Inappropriate micturition consists of the emission of substantial amounts of urine in large puddles on horizontal, usually adsorbent and “modifiable” substrates in various parts of the house (rather than in the litter box). The sequence of elimination is as follows: the cat explores the substrate by smelling it, digs a hollow with its forelimbs, turns on itself, progressively “crouching”, empties its bladder (with its tail parallel to the ground) and then covers the elimination products after having sniffed them. According to some authors inappropriate micturition behaviour can be identified when the animal empties its bladder (with a maintained elimination sequence: digging and covering) in a quadruped position (G. Landsberg). According to Crowell-Davis andSung a cat without elimination disorders will use a litter box about five times a day, while according to D. Hortwitz, Y. Soulard andA. J. Castagna a young cat will use a box about three times a day.
The history taking should collect information on the following:
- the frequency and way the animal micturates (for example, the number of episodes per week, whether the behaviour occurs only when the owner is absent for a few days);
- the place involved (for example, whether the urine is deposited only near a window);
- the surface(s) chosen (for example, whether the cat urinates only on carpets – the information should be used to establish the correct therapeutic approach, placing a material similar to that preferred in a box and then gradually covering it with litter granules);
- the posture assumed by the cat (for example, crouched or standing on all four feet);
- the amount of urine discharged;
- the sequence of the behaviour (for example, whether the cat sniffs, digs before urinating and tries to cover the urine) ;
- the time dedicated to the elimination sequence (for example, whether the cat digs for about 4 seconds, and moves quickly away without covering the elimination products);
- the characteristics of the litter used (for example, the type of litter used, any changes in the type of litter used, the model and position of the box(es);
- cleaning of the litter and box;
- punishment and the cat’s response to the punishment;
- the environmental history (for example, possibility of going outside, a view of other cats from a window or a balcony, a house move, acquisition of new furniture);
- the social history (for example, the occurrence of aggressive behaviour – even only intimidation – between cats living together and/or directed towards the family, the arrival of a new cat in the neighbourhood or the birth of a baby in the family);
- the dietary history (for example, the type of food used in order to plan any changes in diet);
- drinking behaviour (it is useful to measure the amount of water drunk by the cat over 24 hours);
- marking behaviour (the deposition of type F3 and F4 facial pheromones, marking by scratching, urinary marking);
- medical history (results of any past laboratory investigations and clinical examinations).
All animals that urinate in inappropriate places should undergo a complete physical examination. Thediagnostic work-up should include:
- physicochemical examination of the urine (sampled by cystocentesis);
- urine culture;
- full blood count and biochemistry tests (+ thyroid function tests in elderly cats);
- diagnostic imaging (X-rays, ultrasound).
INAPPROPRIATE MICTURITION
Numerous behavioural and/or organic disorders can give rise to micturition in inappropriate places. Most individuals choose an adsorbent and “modifiable” substrate in order to be able to perform the sequence of events that characterize the behaviour. Following punishment by the owner (catching the animal in the act and/or subsequently) the substrate preference may not be obvious and the sequence can become exploited.
Inappropriate micturition may be present right from the animal’s earliest age as a result of poor training because of too few boxes in relation to the number of animals or incorrect removal of the evacuated material. The cat eliminates everywhere, without a substrate preference.
An inadequate nutritional supply (particularly of proteins) around the fourth and fifth weeks of life (due to lack of available food) or disorders involving the digestive system of the kitten (for example, chronic diarrhoea due to a heavy parasite load) can cause changes in elimination behaviour: the kitten does not search for a specific substrate, does not dig and does not cover its elimination products.
Inappropriate elimination behaviour can also be established in kittens following precocious separation from the mother since the choice of place and the sequence of elimination are learnt from the third week of life by imitating maternal behaviour (Fig. 1).
Inappropriate elimination behaviour can also occur suddenly in an adult cat that previously used a litter box correctly. In most cases this is caused by incorrect management of the box: the most common problems are a box that is too small, a box located near the animal’s feeding area or in a throughway (for example, in a corridor), too few boxes for the number of cats in the house, the products of elimination not being removed daily, the litter being too powdery, and the pieces being too small, too big or scented. The presence of an air-freshener in the room containing the litter box can be involved in the development of inappropriate elimination behaviour. Children (particularly those between 9 months and 3 years old) or a family dog can also be the cause: they frequently disturb the cat during elimination in the box and a young cat can be forced to choose other places. Early diagnosis enables recovery of the learning process thanks to behavioural therapy, consisting of correct management of the resources, and pharmacological therapy when a pathological condition is present (intermittent-type anxiety state). The boxes, which should be sufficiently large, should be located in a peaceful room of the house and there should be one more box than the number of cats (Fig. 2). The litter should be unscented, medium-sized sepiolite and elimination products must be removed several times a day.
Inappropriate micturition can be a manifestation of numerous behavioural disorders such as hypersensitivity-hyperactivity syndrome, sensory privation syndrome, cohabitation anxiety and pathological ageing. In order to start the correct treatment, a diagnosis must be made through a behavioural assessment.
- Self-control disorder (hypersensitivity-hyperactivity syndrome): the cat does not use a litter box because it is not able to structure the environment in which it lives correctly, dividing it into different territorial fields. The young cat affected by this problem does not have a substrate preference, but eliminates wherever it finds itself. Some animals dig and cover their elimination products, while others show an incomplete elimination sequence. The cats bite and scratch at every physical contact with the owner because of the lack of control of biting and claw retraction.
- Simple and complex phobias (sensory privation syndrome): the cat is not able to use litter boxes because it remains hidden for long periods of the day and night (Fig. 3). The kitten suffering from this disorder is raised in an environment lacking stimuli and shows defective socialisation with humans and/or other cats, together with multiple phobias, particularly of sounds. Social phobia leads the kitten to avoid contact with any human and can result in fear- or irritation-elicited aggression. Tolerance to cohabitation with members of other species, including humans, is strictly dependent on the behavioural development of the kitten. Primary socialisation between cats develops from about the second to seventh weeks of life and the simple act of giving food is not sufficient to establish correct socialisation with humans: it is sufficient to prevent the animal from running away, but not to create a social relationship. It is worth remembering that, in a litter of several kittens with equivalent experience during the relevant periods, the individual character of each kitten plays a very important role. On occasion of physical contact with the owner the kitten can display irritation-elicited avoidance aggression. In this disorder self-control is correct, but sensory homeostasis is not achieved.
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Cohabitation anxiety: the cat cannot use the litter box because one of the other resident cats prevents its access to the box or uses “ritualised” predatory aggression (an ambush) against the animal as it emerges from the box (Fig. 4). The reason for a behavioural consultation is the onset of territory-related or irritation-elicited aggression in clowders of two or more cats. The animals assessed may be the resident cat and a newly arrived cat or two or more resident cats who are suddenly no longer capable of living together.
- Pathological ageing: the elimination behaviour is characterized by urination and defecation anywhere in the house because of loss of correct learning secondary to the cognitive deficit. A simplified sequence of urinary markingmay appear: the cat does not search for a specific place, micturates a large amount of urine while standing on all four feet (without “petrissage”) and moves away rapidly.
Organic disorders of the urinary system (for example, feline lower urinary tract disorders [FLUTD], emotional or interstitial cystitis), gastrointestinal tract, endocrine system and musculoskeletal system (particularly in elderly animals) can cause the onset of inappropriate micturition. In the case of disorders of the urinary system, the urine is discharged in small amounts both in the litter box and on horizontal surfaces (adsorbent and not): the animal digs for a long time, crouches repeatedly and then moves away. This behaviour is often accompanied by vocalisation because of the pain suffered by the animal during micturition. Furthermore, the cat can associate pain with the litter box and continue to urinate in different places in the house even after having been healed. Some indivduals affected by disorders of the upper urinary tract can empty their bladder while standing on all four feet (sometimes the correct elimination sequence is maintained, sometimes not). In neither case is this urinary marking, but rather inappropriate micturition. In research carried out by D. Frank, 20% of cats showing urinary marking had disorders of the urogenital system.
In a study performed by D. Horwitz in 1997, almost 40% of cats referred for behavioural problems related to urination had a clinical history of cystitis and most of the cats who underwent a behavioural assessment because of recurrent inappropriate micturition had idiopathic cystitis (Buffington et al., 1997, 1999). The organic disorders underlying polyuria and polydipsia can give rise to inappropriate micturition when the litter tray is not managed correctly. The cat produces very large amounts of urine that soak most of the litter. When there is only one litter box, the cat may urinate inappropriately in other parts of the house. When there is an organic disorder, the behavioural signs appear suddenly (within a few days) and the cat shows “incoherent and illogical” behaviours with respect to those of the ethogram of the species. Furthermore, the history does not reveal an evolution of the behavioural problem. Only a functional diagnosis (presence of a pathological state) can be made after the behavioural assessment. It is worth remembering that the endocrine system and the central nervous system are intimately related at a functional level. A prolonged change in one of these systems inevitably leads to dysfunction of the other: for example, an intermittent or permanent state of anxiety present and untreated for many years can cause alterations in thyroid function.
Endocrine disorders, liver and/or kidney failure, infections diseases (such as toxoplasmosis, viral leukaemia, feline immunodeficiency, infectious peritonitis), chronic pain syndromes, tumours affecting the central nervous system (particularly those of the diencephalon and multiple meningiomas) and prolonged administration of some drugs (such as corticosteroids, progestins and sedative or anti-productive neuroleptics) can give rise to a state of chronic depression complicated by involution. As the cat becomes older such organic disorders are often superimposed by pathological ageing, further complicating the clinical picture. In this case both a full blood count and a functional assessment of the thyroid or adrenal gland should be performed before administering drug treatment, because psychotropic drugs can modify hormone secretion.
The veterinarian may also be responsible for the development of inappropriate micturition if he or she does not provide correct information to the animal’s owner regarding the use of litter boxes and educational methods (punishment when the animal is caught in the act / punishment later – the owner must rub the cat’s nose in the products of elimination).
The veterinarian may also be responsible for the onset of inappropriate micturition if he or she fails to promote correct management of the litter box for an animal with an organic disease (for example, a cat with polyuria and polydipsia not being provided with additional trays or a cat with a musculoskeletal disorder not being given a box that is easy to enter). Hospitalising a cat without providing a litter box or resting place within the inpatient cage can promote the onset of inappropriate micturition (Fig. 5). In the former case, the cat could lose its preference for the litter substrate, while in the latter case it will eliminate in the box and rest on top of its own elimination products. The changes induced in elimination behaviour can persist even after the cat returns home. Furthermore, reintroducing a cat into its previous group after a period in hospital without carrying out a behavioural assessment could lead the resident cats to be aggressive towards the animal that was absent.
TREATMENT
The treatment of inappropriate micturition consists in management of the elimination facilities (tray and litter), pheromone therapy, drug therapy (to treat the patient’s behavioural disorder and the pathological state) and behavioural modification.
Suggested readings
- N. Ogata, Y. Takeuchi, Studio clinico sull’utilizzo di un analogo del feromone felino nel controllo della marcatura urinaria del territorio da parte dei gatti Da: J. Vet. Med. Sci., 63 (2), 157 – 161, 2001
- D. S. Mills, J. C. White Follow up a lungo termine degli effetti di una terapia a base di feromone sul comportamento della marcatura urinaria nel gatto Da: Veternary Record, 147, 746 – 747, 2000
- D. S. Mills, C. B. Mills Valutazione di un nuovo metodo di rilascio di un analogo sintetico di un feromone felino per il controllo della marcatura urinaria del gatto Da: Veterinary Record, 149, 197 – 199, 2001
- C. A. Griffith, E. S. Steigerwald, C. A. Tony Buffington Effetti di un feromone facciale sintetico sul comportamento dei gatti Da: J. A. V. M. A., 217, 8, 1154 – 1156, 2000
- D. A. Gunn-MooreA pilot study using synthetic feline facial pheromone for the management of feline idiopathic cystitisDa: Journal of Feline Medicine and Surgery (2004) 6, 133–138
- D. A. Gunn-Moore,Cistite Idiopatica Felina (FIC), pubblicato da Hill’s, 2009
- D.F. Frank ), H.N Erb, K.A. HouptUrine spraying in cats: presence of concurrent disease and effects of a pheromone treatmentDa: Applied Animal Behaviour Science 61 1999 263–272
- Jacqueline C. NeilsonThinking outside the box: feline elimination Da: Journal of Feline Medicine and Surgery (2004) 6, 5–11
- Jacqueline C. Neilson, DVMFeline House Soiling: Elimination and Marking BehaviorsDa: Clinical thecniques in samll animal practice
- Gary M. Landsberg, Andrea L. Wilson, Effects of Clomipramine on Cats Presented for Urine MarkingDa: J Am Anim Hosp Assoc 2005;41:3-11.
- D. Hortwitz, Y. Foulard, A. J. Castagna, Nutrition E n c y c l o p e d i a o f Feline Clinical, This book is reproduced in the IVIS website with the permission of Royal Canin, The feeling behavior of the cat
- L. J. Wright, C. Noonan, S. Ahumada, M. Á. Bullones Rodríguez, D. Buchwald, N.Afari, Psychological distress in twins with urological symptoms, General Hospital Psychiatry 32 (2010) 262–267
- J. Curtis Nickel, Dean A. Tripp, M. Pontari, R. Moldwin, R. Mayer, L. K. Carr, R. Doggweiler, C. C. Yang,, N. Mishra and J. Nordling, Psychosocial Phenotyping in Women With Interstitial Cystitis/Painful Bladder Syndrome: A Case Control Study THE JOURNAL OF UROLOGY® Printed in U.S.A. Vol. 183, 167-172, January 2010
- Guida completa ai problemi comportamentali nel cane e nel gatto, Veterinary Medicine Resource Guide, Volume 1, Comprendere i normali comportamenti del gatto e prevenire l’insorgenza dei problemi comportamentali, K. Overall, pp 28 - 37