Inappropriate elimination, or urinating outside the litterbox, is a fairly common and frustrating problem for felines. As owners we tend to assume the cause is behavioral, but the cause could be rooted in a medical issue that requires treatment or even an emergency room visit.

The causes of inappropriate urination generally fall into one of two categories: environmental issues, such as stress, or underlying medical conditions. In the first of a two-part series, we’ll discuss the latter and talk about ways to address those problems.


Why do medical issues cause cats to urinate outside the litterbox?
There are three broad types of medical conditions that can lead to inappropriate urination: those that make going to the bathroom difficult or painful, those that lead to more frequent trips to the litterbox, and those related to mental or physical deterioration. In the first case, cats that have trouble urinating can start to identify the litterbox with pain and discomfort. In the second, more frequent urination increases urgency and can lead to more “accidents” when your kitty fails to reach the box in time. In the third, cats who lose their cognitive abilities due to age or who have joint problems may end up avoiding the litterbox.

What specific conditions can lead to inappropriate urination?
Below are some examples of each of the three categories. Please note that if you have a male cat exhibiting any signs of difficulty urinating, straining, frequent trips to the litterbox, vocalization while in the litterbox, or any signs of pain – IT IS AN EMERGENCY! If your male cat is exhibiting any of the listed symptoms, do not wait to seek medical attention – it is potentially a life threatening condition.


Conditions making urination painful

–Urinary tract infections (UTIs): If your cat enters the litterbox frequently but produces very small amounts of urine while there, it might be suffering from an UTI that is making the act of urination difficult.

– Kidney stones, bladder stones or other urinary blockages: If your cat has something physically impeding its ability to urinate, it will find trips to the litterbox so painful that it meows or cries when it tries to go to the bathroom. Signs of these conditions include abdominal tenderness, vocalization while in the litterbox, frequent trips to the litterbox, hiding, or lethargy. Remember if you have a male cat and you are seeing any of these symptoms, it is considered a medical emergency and could be life threatening. Call your veterinarian immediately or go to your closest 24 hour emergency center.


Conditions making urination more frequent

–Feline Interstitial Cystitis: This is a neurological disease that affects the cat’s bladder. Signs of this disease include more frequent attempts to urinate, appearing to be straining while doing so, licking while urinating and blood in the urine. Feline interstitial cystitis is a very serious disease and must be treated immediately to avoid a life-threatening scenario.

– Kidney or liver disease: Cats with kidney or liver diseases tend to drink more water in an attempt to flush toxins out of their systems leading to more visits to the litterbox and potentially more accidents.

– Bacterial infections or inflammatory diseases of the bladder and urinary tract. These also increase the need to urinate.

– Hyperthyroidism or diabetes.


Conditions affecting cognitive abilities or physical capabilities

– Age-related declines in brain function. Older cats are more likely to miss the litterbox as their cognitive abilities begin to slip.

– Disorders affecting the nerves, muscles and joints. These don’t increase the need to urinate, but they do make climbing in and out of the box more difficult. Going outside the litterbox ends up being a more comfortable option.


What should you do if your cat has an underlying medical condition that is causing inappropriate urination?
If you notice that your cat is urinating outside of the litterbox consistently, take your feline friend to the vet immediately. Your vet will perform a complete physical examination to determine your cat’s current medical state. Blood work, radiographs, ultrasound, urinalysis and/or a urine culture might be recommended to determine the cause of your cat’s symptoms. Once the underlying cause is determined your veterinarian will be able to help you establish a treatment plan. Treatment varies greatly on the underlying issue but can involve prescription diet or food change, oral medications, environmental changes or in some cases, surgery.