a fairly common cause of euthanasia in cats. I hope this blog helps shed some light on the issue.


  1. Thanks for posting this Dr. Hall. My 10 year old cat Stormy, you may remember him as I got him as a 3 week old kitten while working at Horseshoe Lake, has had several urinary problems. He's even been blocked before a couple years ago. He's been peeing on the floor in one of two places. I just took him to the vet this past Friday to see what the problem might be. Unfortunatley he's a TERROR at the vet and won't really cooperate when needing to be checked out. When I say terror, I mean he becomes Satan and bites and screams and just goes absolutely crazy. So she checked him as best she could and prescribed an antibiotic and we're just kinda waiting to see whether it helps or not. But I'm not really noticing a difference. He's on a special U/R diet since he had the blockage, which seems to be helping because I notice him drinking a lot more than I ever did before. However, from what you described with the IC, sounds a lot like it could be the problem with Stormy. He's always been very spastic, I guess you could say. He doesn't like people, other than people he's used to being around. When I say that, I mean he hisses at our guests so we always have to put him away when we have company. He doesn't really like other pets either, he just tolerates the dogs we have. I wonder if its because he has some kind of anxiety in relation to the urinary problems he's had.

  2. Could be. Is the U/R canned? Feeding canned food is the #1 best therapy for IC. Amitriptylline may also help. :-)

  3. Its not canned because Stormy doesn't really liked canned food. :-( He's such a pain. LOL.