Why Does My Cat Pee Everywhere But In the Litter Box?

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Cat lovers are special folk indeed. They care for an animal that can be aggressive, pouty, arrogant, and just downright silly at times. One of the upsides about having a cat of course is they can go to the bathroom in their litter box, negating the need to take them outside constantly. Now that’s all well and good provided someone has told the cat.

(PetMD) Having been involved on the production side of the Animal Planet’s hit show My Cat From Hell (MCFH) for three seasons, I am now familiar with and have some expectation for the circumstances I find myself in when providing a house call for the reputed cats from Hell. Of course every circumstance is unique, as the only seeming similarities are the cats’ tendencies to be fractious (e.g., aggressive, mean, etc.) or otherwise behaviorally challenging.

If you’ve been following my petMD Daily Vet column, you’ve previously become familiar with some of my MCFH patients like Molly (see A Veterinarian’s Perspective on Treating a Cat from Hell and Animal Planet’s video, Molly’s Follow Up). The first cat I worked on this season was a 100% indoor calico (and thereby female) named Sweet Pea who was driving her owner and his roommate crazy with her habits of inappropriate urination. ED: means cat pees outside litter box.

My role was to lend some holistic veterinary medical perspective, so I examined Sweet Pea and collected blood and urine samples for diagnostic testing.

Before the conclusion of a primary behavior issue can be achieved, medical problems must first be ruled out. With any cat (or dog) having urinary problems, it’s important to start with blood and urine testing to thoroughly evaluate kidney function. Additional diagnostics like radiographs (X-rays), ultrasound, or others may also be needed. Many inappropriately urinating cals have underlying health concerns, such as:

Feline Lower Urinary Tract Disease (FLUTD) — a syndrome of issues including urinary tract infection, crystals/stones, or interstitial cystitis (inflammation of the bladder resulting from a non-medical issue, such as household stress), which all ultimately produce similar clinical signs, including straining to urinate, increased frequency of urination, bloody urine, vocalizing while urinating, etc.

Osteoarthritis (DJD or degenerative joint disease) — joint inflammation leads to pain that causes discomfort while squatting to urinate, which can then motivate the cat to seek out a more comfortable location to eliminate waste (both urine and bowel movements).

Intervertebral Disc Disease (IVDD) — like DJD, decreased shock absorbing capacity in the discs that support the vertebral column (backbones) puts more stress on the spinal cord, nerves, and even the joints that hold vertebrae in place (facets), which leads to the experience of pain while urinating (or defecating).

Anal Sacculitis — when one or both of the paired anal sacs that exist just inside the right and left margins of the anus aren’t emptying properly (impaction) or are inflamed/infected, then discomfort while defecating or urinating occurs.

Renal (kidney) Failure — as the kidneys lose their capacity for filtering the blood and excreting toxins from the body, the concentrated urine results in an associated increase in urine output (also paired with increased water consumption). An increased need to urinate means a cat will visit the litter box or other preferred elimination site more frequently and will also produce larger volumes of urine.

Hyperthyroidism — one of the most common endocrine (glandular) problems affecting senior cats is hyperthyroidism, where benign nodules of thyroid tissue produce larger quantities of thyroxine (thyroid hormone). Increased levels of thyroxine in the blood causes a variety of physiologic and behavior changes, including increased water consumption and urination.

Diabetes Mellitus (DM) — like with renal failure and hyperthyroidism, diabetes mellitus leads to increased water consumption and urination. This occurs as a result of deficient insulin production to appropriately reduce blood sugar levels or resistance to insulin. Instead of appropriately moving out of the blood and into tissue via insulin, glucose is excreted through the kidneys and pulls more water out of the body. More urine produced creates the need for more water to be consumed to meet hydration levels.

Other — some cancers, toxic exposures and other conditions can make cats have the urge to urinate more frequently, larger volumes, or outside of the previous/established location for elimination.

Fortunately, Sweet Pea’s physical exam showed no spinal or joint pain and her anal sacs were normally expressing. Blood tests showed no evidence of kidney or liver disease, hyperthyroidism, or other detectable ailments. Additionally, her urinalysis indicated normally concentrated urine, lacking hallmarks of kidney disease such as the presence of bacteria, crystals, sugar, protein, ketones, kidney cells, or other abnormalities. More importantly, her urine culture was negative. Urine culture is the gold standard test to rule in or out bacterial a urinary tract infection because bacteria may be missed on microscopic examination when present in low numbers or if urine is very dilute.

Once we ruled out underlying health problems, Sweet Pea’s owner was able to attain an improved relationship between human and feline household members through the combination of environmental enrichment and medication.

Sweet Pea has another feline friend named Critten sharing the 100% indoor space. Critten was preventing her from having access to the litter box and causing a general increased level of stress in the household. Their less-than-friendly interactions were videotaped by the owner and are seen on the show. If I were a cat, enduring an attack from another household cat or other animal would scare me away from urinating or defecating in the litter box and force me to pick a new spot… one likely deemed inappropriate by my human caretakers.

By increasing Sweet Pea’s available options to urinate via multiple litter boxes in locations where she wasn’t constantly being stalked by Critten, she electively started urinating in the boxes and not in various places around the apartment. Additionally, locations where she could hide in confined spaces (under the couch, etc.) and potentially urinate were obstructed.

Although this bit of information was not reflected in the episode, Jackson Galaxy and I elected to start Sweet Pea on a behavior modifying medication called Buspirone(BuSpar). She was started on a bodyweight-appropriate dose for 30 days and then her dose was increased when we perceived that she needed additional relief from her household anxiety.

Do you have a “cat from Hell?” f so, what steps have you taken to evaluate the problem with your veterinarian and has the issue improved or resolved?

Dr. Patrick Mahaney writing for PetMD.

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