into two categories: marking or inappropriate toileting. In one study of feline inappropriate elimination cases seen in three different veterinary practices, approximately 30 percent of the patients were noted to be marking, while 70 percent demonstrated inappropriate toileting 11 . A similar study in Barcelona showed comparable results; of 142 cats who presented for inappropriate elimination, 63 percent were diagnosed with a litterbox aversion, 15 percent with marking behavior, and the remaining cats were divided among other causes 5 . Distinguishing between marking and inappropriate toileting requires information about the pattern of elimination noted, as each behavior involves a typical pattern. Marking is a specific type of elimination used for social signaling that can be identified based on a number of characteristics. Cats that are urine marking will first smell a surface, then back up to that surface with their tail in the air. The cat will then tread the hind feet and urinate a small volume, while standing upright and twitching the tail 6 . Only small amounts of urine are deposited, typically on vertical surfaces at socially significant locations, and the cat will not demonstrate any digging behaviors before or after the urination 2 . Cats that are marking will typically still use the litterbox for the majority of their elimination of urine and feces 6 . Inappropriate toileting, however, refers to a scenario in which cats deposit large volumes of urine or feces on horizontal surfaces 2 . These cats are not marking to send a social signal; they are emptying their bladder or bowels normally, but without using the litterbox. Cats with inappropriate toileting will eliminate while standing in a typical elimination posture, with their back curved, and often demonstrate normal digging behaviors before and after elimination 6 . These cats may or may not be using the litterbox for any urination or defecation. Himalayans and Persians are predisposed to inappropriate toileting 6 . The prognosis for resolution of inappropriate elimination, whether due to marking or inappropriate toileting, is dependent on several factors. First, can an underlying cause be identified? If an underlying cause can be identified and managed, the prognosis is good. Second, how long has the problem been going on? Inappropriate elimination that is treated within one month of onset typically has a good prognosis, while cases that have been occurring for over six months have a poor prognosis 4 . Third, how committed is the owner? Treatment of inappropriate elimination requires a substantial commitment from the owner, and efforts to find a ‘quick fix’ will typically result in failure. manner, due to a strange cat’s presence outside that window. Known risk factors for urine marking include a high number of cats living within the home, a high frequency of intercat aggression, significant changes within the home, and the presence of strange outdoor cats that can be seen from within the home 12 . Identifying the trigger for urine marking is often made difficult, however, by the fact that the average owner waits eight months before consulting their veterinarian about a urine-marking problem 13 . This delay may make it difficult for owners to recall the inciting cause of the urine marking, while also making the problem more difficult to resolve due to chronicity. Territorial marking Urine marking is often used by a cat to define its territory, especially as a response to strange cats detected outdoors.
Finally, as with inappropriate defecation, veterinary professionals should perform a physical exam to assess for other possible causes of paw pain (i.e. ingrown toenails, litter matted to paws) or systemic disease that may be contributing to lethargy or decreased mobility 4 . The goal of this comprehensive testing is to find a medical cause, if one exists, or to definitively rule out medical causes so that the focus can shift to behavioral causes 7 . If veterinary professionals suspect that both medical and behavior causes are contributing to the inappropriate elimination, they can implement environmental modification concurrently with medical therapy. Feline lower urinary tract disease: A medical and behavioral cause of inappropriate urination Feline lower urinary tract disease (FLUTD) is the medical condition that is most commonly associated with inappropriate elimination. In one retrospective study, 60 percent of cats presenting for inappropriate elimination had a history of FLUTD 8 . It is known that FLUTD can trigger inappropriate urination during flare-ups (due to increased urgency of urination), but the pain and discomfort of FLUTD can also contribute to behavioral inappropriate urination by making a cat reluctant to use the litterbox. Feline lower urinary tract disease correlates significantly with stress. Cats with FLUTD show a number of aberrant stress- related factors as compared to control cats, including high circulating catecholamine levels, malfunctioning alpha-2 adrenoreceptors, smaller adrenal glands, and suboptimal responses to challenge with synthetic adrenocorticotropic hormone 9 . Studies have demonstrated significant improvements in FLUTD patients when stressful situations are decreased, adequate opportunities for play and rest are provided, and comfortable litterboxes are provided in accordance with the cat’s preferences 10. The use of Feliway™ as an anxiolytic has also been demonstrated to decrease the frequency and severity of FLUTD flare-ups in affected cats 9 . Successful management of FLUTD also involves addressing a number of medical factors (such as diet, concurrent infections/crystals, etc.), but it is important to remember that environmental management plays a significant role in the management of even the acute phase of FLUTD. Furthermore, veterinarians should be alert for possible chronic behavioral effects that may arise from this condition and address these effects as early as possible. Behavioral causes of inappropriate elimination: Marking vs. inappropriate toileting When professionals have ruled out medical conditions, they can diagnose the cat with a behavioral case of inappropriate elimination. These behavioral cases are further divided Urine marking Marking is a common feline behavior problem, frequently reported to veterinarians and behaviorists. While this behavior is often associated with sexually intact cats, studies have demonstrated that 10-12 percent of neutered males and 4-5 percent of spayed females will demonstrate urine marking at some point during their life 8, 12 . Urine marking can typically be attributed to one of several causes, including territorial marking, anxiety-related marking, or sexual marking. Urine marking is observed as small amounts of urine on vertical surfaces, typically on prominent objects such as furniture and plants; near entrances, exits and windows; and on new objects within in the home 8 . The pattern of objects that is sprayed by the cat may provide some indication of the cause of the spraying; for example, a cat that frequently marks around a window may be marking in a territorial
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Book Code: VFL1526
EliteLearning.com/Veterinarian
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