Inappropriate urination

My business partner has a 10 year old female cat, Reilly, who has been having issues with peeing outside the box for several months now. She has been to the vet several times for this; she's had all the usual tests (she did test positive for crystals but no infection. She's now on the dreaded prescription diet; she was on EVO canned before all this started.), run several courses of ABs (despite the lack of infection - vet on autopilot), and even had x-rays to rule out the possibility of stones. When Barbara has caught Reilly "in the act", she makes little "mewing" sounds, and when she does go outside the box (which is not all the time), it's always on soft stuff (pillows, laundry, etc)...classic symptoms. She's not due back at the vet for another urinalysis for another 6 weeks, because the vet recently started her on some kitty cranberry treats and wants to wait and "let that work" before retesting.

There is one stressor that could possibly/probably have triggered all of this. About a year and half ago, Barbara's younger daughter and her two "teenage" kittens moved back home. Reilly started having problems about 8 or 9 months later. The kittens (now young cats) are still there and it looks like they're not going anywhere soon. At this point, everyone seems to tolerate each other fairly well, with the occasional scuffle that we all see in multiple cat households.

Barbara is starting to get frustrated with her vet, because it seems like she's hit a dead end. I'm wondering if Reilly may have something like a chronic cystitis and could benefit from some sort of pain meds, but the vet doesn't "believe" in treating urinary issues with pain meds. Or do you think this is something that originated from the crystals, but has now become behavioral?

Do you guys have any thoughts or ideas about this situation? With pretty much everything else ruled out, does it sound to you like she could be having pain and would pain meds be an appropriate approach? I don't have much experience with this sort of thing, other than little snippets I've read hear and there, so any ideas you have would be greatly appreciated...thanks!

Amy

Adequan is used in cats with chronic cystitis isn't it. Hopefully someone will know more and share. I think its called that in the US. My friends cat is getting injections for this.

Also has blood work been done to check the kidneys and a sterile urine draw AND culture?

Can you open this article: https://docs.google.com/viewer?a=v&...g6WEMm&sig=AHIEtbTu9an-ki5JEy9J0DNIZ8KlWUi6wQ

http://www.marvistavet.com/html/body_the_non-obstructed_cat.html

Thanks, Karrie! I can open the link and have forwarded it to Barbara.

She has not had bloodwork done to check her kidneys (I don't know why the vet didn't automatically do this. My vet runs bloodwork at the drop of a hat!, but has had the sterile urine draw and culture.

Stella could not make it to the litter box because of her Neuropathy. She simply couldn't make it. She was leaving little puddles everywhere...especially on one particular rug. I never reprimanded her, because cats are extremely clean and I knew it was a health issue. Sure enough, when Stella started on Lantus she stopped having these 'accidents'. She now had the energy needed to get to the box.

On another note, cats generally don't like to share littler boxes, and you should have one for each cat in your household. You should also be scooping it daily. They don't want to step on their own waste, let alone the waste of another furry creature sharing the house. Pardon me if this is too 'basic' for the situation at hand, I am just throwing it out there. Good luck! ;-)

Thanks, Mary...any and all ideas are appreciated for sure!

Barbara does have 5 boxes for 4 cats, so she does seem to have that one covered. Reilly doesn't get reprimanded for going outside the box, either - fortunately Barbara knows very well how sensitive kitties are!

Edited to add: You MUST rule out medical problems first!!!

Here is a list I compiled previously. Some of the items may not apply.
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You might try an integrated approach using multiple options from the list below on a consistent basis:

* start with crating, using a medium large crate (30" long is big enough for cat and a litterbox) until progress. She probably won't go where she'd have to lie in it ... but if she does, something is wrong and it may be medical.

* tarps and newspapers may be easier on clean up if you don't crate her

* feeding on a schedule and then placing her in the litterbox (maybe in a crate) within 15-20 minutes after eating, until she goes, then praising and letting her out.

* Feliway/Comfort Zone - friendly facial pheromones which reduce stress and may reduce marking behavior. Cheapest prices are usually on the net (ex www.LambertVetSupply.com ) I've used it and it helps.

* Cat Attract litter - supposed to help attract cat to litter box

* rule out arthritis or constipation - pain causes box avoidance

* watch if the other cats ever attack her in the box and if so, you may need to keep her separated from them. I've got one the others attack, completely unprovoked.

* littebox should be 1.5 times length of cat, litter cleaned frequently, but avoid really strong smelling cleaners as cats may avoid them due to the scent.

* you've got to get residual odors out from areas which were 'nailed' - Nature's Miracle is one option and has good reviews. It _can_ require repeated applications.

* regular play sessions of about 15 minutes to reduce stress and promote bond with you

* reward desirable behaviors - if you see her use the box, praise and treat her

* put unpleasant textures in places she has peed to encourage avoidance

* read some of this author's books: http://www.catbehaviorassociates.com/ she's pretty good - ex "Starting from Scratch"

Good luck.

Thank you - forwarded everything on!

Dr. Lisa's website also has info on litterbox issues and there's a section on inappropriate elimination.

Thanks Sienne!

Hey Amy:

When she urinates outside the box, is she just urinating small amounts and going often and sometimes with blood in it? There is inappropriate urination where they urinate normal amounts but outside the box. If she's running to a lot of different places, straining to pee, only getting a small amount out, acting anxious, etc. then it's different. She may have idiopathic chronic cystitis. Gracie had this. Stress triggers it but there is usually an underlying cause. Sometimes cosequin or supplements like that will help; often times not. There is an FLUTD yahoo group.

She probably does need pain meds if she is having IC issues. Also, she can try Rescue Remedy for animals (no alcohol in it) and the Feliway is a good idea. For Grace, she had high levels of aluminum in her system. Once they started the detox, she never had another issue. But she had it from kittenhood and so your friend's kitty may have a different issue.

Karrie had a good idea BUT kidney infections sometimes will not show up with a c&s. An U/S is often the best way to diagnose it.

I hope your friend can sort it out. It's a very frustrating problem for the kitty and the caregiver.

but the vet doesn't "believe" in treating urinary issues with pain meds.

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That is too bad. Maybe if this vet ever personally experienced the pain of cystitis and understood the vicious cycle between pain => stress => cystitis, she would change her tune.

Please see the Urinary Tract Health page on my website that discusses the issue of sterile cystitis in detail - including the use of buprinex.

Also, my Litter Box page can be helpful if the person is not keeping the litter boxes clean enough. The ratio of boxes:cats is important but it has no bearing on the issue if they are not being kept VERY clean.

One other note - I would not ever crate a cat tat is suspected to have cystitis. All that will do is add to the patient's stress level.

Lisa dvm said:

One other note - I would not ever crate a cat tat is suspected to have cystitis. All that will do is add to the patient's stress level.

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I edited the post to reflect you MUST rule out medical problems first.

She's not straining, peeing small amounts, and there's no blood. It's full on urination with little "mews". Personally, I think she has IC issues and needs pain meds, just from the little bits I know and the lotta bits I've read. Hopefully Barbara will find another vet...this one is such a typical, run-of-the-mill vet who doesn't seem to treat the cats as "individuals". I'd love if she could go to my vet who is VERY thorough, but it's really too far for her. She's trying to find help for Reilly, but it does seem she's reached a dead end with this vet.

I believe she has tried with Feliway, with no luck but I'll mention the Rescue Remedy and Cosequin to her.

Do you think you can ask your vet of any other vets that may be closer to your friend?
Also, it may be worth your friend's travel to see your vet, even just once to get some decent help.

TrixieCat said:

She's not straining, peeing small amounts, and there's no blood. It's full on urination with little "mews".

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This sounds less like IC but the deal with pain meds in non-speaking critters that can't say "HEY!! I'm in pain!" is that it is a 'can't hurt/may help' issue.

It is also what I call a "diagnosis through the back door". IOW, if we see a favorable response to pain meds, the patient was most likely in pain.

Even as much as i hate putting chemicals into any living body, I am a firm believe in treating these patients with pain meds at least for a few days to a week. I see this as a very logical and SAFE part of a thorough work-up.

Is she going in the same spot all the time? I recently went through this with Calypso. She ended up having a chronic UTI with no symptoms-normal volume of urine, no whining, just inappropriate urination. Before her dx of UTI, I ended up placing a litterbox where she was going. (I ended up getting a big storage crate like Dr Lisa describes-she loves it!) She started using that litterbox and I would move it a foot every day or so until I had it in a better location. It's still in the general area where she was going on the carpet, but more in a corner since I have 2 dogs who love kitty snacks-I needed to find a happy balance of the litterbox where she wants it, but harder for the dogs to get to! She hasn't gone outside the box in over a month now, and was just dx last week with the UTI-still waiting for the culture results but she was started on Baytril in the meantime.
I'm planning on getting some of that cat attract stuff to put in the other litterbox since I'd rather have her go in another area where the dogs can't have any access (kitty door to the room), but will leave this box available as long as she uses it. Dr Lisa's website has great info on keeping it really clean. The litterbox is currently in the living room and no smell at all. Not the most attractive thing, but better than the smell in the carpet!