Bladder problems in the cat: Spraying

Feline inappropriate urination.

 This phrase is usually used when referring to urination in an inappropriate location as in not using a litter tray, urinating in several different places or in or on objects as opposed to an inability to hold urine (incontinence) or frequent urination (frequency) or pain or difficulty with urination (dysuria). Inevitably there may be one or more of these factors involved as well as others. 

Bladder inflammation (Cystitis)

 The suffix ‘itis’ refers to inflammation. Inflammation may itself be due to trauma, infection or irritation or infiltration or structural changes within the bladder wall as well as referred discomfort from related structures.

 It may confuse the clinician when manifestations of such signs are more remote as in nerve changes or due to pelvic compressions either from past injuries or even as simple as constipation compressing the pelvic urethra.

 Cystitis is usually associated with frequency and the passing of small drops of urine with or without spots of blood or pinkness. The cause of cystitis may be simple infection. It may be infection secondary to irritating factors such as urine crystal formation or the presence of larger bladder stones.

 We also see interstitial cystitis which refers to changes within the bladder wall and the cause of that is still subject to opinion and controversy.

  Apart from those cases associated with other urogenital abnormalities and crystal formation (including flutd = feline lower urinary tract disorder) the condition referred to here as interstitial cystitis is histologically a plasmacytic/lymphocytic cystitis with ulceration. That means a change of cell type within the bladder wall structure associated in some cases with damage to the lining of the bladder.

 Contemporary suggestions of cause include excessive excretions of brain endorphins and stress triggers.  It is know than the excretion of some chemotherapy drugs may trigger cystitis and one might speculate that other irritant or allergic factors could be involved also

 Treatment of a pure interstitial cystitis may include antiinflammatory drugs or amitryptilline, pain relief or the use of glycosaminoglycan triggers such as glucosamine (Cystaid) or pentosan polysuphate sodium (Cartrophen). The validation of these therapies remains argumentative.

  Treatment of FLUTD may include dietary alterations, increased fluid intake, acidifying agents and antibiotics. Severe cases with urethral obstructions need emergency attention. FLUTD is discussed in more detail in a separate articleDespite the above, simple bacterial cystitis (more so in the female) appears to be a more common cause of inappropriate urination in volume than previously thought.

 Or, perhaps more correctly, there is only something approaching 2% of cats with FLUTD where infection is shown to be involved prior to therapy whereas it may be as high as 50% of cats with inappropriate urination that have urine bacteria.

 Within this subsection one should also consider reservoir infections higher up the urinary system. This is usually kidney disease although in the dog we recognise developmental remnants from the umbilical chord system at the free end of the bladder (so-called urachal remnant) as a possible harbour of infection or dilation (widening) of one or both ureters (the tube from kidney to bladder).

 Dilated ureters are usually secondary to some past obstruction or anatomically incorrect junction with the bladder. 

Territorial marking.

 Territorial marking behaviour is more common by male cats but any cat may feel the need to scent mark it's territory. Such behaviour is usually manifest by the cat 'backing up' to the target and spraying or shaking a few drops of urine at said target.

  Typically this is 'vertical' marking (walls, table legs, televisions) and typically the targets are revisited at regular intervals. Vetical marking may change to horizontal marking if it is difficult to cat to adopt the right posture; either due to changes in domestic arrangements or perhaps patient disability.

 The approach to treatment includes trying to deal with the cause of territorialism. So where cats are entering the house then the use of magnetic cat flaps may be useful. It is obviously difficult to prevent other cats from coming near your house or entering gardens although some rare individuals have used ingenious devices to try and scare strange cats away. There remains the risk that such devices may also affect your own cat.

  Restricted access to areas affected until all scents have dissipated and the use of biological agents to break down urine odours (commercial preps or biological washing powder) can help.

 The uses of masking odours (vinegar neutralises urine smells) or substances to put cats off the area are valid. Citrus oils or spirit soaked rags may work for this purpose. Synthetic chin pheromone (Feliway) used according to the manufacturers instructions may reduce this social pressure and behaviour. There is an argument that using a damp rag and wiping your cat’s chin and transferring it’s own chin pheromones may work as well or better than the synthetic form. 

Avoidance behaviour

 Avoidance behaviour refers to those cats that are unhappy about the location or type of their current litter facilities. Like you, cats do like some privacy before they 'perform'.

 Never locate litter trays in cat 'pathways' i.e through routes (which may not be the same as human traffic-ways) or near outside doors or windows. Your cat will not appreciate having to keep an eye out for trespassers and strangers while urinating. Select one or more discrete or screened off areas for cat pans in handy quiet corners. Consider covered litter trays for further discretion and consider providing a selection of trays and litters for those that prefer another type of litter. Garden soil may contain attractive soil micro organisms that cat can scent. (a bit like your choice between hard or soft toilet paper).

 Also remember that your cat doesn't want to use a dirty toilet either! Empty pans regularly. Again cats with disabilities may find high-sided litter trays difficult to enter. Often small litter trays will lead to cat standing in the tray but urinating over the edge. 

Caught short.

  This refers to cats that have been 'caught short' and suddenly needed to toilet at some time. Having done so for whatever initial reason there is now a new scented area of past cat urination to attract the cat back. Treatment is thorough cleaning, deodorisation and shutting the cat away from this area until the memory has faded.

 Apart from the previously mentioned spirit soaked rags and citrus oils another novel method is to mask off areas with baking foil. Cats may not like the noise of urine striking metal and certainly will avoid walking on crinkly material. This is particularly suitable for corners of rooms of behind heavy furniture. 

Confusion.

  This subset of causes includes those cats that are toxic, old, senile, confused etc. It includes older cats with classic diseases such as hyperthyroidism and high blood pressure and any toxin or disease that can affect mentation. Obviously treatment requires attention to the underlying disease process first. 

Multi-cat territorial situations.  

This is perhaps the most complicated case scenario. Firstly all the above conditions need to be ruled out before assuming this state. If and only if that is the case then there is a possibility of adjusting the hierarchy of the cat household. Observation and record keeping might imply imbalances in the social structure.

 Realistically owners will tend to make assumptions about this so they should be encouraged to keep a diary and discuss events that may or may not suggest 'jealousy', 'fear' or 'phobia'. Cats are less amenable to human interference with social structure than dogs.

 Obviously neutering may make a difference to the balance as indeed may positive and negative support from the owners. It can be difficult to decide which cat or cats are involved or responsible for such marking.

 One novel suggestion has been to feed one cat at a time on a fluorescent dye and then use an ultraviolet light to see of the culprits urine fluoresces. The method is supposedly to feed the target patient with 2 or 3 ‘flourets’ dosed in an empty capsule. I have no experience of trying this.

 Several drugs have been used to control inappropriate urination behaviour as psychoactive substances; Prozac, buspar, amitryptilline and chlorpropramine are the most common of these. Amitryptilline probably works best when the condition has actually been misdiagnosed and is in reality a sub-set of stress-related cytstitis or interstitial cystitis. Megoestrol acetate (Ovarid, Ovaban) has also been used historically and may work because of its conversion to anti-inflammatory properties as much as it may affect sexual hierarchy and dominance. 

Whenever a psychoactive therapy is instituted owners should be aware that it may take several weeks to 'kick-in' and should be used in conjunction with behavioural modification.

  Unhappiness does seem to play a part in inappropriate urination. For some cats this can only be resolved by being in a single cat household and may initially manifest when major domestic changes occur.

  Comments and additions or corrections to the above are always welcome.

  Peter G Knapp MRCVS