Litter Box Laments

One of the most common problems people experience with their feline companions relates to use of the litter box. Or more specifically, non-use of the litter box! Many people automatically assume that urination or defecation outside the designated litter box indicates a spiteful behavior change in their cat. On the contrary, many toileting problems in cats stem from medical conditions. In fact, the only way to prove litter box avoidance is a behavioral problem is to rule out systemic disease.

Posture of a cat straining to urinate,
a medical condition requiring
urgent attention.

Today's blog is not about litter box avoidance due to urinary tract infections, bladder inflammation caused by crystals or stones, irritable bowel syndrome, or systemic disease (such as kidney failure or diabetes). These often treatable conditions are diagnosed by urine, stool or blood tests and imaging studies (e.g., "x-rays," ultrasound) and should always be considered if a previously well-trained feline starts "having accidents" around the house.

So what if your cat truly has a behavioral condition that causes him to abandon the litter box? Cats are fastidious creatures. If something about their litter box is not to their liking they may simply stop using it. My clients often protest that they "haven't changed a thing about the litter box yet suddenly their adult cat won't use it!" A veterinarian professor of mine put it like this: a toddler in toilet-training has no qualms about dropping her pants on the side of the road to use her potty chair when the urge hits, but a teenager wouldn't dream of it! Likewise many cats will tolerate less than ideal litter box setups for years before one day demonstrating that "enough is enough" by peeing or pooping in a preferred location.

Unfortunately what seems like a great litter box set up to the pet owner may be repugnant to the kitty. Consider the following:

Hiding a litter box in a planter seems like a good idea to a
person but breaks Cat Rule Number 1.

1. Your Personal "Porta-Potty." Would you really accept a "Porta-Potty" as a replacement for your home's spacious bathroom complete with ventilation fan? A covered litter box is the equivalent of a public portable toilet. Your meager human sense of smell recoils at the ammonia odor trapped inside. Just imagine how your feline's exceptional sniffer responds!

2. Grand Central Station. For some reason whenever I think about overflowing litter boxes I recall Weird Al Yankovic singing about cleaning "all the bathrooms in Grand Central Station with [his] tongue" in his anti-love song "One More Minute". I'll bet some of you have backed out of a filthy public restroom with a full bladder. I've even met people who won't use an otherwise clean but unflushed public toilet! Is it any wonder then that your cat would rather urinate on a rug than in a litter box that has old waste in it? Litter box waste should be scooped at least daily. The entire box may need to be emptied, cleaned and refilled every one to two weeks.

3. A Very Brady Bathroom. Imagine six kids sharing one bathroom. The inherent conflict is the stuff of which classic Hollywood sitcoms are made! Why then do we think six cats should be forced to share one litter box -- even uncovered and kept immaculately clean? The rule of thumb for litter boxes is "one litter box per cat plus one." Therefore, if you have two cats you should have three litter boxes. And if you're doing the math that means a single cat household should have two litter boxes! To reduce potential inter-cat drama these multiple litter boxes should not be lined up in a row like stalls in a high school lavatory. Also, try to place the boxes on different levels of the home. After all, how would you like to trek from your upstairs bedroom to the basement bathroom in the middle of the night?

Admit it. The basement can be a scary place.
Even for cats -- especially if their only bathroom
is right next to a hissing water heater.

4. Location, location, location. Toilets do not belong in the kitchen. Avoid placing your cat's litter box right next to where you feed him or where he sleeps. (A possible exception to this rule is for the cat who is being nursed through a weakening illness or post-surgical recovery.) A popular spot for the litter box is the basement or mechanical room.  All it takes is the sudden whoosh, whir, or clunk of a furnace, washing machine or other appliance to scare the bejeezus out of a cat settling down to business, and there you have it -- a future litter box avoider.

5. More on the Super Sniffer. Pysch's Burton Guster is not the only one with an exceptional sense of smell. Scent-sensitive people abound. I've had clients whose pet's file was flagged with the note "Remove air fresheners from room prior to appointment! Allergic!" The average cat's sense of smell is said to be about 14 times as strong as the average human's. The "extra fresh" odor controlling kitty litter that appeals to you may knock the socks off your cat. Research shows that most cats prefer soft, sandy litter with no added smells. In fact, any change in litter away from what your cat prefers can cause litter box avoidance. You can skip plastic pan liners (most cats hate them) but make sure you keep 1 to 1-1/2 inches of litter in the box (more is not better here).

6. It's a Cat Thing. When we put ourselves in our cat's "shoes" it is easy to see how the cleanliness and location of litter box can positively or negatively affect his willingness to use it. But some litter box problems stem from feline feelings with which it is hard to identify. For example, most of us do not urinate on objects to claim ownership of them. Nor do we tend to urinate in odd places just to get someone's attention. Territorial scent marking, especially by intact male and female cats, can flare up with the introduction of a new pet, with changes within an established feline family's social structure, or even with the visitation of an outdoor stray merely seen, heard or smelled outside the window! Some cats reportedly urinate or defecate outside the box while staring pointedly at their person as if to say, "Hey, there is something wrong here. Get me some help." It's hard not to get mad, but take a second and listen to your cat when this happens. Then call your veterinarian on his behalf.

An entertaining and enlightening resource for additional litter box management tips is The Fastidious Feline: How to Prevent and Treat Litter Box Problems by Patricia B. McConnell, Ph.D.

Your Pet Pooped on the Floor: Why Your Vet Can't Assume It's Behavioral

Here's the scenario. A family adopts two "teenaged" spayed female cats from the shelter. These two teeny boppers are welcomed into the household by the older neutered male cat and the family's dog. The introduction appears seamless. The new kitties cuddle with the labrador and cavort with the cat. But someone has pooped on the couch! And the rug! The owners know it's one of the cats but which one? Is it Mister, latently unhappy about sharing his digs? Is it one of the new kitties, unsure of her surroundings or just reveling in her new freedom to go where she pleases? The poops are pretty normal looking, so it seems like a behavioral issue.


As the family's veterinarian, my first response is "we gotta get a stool sample and run some tests." The only way to diagnose a behavioral toileting problem is to rule out medical causes first.  


"But how will we know whose poop is whose?"

Sometimes that matters and sometimes it doesn't. I like to run the fecal tests on the aberrant stool...one that's softer or yuckier than most or the one that's been deposited where it doesn't belong. The owner of the stool-- when we're talking cats--usually doesn't matter if the problem is infectious or parasitic. Because cats generally share litter boxes we assume that if one of them has worms (for example) they all have worms and all need to be treated accordingly.

Before long I was in possession a fresh sample from one of the new kitties. When evaluating a stool sample for abnormalities, the first test is simple observation. Yes, it's gross, but what does it look like? How does it smell? Sometimes we'll probe the sample with a be-gloved hand checking for foreign material or worms, but 3 out of 5 senses is as far as it goes! This sample happened to be soft but formed with a portion being slightly runny. 

In my veterinary practice a complete fecal test includes a smear, a float and a Giardia "snap" test. These in-house tests identify the most common causes of inappropriate defecation and outright diarrhea.

The fecal float is the test most well known. This checks for parasites such as worms and Coccidia. Coccidia are a species-specific protozoa that commonly affect young or immune-suppressed pets. As for worms, most animals with light worm loads do NOT have worms visible in their stool, so please don't get a false sense of security that your pet is worm-free just because you see no worms! The fecal float helps us identify intestinal worm infestations by showing those worms' eggs. If the worms inside the pet are not reproductively mature or simply not shedding eggs on a particular day, this test may be falsely negative for worms.

The fecal smear helps identify a bacterial overgrowth of the intestines. Every normal gut has a mixture of beneficial bacteria that help digest the food and provide essential nutrients. A wide variety of internal or external factors can destroy this delicate balance and cause abdominal discomfort and/or diarrhea. Luckily most abnormal findings on the fecal smear are not contagious to other pets and people.

Meet Giardia

The final part of the complete fecal test a Giardia "snap" test. This is a highly accurate test to identify active Giardia infections. Giardia is a contagious and zoonotic (i.e., affects people) protozoal parasite that is  common in the environment. The parasite unfortunately also rears its ugly head in shelters and breeding facilities from time to time.

Lo and behold, while the first two tests showed no significant abnormalities, the kitty's Giardia test was an obvious positive. Wow! Even though the kitty's stools have appeared pretty normal, she has an infectious and contagious medical condition. This is the most likely explanation for poop on the couch and rug, NOT a behavioral quirk. 


The good news is this kitty has a treatable medical condition rather than a behavioral problem. The bad news is all the dogs and cats in the house need treatment because of their close quarters. Shed in the feces, Giardia cysts (i.e., eggs) can remain viable in the yard, litter box, bedding and pets' fur and cause re-infection, so a thorough environmental scouring is necessary. The pets were bathed, their bedding and litter boxes washed, and the yard picked up. Each pet is currently undergoing treatment for Giardia to be on the safe side. The owners have been warned to practice good hygiene when handling the animals and to contact their physician for further advice regarding the zoonotic nature of this parasite.


It is said time and again in veterinary school, "You miss more by not looking than by not knowing." Even though the stool appeared normal and there were plenty of possible explanations for the couch poop, we discovered an important medical problem with our thorough test. Thank goodness we checked! And I'm sure the owners will feel the same way after they've completed a hellish week of medicating three feisty felines!