be performed if indicated based on the cat’s individual risk factors. In all cases, veterinarians should perform a rectal exam, with evaluation of the anal glands. Finally, veterinary professionals should consider abdominal radiographs and/ or ultrasound if evidence in the history or on physical exam suggests gastrointestinal disease 2 . Increased appetite, such as that seen with hyperthyroidism or diabetes mellitus, may lead to increased fecal volume and inappropriate defecation. Therefore, veterinary professionals should perform a complete blood cell count, serum biochemistry, and thyroid level check on any patient presenting for inappropriate defecation 2 . Multiple neurologic and orthopedic conditions can present as inappropriate defecation, such as seizures, lower motor neuron disease, lumbar spinal pain, lumbosacral junction pain, and hip/knee pain 2, 4, 5, 6 . These conditions can make elimination uncomfortable, as well as make it difficult for cats to enter and exit the litterbox 6 . Veterinary professionals should consider radiographs in patients with a history of lameness, reluctance to jump, decreased activity, or an apparent inability/reluctance to raise the tail 4 . Finally, a physical exam may indicate other, less common causes for the inappropriate defecation. Older cats may have ingrown toenails or clumping litter stuck between their footpads 4 , making use of the litterbox uncomfortable. Cats affected with severe systemic disease may not have the energy to walk across the house to the litterbox, and instead may defecate where they are laying 4 . If veterinary professionals detect abnormalities during the medical workup, they must address these abnormalities to effectively manage the problem. If veterinarians still suspect a behavioral cause in addition to the medical condition, they can suggest that clients begin environmental modification and other interventions concurrently with treatment of the medical condition to prevent worsening of the behavioral A number of common medical conditions may lead to inappropriate urination. Therefore, the physical exam and laboratory diagnostics should target these conditions. Feline lower urinary tract disease (FLUTD) is a common cause of inappropriate urination. This syndrome can be attributed to a number of causes, including feline idiopathic cystitis (FIC), bacterial infection, cystic calculi, or bladder neoplasia 4, 5 . On physical exam, veterinarians should palpate the bladder be palpated to assess for pain or discomfort. All cats presenting for inappropriate urination should receive a complete urinalysis to assess for bacteriuria, hematuria, and crystalluria. Additionally, professionals should consider a urine culture to rule out occult infection. Finally, bladder ultrasound may be indicated to assess for uroliths or evidence of chronic cystitis (bladder wall thickening) 4 . Inappropriate urination may also be caused by polyuria/ polydipsia, such as that seen with diabetes mellitus, hyperthyroidism, liver disease, pyelonephritis, and renal failure. A complete blood cell count, serum biochemistry, and thyroid level should be assessed 7 . component of the inappropriate elimination. Medical workup for inappropriate urination As with inappropriate defecation, professionals should also consider neurologic and orthopedic conditions including seizures, lower motor neuron disease, lumbar spinal pain, lumbosacral junction pain, and hip/knee pain 2, 4, 5, 6 . These conditions can make elimination uncomfortable and make it difficult for cats to enter and exit the litterbox 6 . Professionals should consider radiographs in patients who have a history of lameness, reluctance to jump, decreased activity or an apparent inability/reluctance to raise the tail 4 .
3. Stressors: Are any of the following factors present? a. Is new person or pet present in the home? b. Has a person or pet left the home? c. Have you recently replaced or rearranged furniture, carpet, drapes, etc.? d. Has your family recently moved to a new home? e. Do any other environmental changes exist? 4. Indicators of litter box aversion: a. How many cats live in the home? b. How many litterboxes? c. Are the litterboxes covered or uncovered? d. What type of litter? e. How long has this type of litter been used? f. How often is the litterbox scooped? How often is the box emptied and scrubbed? g. Is the litterbox secluded? h. How high are the sides? i. Is a plastic liner used in the litterbox? 5. Signs of pain: a. Does the cat demonstrate straining or discomfort with urination? b. Does the cat show any difficulty with steps, running, or jumping? c. Does the cat display any lameness? d. Does the cat show signs of discomfort when being picked up, hiding, or is it otherwise acting less social than usual? 4 If inappropriate defecation also plays a role (less common than inappropriate urination 5 ), veterinary professionals must also ask targeted questions about defecation. They should question clients about any concurrent gastrointestinal signs (vomiting, diarrhea, tenesmus), changes in appetite, and changes in diet. While taking the history, veterinary professionals should steer the owners towards focusing on factual accounts of what is happening. Many owners develop their own anthropomorphic narratives about their cat’s problem behavior, using phrases like “my cat is jealous" or “she does it when she is mad at me” 2 . Not only are these perspectives often incorrect, they can interfere with the client’s ability to recognize the true nature of the problem and ability to correctly diagnose and manage the inappropriate elimination. While it may be tempting for veterinarians to just gloss over these sorts of comments, addressing owner misconceptions during history-taking permits a more thorough evaluation of the problem and helps to increase owner compliance with treatment. After obtaining a thorough history, veterinary professionals may develop a suspicion for whether the inappropriate elimination is due to an underlying medical condition, urine marking/spraying, or inappropriate toileting. Despite any suspicions, however, the next step must be a thorough physical exam and diagnostic testing to definitively rule out medical conditions that may contribute to inappropriate urination or defecation. Medical workup for inappropriate defecation In addition to a thorough history, veterinary professionals must conduct a thorough physical exam and laboratory diagnostics to rule out medical causes of inappropriate defecation before assuming that the inappropriate defecation is caused by a behavioral problem. A variety of gastrointestinal diseases, including intestinal parasites, inflammatory bowel disease, intestinal neoplasia, or constipation, may contribute to inappropriate defecation. Therefore, veterinarians should perform a fecal flotation to rule out intestinal parasites, with additional fecal testing to
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