Visiting Vet: Feline inappropriate elimination

What to do when cats go in the strangest places.

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“Something’s not right with my Beauty,” the owner said when the 9-year-old tortoiseshell cat arrived for her annual checkup. “She’s just grumpy … and she’s been urinating outside her litter box.” I examined Beauty, admiring her classic “torti” coat, a black-brown base flecked irregularly with bits of reddish-orange and amber. Beauty lives with two other cats. Once or twice a month this past year she has exhibited episodes of feline inappropriate elimination (FIE). That means urinating or defecating in places which we humans don’t like. For Beauty, her misbehavior was limited to peeing. Places she preferred included the bathtub, the kitchen floor near a potted plant, and the bathroom floor near, but not in, the litter box. As to being grumpy, Beauty was doing things like nipping at her mother when being patted. I took a deep breath. We had a lot to talk about.

“FIE can be divided into two groups,” I explained, “behavioral or medical. But the two often overlap.” Medical causes for inappropriate urination are lumped together as feline lower urinary tract disease (FLUTD). FLUTD includes urinary tract infections (UTI), bladder stones or tumors, and a thing called feline interstitial cystitis (FIC), which is an inflammatory condition of the bladder of unknown cause, sometimes related to stress. Behavioral causes of inappropriate urination include litter box aversion, and urine marking. I could write an entire article about each of these, and many cases involve multiple causes. My challenge was to give Beauty’s mom thorough explanations and make recommendations all in a single appointment slot.

First we would want to rule out medical issues. Statistically, the overwhelming majority of young to middle-aged female cats with FLUTD have FIC. The incidence of bacterial UTI is less than 10 percent in young cats, but increases with age. UTI symptoms tend to be persistent, FIC symptoms usually more intermittent. Got all those initials? In plain English this means that since Beauty wasn’t really old, and because she only peed inappropriately now and then, the most likely medical explanation was FIC.

How could we tell for sure? The gold standard involves collecting a sterile urine sample for urinalysis, culture, and sensitivity. This is done by shaving a small spot on the belly, giving it a scrub, then, using a needle and syringe, poking quickly through the abdominal wall into the bladder and drawing out urine. Usually done with the animal awake, it’s fast and not nearly as bad as it sounds. If no bacteria grow when this sample is cultured, we rule out bacterial UTI. Urinalysis, which evaluates other properties including pH, specific gravity, presence or absence of glucose, protein, red and white blood cells, and so on, also helps with diagnosis. Finally, radiographs can identify bladder stones and tumors, though rarely ultrasound or special imaging is necessary.

I laid out the diagnostic options to Beauty’s mom, but our discussion was only halfway done. It was possible the behavior was completely, well, behavioral. Cats, being cats, can be extraordinarily picky about litter boxes. How many litter boxes were there? Specialists recommend one per cat plus one extra. There should be at least four in Beauty’s house. Where were the boxes? Cats like to feel private, but not trapped. Did she use liners or covers? Some cats hate those. What kind of litter? Many cats have “substrate preferences,” reacting to scent, texture, even size of particles. Some hate clumping litter, or prefer sand, or classic “clay.” How often were the boxes cleaned? Some cats will only use a pristine potty.

We concluded by discussing the emotional aspects of FIE. Clients often share tales of woe about cats who pee in laundry baskets, on shoes, on one specific person’s bed, in luggage, on rugs. People anthropomorphize, thinking the cats are angry, resentful, spiteful. I dunno. I know my favorite cat of all time, my Baby Buck, gave me the quintessential FIE story. Baby Buck liked to pee on warm electrical appliances. The stereo. The microwave. The stove top. I first learned of this endearing habit one morning when I popped my bagel in the toaster. The odor of burning cat urine filled the kitchen. That’s right. She had peed in the toaster. That appliance went straight into the trash. Three toasters later, we took to hiding our toaster in a cupboard, but continued to clean up puddles from other electronics.

I tried everything to stop this behavior. She didn’t seem upset. She was happy, loving, purring. The episodes seemed completely random. I ruled out medical causes. I tried multiple psychotropic drugs sometimes used to treat FIE. Nothing worked. Then Feliway came on the market. This synthetic “feline facial pheromone” mimics the scent happy cats leave when they rub their cheeks against things. Misting Feliway on our electronics gave Baby Buck the message to rub her cheek on them instead of urinating. Miraculously, it worked! Using the spray weekly, the behavior was adequately controlled, though I still kept the toaster hidden.

Beauty’s owner laughed at Baby Buck’s story, while I told her one last thing. “Tortoiseshell cats have a reputation for being temperamental. That grumpiness may just be her personality.” Many veterinarians have always believed torties are prone to being scrappy and unpredictable, but our anecdotal observations have finally been confirmed in an article titled “The Relationship Between Coat Color and Aggressive Behaviors in the Domestic Cat” in the January 2016 Journal of Applied Animal Welfare Science. Based on a survey of more than 1,200 cat owners, veterinarians from University of California, Davis, reported that calico and tortoiseshell cats tend to challenge their owners more than those with many other coat colors. This included an increased likelihood to hiss, chase, bite, swat, or scratch people. Don’t get me wrong. I love torties, but apparently their feistiness is genetic. Beauty’s mom is going to make some environmental and dietary changes, and took home a bottle of Feliway. If this temperamental tortie keeps acting, well, pissy, we will pursue medical diagnostics. At least her owner doesn’t have to hide the toaster.