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Peeing Outside the Box Means Exile or Death for Many Cats

Urinary problems lead owners to surrender or euthanize more cats than all other disorders combined. Here's what you need to know.

Dr. Marty Becker  |  Jan 18th 2016

Editor’s note: This story originally appeared in the November/December issue of Catster print magazine. Click here to subscribe to Catster magazine.

I don’t mean to scare you, but I wanted to get your attention: Urine kills. More house cats are euthanized, made outdoor-only cats, or given up by owners because of what’s termed “inappropriate elimination,” than all other diseases and conditions combined.

Inappropriate elimination means that the cat doesn’t go to the bathroom where we want him to. The preferred or mandated potty spot for cats is typically a small box a little more than 1 square foot in a house that might be as big as 2,500 square feet. This is asking for some pretty precise targeting from a cat who, in the wild, might have a territory of an acre (at least four typical home lots) with one corner of that serving as his toilet. So for a cat, taking a whiz in a little plastic box is the feline equivalent to the targeting required for one smart bomb to hit a target that in the past was taken out with saturation bombing.

It's amazing that cats use their litter box when they could pee all over the house. Cat uses litter box by Shutterstock

It’s amazing that cats use their litter box when they could pee all over the house. Cat uses litter box by Shutterstock

Urinary issues in cats have many possible causes. Medical reasons can include a simple bladder infection as well as more complex hormonal problems. Cats receiving IV or subcutaneous fluids need to urinate more frequently.

Other triggers are behavioral. “Stinking outside the box” can come from introducing another cat into the household or from switching to a litter the cat doesn’t like because of its texture beneath his paws, its fragrance, or the amount of dust it produces. Whatever the cause, it’s usually the behavior of peeing outside the box that causes people to come scurrying in with their cats to find out what the problem is.

Even the most talented veterinarians at top veterinary schools in the country can have problems diagnosing the cause of feline urinary problems. Doing a physical exam and taking a detailed history is an important start, but typically we’ll need tests to look past obvious symptoms and theories to find the exact problem. Put another way: What we do in the exam room might give us the ZIP Code of the issue, but what we find out with blood tests, radiographs, and ultrasound can give us the street address.

My colleague Dr. Gary Marshall, a feline practitioner at Island Cats Veterinary Hospital on Mercer Island, Washington, said the most common medical problems he sees in feline patients are idiopathic cystitis — meaning the cause is unknown — and bladder or kidney infections. “I believe idiopathic cystitis is misdiagnosed the most because it is a diagnosis by exclusion,” he said. “It gets easier to diagnosis with subsequent episodes.”

If your cat won't use the box, get her checked out at the vet. Kitten in litter box by Shutterstock

If your cat won’t use the box, get her checked out at the vet. Kitten in litter box by Shutterstock

Age can be a clue. Idiopathic cystitis is at the top of Marshall’s list of suspects when a young cat is having slow and painful urination: the kind where you feel like you really have to go but you can squeeze out only a few drops (we call it “stranguria” for a reason). The older the cat, the harder Marshall looks for bacterial infections.

Interestingly, he rarely sees cats with crystals in the urine or bladder stones causing blockages, a change he attributes to better diets. Blockages do still occur, though, and typically affect male cats. If you notice your male cat straining to urinate, get him to the veterinarian right away. It’s an emergency!

Once we have a diagnosis, we can begin treatment. For idiopathic cystitis, analgesics to relieve pain and reduce inflammation are the first step. They can help to relax the muscle of the urinary tract, making it easier for the cat to urinate.

Switching to wet food is also important. The water in canned food helps to dilute the urine and causes the cat to urinate more often, both of which are helpful in, er, relieving this problem. It’s best if cats prone to this condition stay on a canned-food diet for life. The problem usually resolves in three to seven days, but it’s not unusual for it to recur.

Bladder and kidney infections are treated with pain medications, to help the cat urinate more comfortably, and antibiotics to put bacteria on the run. Subcutaneous fluid therapy may be necessary if the kidneys are affected.

Your cat may also urinate inappropriately if he has kidney disease or renal degeneration. If you have a senior cat, chances are you’ll be facing kidney disease sooner or later.

It's really hard to manage kidney problems in your cat. Kitten and toilet rolls by Shutterstock

It’s really hard to manage kidney problems in your cat. Kitten and toilet rolls by Shutterstock

While it can be managed, renal degeneration is a challenging situation for owners. Treatment calls for a big commitment for the rest of the cat’s life. You may find yourself learning how to administer subcutaneous fluids at home, for instance. Cats may also need appetite stimulants and antiemetics (to prevent vomiting). Many of them can do very well for a long time, though, and a number of owners I know are grateful for the additional time they receive with their beloved cats.

Cat owners: If you want to do just one thing to help prevent urinary problems, I have four words for you: Feed more canned food. Even if you don’t want to make it your cat’s sole food, at least increase the percentage of it in your cat’s diet.

Read more by Dr. Marty Becker:

About the author: Dr. Marty Becker, “America’s Veterinarian,” has spent his life working toward better health for pets and the people who love them. The author of 24 books, Becker was the resident veterinary contributor on Good Morning America for 17 years. He is currently a member of the board of directors of the American Humane Association, as well as its chief veterinary correspondent; a founding member of Core Team Oz for The Dr. Oz Show; and a member of the Dr. Oz Medical Advisory Board. When his schedule allows, he practises at North Idaho Animal Hospital. Connect with him on Facebook, YouTube, Pinterest,Twitter, and Google Plus.

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