Thursday, June 19, 2014

Think Like a Cat: The Cat Who Urinates Out of the Box

One of the most common problems that veterinarians are asked to treat is a change in litter box behavior: the cat who is urinating out of the box.

The complaint might be in the form of wet yellow surprises on articles of clothing (laundry basket contents are a favorite) or slippers, or even on stovetops, bathtubs or expensive Persian rugs. Many owners notice the cat backing up to vertical surfaces like walls and flicking the tail which is pointed straight up as urine squirts out. You might recognize this as marking behavior. And yet another presentation might be in the form of the distressed cat who is obviously trying to tell the owners something by urinating frequently in front of them, typically in a room frequented by humans, and likely producing miniscule amounts of blood-tinged urine, if any.

This myriad of presentations requires some detective work to determine what is amiss and what needs to be done to correct this.

It’s always helpful to first try to get in the cat’s head. Cats are very sensitive to changes in their environment, whether we’re talking changes in litter box substrate, location or architecture (covered v. open); or changes in the household activity like owners coming or going, new pet acquisitions, stress in the humans from any cause, feral cats marking outside the window or a big evergreen tree that has moved into the living room in December. They can also be very sensitive to “uncomfortable” living situations, like a bully cat in the household, confinement in a room while squirrels and birds tease them at the window or noisy households that might even involve a loud washing machine situated next to the litter box.

In any of the above scenarios, the cat’s favorite target organ for stress can be the bladder.

Even with the best of feline diets, stress can appear in the bladder in any of the above forms, for any of the above reasons (and more). Sometimes the solution is to remove the stressor or relax the cat. If the stressor cannot realistically be eliminated, we recommend Feliway made from synthetic feline facial pheromones, a.k.a. “kitty aromatherapy Prozac” (our special nickname), or Pet Remedy, an aromatherapy with valerian that we import from the U.K.  Both of these are found in spray and aerosol plug-in forms. Many cats respond to individualized homeopathic prescribing which removes the cat’s susceptibility to these stressors. At WAH, we rarely resort to pharmaceutical therapies for psychological use in cats.

Many kitties suffering from bladder distress have secondary physical problems. The most life-threatening of all is the complete urethral blockage in male cats. These cats can’t urinate and will be very sick within 24 hours, dead within 48 hours. Obviously, if you think your cat is not passing any urine, you should bring him to a veterinarian immediately. It’s worth mentioning that a small subset of these cats won’t show any signs of urinary distress—they just stop eating, maybe start vomiting, and act like a generically sick cat. This is a good reason to take your sick cat to the veterinarian immediately, regardless of what your Internet search might lead you to suspect.

 Other non-imminently-life-threatening physical problems include spasms in the urethra (the tube leading from the bladder to the outside world), bladder stones (about 25% of these cats) or infections (less than 5% of these cats). A urinalysis is usually the first (and easiest) diagnostic test to run. Radiographs (a.k.a. “X-rays”) are helpful, either at the initial visit or at a follow-up visit if the problem is not resolving. Ultrasound of the urinary tract can be helpful in intractable cases, especially if a tumor is suspected in older cats.

Specific therapies that might be needed include medication to relax that spasming urethra, antibiotics for those rare bacterial infections, fluid therapy to help flush out crystals and protein-mucus clumps, and pain medication in some cases. While prescription diets might help some of these cats, at WAH we focus on converting to more species-appropriate diets, like high protein canned foods or raw diets if the cat will oblige. A diet with high water content is essential.

Remember: Cats with out-of-the-box urinating behaviors are trying to tell you something. They likely have emotional issues that need to be addressed and physical consequences that require attention.  Yes, the mind-body connection is alive and well in our feline companions and being expressed in the urinary tract!

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