Urinating out of the box; why does my cat do that?

I went to a seminar on Pearl Harbor Day 12/7/11. The topic of this seminar was Feline Medicine. It was put on by the Michigan Veterinary Medical Association.  The speaker was Renee Rucinsky, DVM, Diplomate ABVP (Feline). The sequencing of letters following her name are, DVM (Doctor of Veterinary Medicine): Diplomate of American Board of Veterinary Practitioners with a specialty in Feline Medicine.  She is a rare presenter she likes Veterinary Medicine, surgery if needed and has a keen sense of humor.  She was the chair of the committee which developed the Diabetes guidelines put out by the American Animal Hospital Association.

One of the questions asked was about urine elimination problems.  Some cats tink outside the box. She responded "because it's a cat."  People think all veterinarians have all the answers about animals. The truth is we do not.  After years of study we can detect patterns of a series of cats in response to certain circumstances and get a feel as to how most will react. DVMs and very astute owners are able to start thinking as a cat. Does this mean we under stand cats completely? Heck no!  It is most likely the cat has developed "litter box / litter aversion" due to uncomfortable urination or being mugged by another cat when entering or exiting the litter area. Or the doorbell rang once before and my favorite is "because it's a cat".

Simple things like "that giant spider was not there twenty seconds ago" can cause absolute panic in some cats. Other cats are overjoyed because "I have a new toy to play with". It is important to understand all cats are not alike, not even in the dark. 

The primary cat that gets FLUTD is usually a young neutered male.  Once you think you   know a disease they come up with another acronym for everybody to learn.  FLUTD is feline lower urinary tract disease. It has been around since Hector was a pup.  It used to be known as "sand," crystal urethra, caused by excessive "ash" and or magnesium in the diet. It would be urolithiasis (sand) in the urethra and or uroliths in the bladder.  It is also known as a "blocked tom cat". The incidence of FLUTD is much greater in males (neutered or not) than in females (queens).  The discomfort and pain is just as severe in both genders. The bladder gets distended maximally and the kidneys keep pumping out more urine.  This is what is expected normally. Have you ever been on a car trip and you drank more water / fluids than you estimated the time and distance to the next rest area. You finally see that blue sign stating the distance to the next rest area. As you get there you find all of the stalls are broken. You have just felt close to what these cats feel like.
Obstructive urinary disease is painful, scary and expensive to treat.  Some cats will develop a lethal level of elevated potassium. Excessive potassium does bad things to the heart. It irritates cardiac tissue, messes with the electrical impulse and will even cause the cardiac muscle to stop.  Other problems are the urea levels in the blood system are super elevated with BUN and creatinine going up to dangerous levels.  This is not a disease to be treated with wishes and pixie dust.  Anesthesia, anti-inflammatory drugs and an unblocked urethra with IV fluids going in and a catheter connected to a collection system and pain abating medications are needed to treat this disorder.  There may be repeated episodes. This may result in need for corrective surgery called a penile urethrostomy.  This is a surgical procedure designed to maximize the exit and allow urine to be voided with out developing uremia, life threatening and a client with tears in their eyes.

There is also a behavioral issue as some of the young males do not have their bubble meet the required diameter of cats without this problem.  A very small percentage of cats may have anatomical issues (urachal diverticulum / cyst) and this will act much the same as an inflamed urinary bladder.

When there is a flare up the focus is on treating the current situation. Once the condition is back to normal the cat has gone home and looking for nourishment we can focus on controlling the triggers that can cause FLUTD.  FLUTD is a whole cat problem not just a Bladder problem. How and what is being fed (canned or kibble). How obese is this cat.  Yes weight is a major contributor. Was the cat a bottle baby? They never seem to complete maturity and continue to be a "needy" cat. What is the "atmosphere" in the house? Increased tension such as a "divorce" will cause tempers and voices to increase. Cats are perceptive and feel the "vibrations" between people and internalize them. . Where is the cat eliminating in the house? Near the box, by the litter box, by the front door, in the bath tub, in sink, on clothes, plastic items are also targeted by cats with this disorder.

Diet by getting a cat to eat canned food is important for two major goals. One goal is by increasing fluid intake and out put of urine. This lowers the specific gravity of urine by generating more dilute urine.  This also allows the urine pH to be in the target range of 6.25 to 6.50.  If a cat will not eat canned food we may need to float the food in water or as I say "bobbing for biscuits".  The second goal of canned food is it will meet caloric requirements to maintain appropriate lean body muscle mass. It also makes for a skinnier more active cat.

Some cats need chemical help to complete the tethered trip back to litter box social graces.  Some cats need to be divorced and or rehoused. A different environment may be what is needed. Some choices are not what an owner wants to hear. The cat may also need time outside to get it together. It just depends on the cat.

Couch cats are prone to FLUTD, diabetes, feline lipidosis and diseases that are better not having to be treated. It is better for the owner and cat. They will maintain a longer healthier relationship.  We take care of them "because it's a cat".

 For more information about a specific case, consult your veterinarian.
The outside of a pet is good for the inside of a human.