Feline Housesoiling

Part II. Urine and Fecal Marking

The Veterinary Behavior Clinic, Southern Pines, North Carolina

Barbara Sherman Simpson, MS, PhD, DVM

Although unacceptable to cat owners, marking is a normal feline behavior. 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 behavior 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 (discussed in Part I) or marking behavior, 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, feces, or both. Once the cat or cats responsible for the problem have been identified, medical conditions that might be contributing to the behavior problem should be ruled out. A thorough behavior history should be taken to detect environmental or social factors that may play a role in the problem. After any medical problems are addressed, behavior 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 traveling from the center 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 behavior 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 odors 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 odor, 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 (discussed in Part I). 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, odor, and location preferences consistent with marking. The habit is very situation-specific and is responsive to treatment or marking behavior. 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 behaviorists 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.

FECAL MARKING (MIDDENING)

Fecal marking among farm cats is suggested by their tendency to defecate away from the farmyard at conspicuous "middening sites." Piles of exposed feces accumulate, suggesting communication of individual or sexual identity or a means of assessing population density and animal movements.12,13 In contrast, feces 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 fecal marking has not been well documented among house cats,1 but patterns of fecal 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 multiplecat households. Even if the owner has seen one cat exhibit the behavior, 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 behavior, 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, behavior, surgical, and pharmacologic methods (Table 1).15 Prior to treatment, the behavior 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 misbehavior. If these environmental factors are not corrected, the prognosis for successful pharmacologic control is poor.

Table I

Recommendations for Treatment of Marking Behaviors 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 odor deterrent (e.g., citrus spray) at sites of urine marking, or spray synthesized

F3 facial pheromone at sites of urine marking. Use dedicated animal odor repellents outside the house to keep outdoor cats away; refresh according to instructions.

Behavior

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.

Behavior Methods

Behavior 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 behavior.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 behavior. Control is best achieved by decreasing the motivation to perform the behavior.

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 behavior 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, fecal marking should be treated as urine marking. Sites of fecal 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 fecal marking. The same pharmacologic agents used in the treatment of urine spraying to decrease anxiety and arousal may reduce the incidence of fecal 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

Behavioral 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.

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.

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 behavior regimens and the motivation level of the cat.

Hepatic necrosis is a rare, idiosyncratic effect of diazepam therapy in cats.34 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.34

TABLE II

Classes of Drugs Used for the Treatment of Feline Housesoiling

Class

Examples

Neurotransmiter

System

Latency to Desire

Behavioral Effect

Potential Side Effects

(may be immediate)

Benzodiazepines

Diazepam

y-Aminobutyric

acid

Immediate

Sedation, idiopathic

hepatic necrosis (rare)

Azaperones

Buspirone

Serotonin,

dopamine

1-3 wk

Irritability, alterations

in social behavior .

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

Progesterol

receptors

1-2 wk

Obesity, diabetes mellitus, mammary hyperplasia, mammary carcinoma, blood dyscrasias

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 behavior ranging from irritability to increased affiliative behavior to the owner. Mild gastrointestinal (GI) side effects have been reported. When tapered off buspirone, cats tend to resume spraying behavior in 50% of cases. 23"5 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 behavior activities and have wide applicability to be havior 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 feu retention are contraindications to the use of thes agents.38 Due to the tendency of tricyclic antidepres sants to exacerbate cardiac conduction disturbances i~ human patients with underlying cardiac abnormalities a screening electrocardiogram within 4 weeks of initia tion 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 sera tonin and effectively increasing its bioavailability.37 They have been used in cats for the treatment of refrac tory urine spraying. Because most of the serotonin re ceptors in the body are found in the GI tract, commo 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 avoide by starting at a low dose for I week and then increasin the dose over 2 weeks. Other side effects include id iosyncratic 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. Re sponse 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.

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 every

12-24 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

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 behavior 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, behavior 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. Simpson owns The Veterinary Behavior Clinic, Southern Pines, North Carolina and is affiliated with the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina. 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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