Medical Maintenance

Inappropriate Urination: Why is My Cat Peeing ALL OVER My House?!

Peeing cat.jpeg


Feline inappropriate elimination is a common behavioral problem reported to veterinarians, accounting for approximately 50% of all behavioral referrals.  At least 10% of all cats will develop elimination problems in their lifetime. Unfortunately, it is also a leading reason for relinquishment of cats.  Elimination problems can develop as a result of conflict between multiple cats in a home, a dislike for the litter-box type or the litter itself, as a result of a past or present medical condition, or a more complex issue of perceived inefficiencies within their environment. In this post, we will review some of the most common causes for inappropriate urination, and some steps to help correct the problem.  We can often categorize the underlying causes in to four main groups including Medical, Litter Box Aversion, Territorial, and Attraction to Another Location.

Medical Problems

When you notice that your kitty is urinating outside of the litter box, the first step is to rule out medical issues with a Urinalysis and bladder radiographs (x-rays). The most common medical cause is “idiopathic stress-induced cystitis,” which accounts for approximately 75% of cases. This means that there is inflammation (and therefore pain and sense of urgency) within the bladder, but there is no identifiable cause.  We do know that stress can precipitate these symptoms. Cats who are affected may have recurrent episodes with varying frequency throughout their lives if the underlying stressor is not identified and controlled (see below).  The next most common cause is bladder stones, accounting for approximately 15% of medical cases, followed by urinary tract infections, which account for less than 5% of medical case.  Less commonly, urinary crystals and bladder tumors are seen.  If a medical problem is identified, your kitty will be treated in a way to resolve the underlying medical cause, and increase comfort.

Radiograph of a cat with a distended bladder

Radiograph of a cat with a distended bladder

Litter Box Aversion

tidybreeze-open top litter box.jpeg

It’s no secret that many cats can be very particular about almost everything in their environment, so it’s no surprise that they may have strong opinions regarding the litter box; however, preference is not the only factor in litter box aversion. Cats who have had a previously negative experience in the litter box, particularly past episodes of pain (urinary obstruction, constipation), may also develop aversion.  One common indication of litter box aversion is when episodes of inappropriate elimination occur near (but not in) the litter box, however this is not always the case.  Cats typically prefer their litter box in a quiet, low-traffic, and easily accessible location.  They often prefer an uncovered box for multiple reasons. First, cats have a sense of smell that is 60-100 times more sensitive than our own, and being cooped up within a box with excrement can be unpleasant…think Porta-Potty.  Additionally, since cats are prey animals (as well as predators), they are instinctively more vulnerable during elimination. Being able to see potential threats is important for emotional security, even for indoor cats whose greatest threat may only be the vacuum cleaner.  Most cats also prefer non-scented litter that is at least 2 inches deep for digging and burying.


There isn't anything more adorable than a box of kittens, but these little cuties like to spread out and have their own privacy for litter box time!

There isn't anything more adorable than a box of kittens, but these little cuties like to spread out and have their own privacy for litter box time!

One of the most important aspects of feline comfort is being able to distinguish, and have control over, their territory. It is essential to remember that cats may be threatened with any change in their environment, with some common examples including new pets, children (especially small ones that crawl and grab), house guests, conflicts with pre-existing pets, outdoor cats in the neighborhood, anything that alters the smell in the house…the list is endless!  When cats do not have the appropriate materials to help them cope with these potential stressors, urinary and fecal marking may occur, as increasing their scent helps them feel more secure.  To combat territorial marking, we must consider normal cat behavior. Cats use their scent glands on the face, paws, and tail base to mark things within their territory. This is what is happening when your kitty rubs her face and hind end, or scratches, on all aspects of your furniture, and then smells it immediately after. These pheromones let her know that she is safe and that these items belong to her. Helping to increase that sensation decreases the chance of your kitty marking in other ways.  To help increase pheromone levels, we recommend using a synthetic pheromone called Feliway, which is available in diffusers and spray. Additionally, when threatened, cats prefer seeking a positional higher than the threat, since that is where they have the most chance of safety. This can be accomplished by adding vertical space, including cat trees and shelving. They also may seek places to hide, so providing covered hiding places for them is also important.  In multi-cat households, we also recommend “spreading out the resources” so that your cats do not have to toilet, eat, drink, or play in the same area without it being their choice – nobody wants to be forced near their siblings 24-7!

Attraction to Another Location

As mentioned previously, cats like to toilet in places that are easily accessible, quiet, and have specific odors, and if the litter box is not meeting their needs, they often will find somewhere else that is more preferable. Additionally, when a cat has marked an area, it is essential to do a deep cleaning of that spot as soon as possible, as cat urine can soak through to the padding of the carpet, making it almost impossible to fully eliminate, and will continue to attract them to use this location.  Using enzymatic cleaners such as “Nature’s Miracle” helps to naturally break down the components of urine to eliminate the smell. You should always avoid harsh chemicals or those with intense scents, as this may cause your kitty to want to mark over it.


Dr. Elise and one of our happy feline friends

Dr. Elise and one of our happy feline friends

Cat behavior is extremely complex, and the problems and solutions presented above only scratch the surface of the explanations and modifications for feline inappropriate elimination. The most important aspect is to first eliminate medical problems. After this is done, and you cannot immediately correct your kitty’s inappropriate elimination, please consult with your veterinarian at Southpoint Animal Hospital for further guidance. Behavioral marking is often due your cat’s perceived deficit of some aspect of their environment in which their emotional needs may not be being met.  SPAH does offer an In-home Environmental and Behavioral Assessment, with Dr. Elise Hattingh, to evaluate your cat’s environment and relationships in order to maximize feelings of security, and therefore, eliminate marking. In an hour long visit, Dr. Elise will review the environment, watch the interactions between family members and other cats, and make suggestions based on your kitty’s behavior.  This service has been extremely successful for many cats and owners to find peace in their homes.

For more information, consider attending Dr. Elise's Feline Behavior Workshop on Saturday, April 21. Details here!

Fat Cat Solutions

A fat cat is a happy cat, right?   Well, they might tell you that at meal time, but the rest of the day (and there will be less of those) not so much. There are very alarming and very critical clinical consequences of obesity, including (but not limited to):

  • Diabetes

  • Urinary disease

  • Osteoarthritis

  • Skin conditions

  • Lack of energy

  • Decreased Quality/Quantity of life

Now that I have your attention, let’s see if your cute little butterball is overweight. Your fingers and eyeballs are probably the best test around.  Scales often lie to us, having trouble telling the difference between muscle and fat, but also because there is such a variety in normal sizes of cats.  

At Southpoint Animal Hospital, we like to use the Body Condition Scale (BCS).  It is a 1-9 sliding scale based on physical characteristics, such as how easily palpated the spine or ribs are. Check out the BCS below:

cat purina BCS.jpeg

OK, now raise your hand and repeat after me:

"I have a fat cat, but it is not my fault."

I have a different opinion for fat dogs, but that is a whole different story. There, now that we all feel better, let’s get down to losing some kitty belly.

Weight Loss in Cats

What makes this such a difficult task is that cats are amazingly efficient creatures. When someone rings your doorbell and the dogs go crazy, what does your cat do? Perhaps roll over on the couch to better see the door, but most of the time they can’t even be bothered with that. However, in the wild, a cat must catch approximately six mice a day just to stay alive, they also only successfully catch their prey 1 out of every 4 hunting episodes. Therefore, they must track, hunt and attempt to catch a mouse 24 times a day. My cat hunts twice: once in the morning to get her morning yum-yums, and once at night to get her evening yum-yums. No tracking, no hunting, no pouncing, no rending of flesh - just a banquet feast for 30 seconds. And that (if you are still reading this far into the article) is how we are going to get your Chubby-Wubby to lose some weight... We gotta get them to move! Notice I did not say put them on a diet. We will get more into food later on, but first, let’s work on exercise.


Passive Methods:


Place their food bowl in a more difficult location: on a raised surface, their tree house, anything that will make them move a bit to get to it. The picture on the left is my home-made tree house (that of course the cats don’t play on anymore), but they have to climb up to get their food. Make sure the location is safe and that they are actually able to get to it!

Cat fence: Yes, you read that right. I am recommending that your cat goes outdoors. I don't mean a free for all, return to the wild to hunt 24 times a day kind of outdoors, but a properly enclosed, safe outdoor exercise area. You can easily and relatively inexpensively convert an existing fence to a cat-proof fence. Many companies offer these conversion kits. Your kitty will get all the benefits of being outside (fresh air, exercise, mental stimulation) without the dangers (dogs, other cats, cars).  Just don’t forget flea and tick preventatives if you do this!

Get another cat: I think all homes should have 2 cats... most of the time. All cats are individuals, but they usually love to have a companion around to play, groom, and be lazy with.

Active Methods:

Laser lights: My favorite mode of activity with my cats because I can be sitting in my La-Z-Boy and my cats are tearing up the living room running after it. Remember that cats are sprinters - they will play for a minute or two and then want to rest. They are the big cat taking down an antelope - fast as lightening but not built for a marathon. It is amazing how much fun a $12 laser pointer from Office Depot can be. Caution - don’t point it into their eyes!

Automatic laser lights: The lazy (or very busy!) man's laser light. Works while you are gone, and your kitty will never know when it is coming! Many versions are out there, a lot at less than $30.


Good old fashion feather on a string: It kicks that predatory instinct on high. Just don’t leave the string on the floor in case a kitty might decide to eat it!

Fake mouse: The little plastic bodied/rabbit fur cheapies at any pet store. I probably have a dozen under my fridge right now. My cats love them.

Milk Rings: I should market these things, call them Dr. Lapham’s Special Cat Toy. Only $1.99 on sale now! I have a dozen or more also under fridge as we speak (apparently I have a lot of things under my fridge).


If you want your cat to have no energy and NOT lose weight - put them on a traditional weight loss diet (ie - high fiber, low calorie). In other words, we need to feed them food that their bodies were meant to digest, to give them the energy to be active, and to satisfy them to not bug us at 5AM for breakfast: a canned high protein diet, home cooked diet, or raw diet- we can have the debate in person as to what is best for your cat. The key is NOT high carbohydrate, NOT dry kibble.  

Once we have switched them to a canned high-protein diet, then we can start to reduce their total amount of energy (food) a small amount at a time, generally starting with a 10% reduction.  This should be done under a supervision of a veterinarian as we also want to make sure they are getting adequate nutrition.


It took time to put the weight on, so it will take time to get the weight off. We don’t care so much how long it takes, just as long as your cat’s weight is going the right way.


For more information on weight-loss, nutrition, and other feline-related issues, we recommend the following sites and resources:

Indoor Pet Initiative - Ohio State Univ, College of Veterinary Medicine - tons on info to keep our cats sane!

Catalyst Council - Feline related information

Catinfo.Org – Great info on many feline-related topics, in particular nutrition.

So let's get to it! We've given you a lot of great suggestions to help your furry feline friend shed some weight this New Year, the rest is up to you!

The Dental Health of Our Pets

There is no topic that is discussed more on a day-to-day basis than periodontal disease.  I’m the first person to admit to getting up close and personal with my four legged family members, and I know from first-hand experience how unpleasant a loving kiss can be when it comes from a foul smelling mouth!  So I thought I would take the time to expand on common questions and concerns that my clients have about periodontal disease and what we as responsible pet owners can be doing to prevent or slow down its progression.

First off, why should we care about periodontal disease?  Other than the obvious bad breath, does periodontal disease affect my pet?  The answer is a resounding YES!  Periodontal disease is recognized as the second most common disease process that veterinarians diagnose, with the first most common disease process being superficial dermatitis (skin disease), no big surprise there… 

As I have stated, the most common adverse effect that we as pet owners notice is the horrendous breath that welcomes us with the affectionate kisses that our cats and dogs provide.  This halitosis (bad breath) is due to bacterial overgrowth on teeth.  It turns out that bacterial overgrowth on teeth stinks to high heaven, and when that bacterial growth is left unchecked it is not subtle.  Our mouths are full of bacteria. It can colonize teeth within 4-6 hours.  This is why I can brush my teeth before bedtime, and yet I wake up with my wife commenting on my bad breath first thing in the morning.  The same process occurs in our pets, but our pets rarely brush their own teeth 2-3 times daily.

If we were only worried about bad breath then we would not make such a big deal about focusing on improving our pet’s dental health, but there are several other negative factors that concern us.  My biggest concern with periodontal disease is the chronic inflammation and the associated pain and discomfort that accompany it.  I’m always amazed at how tolerant our four legged loved ones are of pain and how little they are capable of expressing it.  I can’t tell you how many “normal” patients I have treated that have terrible oral pain, but show no detectable outward clinical signs.  Full disclosure, I am just as guilty as anyone of my clients when it comes to recognizing my own dog’s periodontal disease.  Both of my dogs fractured one of their premolars (the largest tooth in their mouths), and I didn’t have a clue until I took them in for their regular dental prophylaxis.  They both showed signs of severe endodontic disease  (disease below the gumline) during their dental cleanings and had to have a tooth extraction.  I was shocked, as a veterinarian and pet owner, to have found such diseased teeth in my own dogs because I never picked up on any abnormal clinical signs.  I was equally shocked to watch as my dogs’ overall demeanor and energy levels improved following their dental work.  For me it was only after I removed the problem that I recognized how much my dogs’ periodontal disease was affecting their day-to-day comfort.

And lastly, periodontal disease can cause a chronic inflammatory state that impacts the rest of our pet’s health.  Studies have shown that dogs and cats with chronic periodontal disease have a greater incidence of microscopic disease in several major organ systems, including the heart, kidneys, lungs and liver.  As with any chronic disease process, when addressed early and managed appropriately, we can prevent long term disease and help improve the overall health and quality of life of our pets. 

BEFORE  Severe calculus and gingivitis, persistent puppy canine tooth. 

BEFORE Severe calculus and gingivitis, persistent puppy canine tooth. 

AFTER  Post dental cleaning and extraction of puppy tooth.

AFTER Post dental cleaning and extraction of puppy tooth.

Enough about why we should care about our pet’s oral health, here are some recommendations to stay ahead of this common problem:

  1. Have your pet’s teeth evaluated by a veterinarian at least once a year. I can’t stress enough how important this is.  If we can recognize dental disease early and address it, we can prevent long-term negative implications.
  2. Brush, Brush and Brush!!! That’s right folks, brushing your pet’s teeth is still the number one preventative treatment.  There simply is no substitute for daily teeth brushing.  I know everyone reading this is groaning to themselves and I am fully aware of how much time and commitment daily teeth brushing requires, but with most pets it is doable.  I am the first to admit I failed many times when trying to train my dogs to accept teeth brushing.   But in my case I was the problem and not my pets.  The key to successful teeth brushing is setting a routine, positive reinforcement and most importantly BEING PATIENT!  I have countless stories of clients who have really committed to preventing periodontal disease.  A lot of my clients do not brush their pet’s teeth because they are nervous about it or just simply do not know how to get started.  Next time you are in the office, ask one of us to sit down with you and demonstrate proper brushing technique and appropriate training. 
  3. I am not deluded to thinking that each and everyone of us will be successful with daily brushing, thankfully there are some alternatives (these are by no means replacements for brushing).  Incorporating some combination of the following preventative measures can help slow down the rate of periodontal disease:
    • Dental Chews-  There are a variety of dental chews on the market.  I recommend a daily chew called Oravet made by Merial.  Next time you are in ask about the different chews that are available and we can find the one that fits with your individual pet.
    • Oral gels and rinses- These are a little more labor intensive than giving our pet a chew, but they can have great benefits and are easier to apply than brushing.
    • Water additives- These can be very helpful, however always speak with a veterinarian before using.  Some animals will dislike the flavor of the water additive and will avoid drinking water which can have negative adverse effects.
    • Dental Diets-  I am not a huge fan of dental diets.  I think implementing some combination of the options listed above is more effective.  I strive to get each and every one of my patients on a high quality diet for the benefit of their overall health and the dental diets really limit what we can choose from.
  4. Lastly, we have to remember that periodontal disease is progressive even with the best preventative plan.  When our pet’s dental disease progresses beyond basic preventative measures then it is time to have their teeth cleaned professionally.  Having a professional dental cleaning will be a decision we will make together during one of our visits.
BEFORE  Severe calculus and gingivitis.

BEFORE Severe calculus and gingivitis.

AFTER  Post dental cleaning procedure.

AFTER Post dental cleaning procedure.

There is a lot of information out there that touches upon dental disease in dogs and cats.  If you are interested in reading more about it then I recommend visiting the Veterinary Oral Health Council’s website. This website was created by board certified veterinary dentists and is a wealth of knowledge and recommendations when it comes to preventing and addressing periodontal disease.

Remember that this is a joint effort and there is no one single plan that works best for each dog or cat. Don’t be shy next time you are in the exam room with one of us, we encourage questions and or concerns about our pets’ dental health. 

BEFORE  Severe calculus and gingivitis.

BEFORE Severe calculus and gingivitis.

AFTER  Post dental cleaning procedure.

AFTER Post dental cleaning procedure.