Litter box issues – a vet’s examination

Today’s guest is Dr. Jessica Vogelsang, aka Dr. V., aka vet blogger extraordinaire at

litter box issues

Having litter box issues? Here, Dr. V. gives us a snapshot of the medical evaluation you can expect if you take your sweet kitty into the vet because he or she is “peeing outside the litter box.”

I can’t say this enough: if your cat starts peeing or pooping where he shouldn’t, always take him to the vet to rule out any medical issues.

And now….I give you Dr. V.!

Few words strike terror into my heart as much as, “My cat is peeing all over the place.” I admit when a client says this, my first response is a big sympathetic sigh. It’s one of the most frustrating issues we deal with in veterinary medicine, not necessarily because of the medical complexities, but because figuring out what the heck is going on is a process.

So why does your vet insist on doing an examination and testing before agreeing with you that your cat has a behavioral problem? I am the first to agree that yes, many times, this is a behavioral issue.

That being said, there is only one way to know for sure: by eliminating medical causes of inappropriate elimination first. We would have failed you as a doctor if we simply gave you ideas for litter box preference tests while ignoring the early signs of diabetes, for example.

When a client presents a cat to me for an inappropriate elimination workup, here is my own process that works for me:

1. Spend time talking to you to figure out clues to help us narrow down the cause. Is the cat using the box at all? Just for urinating? Just for defecating? How long has this been going on? How many litter boxes do you have? There are at least 20 questions I ask to help get a picture of the problem. This is not a 15 minute visit.

2. Perform a full physical examination. Are there clues pointing to a medical condition, such as dehydration, a painful belly, a heart murmur, or weight loss? Cats that don’t feel well, for almost any reason, can manifest this as a behavioral change.

3. Testing. If the cat hasn’t had bloodwork in the last few months, it’s always a good idea. A basic bloodwork panel can pinpoint infections, diabetes, renal failure, and hyperthyroidism. A urinalysis is always indicated as well to rule out urinary tract infections, FLUTD, and crystals in the urine.

4. If everything comes back clear and the signs point to a behavioral issue such as marking or litter box aversion, we move forward with behavioral modifications and sometimes medication.

That’s a pretty basic framework, and obviously the approach is tailored to each individual, but it’s necessary to be thorough. It’s a pain, yes, and cats aren’t too thrilled with the sample collection, but if you as owners commit to following through with a systematic process, we can often help with the problem quite a bit.

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  1. Great post! It’s so important to rule-out possible medical causes of inappropriate elimination. Another source I often use/refer people to is Dr. Sophia Yin’s website. Here’s one of her articles about medical reasons for pooping outside of the litterbox:

  2. Our new cat “Tigger” seems to pee at the side the litter box. Most of the time it is inside where it should be, but sometimes at least once a day, she misses and some gets on the paper at the side of the litter box. She started pooping in the box, but then she started going in the bathtub, in the bathroom where we have her litterbox and her food dishes. When we brought her in from the outside, we took her to the vet for an exam and shots and that was two months and a half ago. At first, we shut her in the bathroom at night, and then let her out during the day, (for about two weeks) and she stayed pretty much in the family room which is near the bathroom where she has her litterbox. We have 4 other cats, and one of them is a male cat, and very dominate. We find that Tigger is also dominate to a degree, that either its from her being an only cat or she has been on her own for awhile. She came by one day during our feeding of feral cats in the backyard and we noticed how friendly she was. We liked her right away and thought of finding her a good home. So she continued to come by and we continued to feed her and try to find a home for her. She always wanted to come into the house, but of course we couldn’t let her because we didn’t know if she had shots and there was the possibility of having diseases. She didn’t appear to be sick at all. So when we thought we had someone who would agree to take her, we brought her in and made a place for her in our garage because it had started to turn cold outside. It was warmer for her and she liked it but still wanted to be where we were, and she knew there were other cats around inside the house. So, the person was going to come by to get her, but they never showed. I called her and had to leave a message, but she never called us back. So we took that to mean she was no longer interested. Since we had come this far with Tigger, we decided to keep her and take her to the vets and have her go through the routine tests and if okay proceed with the necessary shots so we could bring her inside the house to meet the other cats and hopefully become part of our cat family. The only problem so far is Sunny, our dominate cat, has tusseled with her and when the opportunity arises, they stare at each other. The others peek at her from around the corners of our kitchen and livingroom but they never chase her, but on occaision she has chased them. Sunny will come in the area where she is at, and will almost stalk her. She used to go near where my husband sets in his recliner, to feel protected, but now she growls and advances toward Sunny wherever he comes near her area. This has been happening for the past week or so, and we have just been hoping it will get better, as we have heard sometimes its difficult when introducing a new cat to the cat family. She acts like she would like to be friends with the other cats, but Sunny seems to prevent that, and she hisses at him and the others. She will go into the living room (where the other cats generally are) carefully to look around especially if she doesn’t see any other cats in sight, until Sunny sneaks from behind the couch or a chair and attacks her….she does not normally back down, but lately, I have noticed a couple of times when he has come into her area, she kind of acts humble and does a low slow walk over to where my husband is setting in his chair, and we tell Sunny to stop and be nice to her, and then she comes up and starts growing and hissing not far away from him, as if to say “get out of my area or I will attack you” I just don’t know what to think and I wonder if she is so stressed that would cause her to not go in the litter box. This morning when I was going around cleaning them I noticed she had done both in the box, and didn’t miss the box! (we have two boxes on the other end of the house where the 4 other cats primarily stay, and three boxes on the side of the house where the bathroom is that her box is located.) Sunny from time to time will go in her box, if he gets the chance and will use any of the other boxes in the other two bedrooms (which were the ones that Sunny and the other three cats used before we took Tigger in the house) I have also seen Tigger use one or two of these boxes. Should I take the box (that we consider hers) and put it in the bedroom with the others or what. If we both go away, we always put Tigger in the bathroom (where her litter box is now and where her food dishes are) but this hasn’t happened much, because I usually am the one that does the grocery shopping and errands, and my husband stays home by choice. So, can you hopefully tell me what I may be doing wrong in trying to get Tigger to be friends with the others, am I not scolding Sunny enough….I am very frustrated and I would like them to be friends with one another.

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