By Dr. Neelam*
Every cat owner dreads seeing puddles of urine or patches of faeces around the house, on the rug or on any other undesirable location. These events can even lead to a change of relationship between the cat and the parent, and can be a major reason for the outdoor banishment and relinquishment of cats to shelters. PERIURIA (urinating around) and PERICHEZIA (defecating around) are the two components of house soiling. The cat parent and the veterinarian must work synergistically towards a proper diagnosis of the underlying issue i.e. medical or behavioural and make a targeted treatment plan. The diagnosis of Perichezia is simple and most of the owners are not bothered about it given the ease of clearing up. So, this article focuses on the Periurial aspect of house soiling, which is in itself a detective’s job for both the parent and the treating veterinarian.
A case with Periuria has two main reasons broadly: MEDICAL OR BEHAVIOURAL
MEDICAL-The veterinarian firstly reviews it from medical origin point wherein physical examination and relevant diagnostics like blood tests, urinalysis and imaging will be performed.
BEHAVIOURAL- This aspect has two broad categories, one being MARKING (spraying) mainly used as the elimination for communication purpose and the other being TOILETING (littering) which is basically an aversion or preference for a particular site, meaning they don’t like the site or the equipment provided or they prefer the other location more.
If the owner is lucky enough to catch the cat in the act of urine elimination or the location of urine deposition, then it can be a bit useful in determining the probable cause. For example if there is Vertical deposition of urine like on curtains , sofa arms then the reason could either be medical or marking(communication) and if there is horizontal deposition(squatting on flat surfaces) then the reason could be medical or Toileting(Aversion/Preference).The medical health, physical and social environment are interrelated to an extent that any one character which is not up to the desirable level, can impact the others too.
- MEDICAL ASPECT
Around 40% of the cats reported with periuria (vertical or Horizontal) have underlying medical issues like Renal insufficiency, Urolithiasis or Feline Idiopathic Cystitis (FIC). Age of the cat also gives a little hint towards the probable medical cause of the problem as there are more chances of particular conditions in certain age categories-
- < 1year – Urolithiasis, anatomical abnormalities
- 1-7 years – FIC, Urolithiasis
- >8 years- Bacterial infections, Renal Failure, Metabolic disease, Osteoarthritis, Neoplasm, cognitive dysfunction/ senility, neurological and sensory impairment especially in relation to smell and vision, weakness.
Feline Lower Urinary Tract Disease (FLUTD)includes abnormalities in the structure and function of the bladder and the urethra. In Lower Urinary Tract Disease, the rate of incidence noticed in practice and as reported by researchers are as follows: FIC(55%), Urethral plug(16%), UTI and behavioural (15%), stones(14%), making FIC a clear winner as a major cause for Periuria. FIC is a sterile inflammation of bladder and owing to its unknown aetiology, it is termedidiopathic. Since the other LUTD reasons of Periuria are fairly straight forward in the diagnosis, so we will focus on the various aspects of FIC here.
The most common signs of FLUTD/ FIC include:
- Dysuria/ Stranguria-Difficult or painful urination
- Pollakiuria-Increased frequency of urination
- Haematuria-Blood in the urine
- Periuria– Urinating outside the litter box
- Overgroomingespecially frequent licking of the genital region.
- Stress is a major contributing factor of FIC. So, the intervention for FIC would ideally involve all the three possible factors-medical health, physical environment, and social environment.
Diagnosis:Physical examination, blood test, urinalysis, and Imaging (radiograph and ultrasound) are necessary to confirm the diagnosis and the preference of the tests would change according to the various factors considered in the process like the age of the cat etc.
Management: The environmental needs (physical and social) areparticularly important for the optimum well-being of a cat. Cats often do not express overt signs of stress and anxiety, but stress management is of prime importance. Even stoic cats can have elevated levels of stress hormones. Thepsychosocial stress is related to chronic stress in cats. The 5 pillars of a healthy feline environment are-
- Provide a safe place
- Provide multiple and separated key environmental resources: food, water, toileting areas, scratching areas, play areas, elevated perches and resting or sleep areas.
- Provide opportunity for play and predator behaviour by providing feeding devices and practices that require the cat to actively acquire food.
- Provide positive, consistent, and predictable human-cat social interaction
- Provide an environment that respects the importance of the cat’s sense of smell
Therapeutic nutrition also is a particularly important factor in the treatment of FIC. Certain nutrients like L-Tryptophan and Alpha-casozepine increase brain serotonin which improves the coping ability and decrease anxiety in stressed cats. Omega 3 fatty acids and antioxidants also reduce the incidence of FIC drastically. These components are added in certain commercial foods specially formulated for urinary care in cats. Canned wet foods also help in the reduction of recurrence rates of FIC indicating either the increase in moisture content of these foods lead to the dilution of urine resulting in the clinical improvement of FIC or the positive frequent feeding interaction with wet food could have helped in the resolution. Make sure to provide water to them in a way they like.
Synthetic pheromone diffusers also help in cats with episodes of FIC.
- BEHAVIOURAL ASPECT-
MARKING –Marking is a communication problem. This is a sophisticated interpersonal communication. By urine marking, a cat tells other cats of his presence and makes a statement about his territory or for mating. Cat to cat conflict is one of the most common reason for urine marking and it is usually anxiety based rather than intolerance based. Marking can be triggered by genetic predisposition, excitement and/or stress, not being neutered, being in oestrus, being male, inappropriate attempts at punishment, specific inter-cat situations( such as aggressive encounters, territorial disputes or simply the sight or noise of an outdoor cat), novel scent on house objects, perturbation of familiar marking and certain specific environmental changes such as new furniture.
- The medical management of Marking Behaviour would include Psychotropic medication, therapeutic nutrition, synthetic pheromonesor gonadectomy.
- The Physical environment should be enhanced by making plenty of cat friendly resources available as mentioned earlier.
- The social management would include controlling stressors, reduce arousal, Desensitisation and Counter conditioning therapy
TOILETING (LITTERING)-This is an aversion or preference for a site. A few risk factors or triggers have been attributed to this behaviour like the quality of litter(personal preference, depth of litter, granule size, new litter, fragrance, reduced cleaning regime) or litter box( covered vs uncovered, location , quantity, size, style).
Management:The management would involve the improvement of litter box in terms of optimum size and numbers , litter material preferences of the cats, resource accessibility and location in the house, litter cleaning frequency and the type of cleaners used for them, prevent unsupervised access to the new undesired location, making the soiled areas less appealing .The human cat interaction time should be increased.
Multi Modal Environmental Modification (MEMO) is a promising adjunctive therapy for indoor housed cats in reducing the chances of Periuria.
In conclusion, establishing an early diagnosis and integrated treatment plan goes a long way in treating periuria and ultimately preserving the human-animal bond.
*The author is a small animal practitioner in Gurgaon with a career spanning 23 years. She specializes in Internal Medicine and Dermatology.