Inappropriate Elimination

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Cats who pee outside the litter box are 2-6 times more likely to be relinquished to a shelter. In today’s episode, Dr. Lauren Harris talks about inappropriate elimination and the significant damage to the human animal bond. Restoring that bond requires appropriate diagnosis, which is obtained by partnering with a veterinarian to evaluate for underlying medical conditions. If no medical reason can be found, behavioral assessment can help determine a cat’s aversions and preferences to help get them going where they should.


[00:01:05] Welcome, everyone, to today’s episode of Your Vet Wants You To Know. I am very excited. I have a great topic for us to talk about today, and a really lovely guest who is going to do a wonderful job breaking down today’s topic for you, making it easy for you to understand what’s happening, and what you can do to help your pet. Today’s topic is ‘Why Your Cat Is Peeing Outside The Litter Box.’ I know this is definitely something that I saw my family struggle with when I was younger, so I’m really excited to break this topic down and get a little bit more information about what we can do to help repair the human animal bond that gets damaged when this is happening. I would like to welcome my guest, my wonderful, lovely dear close friend, Dr. Lauren Harris. Welcome. 

[00:01:57] Dr. Harris: Thank you. Thank you so much for having me. 

[00:01:59] Dr. Lancellotti: I’m so excited to talk about this because I know this is something that a lot of pet owners struggle with. Certainly, it is a reason why cats get rehomed, and why there is a feeling of resentment in some families towards a pet. Let’s talk a little bit about what pet owners often say to you when their cat is going outside of the box. 

[00:02:20] Dr. Harris: Oh, absolutely. I’m a family veterinarian, so I’m often the first line of people that they come to when they’re having an issue. And they are very frustrated. They take it so personally. They’re talking about how their cat is mad at them, how their cat is ruining things in their household, so it can be, not just frustrating, but also a financial issue when the cats are ruining floors that need to be replaced or bedding. So, they often take it very hard and anthropomorphize the cats a little bit as well.

[00:02:51] Dr. Lancellotti: Yeah. I can certainly understand that financial stress that people feel. I remember, in our home growing up, our one cat ruined a whole bunch of rugs and had to be completely replaced. Several room’s worth of rugs were just completely ruined. There was no salvaging them. So, it’s not just the financial strain of bringing the cat to the vet to figure out what’s going on, but also replacing those damaged items in the house too. 

[00:03:18]Dr. Harris: And of course, you found cat urine is a very strong, very tenacious smell, so it tends to stay put once you get it somewhere. 

cute orange cat

Is my cat a bad cat?

[00:03:27] Dr. Lancellotti: Yeah, it can be very frustrating. What are some of the reasons for cats to not use the litter box? Are they just being bad cats? Why is this happening? 

[00:03:36] Dr. Harris: Oh, not at all. So, I want to jump right out in front of that. It’s not because they’re bad cats. There’s a host of reasons, both medical as well as behavioral, that cats can be “eliminating” outside the litter box, whether it’s urine or feces. That can be related to pain. If they have, for example, irritable bowel disease or Pandora syndrome, which is like a stress related cystitis- it causes pain when urinating. So, there are a lot of medical reasons to eliminate outside of the litter box, and there’s behavioral reasons as well. Kitties can be very specific in a litter box. They can have preferences for light levels,  the cleanliness level of the litter box, where the litter box is located in the home (if it’s too bright, if it’s too dark, if it’s too noisy, if there are other kitties in the household that wait outside while they’re going potty). There can be a lot of things about a litter box that push them in a different direction in wanting to eliminate somewhere else that they perceive to be safer or more comfortable for them.

[00:04:36]Dr. Lancellotti: It sounds like cats are very specific in what they like and what they don’t like, a little bit like my four year old in what she likes and what she doesn’t like. 

[00:04:44] Dr. Harris: That’s very true. They know exactly what they like and if it’s not there, they’ll go somewhere else. 

Get Curious!

[00:04:49] Dr. Lancellotti: So how can pet owners get inside their cat’s brain and figure out what it is that their cat likes and doesn’t like?

[00:04:58] Dr. Harris: That’s a great question. It’s similar to parenting a four-year-old. It’s important to not get mad, but get curious instead (or both, whatever works). The Indoor Pet Initiative has a questionnaire to evaluate the litter boxes in your home. “Do you have enough litter boxes for the number of cats you have? Do you have enough litter boxes for the area?” It helps you look at the litter boxes from your cat’s perspective to help determine if they might be too bright, too dark, too noisy, too much traffic walking by, etc. That can be a very helpful resource for pet owners to help them see from their cat’s perspective, and that could be a good first step for pet owners to take before they bring in their family veterinarian to help. 

A Perfect Litter Box

[00:05:41] Dr. Lancellotti: Would you say that there is a perfect litter box for all cats? I know there are tons of litter boxes out there on the market, but would you say is the best one for all cats? 

[00:06:12] Dr. Harris: There’s no perfect litter box. Cats, like people, are their own unique individuals. What I think is a perfect meal or a perfect outfit for me is not going to be the same for another person. There are lots of different varieties, and cats may have a preference, so it’s important to try different things if we think that the litter box itself is the problem.

Is there a medical condition?

[00:06:34]Dr. Lancellotti: Excellent. So, maybe it’s not just the litter box, maybe there might be an underlying health condition causing these accidents in the house. Is there something that you would recommend, steps that they could take, to figure out what that underlying health condition might be? 

[00:06:50] Dr. Harris: Absolutely. The first step, of course, (I think, as a family veterinarian) is to loop me in. Bring your cat in for an examination. Tell me what’s going on. Tell me the problems that you’re having and be as descriptive in your observations as possible. So, if you can say something like, “my cat will urinate in the litter box, but only poops in the bathtub,” you wouldn’t think that would be helpful, but it may provide a detail (that you hadn’t noticed) that I might pick up on. The first things that we’ll do, of course, will be a physical examination and a discussion of what you’ve observed at home. Based on your history and my examination, I might recommend things like blood work to check on organ function. I will likely recommend a urinalysis to help us check on kidney function, look for a urinary tract infection- things along those lines. Based on the results of those tests, we might move forward into imaging like x-rays or an abdominal ultrasound. 

[00:07:46]Dr. Lancellotti: Yeah, because sometimes these things aren’t behavioral. Sometimes the cat has an actual medical issue that’s making it really difficult for them to want to use the litter box because, say it’s painful for them to urinate, and every time they urinate in the litter box, they associate the litter box with the pain that they’re experiencing. So, if we can find out what it is that is causing that pain and address the problem, the cat may return to using the litter box once they start to feel better. 

[00:08:16] Dr. Harris: That’s an excellent point that you make. They can develop an association between pain using the litter box and the litter box itself, which can be frustrating for pet owners as well as their family veterinarian. If, for example, a urinary tract infection has resolved, there may still be some lingering litter box avoidance, because the cat remembers that they were using the box and that it hurt, so they’re going to go do something else instead.

Evaluating aversions and preferences

[00:08:41] Dr. Lancellotti: So, what happens if the pet owner has done all this testing and there doesn’t seem to be an underlying health condition? What would you recommend, as far as next steps, in that case? 

[00:08:52] Dr. Harris: Next steps, in that case, would be to evaluate possible behavioral causes. We talked about evaluating the litter box from the perspective of the cat. Are they afraid of specific things associated with the box? There may also be social stressors. A lot of the time, pet owners may not be aware or may not be fully tuned in to the social structure of the pets in their household, so they may not necessarily have noticed that their younger cat will wait outside the litter box when their older cat is going (for example). So, evaluating those things can be really helpful in addressing those concerns. We may need to try behavioral medications. For example, anti-anxiety medications can be helpful sometimes, in multi-cat households, when the social stressors make them a little bit litter box-avoided. They don’t want to be vulnerable in a stressful situation, so medication can help them with that. 

[00:09:47] Dr. Lancellotti: That’s what it is when a cat is going to the litter box in a multi-cat house and there are not enough litter boxes available. There’s no sense of privacy and maybe they just want to feel like they can have a minute to themselves. We all kind of just need a minute to ourselves when we’re using the restroom, so cats are not very different from people in that regard.  Having a setup at home where there are enough litter boxes for every cat and an additional one (if there are 3 cats in the house having 4 litter boxes), gives them the opportunity to spread out and have a preferred litter box and make sure that they’re away from other cats too.

[00:10:26] Dr. Harris: Absolutely. Yes. And balancing the different preferences of different cats- one cat may prefer one box because it’s in a darker location, another may like one closer to the center of activity, so if you have multiple different boxes, it’s easier for them to find a box that checks the boxes on their list, so to speak.

Enrich your cat's life!

A cat hunts for its meal with the Doc and Phoebe’s Indoor Hunting Cat Feeder.

[00:10:45] Dr. Lancellotti: That’s great. What other things can we do for these cats that are having this issue with urinating and defecating outside the box? Are there things that we can do to enrich their environment, to make them feel like they are less stressed overall in their life?

[00:11:01] Dr. Harris: Yes, absolutely. So you’ve probably seen (for example, around Halloween time) videos of zoo animals playing with pumpkins or the lions in the zoo sitting in cardboard boxes. So, we’ve all seen those fun videos that go around the internet and that’s a principle called ‘enrichment.’ It’s something that zookeepers work very hard at with zoo animals to keep their minds engaged. Cheetahs aren’t hunting for prey anymore when they’re in a zoo environment, they are fed, but done so in a way that engages their bodies as well as their brains. And we bring the same principles to our indoor kitties. You can get feeders that they have to chase, feeders that they have to search for throughout your home, but also different games that you can play with. The laser pointer is a common example, or the string-on-a-stick toy- different things to keep them moving and busy and excited. Also, it helps them to feel fulfilled, and then you’re less likely to run into boredom or stress related behavioral issues.

[00:12:02] Dr. Lancellotti: You had a couple of really good points there. The Indoor Hunting Cat Feeder is something that I’ve mentioned previously on a Scratching The Itch segment, and I love those. They were designed by a veterinarian who’s also a mom. She designed these three little mice that you fill with kibble for the cat and you hide them around the house. So, the cat has to harness its natural prey drive to find its food and hunt for it around the home. It’s really fun for them to do and it focuses on what their natural instincts are. But I also like that you mentioned lots of cat toys. It makes me really sad that my husband is highly allergic to cats, because I would just sit there and play with a cat all day long if I could have a cat in the house. We have a neighbor who has an indoor-outdoor cat that my daughter loves, and so they actually, the other day, made a cat toy out of just a stick that they found in the neighborhood with some twine that we have for arts and crafts around the house, and then there were some little streamers that the cat could pounce on and attack. So it’s not something that you need to spend a whole lot of money on to enrich the cat’s life, but it’s something to play with and have fun with.

[00:13:11] Dr. Harris: And good for the human animal bond as well for you guys to play together. 

[00:13:15] Dr. Lancellotti: Absolutely. I also wanted to mention, I love pheromones. Pheromones are an odor that is species specific, so humans have a pheromone that only other humans can detect, dogs have dog pheromones and cats have cat pheromones as well. And this is a scent that is released, in regards to the emotional state that the animal is in. There is a synthetic pheromone that has been made designed specifically for cats called Feliway, and that will decrease the stress in the cats at home. They come in a couple of different formulations. There’s a diffuser that you can plug into the wall. So, in a certain area where the cat has gone to the bathroom inappropriately, you can plug in the Feliway there to make that a less stressful environment. There’s a spray that you can use to spray on different parts of the household, so it’s a really good tool to reduce stress, in addition to all the other things that Dr. Harris talked about with enhancing and enriching what the cat is experiencing in the home.

Your Veterinarian is Here to Help!

Do you have any other advice or gems that you want to share with pet owners who are struggling with their cats’ inappropriate elimination? 

[00:14:33] Dr. Harris: I really just have nothing but sympathy. I know that it’s so hard and it’s so frustrating. And in our busy lives, it’s very difficult to do anything other than go for your gut response. “Ugh,, I can’t believe he peed on the bathmat again.” But just knowing that your cat as an individual with a complex inner life of their own, and trying to get curious about that, the sooner that we can stop the inappropriate elimination, the less likely it is to be an ongoing problem throughout their life. Try to address it as soon as you can, “rope in” your family veterinarian right away, if you need to, and we’ll help walk you through the process.

[00:15:12] Dr. Lancellotti: I think that’s such an important point- talking to your family veterinarian to figure out together what’s going on with your individual animal, because there might be a medical problem and working with your family veterinarian can get to the bottom of that. Also, family veterinarians have a lot of experience with behavior and other things that could be going on that are outside of medical conditions. They can certainly help with figuring out what’s going on with your cat’s personality, what things you can do in your home to improve your cat’s overall quality of life, and restore that human-animal bond that’s so important to pet ownership to begin with. Many family veterinarians are very comfortable managing pets with inappropriate elimination issues, but the link to the American College of Veterinary Behaviorists to find a behavior specialist will be posted on the website. If you would like to consult with a specialist after working with your family veterinarian. If you have a cat that has had problems with inappropriate elimination, or you just want to share pictures of ways that you have enriched your cat’s life, we would love to see those, so I would encourage you to join the Facebook group and share pictures of different things that you’re doing (your cat playing with a laser- we all love to see videos of that) or different ways that your cat gets its food (any food toys that you use). Sharing those will help to encourage other pet owners on how to enrich their animal’s life as well. If you’ve gotten value from the show, I would encourage you to leave a rating and write a review so other pet owners can find us and hopefully get help for their pets as well.   

Scratching the Itch

Dr. Amir Khalil, a veterinarian from the international animal welfare organization Four Paws International, comforts Kaavan during his examination at the zoo in Islamabad, before leaving for Cambodia. Photo: Anjum Naveed/AP

I like to end each episode with a short segment called Scratching The Itch. The segment is designed to highlight something- a human interest story, or a product, or a website that provides relief or just makes you feel good- hence, scratching the itch. Dr. Harris, I would love to know if you have something that you think would scratch the itch for our audience today. 

[00:17:20] Dr. Harris: I do. I just read this story this morning about a veterinarian who helped to rescue (I believe it was) the last elephant in Pakistan, in a zoo, all by himself. The elephant’s named Kaavan, and this veterinarian spearheaded an effort over several years (I believe) to help get this elephant to a sanctuary in Cambodia. It involved rehabilitating his body. He was severely overweight, which made it difficult to transport him by plane and also involved training him to tolerate transport. But now this elephant gets to live out the rest of his life with other elephants, which I think is just so wonderful. 

[00:18:03] Dr. Lancellotti: Yeah, I was reading this article that you sent me and, oh my gosh, it just got me right in the heart. It’s such a feel good story. This veterinarian has devoted his life to helping animals out of really bad situations. So, I absolutely love this. Thank you so much for sharing it. It made me feel so good to know that there are people out there who are doing this work and who are helping animals in these situations. Thank you, Dr. Harris, so much for sharing this with us. This is a great Scratching The Itch. And thank you so much for coming on the show and for talking to pet owners about things that they can do for their cat if they’re not using the litter box. I hope people find some value from today’s episode, and I certainly learned some things as well. 

[00:18:58]Dr. Harris: Great. Thank you so much for having me. I’m glad I could help. 

[00:19:02] Dr. Lancellotti: I look forward to your next visit with Your Vet Wants You To Know.


  • Borns-Weil, Stephanie. In Urology, Veterinary Clinics of North America: Small Animal Practice. March 2019 49(2):141-155
  • H.C. Carney, T.P. Sadek, T.M. Curtis, et al. AAFP and ISFM guidelines for diagnosing and solving house-soiling behavior in cats. J Feline Med Surg, 16 (2014), pp. 579-598

Recommended Links (Note: some of these links contain affiliate links. This means if you click on the link and purchase the item, we receive an affiliate commission at no extra cost to you. All opinions remain backed by evidence based medicine.)

Indoor Hunting Cat Feeder

Feliway Feline Pheromones

Feline House Soiling Brochure

House Soiling Cat Owner Questionnaire

Instructions for Cat Owners

Indoor Pet Initiative

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