Feline Housesoiling Problems 
Part I:  Inappropriate Urination and Defecation

Article (c) and reproduced by kind permission of Dr. Barbara Sherman Simpson, MS, PhD, DVM
Animal Behavior Service of the Veterinary Teaching Hospital, North Carolina State University College of Veterinary Medicine,
www.animalbehaviorservice.com

Feline housesoiling problems are the most common behaviour complaints made by cat owners to primary veterinarians. In addition, elimination problems involve 33% to 59% of  referred feline behaviour problems.^1-4 If not resolved, housesoiling problems can lead to rehoming, relegation outside the home, abandonment, or euthanasia of the offending cat (Figure 1).⁵ These behaviour problems impact feline-human relationships, including the owner-pet bond, and can lead to the loss of the cat as a veterinary patient. The welfare of the pet as well as economic incentives should prompt veterinarians to develop expertise
in the diagnosis and treatment of such behaviour problems.

Feline housesoiling problems can be divided into those relating to elimination outside the litterbox (discussed in Part I), including inappropriate urination and defecation, and those related to marking behaviour, which can involve either urine or faeces. In all cases, it is imperative that medical differential diagnoses be eliminated before proceeding to behaviour therapy.⁴

Even when a medical diagnosis is made, behaviour therapy may be needed concomitant with medical treatment because behaviour problems can arise as a result of negative conditioning. For example, a cat experiencing urethritis may associate pain with the litterbox and seek alternate sites for urination. A behaviour .modification program may be required to re-establish satisfactory litterbox use.

HOUSESOILING

Urine housesoiling problems include inappropriate urination and urine marking. Although both involve urine, the functions of each of these activities differ. Inappropriate urination, discussed here, involves elimination of urine outside the litterbox at locations. unacceptable to the owner. Urine marking involves the use of urine in the act of olfactory communication, which may occur independent of the act of urination. Fecal housesoiling problems include inappropriate defecation, which may accompany inappropriate urination, and faecal marking, called middening.

Inappropriate Urination

Inappropriate urination occurs on horizontal surfaces outside of the litterbox and may be exhibited by individuals of any age, breed, or j sex. In cases of simple inappropriate urination, cats squat to urinate outside the litterbox. Often the location is in the vicinity of the litterbox or other locations in the house. Remote, private sites, such as behind a couch, may be favoured. There may be a specific substrate preference,^6-7 such as topsoil surrounding houseplants, shag carpet, or small area rugs. A spontaneous preference for a novel or nonabsorbent substrate, such as a porcelain sink, may be associated with a lower
urinary tract problem. Cats that urinate on the owner's bed or on clothing of specific individuals are exhibiting marking behaviour.^2,8 .

When medical causes have been eliminated, the behaviour history should include
information on environmental factors that may be contributing to the problem.
One common behavioural cause of inappropriate urination is dissatisfaction with
some quality of litterbox, including insufficient cleaning.

Another important environmental factor is the relationship with other cats in the household: For example, another resident cat may provide olfactory cues litterbox that deter the problem cat from the site or playfully pounce on the problem cat as it exits a covered litterbox, forcing it to seek "private" elimination site where. Evaluating features of the litterbox and social environment requires a systematic process of "asking the cat" what it prefers. This approach involves providing boxes with different litter types in different
location counting the number of eliminations per box per day.

In general, inappropriate urination can be effective treated by environmental control. Cats with a h of intermittent hematuria and waxing and waning may benefit from presumptive treatment for inter cystitis. Such cats may benefit from the use of the cyclic antidepressant amitripryline , which has been used for the treatment of inter cystitis in women; it has also been shown to be effective for management of feline interstitial cystitis.⁹

Inappropriate Defecation

There are numerous behavioural diagnoses for inappropriate defecation, including
dissatisfaction with such qualities of the litterbox as location, type, or cleanliness. In these cases, inappropriate defecation may accompany inappropriate urination.⁸ Observation of the cat may be suggestive. Although there are individual differences, the normal behaviour
sequence for defecation involves choosing a site with loose substrate (such as a litterbox), digging a shallow depression, defecating at the site, and then covering the faeces with raking movements. The latter behaviour is stimulated by the odour of faeces and may be attempted when defecation occurs on the floor. ¹⁰

Cats that deviate from the normal behaviour sequence and straddle the litterbox,
tiptoe into it, shake their paws after touching the litter, or exit the box immediately without covering the faeces are indicating an aversion to the litter.⁶ Some cats will not defecate in litterboxes that are cleaned infrequently. Other fastidious cats prefer to urinate in one litterbox and defecate in an adjacent clean box.

Social interference is a common cause of inappropriate defecation. Another cat may interfere with the completion of the problem cat's preferred defecation routine. A child or coprophagic dog in the household may follow the cat to the litterbox and disturb litterbox use. Surreptitious observation of the cat near the litterbox may provide important information about features that influence the cat's decision not to use it.

DIFFERENTIAL DIAGNOSIS

Elimination behaviour problems may be secondary to medical disorders. Thus a medical evaluation is indicated for all cases of feline housesoiling.

Urine Elimination Problems

All cats with elimination disorders should be physically examined with particular attention to palpation of the kidneys and urinary bladder. A neurologic examination should be performed. The general history should explore changes in eating, drinking, or activity patterns that may suggest a medical cause affecting litterbox use. For example, a cat with polyuria due to diabetes may find the litterbox unacceptably wet and may seek alternate locations for elimination. The owner's presenting complaint may be that the cat is eliminating outside the litterbox.

Appropriate screening tests should be performed. For urine-related problems, a urinalysis (including specific gravity and sediment analysis) is the minimum data base. The collection method should be by cystocentesis except in cases in which cystitis is suspected. In such cases, a voided sample should be obtained (if possible) to avoid further trauma to the bladder.¹¹ Cystocentesis can result in inadvertent hematuria, which can be differentiated from cystitis by the absence of other signs of inflammation in the urine.¹² Serial samples should be collected from any cat in which the behaviour symptoms wax and wane.

A complete blood count with differential and serum biochemistry should be performed as a screen on any cat with suspicious findings on physical examination and prior to the use of extra label medications.⁴ These values will be within normal limits if the inappropriate urination is strictly a behaviour problem. If the behaviour problem is secondary to a medical problem, there may be detectable abnormalities such as uremia, glycosemia, or hypercalcemia. Further diagnostics, such as plain or contrast radiography or ultrasonography, may be needed.

Inappropriate urination may be associated with a number of medical conditions, particularly those associated with hematuria, polyuria/polydipsia, dysuria, or pollakiuria. Older cats may suffer from arthritis or senility, which can limit their ability to 'locate and climb into a litterbox.⁸ Neurologic abnormalities may be implicated. Cats with refractory inappropriate urination should be tested for the presence of hyperthyroidism, feline leukemia, and feline immunodeficiency virus. The most common medical abnormalities associated with feline inappropriate urination are listed in Table I below.

In a retrospective study comparing cats that exhibited inappropriate urination with controls, problem cats were significantly more likely to have had a history of lower urinary tract disorders (LUTDs).¹³ A survey at a large teaching hospital found that 37% of cases referred to the behaviour service for inappropriate urination had a history of feline LUTD.4 Feline LUTDs such as metabolic disorders (uroliths), congenital abnormalities, neurogenic disorders, and inflammatory and neoplastic processes should be investigated as potential underlying causes of inappropriate urination.¹⁴

Nonobstructive idiopathic interstitial cystitis is an LUTD characterized by inflammatory changes in the urinary bladder that may be accompanied by behaviour changes in litterbox use.15 Because the disease waxes and wanes, it may be in remission-and the urinalysis may be within normal limits-by the time the owner seeks treatment for the secondary elimination problem. Interstitial cystitis should be considered in any cat with a history of hematuria and intermittent inappropriate urination.

Urine. marking is not usually associated with a medical condition; however, behaviourists have anecdotally noted an increase in spraying concomitant with inappropriate urination in some cases of LUTD,16 possibly due to agitation associated with pain. Therefore medical evaluation should be standard for any cat in which urine marking is associated with inappropriate (i.e., squat) urination or with medical abnormalities (e.g., hematuria).

Fecal Elimination Problems

In cases of fecal housesoiling, a fecal examination should be performed to rule out constipation, diarrhea, and internal parasites. Discomfort associated with constipation in the litterbox may cause the cat to continue to seek alternate sites not associated with pain. Enteritis or colitis may cause changes in elimination habits. Urgency associated with loose stool may make the litterbox too far away. Additional tests may be suggested by the history, physical examination, or fecal tests, particularly if concurrent illness is suspected.

THE BEHAVIOUR HISTORY

At first inquiry, the client should be asked to keep a daily record of the number of eliminations in each litterbox and the number of eliminations outside the litterbox with the location noted (see Behaviour Diary below).

This information is used to quantify the frequency and location of the problem at the start of treatment. The process encourages owners to clean each litterbox daily and to monitor for new housesoiling incidents. After treatment is initiated, owners should continue to keep detailed records of all eliminations and their locations to evaluate the success of treatment.

As part of the behaviour history, the client should be asked to make a map of the interior of the home, with sites of elimination and litterboxes marked so that patterns can be visually identified (Figure 2). An electric probe to detect wetness in the carpet pad, available from professional carpet cleaners, may be needed to identify some urination sites.¹⁷

Solving an elimination behaviour problem often requires a search for information in the history that suggests the underlying cause. This investigation is facilitated by questions designed to provide "clues" that can lead to a specific diagnosis and treatment (Table II).

Table II Historical Questions Regarding Feline Housesoiling
Question	Rationale
Which animal is eliminating?	In single-cat households, there is no ambiguity. It may be difficult in multiple-cat households to determine with certainty which cat is responsible for inappropriate elimination. Often, one cat has been identified by the owner but more than one cat may be housesoiling. The offending cat(s) may be identified by serially isolating each cat and noting any change in the housesoiling pattern either visually or by the use of fluorescein dye (see text).
What is being eliminated?	Determine whether urine, feces, or both are being eliminated inappropriately. " Dissatisfaction with the litterbox is strongly implicated when both are being deposited outside the litterbox.
If the elimination product is urine, is it deposited on vertical or horizontal surfaces?	Vertical surfaces indicate urine spraying. Horizontal surfaces usually indicate inappropriate urination.
Where in the home doeshousesoiling occur?	The use of a map with sites indicated by the owner is helpful and may indicate a location preference or influential social factors between cats (see Figure 2). An acute shift from one substrate, such as litter, to an unusual substrate, such as a porcelain sink, suggests a lower urinary tract disorder.
How often does elimination occur?	Baseline frequency is necessary to determine the extent of the problem and to monitor improvement.
When does the problem occur?	Daily or weekly temporal patterns of inappropriate urination may suggest a specific environmental trigger.
How long has the problem been going on?	Acute onset in a cat that has previously reliably used the litterbox suggests a medical problem or a social cause. Duration of the problem affects prognosis. Chronic (months to years) problems have a guarded prognosis for complete resolution.
Were there any environmental changes associated with the onsetof the problem?	Changes in elimination habits can occur with environmental change, such as a move to a new house.
What measures have been taken to correct the problem?	Learning what techniques have already been attempted can help guide the treatment plan.
Describe the litterbox(location, size, box type, litter type, how often cleaned).	Dissatisfaction with the litterbox is a common cause of inappropriate elimination, particularly when both urine and faeces are involved (see Table IV).

Several methods may be used to positively identity which cat (or cats) is exhibiting inappropriate elimination in a multiple-cat household. Observing that inappropriate elimination occurs shortly after one cat's access to the litterbox is deterred by another cat is suggestive. Serial isolation restricts the spatial utilization -of each cat sequentially and monitors housesoiling. Each cat is isolated one at a time in a small room, and the "culprit" is identified by process of elimination. However, such a protocol may sufficiently alter the
social milieu such that inappropriate elimination may not occur.

Fluorescein dye (0.3 ml subcutaneously, 0.5 ml orally, or six fluorescein strips in gel capsules orally) may be administered to one cat; any urine that is found outside the litterbox during the next 24 hours can be checked for fluorescence using a Wood's light.¹⁸ If such urine does not fluoresce, Fluorescein should be administered to each cat until the one responsible is found. A positive test does not eliminate the possibility that more than one cat engages in urine marking at other times. If fluorescein is administered but no urine is found outside the box (a common finding when the frequency of the problem is low), the test must be considered a diagnostic failure and should be repeated. Prior to
administration of fluorescein, the owner should evaluate a "fluorescent-negative" urine mark with the Wood's light so that he or she can distinguish it from one that is "fluorescent positive."

Figure 2 -Sample of a house plan submitted by the owner at the time of the initial
visit. Litterboxes are marked with circled numbers. Feeding (F), play (P), and
urination (U) sites are also noted. In this case, the problem was an older cat
whose inappropriate urination began when a young, playful cat was added to the
household. The older cat retreated to the master bedroom (presumably to avoid the young cat) and began to urinate outside the litterbox there. Access was to a covered litterbox in the master bathroom that was cleaned daily. When a second, uncovered litterbox was added in the master bathroom, the cat began to use that, and the elimination problem resolved. The covered litterbox was eventually removed.

TREATMENT

Appropriate treatment is initially determined by the presence, if any, of a medical cause associated with the behaviour problem. Once any medical problems have been appropriately addressed and a behaviour problem has been identified, treatment may consist of one or more of the following: surgery, environmental changes, behaviour modification, and pharmacotherapy. A medical evaluation is always warranted prior to the use of medication. Treatment failure in a multiple-cat household should prompt reassessment. More than one cat may be housesoiling. Refractory cases or those in which the affected cat exhibits signs of anxiety or arousal may benefit from antianxiety medication.

Inappropriate Urination

The goal of treatment of inappropriate urination is to enhance the appeal and accessibility of the litterbox and to decrease the availability and appeal of alternate sites.⁸ Details of the behaviour history may suggest a treatment plan based on location or substrate preference. Cats that approach the litterbox and eliminate in its vicinity are attracted to the loose substrate but are dissatisfied with some other component of its quality or location." Methods of improving litterbox use are presented in Table III below.

Table III Recommendations for the Treatment of Inappropriate Urination and Defecation in Cats 5-21
Treatment Modality	Specific Suggestions
Environmental control
Litterbox	Scoop out the litterbox daily. Clean it thoroughly once a week. Do not use scented cleaners or deodorants in or near the litterbox.Provide at least one litterbox per cat and distribute them in more than one location. Be sure litterbox is not located in a high-traffic or high-noise area. Move food bowls away from the litterbox. If the litterbox is a covered type, provide an additional large, uncovered litterbox without a fitted rim to determine the cat's preference. Offer unscented, fine-grained, clumping-type litter in the alternate box.19 Do not use a liner in the alternate box because the odour of the plastic may be objectionable to some cats.8
Inappropriate elimination sites	Place an alternate litterbox over sites of "accidents." Once the box is being used regularly, it can be moved several inches per day to a site more acceptable to the owner. Use deterrents at the site of inappropriate elimination. These can be an unacceptable substrate such as aluminium foil or plastic sheeting or odour deterrents such as citrus spray. Pine cones may be placed at the base of houseplants to physically deter elimination there.
General management	For longstanding problems and to reduce the owner's distress regarding damage to carpets and floors, it may be necessary to confine the offending cat in a small room (e.g., a bedroom) remote from sites of housesoiling. A litterbox, food, and other necessities should be provided. When regular litterbox use has been achieved or when the cat is well supervised, it can be let out of the room for increasing periods. Other management techniques should also be practiced. Clean all inappropriate sites with an enzymatic cleaner. Use a citrus deodorant spray or double-sided tape to discourage the cat from visiting problem areas.Use an electronic sound alarm or electronic mat to deter a cat from an area where eliminations occur.
Behaviour modification
Positive reinforcement	Behaviour modification techniques include rewarding the cat with a favored treat for appropriate use of the litterbox.22
Punishment	To be humane and effective, punishment must be of appropriate intensity and must follow within I second of the offensive behaviour. Because the latter is rarely possible, punishment is rarely effective. Corporal punishment or rubbing the cat's nose in the elimination product is not appropriate or effective. Punishment associated with sounds or movements by the owner (as reaching for a spray bottle) will condition the cat to avoid the owner. Counter conditioning may be used by feeding or playing with the cat at inappropriate elimination sites.
Pharmacotherapy	Drugs are not usually indicated for inappropriate urination. Instead, an environmental and behaviour management plan should be implemented. Drugs should be considered for refractory or complicated cases of inappropriate urination (see Part lI).
Owner compliance	Owners should maintain a record of the number of urinations and defecations inside and outside (with location) each litterbox each day so that progress can be documented.

The owner should monitor the house carefully for sites of inappropriate elimination so that the frequency can be noted and the site can be cleaned properly. Owners assume that the cat returns to the same site because of urine odour cues. Although this has not been scientifically demonstrated, prompt identification and cleaning of the site reduce the likelihood of unpleasant urine odours in the home. After the site is identified, urine should be blotted repeatedly with a dry paper towel to reduce the volume at the site. The area
should then be infiltrated with a commercially available enzymatic agent designed for this purpose.^17,20 Odour-masking agents may satisfy the owner and deter the cat from the area.

Inappropriate Defecation

Treatment of inappropriate defecation includes environmental alterations and behaviour modification. Usually, pharmacotherapy is not required unless the problem relates to generalized anxiety or there is a functional component of marking. The environment can be altered by adding a second litterbox for defecation. Qualities of the litterbox may be improved by cleaning it more frequently, increasing the depth of litter, or switching to an unscented litter (Table IV ^5,21). It may be necessary to prevent the cat from having access to those areas where it defecated outside the litterbox in order to reestablish appropriate litterbox use.

Table IV Litterbox Characteristics Affecting Inappropriate Urination in Cats
Litterbox Characteristics	Comments
Frequency of cleaning	Many cats will reject a soiled box and eliminate elsewhere. Owners who travel frequently, leaving the cat and the litterbox untended for days at a time, may increase the cat's dissatisfaction with the litterbox because of excessive soiling; separation anxiety may also play a role.
Number of boxes	A minimum of one litterbox per cat should be available to ensure cleanliness and reduce interference among cats.
Location	Remote sites (e.g., a basement) may be inaccessible to an older or infirm cat. Bathrooms and laundry rooms may be associated with excessive noise or odours that may be offensive or frightening.High traffic areas may be rejected as unsuitable locations.
Box type	A covered litterbox may restrict odours to an offensive level or may be too small for large cats to move around in comfortably. The covered litterbox may allow other cats, pet dogs, or young children to target the cat as it exits.
Litter type	Preference tests indicate that most cats prefer unscented, fine-grained (clumping) type litter over other substrates.19 Scented litter is more frequently associated with housesoiling problems than is unscented litter.13
Deodourizers	Cats may be averse to odours that humans consider attractive. The owner should avoid the use of deodourizers in or near the litterbox.
Number of cats	In multiple-cat households, there is a greater likelihood of heavy litterbox use, possibly resulting in an excessively soiled litterbox. Another cat may interfere with the problem cat as it approaches the litterbox, either through odour cues or physically (e.g., aggressive acts or play solicitation in the vicinity of the box).

For clients with good observation skills and patience, positive reinforcement of appropriate litterbox use may be effective. Initially, the cat must be fed twice a day on a regular schedule to determine the daily time of defecation. At the determined time, the client should take the cat to the litterbox and wait until it defecates. The cat should then be rewarded with a special food treat, such as fresh salmon. This protocol should be repeated until the association between the litterbox and defecation is confirmed.²²

CONCLUSIONS

Feline housesoiling is a common behaviour complaint that causes frustration on the part of the owner and can lead to euthanasia of the offending cat. Successful treatment requires identification of the cat responsible (in multiple-cat households) and of the cause of the problem. Housesoiling can be divided into elimination problems, and marking behaviour. Elimination problems may have medical or .behaviour causes. A physical examination and appropriate laboratory tests are indicated to rule out medical causes or suggest appropriate medical treatment.

A careful behaviour history may reveal the factors) ,contributing to the problem. Common elements include dissatisfaction with some quality of the litterbox, including cleanliness, litter type, or location. Social interference between cats or from other household members may contribute to litterboxaversion. Behaviour treatment is often suggested by the behaviour history. Resistant cases or those involving social factors may benefit from psychotropic drugs.

REFERENCES:

1.
Beaver BV: Effectiveness of products in eliminating
cat urine odors from carpet. JA VhIA
194(11):15$9-1591, 1989.

2. Blackshaw JK: Feline
elimination problems. Anthroavs 5:52-56, 1992.

3. Olm DD, Houpt KA: Feline
housesoiling problems. Appl Anim Behav Sci 20:335-345, 1988.

4. Overall KL: Clinical
Behavioral Medicine for Small Animals. New York, Mosby, 1997, pp 160-194.

5. Cooper LL: Feline
inappropriate urination. Vet Clin North Am SmallAnim Pract27:569-600, 1997.

6. Borchelt PL,
Voith VL: Elimination behavior problems in cats, in Voith VL, Borchelt PL (eds):
Readings in Companion Ahimal Behavior.

Trenton, Veterinary
Learning Systems, 1996, pp 179-190.

7. Overall KL:
Diagnosing-feline elimination disorders. Vet Med 93:350-362, 1998

8.Hart BL: Behavioral and
pharmacologic approaches to problem urination in cats. Vet Clin North Am Small
Anim Pract 26:651-658, 1996.

9. Chew DJ,
Buffington CAT, Kendall MS, et al: Management of nonobstructive lower urinary
tract diseases in cats. Suppl Compend Contin Educ Pract Vet 19:53-61, 1997.

10. Beaver BV: .Feline
Behavior: A Guide for Veterinarians. Philadelphia, WB Saunders Co, 1991.

11. Osborne CA: Can
cystocentesis methods contribute to diagnosis errors of uroliths? DVM News
29:11 S, 1997.

12. Kruger JM, Osborne CA,
Ulrich LK: Cystocentesis. Vet Clin North Am SmallAnim Pract26:353-361, 1996.

13. Horwitz
DF: Behavioral and environmental factors associated with elimination behavior
problems in cats: A retrospective study. ApplAnim Behav Sci 52: 129-137,
1997.

14. Osborne
CA, Kruger JM, Lulich JP: Feline lower urinary tract disorders: Definition of
terms and concepts. Vet Clin North Am Small Anim Pract 26:169-180, 1996.

15.
Buffington CAT, Chew DJ, DiBartola SP: Interstitial cystitis in cats. Vet
Clin North Am Small Anim Pract 26:317-326, 1,996.

16. Hart BL: Feline
Behavior. Santa Barbara, Veterinary Practice Publishing Company, 1980.

17.
Melese-d'Hospital P: Eliminating urine odors in the home, in Voith V, Borchelt P
(eds): Readings in Companion Animal Behavior. Trenton, Veterinary
Learning Systems, 1996, pp 191-197.

18. Hart BL, Leedy M:
Identification of source of urine stains in multi-cat households. JA VMA
180:77-78, 1982.

19. Borchelt PL: Cat
elimination behavior problems. Vet Clin North Am Small Anim Pract 21:257-264,
1991.

20. Beaver BV: House soiling
by cats: A retrospective study of 120 cases. JAAH425(6):631-637; 1989.

21.
Landsberg G, Hunthausen W, Ackerman L: Handbook of Behaviour Problems of
the Dog and Cat.
Oxford, Butterworth Heinemann, 1997.

22. Mathews SL: A different
approach to the litterbox problem. Feline Practice
14:7-11, 1989

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Feline Housesoiling Problems Part II. Urine and Faecal Marking

Although unacceptable to cat owners, marking is a normal feline behaviour. The most common form of urine marking is spraying, a stereotyped motor pattern with consistent features among cats.' The cat orients to a vertical surface, raises and quivers its tail, and directs a stream of urine caudally. Sniffing the surface may precede this display. Typically, the amount of urine expressed is small relative to that of normal voiding. If the owner does not witness this stereotypic behaviour sequence, he or she may detect urine marks on upright surfaces. Cats that urine spray usually continue to use the litterbox for normal
urination and defecation.²

Housesoiling problems may involve elimination outside the litterbox or marking behaviour, covered in this article. As described in Part I, elimination outside the litterbox generally involves dissatisfaction with some environmental or social feature associated with the litterbox or conditioned avoidance. Inappropriate elimination may involve urine, faeces, or both. Once the cat or cats responsible for the problem have been identified, medical conditions that might be contributing to the behaviour problem should be ruled out. A thorough behaviour history should be taken to detect environmental or social factors that may play a role in the problem. After any medical problems are addressed, behaviour therapy to systematically alter the cat's environment is initiated. In some refractory cases in which arousal or anxiety plays a role, pharmacologic approaches may be helpful; such therapy is discussed in this article.

URINE MARKING (SPRAYING)

Urine spraying is more common in but not restricted to males. Maximal rates reported for feral male cats are 62.6 sprays per hour versus 6.0 per hour for females.³ Of male domestic cats castrated between 6 to 10 months of age, 30% exhibited occasional urine spraying and 12% exhibited frequent (problem) spraying.⁴ In contrast, 4% of females ovariectomized at the same age exhibited frequent urine spraying.

In addition to sex differences, there are widespread individual differences in the propensity to spray urine. This may be due to breeding or dominance status or activity patterns.³ Aggressive interactions between cats have been proposed to play a role.⁵ An individual farm cat may spray most frequently while travelling from the centre of its home range, when hunting, or after an agonistic encounter.⁶ It has been suggested that urine marks act as a "keep out" signal (i.e., they are used by certain cats to communicate their presence so that other cats will avoid using the same space at the same time), although
there is no evidence that cats sniffing urine marks change their route of travel in response. The ability to recognize urine of familiar versus unfamiliar males has been demonstrated.⁷ This recognition would permit a resident to monitor the activity of other cats in a given area to avoid confrontation or competition for resources.

Among house cats, urine marking is indicative of a high level of arousal, often associated with the presence of other cats inside or outside the home. Urine marking may be a form of "passive aggression" toward another animal or animals.⁵ The location of the urine mark may suggest the source of stimulation. Spraying around doorways and windows indicates response to the presence of an outdoor cat or cats. Spraying along internal walls and furniture suggests a response to cats in the household, including a new cat. In fact, the probability of urine spraying by at least one cat in a household increases with the number of cats in the household.⁸

Changes in the household can influence the incidence of spraying, possibly due to anxiety.⁹ For example, a move to a new house can precipitate the behaviour in some cats. The addition of a new cat to the household is a common stimulus for urine spraying. It has been suggested that the presence of a cat's own urine odours makes it more self-confident and comfortable in the face of anxiety-producing stimuli.¹⁰

There is a tendency for some cats to repeatedly mark specific locations or substrates. Stereo speakers and kitchen appliances are frequent targets, as are objects impregnated with the owner's odour, such as shoes, clothing, or briefcases.⁹ Novel or unfamiliar objects, such as a new piece of furniture or a shopping bag, may be marked when first brought into the home. Moving the target object to a new location and observing the cat's response differentiates between location and substrate preference.¹¹

Urine marking can occur on horizontal surfaces, confusing the dichotomy between urine marking and inappropriate urination. The amount of urine produced in this fashion is relatively large, as though the cat is voiding. When horizontal marking occurs, however, there are specific substrate, odour, and location preferences consistent with marking. The habit is very situation-specific and is responsive to treatment or marking behaviour. Examples include urine marking the bed of the owner or clothing left in an open suitcase by a newly arrived house guest.

Urine marking is not usually associated with a medical condition; however, some behaviourists have anecdotally noted an increase in spraying concomitant with
inappropriate urination in some cases of lower urinary tract disease," possibly due to agitation associated with pain. In some cases, medical abnormalities have been detected in cats that spray urine. Therefore a medical evaluation should be made on any cat in which urine marking occurs, particularly when associated with inappropriate (squat) urination or with medical abnormalities, such as hematuria.

FAECAL MARKING (MIDDENING)

Faecal marking among farm cats is suggested by their tendency to defecate away from the farmyard at conspicuous "middening sites." Piles of exposed faeces accumulate, suggesting communication of individual or sexual identity or a means of assessing population density and animal movements.^12,13 In contrast, faeces are typically covered or partially covered at communal latrine sites in the farmyard. The latter are in loose substratum, such as sand, tilled soil, gravel, or hay. The occurrence of faecal marking has not been well documented among house cats,¹ but patterns of faecal deposition suggest it in some cases in which
conspicuous sites are repeatedly chosen.

DIAGNOSIS

As with inappropriate urination, there may be uncertainty regarding which cat is urine marking in multiple cat households. Even if the owner has seen one cat exhibit the behaviour, this does not rule out the possibility that more than one cat is urine marking. To identify the "culprit," individual cats may be isolated one at a time in a room to determine whether urine marking occurs in that room or in the rest of the household in the absence of the isolated cat. Unfortunately, because social interactions among cats may trigger marking behaviour, isolating one individual may reduce the probability of marking by that cat or others. Administering fluorescein dye to one cat and subsequently checking urine for fluorescence using a Wood's light,¹⁴ as described in Part 1, can also be used to identify the cat that is urine marking.

TREATMENT

Treatment of urine marking can be accomplished by environmental, behaviour, surgical, and pharmacologic methods (Table I).¹⁵ Prior to treatment, the behaviour history should attempt to identify stimuli for urine marking, such as the presence of an outside cat, so that they can be removed to reduce the incidence of the misbehaviour. If these environmental factors are not corrected, the prognosis for successful pharmacologic control is poor.

Table I Recommendations for Treatment of Marking Behaviours in Cats
Treatment Modality	Specific Suggestions
Environmental management	Restrict the cat from areas where spraying occurs by closing doors or using motion detectors or electronic mats. Block the indoor cat's view of outdoor cats by covering windows and restricting access. Reduce the number of cats outside or inside the house.
Environmental treatment	Make the location aversive to the problem cat by spraying an odour deterrent (e.g., citrus spray) at sites of urine marking, or spray synthesized F3 facial pheromone at sites of urine marking. Use dedicated animal odour repellents outside the house to keep outdoor cats away; refresh according to instructions.
Behaviour modification	Establish positive interactions with the cat in scheduled play times each day. Avoid punishment because it may increase the cat's anxiety and fear of the owner and is rarely curative.
Pharmacotherapy	Decrease arousal by administering antidepressants. Decrease anxiety by administering benzodiazepines or antidepressants.Administer antiandrogenic hormone treatments.
Surgical treatment	Castrate intact males. Perform olfactory tractotomy in cats refractory to all other treatments.

Environmental Methods

A new environmental treatment involves exposing the cat to a synthesized facial pheromone (dubbed the F3 fraction) when urine spraying is problematic'^16,17 or when cats are introduced to new households.¹⁸ The commercial product (Feliway™, Abbott Laboratories), previously available only in Europe, is applied daily to sites of urine spraying and on prominent objects in the home. Although the exact mechanism of action is unknown and results of blinded trials among exclusively indoor cats are not yet available, the product appears to reduce the incidence of urine spraying in some single and
multiple-cat households.^16,17 An obvious benefit in multiple-cat households is that the positive identity of the problem cat or cats is not required because the entire household is treated. There are no reported side effects to this environmental treatment.

Behaviour Methods

Behaviour modification consists of scheduling play or grooming time with the cat to increase social interaction with the owner. Increasing the cat's focus on pet-owner interactions has been assessed to be an effective component in the treatment of marking behaviour.^12,19 Punishment should be avoided. Punishment by the owner may deter the cat in the owner's presence and encourage the cat to become more secretive, but it is
rarely effective at eradicating urine marking. In fact, punishment may worsen the problem by creating an unpredictable environment for the cat. The owner should know that urine marking is a highly motivated, normal behaviour. Control is best achieved by decreasing the motivation to perform the behaviour.

Surgical Methods

Surgical treatment can affect the incidence of urine spraying. Studies of house cats have shown that males castrated prepubertally or as adults are less likely to urine spray than are intact males.20 After castration, approximately 80% to 90% of males that urine spray will show at least 75% improvement in the behaviour immediately or within several months.²¹
For refractory cases in which euthanasia is imminent, olfactory tractotomy has been shown to reduce urine spraying.²¹

After inappropriate defecation has been ruled out, faecal marking should be treated as urine marking. Sites of faecal marking should be cleaned with an enzymatic cleaner²²
and then treated with an olfactory deterrent, such as a citrus-scented spray. There is no evidence to date that pheromone treatment of the household will alter patterns of faecal marking. The same pharmacologic agents used in the treatment of urine spraying to decrease anxiety and arousal may reduce the incidence of faecal marking.

Pharmacotherapy

Pharmacologic treatment of urine spraying attempts to attenuate the cat's arousal and/or anxiety in response to social or environmental situations (Figure 1). Openlabel trials of diazepam,^23,24 buspirone,⁹ and clomipramine²⁵ have shown that these drugs markedly reduce the incidence of urine spraying in 55% to 75% of cases. Double-blinded controls are needed to more accurately evaluate the effectiveness of these treatments over placebo.⁹
Paroxetine and fluoxetine have shown promise in individual refractory cases .²⁶

Pharmacotherapy plays an important role in the successful treatment of elimination problems, particularly those associated with marking. At present, there are no drugs approved by the FDA for the treatment of inappropriate elimination in cats. The experimental nature of these treatments and the risks involved should be explained to the client. Such a discussion should be documented by a notation in the medical record or the use of a dedicated release form.²⁷ Prior to the use of these agents, a medical evaluation, including complete blood count and serum chemistry (with total thyroxine), is recommended to rule out underlying conditions that may contraindicate or complicate their use.²⁸

The use of psychotropic drugs should be initiated when the owner is present to monitor the patient, and an emergency contact number should be given for after-hours medication questions. Clients are often willing to assume some risk in the treatment of the elimination disorders because the alternative to successful treatment may be rehoming or euthanasia.

Many psychotropic drugs have human abuse potential. In particular, benzodiazepines are controlled substances, and the tricyclic antidepressants can cause fatal cardiac arrhythmias in cases of deliberate or accidental overdose.29 Sensible precautions should be taken to ensure that prescriptions for pets are not abused by humans.

Familiarity with the medications should include knowledge of common side effects and drug interactions. For example, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) can interact with drugs classified as monoamine oxidase inhibitors (MAOIs). Concomitant use of SSRIs with the MAOIs amitraz or deprenyl can lead to serotonin syndrome and should be avoided.30

Behavioural and physiologic characteristics of the drugs aid in their selection. Certain pharmacologic agents reduce spraying in males more than in females. The greater effectiveness in males may be due to antiandrogen effects or differences in receptor sites. Bromocriptine is an ergot alkaloid that acts as a dopamine agonist. In its injectable form, which is no longer available, a dose of 2 to 5 mg/cat subcutaneously was shown to reduce urine spraying in 85% (n=27) and 40% (n=5) of male and female cats tested, respectively." The oral form may be used twice a day for 4 to 8 weeks. A study of the effect of synthetic progestins on the frequency of urine spraying concluded that it is effective in 55% of males
and 25% of females. ³²

Drug Classes

Choosing a specific psychotropic drug depends on a number of variables, including side effect profile, dosing regimen, familiarity with the drug, latency to effect, and cost. In general, if one drug causes unacceptable side effects or lack of efficacy, a drug from another class should be utilized. Drugs in each class share biochemical characteristics and mechanism of action. Table II lists common classes of medications used to treat urine marking; common and rare but potentially serious side effects are included.

TABLE II Classes of Drugs Used for the Treatment of Feline Housesoiling
Class	Examples	Neurotransmiter System	Latency to desired Behavioural Effect	Potential Side Effects (may be immediate)
Benzodiazepines	Diazepam	y-Aminobutyricacid	Immediate	Sedation Idiopathic hepatic necrosis rare
Azaperones	Buspirone	Serotonin Dopamine	1-3 wk	Irritability Alterations in social behaviour .
Tricyclic antidepressants	Amitripryline Clomipramine	Norepinephrine Serotonin	1-4 wk	Sedation Anticholinergic effects
Selective serotonin reuptake inhibitors	Fluoxetine Paroxetine	Serotonin	1-4 wk	Inappetence Sleep disturbances Irritability
Synthetic progestins	Megestrol acetate	Progesterolreceptors	1-2 wk	Obesity Diabetes mellitus Mammary hyperplasia Mammary carcinoma Blood dyscrasias

Cost may play a role. In the United States, benzodiazepines and tricyclic antidepressants are available in generic forms, which are less expensive than proprietary forms. The azaperones and SSRIs are not available in generic formulations. Table III lists specific drug names and doses.

TABLE III Drugs and Dosages Used to Manage Feline Housesoiling
Drug Class	Generic Name	Dosage for Cats (orally)	Comments	References
Benzodiazepine	Diazepam	1.0-4.0 mg every12-24 hr	Sedating until tolerance develops (5-7 days)	23,24
Azaperones	Buspirone	5-7.5 mg every 12hr	May affect social interactions among cats	9,35,36
Tricyclic antidepressants	Amitriptyline	2.5-7.5 mg every 24 hr	Give at bedtime to manage sedation; bitter tasting	15, 36
	Clomipramin	1-5 mg every 12-24 hr	Compounding to a 2.5 mg/ml solution facilitates dosing	25,28
Selective serotonin reuptake inhibitors	Fluoxetine	1-2.5 mg every 24 hr	Available as an elixir; give in the morning to avoid changes in sleep cycle	26, 36
	Paroxetine	1.25-2.5 mg every 24 hr	More sedating than fluoxetine; taper dose over 1 wk to discontinue	26, 36

Benzodiazepines

Benzodiazepines act on specific receptors in the central nervous system by facilitating y aminobutyric acid, a widely distributed inhibitory neurotransmitter. Drugs in this class are used to treat fears and phobias as well as states of anxiety and arousal. They have been shown to be useful in the treatment of urine spraying in cats. Side effects in humans include sedation, ataxia, muscle relaxation, increased appetite, paradoxic excitation, and memory deficits.³³

Abrupt discontinuation can lead to recurrence of the original problem or nervousness.³³ When the drug is discontinued, it should be slowly tapered. Once diazepam has been
discontinued, spraying can resume in up to 90% of cases.²³ Although tapering the medication is often attempted after several months of successful therapy, continued therapy is commonly required, depending on the owner's success with environmental and behaviour regimens and the motivation level of the cat.

Hepatic necrosis is a rare, idiosyncratic effect of diazepam therapy in cats. It may be irreversible and fatal. It has been reported in apparently normal cats within 7 days of oral therapy with generic and proprietary diazepam.³⁴ It is not known whether other benzodiazepines will produce the same response when their frequency of use approaches that of diazepam. It is recommended that a biochemistry screen be conducted prior to oral diazepam use²⁸ and after 3 to 4 days of therapy.

Azaperones

Azaperones have serotonergic and dopaminergic mechanisms. One azaperone, buspirone, has been shown to be efficacious for the treatment of urine spraying.³⁵ The drug has no potential for abuse and is not sedating. Buspirone may take 1 to 3 weeks to show an effect. Side effects include idiosyncratic changes in social behaviour ranging from irritability to increased affiliative behaviour to the owner. Mild gastrointestinal (GI) side effects have been reported. When tapered off buspirone, cats tend to resume spraying behaviour in 50% of cases. ^{23 25} Buspirone appears to be more effective in multiple-cat than in single cat households ,³⁶ suggesting that buspirone influences social factors that mediate urine spraying.

Tricyclic Antidepressants

The tricyclic antidepressants are drugs with a rang of behaviour activities and have wide applicability to behavior treatment.³⁷ Acting therapeutically on the nor epinephrine and serotonin neurotransmitter systems tricyclic antidepressants also affect other receptors which explains their antihistaminic and anticholinergi (atropine-like) side effects. Because of the latter, cardio vascular abnormalities, glaucoma, and urinary or feuretention are contraindications to the use of these agents.³⁸ Due to the tendency of tricyclic antidepressants to exacerbate cardiac conduction disturbances in human patients with underlying cardiac abnormalities a screening electrocardiogram within 4 weeks of initiation of therapy with these compounds is recommended

Selective Serotonin Reuptake Inhibitors

The SSRIs act selectively on the serotonin neuro transmitter system by blocking the reuptake of serotonin and effectively increasing its bioavailability.³⁷ They have been used in cats for the treatment of refractory urine spraying. Because most of the serotonin receptors in the body are found in the GI tract, common side effects include inappetence and other GI sign such as anorexia, nausea, and diarrhea. GI side effect (which occur in up to 25% of humans) may be avoid by starting at a low dose for I week and then increasing the dose over 2 weeks. Other side effects include idiosyncratic anxiety, irritability, insomnia, or sedatior Fluoxetine may have 3 to 4 weeks latency to effect an a long elimination half-life of the active metabolite. Response to paroxetine appears to be more rapid in cats. Paroxetine has a shorter elimination half-life and should be tapered when discontinued. When using any SSRI, cats must be carefully monitored for water and food consumption, weight, and elimination habits

Synthetic Progestins

Because synthetic progestins have a higher incidence of side effects, including obesity, diabetes mellitus, mammary hyperplasia and carcinoma, and blood dyscrasias,³² their
routine use has declined and is now reserved for cases refractory to first line treatment with other psychotropic agents. They are not discussed further here.

CONCLUSIONS

Solving feline elimination problems requires a systematic approach. Realistic expectations should be made regarding control of longstanding cases. Medical differential diagnoses for elimination disorders must be ruled out before a behavioral diagnosis is made. Marking behaviour must be differentiated from inappropriate elimination because the motivating factors and specific treatments differ. Prior to treatment, a baseline of the number of marking events occurring each week should be established so that progress can be monitored. In general, treatment consists of environmental control, behaviour modification, surgery, and pharmacotherapy. In many cases, an aggressive approach is warranted-by the time consultation is sought, the owner may have little patience left.
Therapeutic failure may result in the cat being euthanatized, rehomed, or abandoned.

About the Author

Dr. Sherman Simpson is Director of
The Animal Behaviour Service of the Veterinary Teaching Hospital, College of
Veterinary Medicine, North Carolina State University, . She is a Diplomate of
the American College of Veterinary Behaviorists and is Certified as an Applied
Animal Behaviorist by the Animal Behavior Society.

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