Feline inappropriate elimination (FIE), also called feline soiling or ‘accident’, is one of the top reasons many cats are given away, abandoned, relinquished to animal shelters, or euthanized. It is also one of the most common reasons cats are brought to the veterinarian. This undesirable behavior encompasses defecating and/or urinating outside the litter box as well as spraying or urine-marking.
The underlying issues that fuel inappropriate elimination in cats are multifaceted—medical, behavioral, and environmental. A comprehensive approach to diagnosing and treating this common behavioral problem is essential. Veterinarians should conduct a meticulous assessment of the cat’s medical history and perform a thorough physical examination and necessary diagnostic tests and procedures. Identifying and addressing the underlying cause(s) can help veterinarians develop effective treatment protocols to correct inappropriate behavior and improve the overall well-being of affected cats.
Related: Diagnosis and Treatment of Feline Inappropriate Elimination
Common medical causes and treatment of feline inappropriate elimination
The most common medical causes of inappropriate urination in cats include:
- Urinary tract infection
- Feline Lower Urinary Tract Disease (FLUTD)
- Renal disease
- Hyperthyroidism
- Diabetes mellitus
- Urinary calculi and plugs
- Endocrinopathies
- Structural anomalies
- Cognitive dysfunction
Digestive tract problems, such as inflammatory bowel disease (IBD), bacterial overgrowth, constipation, neoplasia of the gastrointestinal tract, or parasitic infections, are common issues for undesirable defecation. This can increase the frequency or urgency to eliminate, which eventually decreases the cat’s control over defecation. Obese felines or those suffering from orthopedic or neurologic pain may experience discomfort when posturing to eliminate or when entering the litter box.
Diagnosing the causes of feline inappropriate elimination
The recommended minimum database for diagnostics should include the following:
- Complete physical exam
- Urinalysis
- Fecal flotation and smear
- Complete blood count
- Biochemical profile that includes t4
Additional diagnostics may be necessary based on the results of the initial tests and may include:
- Urine culture
- Full thyroid panel
- Ultrasound and/or radiographs of the abdomen, spine, and/or extremity
Depending on the results of the procedures that have been performed, consider including the following in the treatment plan:
- Antibiotics may be prescribed if urinalysis reveals the presence of bacterial organism/s
- Pain medications to alleviate a cat’s pain and discomfort
- Anti-inflammatory medications
- Urinary acidifiers
- If there is an obstruction, fluid therapy may be necessary to flush out bacteria and maintain hydration
- Uroliths: A prescription diet to dissolve the urolith. Persistent or recurring uroliths may require surgical removal
- Urethral obstruction: requires emergency veterinary care to dislodge the obstruction by flushing the urethra with a sterile solution through a catheter. Intravenous fluid therapy to correct hydration and electrolyte imbalances. Pain medication and a prescription diet may be given. For recurrent urethral obstruction, particularly in male cats, perineal urethrostomy may be required.
Behavioral causes and treatment
Before a behavioral diagnosis can be made, rule out and address the underlying medical disease. After addressing medical issues, make a behavior diagnosis list based on detailed historical information from the cat owner.
Veterinarians should always keep in mind that even when a medical cause has been treated, the behavior may persist. This may be attributed to a conditioned negative emotional response associated with the litter box. It could also be a conditioned positive emotional response to the newly chosen substrate or location. In this case, behavioral intervention should be made.
The most common behavioral causes of feline inappropriate elimination include marking, anxiety or frustration, and litter box problems (such as aversion to and location preference).
Behavioral treatment plan
The first step is to establish whether the cat’s behavior is associated with marking or inappropriate elimination. Base your assessment on the historical information provided by the cat owner. This should include the cat’s immediate environment, social relationships, and elimination behavior. The social relevance of the sites where inappropriate elimination is committed should also be considered.
Knowing the history of the who, what, where, why, and how the cat is inappropriately eliminating will help guide the veterinarian to the root cause and successful treatment plan. Having clients complete a behavior history questionnaire is an efficient means of collecting essential information.
Next, identify if there are inadequacies in the management of the litter box. There may be an aversion to the location, size, or design of the litter box, type of litter, etc. Take note that environmental anxiety and social conflict can significantly contribute to both marking and inappropriate elimination
Neutering for spray-markers
Neutering is recommended for cats that engage in urine-marking. The addition of a vertical litter box may be necessary for cats that urine-mark while standing inside the litter box. If a cat persistently returns to a specific spot to mark, a marking station can be placed using absorbable pads that are attached (taped or pinned) to the wall. A vertical litter box may also serve the purpose.
Spray-marking may also be reduced when a cat has limited visual access to triggers in the immediate environment, such as outdoor cats.
Litter box management and hygiene
Proper litter box hygiene can significantly improve inappropriate elimination in cats. Daily scooping and fully emptying the litter box contents every week help keep the litter box clean and odor-free. Use a cleaning product that doesn’t leave a strong odor after rinsing. Litter boxes should be replaced yearly, as dirt and odor can seep into the plastic material over time. Also, many cats tend to have aversion to litter box plastic liners.
Management of soiled areas
Cats tend to return to areas where they have previously marked or eliminated to do their business. A thorough cleaning and the use of enzymatic cleaning products can reduce and prevent urine odors from persisting.
In some cases, the cat’s access to these areas must be restricted. However, if this is not possible, the cat should be confined to a room when the owner is unable to directly supervise. When confined, the cat should have easy access to fresh food and water, clean litter boxes, scratching posts, toys, etc.
Environmental modification and stressor reduction
Considering that anxiety and social discomfort are common underlying factors in feline urine marking, particularly in neutered cats, undertaking measures to reduce stressors and conflict between cats is key. These include providing a living space that makes the cat feel safe and comfortable, having a consistent daily routine, regular interactions with the cat owner, etc.
Avoid punishment
Punishment should be avoided because it can only exacerbate the problem, considering that many feline inappropriate elimination problems are rooted in anxiety or social conflict.
Pheromones
Pheromones can reduce urine marking as well as relax cats. The use of these products may be beneficial in cases in which the underlying cause is stress or anxiety.
Drug therapy
These include anti-anxiety diets, supplements, and anti-anxiety medications. The goal of giving these products is to support and help regulate the body’s response to and improve its ability to cope with a stressful environment.
The veterinarian and cat owner must work together to diagnose and create a behavioral treatment plan to address the issue. Owner compliance is a major factor in the treatment of the problem. The key to creating a successful treatment plan for feline inappropriate elimination involves understanding a cat’s natural elimination behaviors, conducting a detailed and thorough history, and systematically ruling out and treating any underlying medical conditions.
References
- Herron, M. E. (2010). Advances in Understanding and Treatment of Feline Inappropriate Elimination. Topics in Companion Animal Medicine, 25(4), 195-202. https://doi.org/10.1053/j.tcam.2010.09.005
- Introduction to Animal Behavior and Veterinary Behavioral Medicine. (2024). United Kingdom: Wiley.
