Cats are known for their meticulous cleanliness, which extends to their toileting habits. When changes in their behaviour such as peeing everywhere and meowing a lot occur, it can be a significant cause for concern. These unusual actions can be symptoms of underlying health issues, stress, or anxiety, and it’s crucial to understand the reasons and remedies. This article delves into the causes and solutions for such behaviour and offers insight into when it might be time to seek professional veterinary help.
Why is my cat peeing outside the litter box?
There are multiple reasons a cat may be peeing outside the litter box that typically have a medical or behavioural cause.
Medical causes
Pet owners may notice their cat is peeing small amounts of urine frequently, or a regular amount of urine frequently, often combined with increased thirst (polyuria/polydipsia). This can help the veterinarian narrow down an underlying cause.
Cystitis
Cystitis is characterised by inflammation or infection of the bladder, frequently contributing to lower urinary tract disease in cats. This condition can either lead to or develop as a result of urolithiasis, a term referring to stone formation within the urinary tract. The onset of cystitis can be sudden (acute) or it can persist over time (chronic), and it’s a usual suspect when a cat, especially a female one, begins to urinate often or in inappropriate places.
Due to the anatomical structure of female cats, which includes a shorter urethra, they are more susceptible to cystitis. This shorter urethra allows bacteria from the perineum, the area around the anus, to more easily travel up into the bladder.
Urinary tract infection
A urinary tract infection (UTI) happens when bacteria, or less commonly viruses, invade the urinary tract which is made up of two kidneys that filter the blood and produce urine by eliminating surplus water and waste materials. Additionally, it includes two ureters that carry urine from the kidneys to the bladder, the bladder itself that holds the urine until it’s expelled, and the urethra, which is the passageway for urine from the bladder to the outside.
Hyperthyroidism
Hyperthyroidism (FHT) is an endocrine (hormonal) disorder that is caused by the overactivity of the thyroid gland due to a benign tumour that speeds up your cat’s metabolism. This leads to a hyperdynamic cardiovascular state in which the heart beats faster which eventually causes congestive heart failure and secondary hypertrophic cardiomyopathy.
Urolithiasis (bladder or kidney stones)
Also known as uroliths or calculi, bladder or kidney stones are hardened accumulations found in the urinary bladder and kidneys. These stone-like formations result from high concentrations of specific minerals in the urine. The majority of uroliths are composed of struvite. Other types of stones can form from minerals like calcium oxalate, ammonium urate, calcium-ammonium-phosphate, urate, and cystine.
Kidney disease
Kidney disease occurs when the kidneys can no longer purify the blood as effectively as they are supposed to. This efficiency loss is often due to the damage or destruction of nephrons, the small filtering entities within the kidneys. As a result of this impairment, metabolic waste substances accumulate in the blood.
Chronic kidney disease is slow and progressive and occurs most often in middle-aged to senior cats. Acute kidney disease occurs quickly and is generally associated with a kidney insult due to toxicity or a urinary blockage.
Diabetes
Diabetes is a common disease where the cells build up a resistance to insulin, a hormone necessary for glucose to enter the cells, which leads to elevated blood sugar levels.
The islet cells in the pancreas produce the hormone insulin. When food is digested, it is broken down into various organic compounds in the small intestine, including glucose, which cells utilize for energy, growth, and repair. As glucose makes its way into the bloodstream, the pancreas releases an appropriate amount of insulin in response. This insulin functions like a key, opening up cells so that glucose can enter. When insulin reaches a cell, it prompts the cell to activate glucose transporters, which then draw the glucose into the cell through its wall.
If the body’s cells do not receive adequate glucose due to a lack of insulin or heightened resistance to it, they cannot operate correctly, given the shortage of energy derived from the glucose.
Arthritis
Osteoarthritis is a condition marked by the degeneration of joint structures and associated tissues. Cartilage is a smooth and slick substance that covers the bone ends in a joint, and serves as a cushion and shock absorber, facilitating the smooth gliding of bones over one another. When osteoarthritis takes hold, this protective layer deteriorates and wears off, revealing the underlying bones, which results in pain, inflammation, and rigidity. As the condition advances, the joint’s mobility may progressively decline.
Behavioural causes
Dementia
Also known as cognitive dysfunction syndrome, feline dementia is marked by a decrease in awareness, an increase in confusion, and a reduction in responsiveness. The pathology of CDS is not understood. In humans, it is thought to be caused by plaques forming on the brain or reduced or blocked blood flow to the brain due to damaged blood vessels and chronic free radical damage.
The acronym VISHDAAL is used to summarise classic signs of CDS in cats.
- Inappropriate Vocalisation
- Altered Social Interaction with household members
- Changes in Sleep
- House-soiling
- Spatial and temporal Disorientation (forgetting the location of the litter box)
- Changes in Activity
- Anxiety
- Learning and memory deficits
Stress or anxiety
Cats can experience stress for a number of reasons such as a new family member, or loss of a family member, household changes, changes to routine, or a new cat or dog in the area. Stress can manifest in a number of ways such as excessive grooming, hiding, uring outside the litter tray and crying.
Dirty litter box
Cats are fastidiously clean animals and many will refuse to use a dirty litter tray, choosing a ‘cleaner’ location to go to the toilet. Bear in mind that a cat’s nose is only inches away from the litter itself, which makes it an even more unpleasant experience.
Litter tray location
Equally as important is the location of the litter tray, if its in an area of the house that is too busy, or the opposite, too remote, the cat may choose his or her own location. Kittens and senior cats should have easy access to litter trays. Do not place litter trays next to food or water, nor should we expect a cat to navigate stairs to a basement. For kittens whose world is still very small, this may be too overwhelming, and senior cats may experience pain.
Inter-cat aggression
Not all cats get along and aggression between two household cats can lead to litter tray issues, particularly if one cat is bailing up another.
Does this mean something different in male and female cats?
While the symptoms of frequent urination and excessive vocalisation can indicate similar issues in both male and female cats, the interpretation and potential severity may differ based on sex due to differences in their anatomy and certain health predispositions.
Both male and female cats may display these symptoms due to urinary tract infections, bladder stones, or other bladder-related problems. Stress, behavioural issues, or conditions like hyperthyroidism can also cause these signs in both sexes.
Male cats are especially at risk for developing a urinary blockage or obstruction due to their narrower urethra, which is a life-threatening emergency. If a male cat is straining to urinate, crying in pain, and frequently visiting the litter box, it’s critical to seek immediate veterinary attention, as this could indicate a urinary blockage.
In female cats, the urethra is wider, making urethral blockages rare. However, females have a higher incidence of cystitis, which can also present as frequent urination and excessive meowing. Other possibilities in older females include endocrine disorders like diabetes or kidney disease.
Other symptoms to look for
Due to the wide range of possible causes of a cat peeing and crying, symptoms may vary depending on the underlying cause. Common urinary diseases cause the following symptoms:
- Increased urination
- Increased thirst
- Urinating outside the litter tray
- Blood in the urine
- Crying
- Genital licking
Is my cat in pain?
This depends on what is causing the cat to urinate outside the litter tray. A fully-blocked male cat that is unable to urinate will experience extreme pain. Osteoarthritis is a slow and progressive joint disease and cats will experience pain ranging from mild to severe. There is a strong probability that a cat who is urinating outside the litter box accompanied by crying is experiencing pain and discomfort.
Is frequent urination and meowing a reason to be worried?
Frequent urination and meowing can be a medical emergency, particularly in the male cat. If a full urinary blockage develops in the male cat an inability to pass urine causes a buildup of waste products and toxins that are usually expelled from the body through urination. This can cause a rapid decline in kidney function and potentially result in kidney failure, which is life-threatening.
Furthermore, the blockage can also cause an increase in pressure within the bladder, which can eventually lead to bladder rupture—a very painful and emergency condition. Moreover, the elevated pressure can lead to a backflow of urine to the kidneys, causing damage and infection.
In addition, the increased levels of potassium in the blood due to waste buildup can cause a severe imbalance in electrolytes, which can have a detrimental effect on heart function and may lead to life-threatening heart rhythm abnormalities.
Immediate veterinary care is essential when a urinary blockage is suspected, to remove the obstruction and initiate appropriate medical treatment.
When to see a veterinarian
All cats that are urinating outside the litter tray and crying should be seen by a veterinarian immediately. If possible, bring along a sample of urine for evaluation. The veterinarian will perform a complete physical examination and obtain a clinical history from you. This will include how long the cat has been urinating outside the litter tray, how is the cat eating and drinking, and how long have you noticed the symptoms.
During the examination, the veterinarian will feel the bladder, a painful, distended bladder, which is the most common finding in a blocked cat. Baseline tests will include a complete blood count, biochemical profile and urinalysis to evaluate organ function and check for electrolyte imbalances. These tests can help the veterinarian diagnose the underlying cause. Additional tests such as imaging studies may also be necessary.
Treatment
The treatment will depend on the underlying cause. Most cases of cats peeing outside the litter tray and crying are related to urinary tract disorders, especially in male cats. The treatment for urinary tract disorders includes intravenous fluids to help dilute the urine as well as correct electrolyte imbalances. Cats with urinary tract infections will receive a course of antibiotics.
Urinary blockage
Cats with urinary blockages will have a catheter inserted into the penis under general anesthesia to empty the bladder and will receive fluids to correct electrolyte imbalances. The catheter will remain in place for several days to allow the urethra to heal.
Uroliths
Alkalising diets or urinary acidifiers can dissolve struvite stones. It can take several weeks to several months for stones to dissolve. Diets are not always entirely successful, and it is not possible to dissolve all types of bladder stones with diet. Stones that cannot be dissolved will require surgery. Advantages are that it is 100% successful and will confirm the type of stone involved. The veterinarian makes an incision in the bladder and removes the stones with forceps.
Hyperthyroidism
Radioactive iodine therapy is the gold standard treatment for hyperthyroidism. Radioactive iodine targets the tumour while sparing the thyroid. Other options include a veterinary diet or medications. The latter two options will require lifelong treatment.
Diabetes
If dietary changes are unable to manage diabetes, the veterinarian will prescribe medications to lower blood glucose or insulin injections.
Osteoarthritis
There are a number of treatment options for arthritis, which include nonsteroidal anti-inflammatory drugs (NSAIDs)Â to treat inflammation, disease-modifying osteoarthritis drugs (DMOAD) to slow down its progression, nutriceuticals and prescription diets and in some cases, surgery.
Behavioural
For cats with behavioural issues, it is important to narrow down the trigger and address it by making changes to the home. In some cases, the cat can also benefit from anti-anxiety medications such as Clomicalm.
Steps you can take at home to help your cat
If your cat is urinating inappropriately and crying, it’s very important to seek immediate veterinary care, as these could be signs of a serious condition like a urinary blockage, which can be life-threatening.
- Provide adequate numbers of litter trays, as a rule, there should be one litter tray per cat, plus one extra. Remove solids twice a day and replace all litter once a week.
- Cats with arthritis can find it difficult to climb into and out of a litter tray. Look for trays with low sides to make it easier for the cat to climb into. If your home has multiple floors, ensure there is a litter tray on each level.
- Provide plenty of clean and fresh drinking water to encourage your cat to drink.
- If you have a cat prone to cystitis, urinary stones or urinary tract infections, speak to your veterinarian about switching to a wet diet. Dry food contains 10% water, and many cats won’t compensate for this by drinking more. This causes urine to be concentrated, which can exacerbate urinary tract diseases.
- Limit stress by minimising any changes to their routine or environment that could cause stress.
- Use Feliway diffusers around the home. These diffusers emit a synthetic pheromone that mimics the cat’s natural feel-good pheromones.
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