Animal Behavior Case of the Month - House Soiling

JAVMA, Vol 224, No. 10, May 15, 2004

This feature is sponsored by the American College of Veterinary Behaviorists. Readers of the JAVMA are invited to submit reports, which should include a brief description of a behavioral problem, the evaluation and treatment, and a succinct discussion of the case.
Send contributions to Dr. Katherine A. Houpt, Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401.

Statement of the Problem
A cat was examined because of urine spraying and inappropriate urination for the past 10 years.
Signalment
The cat was an 11-year-old castrated male Persian
(cat A).
History
The owner had obtained cat A from a breeder at 8 weeks of age. The owner had a female Persian cat (cat B) that was 1 year old when cat A was acquired. Cats A and B were bred once before both were neutered. The owner kept 1 of the offspring (cat C), a female that was 10 years old at the time of the behavior consultation. All 3 cats were kept strictly inside. Cat A was friendly with cats B and C.
Inappropriate elimination first occurred in 1990 while the owner was involved in a divorce, and cat A started urinating outside the litter box. The problem resolved after the divorce when the owner moved to a new location. In 1992, another episode of house soiling occurred while the owner was away and the door to the room containing the litter box was accidentally closed. Without access to the litter box, all 3 cats eliminated in the dining room. Cat A was first observed spraying urine in 1993 when the owner had started dating her current husband. The problem had gotten progressively worse in the past 2 years.
There was 1 hooded litter box for the 3 cats, which was located in the laundry room. Various brands of clay litter had been used. The litter box was scooped twice daily and emptied monthly. When the owner was able to observe cat As behavior in the litter box, she noticed that the cat scratched on the inside of the lid and around the outside of the box, rather than in the substrate, and rarely buried urine or stool.
The owner thought that cat A was the only culprit, since she had observed him urinating outside the litter box on numerous occasions and had never seen cats B or C do so. Cat A was seen backing up to objects, lifting its tail, and spraying a small quantity of urine. The cat was also observed squatting to deposit a moderate quantity of urine on horizontal surfaces. At the time of the behavior consultation, house soiling occurred daily and had been detected in every room of the house.
The owner provided a floor plan of the house with urine locations marked (Fig 1). Urine spraying primarily involved the baseboards, windowsills, couch, and walls in the great room.

Urine was also found against the stairs and inside and outside the hood of the litter box. When access to the bedrooms and bathrooms was restricted, cat A sprayed urine against the closed doors. The cat squatted to urinate on the sofa cushions and on the carpet in the great room.
Cat A was very social with people and the other cats in the household. The owner had noticed an outside cat near the house, but did not recall seeing any unusual or aggressive reactions toward this cat.
The owner had purchased a new sofa and had the carpets professionally cleaned. She tried treating urine marks with a pheromone treatment;' but found this to be impractical because there were too many locations requiring treatment. Confinement to a single room resulted in cat A spraying urine all over that room. The owner had never physically corrected cat A for urine spraying or inappropriate elimination. Treatment with buspirone and amitriptyline had not had any effect. Because of pressure from her husband, the owner was considering euthanasia if the problem could not be resolved.
Cat A had been front declawed and neutered at 1 year of age and had recovered without incident. There were no health problems until 1996 when the regular veterinarian auscultated a grade III of VI cardiac murmur and noticed tachycardia (heart rate, 256 beats/min). Cardiomyopathy was suspected.
In February 1997, cat A was examined by the veterinarian because of lethargy of acute onset. Results of routine laboratory testing were indicative of hepatic disease, and supportive care was initiated. Within 2 days, the problem had resolved. A toxin, infectious agent, or hepatic lipidosis was suspected but never confirmed. In April 1997, a diagnosis of hypertrophic cardiomyopathy was made on the basis of results of thoracic radiography and echocardiography. Treatment with atenolol (12.5 mg, PO, q 24 h) was started. A 3-month trial of buspirone (5 mg, PO, q 12 h) for inappropriate elimination was prescribed, but house soiling persisted.
In September 1997, cat A was examined by the regular veterinarian because of vomiting and diarrhea. Laboratory testing indicated dehydration and hyper-globulinemia, and a diagnosis of gastroenteritis was made. The cat responded to a change in diet.1' In October 1997, the regular veterinarian prescribed amitriptyline (2.5 mg, PO, q 12 h) for treatment of the house soiling. Results of a pretreatment CBC and serum biochemistry profile were normal. Cat A was severely lethargic while receiving amitriptyline and, in November 1997, was examined again because of diarrhea. It was not determined whether the diarrhea was related to the medication, but it resolved after treatment with amitriptyline was discontinued in December. Because the house-soiling problems had not resolved, cat A was referred for a behavior consultation in May 1998.
Physical Examination Findings and Laboratory Results
At the time of the behavior consultation, cat A weighed 5 kg (11 Ib). Body condition was good, and the cat was well groomed. Hair under the tail had been trimmed to prevent soiling. A grade II of VI cardiac murmur was auscultated, and the heart rate was 176
beats/min. There was a moderate amount of dental tartar present, but the remainder of the physical examination was unremarkable. The only medication the cat was currently receiving was atenolol (12.5 mg, PO, q 24 h). Results of a serum chemistry profile and uri-nalysis were unremarkable, and serum thyroid hormone concentrations were within reference limits.
Diagnosis
The diagnosis was urine spraying combined with inappropriate urination. The owner had observed cat A spraying urine on upright surfaces and urinating on horizontal surfaces. Although deposition of urine on horizontal surfaces could have been marking behavior, the quantity seemed suggestive of true urination.2"1 Factors to be considered as potential causes of inappropriate elimination include substrate aversion or preference, location aversion or preference, lack of cleanliness, overcrowding, medical problems, and environmental stress.'7 Urine spraying has been attributed to territorial marking, intraspecies aggression, stressful environmental changes, hormonal influences, high cat density, and medical problems.4'" Possible medical causes of the urine spraying and inappropriate elimination were eliminated with the appropriate diagnostic tests.1
Substrate aversion was diagnosed because cat A avoided digging and scratching in the substrate in the litter box.2 Because cat A still used the litter box for defecation and went to that location to urine spray, location aversion was ruled out. It was thought that there were not enough litter boxes for the number of cats in the household. House soiling seemed to coincide with changes in the owner's personal life, making environmental stress another important factor.2
The urine spraying in cat A appeared to have been associated with stress in the owner's life and the introduction of a new person into the household. Territorial marking in response to an outside cat that was visible or marking near the house was also a likely contributing factor.'' The possibility of subtle hierarchy disputes among the household cats was considered,4'" but not supported by the history.
Treatment
The problem of inappropriate urination was addressed by adding additional litter boxes, modifying the cleaning schedule, selecting an additional location for 1 of the litter boxes, and performing a litter preference trial. It was recommended that at least 3 litter boxes be provided,14 and that the owner monitor litter box activities. When cat A was observed using the litter box, the cat was to be praised and offered a food reward.' The owner was instructed to continue cleaning the litter twice daily and to start changing the litter completely every week." An alternate location for 1 of the additional litter boxes was recommended, along with removal of the hoods from the litter boxes.12 The litter preference trial w»s done by placing at least 2 litter boxes in the same location, each containing a different substrate. The current litter and either unscent-ed clay litter, wheat-based litter, or shredded paper were suggested.
For the urine spraying, it was recommended that cat As visual access to unfamiliar cats be restricted by covering windows, moving furniture away from windows, and using deterrents to keep outside cats away.24512 Because some researchers believe that encouraging facial marking may decrease the desire to mark with urine,13 grooming combs were applied around the house. Soiled areas were cleaned with an enzymatic odor eliminator, and cat As access to these areas was somewhat restricted by closing doors and covering the couch with plastic.14810
Medications were selected on the basis of safety concerns and the owner's desire for a rapid response because euthanasia was being considered. Treatment with alprazolam (2.5 mg, PO, q 12 h), which has been used for anxiety-motivated urine spraying in cats,6 7 was started in May 1998. Any effect was expected to be seen rapidly, but the owner was warned about adverse effects seen with other benzodiazepines, including sedation, ataxia, and hyperphagia.17 2 The owner was also advised that fatal hepatic disease had been identified in a small number of cats being treated with diazepam and that although not reported for alprazolam, hepatic disease was a possible risk. Hepatic screening tests were done 3 days after treatment with alprazolam was started. Because a substantial number of cats resume spraying when benzodiazepine treatment is discontinued,4 7 combination treatment was recommended. Buspirone and amitriptyline had previously been ineffective, and there were concerns about the use of clomipramine because of the cat's history of cardiac problems,7 so flu-oxetine (5 me, PO, q 24 h) was prescribed.
Follow-up
During a recheck examination 1 week later, the owner reported that the house soiling had completely ceased and the only adverse effect of the medications was mild sedation. During a follow-up visit 2 weeks later, there was still no evidence of house soiling and cat A seemed to prefer the wheat-based litter to clay litter. The owner started to taper the dose of alprazolam in June 1998 and discontinued administration in July. The dosage of fluoxetine was maintained while the alprazolam dosage was tapered.
At the 2-month recheck examination, there had been no incidents of inappropriate urination since treatment had been started. The dosage of fluoxetine was decreased to 2.5 mg, PO, every 24 hours, and results of routine laboratory tests were normal. One month later, when the owner began to give the medication every other day, urine spraying recurred. Therefore, the dosage was again increased to 2.5 mg, PO, every 24 hours. The dosage was decreased to 1.25 mg, PO, q 24 h in September, and routine laboratory tests were again performed. By November 1998, all medications had been discontinued without any recurrence of the house-soiling problem.

Feliway, Farnum Pet Products, Phoenix, Ariz.

Prescription diet w/d, Hill's Pet Nutrition, Topeka, Kan.
References
1. Cooper LL. Feline inappropriate elimination. Vet Clin North Am Small Anim Pract 1997;27:569-600.
2. Borchelt PL, Voith VL. Elimination behavior problems in cats. Compend Contin Educ Pract Vet 1986;8:3-12.
3. Eckstein RA, Hart BL. Pharmacologic approaches to urine marking in cats. In: Dodman NH, Shuster L, eds. Psychopharmacolo-gy oj animal behavior disorders. Maiden, Mass: Blackwell Science, 1998;264-278.
4. Hunthausen W. Housesoiling problems in cats, in Proceedings. Friskies PetCare Symp Small Anim Behav 1997;26-32.
5. Beaver BY Feline behavior: a guide jor veterinarians. Philadelphia: WB Saunders Co, 1992;208-224.
6. Landsberg GM, Hunthausen W, Ackerman L. Handbook oj behaviour problems of the dog and cat. Oxford, England: Butterworth-Heinemann, 1997;88-95.
7. Overall KL. Clinical behavioral medicine jor small animals. St Louis: Mosby Year Book Inc, 1997;160-194.
8. Bradshaw JWS. The behaviour oj the domestic cat. Walling-ford, UK: CAB International, 1992;57-99.
9. HalipJW, Luescher UA, McKeown DB. Inappropriate elimination in cats, part I. Feline Pract 1992;20(3):17-21.
10. Overall KL. Animal behavior case of the month. Urine spraying by a cat in a multi-cat household. J Am Vet Med Assoc 1994; 205:694-696.
11. Olm DD, Houpt KA. Feline house-soiling problems. Appl Anim Behav Sci 1988;20:335-345.
12. HalipJW, Luescher UA, McKeown DB. Inappropriate elimination in cats, part II. Feline Pract 1992;20(4):25-29.
13. Dehasse J. Feline urine marking. Appl Anim Behav Sci 1997; 52:365-371.