Help with elderly cat peeing outside litter box

April 18, 2023 11:27 AM

My 17 year old cat has been peeing outside the litter box on and off for a few months now. Multiple vet visits have mostly ruled out any obvious health issues. Nothing in her life has changed and she doesn't seem any more anxious than usual. I'm at a loss. Obviously YANMVeterinarian, but do you have any ideas or advice?

Last May she started peeing outside the box, was diagnosed and treated for a UTI, and the problem resolved (or so I thought). She started again in around December, I took her back to the vet, who did bloodwork and gave her antibiotics for a likely UTI. Antibiotics didn't help, so I took her back and they repeated her blood work and did a urine culture. No UTI, kidneys look good, and she is not diabetic. Her thyroid hormone (T4?) was borderline high, but the vet wasn't concerned about that.

Nothing in her life has changed - we haven't moved in over 10 years, litter boxes are in the same location, same type of litter, she eats the same food she always has. She does drink a lot of water. I do have another cat, but she has tolerated him for 12 years and nothing about their interactions have changed.

The litter boxes are located at the bottom of stairs, and she is peeing either on the stairs or right next to one of the boxes. Not every time, sometimes we get a break for a week or so, then it starts again. I put a box at the top of the stairs, thinking maybe arthritis was making stairs difficult, but she ignored it and kept peeing on the stairs. I blocked access to the stairs, trying to force her to use the box at the top of the stairs, and she peed about 8 feet away from it. The layout of our house makes it very difficult to confine her anywhere, but she has been confined to a room downstairs since the weekend, and is miserable being locked up but has been using the box just fine.

I'm not sure what to do? This is causing me a good bit of stress, and I don't want her to be in any pain. We are going to try solensia injections for arthritis, which she almost certainly has, but I'm not sure that's the cause of the problem? The next step would be some sort of anti anxiety drug but the vet says they don't always work.

Sorry this is so long. If this has happened to your cat, how did you deal with it? Can this be fixed, or is it likely going to be a problem for the rest of her life?

posted by Shal to Pets & Animals (10 answers total)

Once they start associating a place with peeing you've got a problem. They may be perfectly healthy but conditioning makes them want to pee there, and makes it easier for them to pee there than anywhere else.

When I had an elderly cat dying of kidney disease he started peeing on my bedroom floor; I started cleaning it up and didn't discourage him, because the alternative was him going to different spots all over the house which I might not find and which might result in the pee damaging the floor or whatever he peed on. That's the risk. If you discourage her from going in the same spot on the stairs she might instead take to doing it in your closet, or behind the stove or multiple different places. I cleaned that floor with enzymatic cleaner and strong cleaners multiple times a day and visitors all assure me that even close to the ground there is no smell.

The first thing I would do is look at the spot she is peeing and make it as piss resistant as possible so that when/if she pees there it's not as big a problem. You might find that puppy pads in the right location are the best solution.

Another thing you can try is a different box preferably with really low sides. There is a chance that she associates her box with pain and difficulty peeing, so a new box might take away that association. A really shallow box might help make her more relaxed (no sense of being trapped) and be easier to get in and out of, what with the arthritis. If you have to use a deep box, then a ramp level with the rim of the box so she doesn't have to step up and into it can help.

Cats prefer to pee in the centre of a clearing outside, or the centre of a room inside. Has she peed in the centre of the downstairs room/basement? Can you simply put a new box in that location?

Make sure you never harass her about peeing, as that will make her secretive about it. Something you really, really do not want. That way leads to discoveries that involve discovering weeks of cat pee saturating things that can't survive it.

Also try picking up half a dozen disposable cat boxes and putting them around the house in random locations. If she starts using one, simply keep replacing it. It may not be optimal, but having a box under the kitchen table or in the guest bedroom is better than refinishing the stairs. And actually stairs are good - because if you have to refinish them you can do only two steps and not have it show, unlike if you need to get only a small patch of badly discoloured floor and then try to make the refinished part match the rest of the room.
posted by Jane the Brown at 11:57 AM on April 18, 2023 [5 favorites]

I'm so sorry you're dealing with this, it's a very frustrating problem with elderly pets that can put you into a constant state of paranoia. Definitely been there.

My old boy got better with this when we put him on kitty prozac, fluoxetine. It didn't go away entirely, but he was nearing the end and had a bunch of other issues weighing him down. In your situation I would be willing to try the fluoxetine even if it may not take your girl to 100% litter box usage. I know how much any relief from a problem like this helps, mentally.

We started with 1/4 of a pill then went down to 1/8 (with a really great pill cutter), when his appetite was affected a tad too much. As long as you keep an eye on how she's behaving and you're okay waiting out a few weeks for meds to saturate her system, there isn't much to lose trying.
posted by It Was Capitalism All Along at 11:58 AM on April 18, 2023 [1 favorite]

Shal has it right - once they pee on a spot, they'll want to go there again and again, regardless of how many litterboxes are available nearby. Its smells like their spot, so they go.

We had a similar experience with one of our older cats a few years ago, since passed. She liked peeing on our bed (that was a great year). The only way to resist was three things: Obsessively clean the bed, but also cover the bed with plastic when we weren't in it, and stop her from coming in the room. I think you want to come up with a plan to limit your cat's exposure to that part of your home; get a professional cleaning of the places she's peed, and cover the spots she has peed with cleanable materials.

I'm skeptical it can be "fixed" at that age. But you can mitigate it, probably using some of the strategies you already are using, plus a little more.
posted by RajahKing at 12:15 PM on April 18, 2023

My aunt has an elderly cat (22 yo) who is peeing outside the box. Switching to ergonomic boxes with low lip entry did nothing to help. I suggested she just buy doggie pee pads and put them in his favorite pee spots and he's been dutifully peeing on the pee pads ever since. It's not ideal but the cat is so old she doesn't imagine she will have to deal with 2 pee pads on the floor for too long.
posted by MagnificentVacuum at 12:26 PM on April 18, 2023 [6 favorites]

I came to a similar detente with an elderly cat - a microfibre cloth in his favourite spot, which was thankfully tiled and easily cleanable, so I'd rinse the cloth in the sink, wipe the tiles with a disinfectant, and toss the wet cloth in a diaper pail, then replace it with the next clean cloth. They laundered fine with a bit of oxygen-based stain remover. Honestly not much fuss at all, and less expensive than pee pads, plus he seemed to enjoy digging into the cloth and folding it to his satisfaction. (Vet also recommended CBD oil, which improved his mood otherwise, but didn't change the toilet habits.)
posted by I claim sanctuary at 1:00 PM on April 18, 2023

The arthritis was my first thought as well - if the sides of the litter box are high, it could be causing joint pain to get in and out. So your elderly kitty may just be deciding not to do the part that hurts.

FWIW, my cat is currently on solensia and it has done wonders for his mobility.
posted by invincible summer at 2:42 PM on April 18, 2023 [2 favorites]

As my cat got older and his arthritis progressed, it became harder for him to step up over the side of his litter box. We eventually jury-rigged him a more ergonomic litterbox out of a big Rubbermaid tote, which we cut down to be very shallow on two sides. We also attached a couple of sturdy cardboard box-lids taped together to make a shallow ramp up into the litterbox. This helped for quite a while, as did the Cosequin joint health supplements my vet recommended.

Over time, his arthritis got worse, and the lower-sided box stopped working for him. At that point, we switched to large, shallow boot tray filled with about 1/4" of litter, and/or several pee pads spread out in the area he liked to pee. Going downstairs to pee also eventually became fully impossible for him as his age advanced and his condition worsened.

I'm sorry and your cat are going through this; I wish you both the best.
posted by ourobouros at 2:49 PM on April 18, 2023 [3 favorites]

Others have already given you lots of good general advice and things to try. When our old gal was between 18 and 21, she just became very vague about what she considered "in the box." "Near the box" worked for her about half the time. I started ordering disposable waterproof pads (what the EMTs call "chucks") in bulk from a sanitary supply store online. Had about 40 shipped to my house monthly, put one right in front of each litterbox, and swapped them out as needed. She seemed quite happy to pee on those. It was an absolute lifesaver, and they only cost about $24 a case.

These weren't pee pads designed for pets. Those are scented to encourage dogs to pee on them. We have dogs, so we didn't want that! These were medical, made for protecting beds and chairs. You can get all different sizes, in different size packages. Might be worth ordering a few to see if your kitty takes to them like ours did.
posted by helpthebear at 4:56 PM on April 18, 2023 [5 favorites]

This symptom was the beginning of the end for my 16yo cat :( They think it was a brain tumor (we got a referral to a neurologist but she declined rapidly before the appointment so we didn't bother with the MRI in the end).
posted by elizabot at 9:54 AM on April 19, 2023

Response by poster: Thanks so much everyone for your comments and suggestions. I'm going to try a few things - new litter boxes with easier access, liberal use of puppy pads (or medical grade pads, great idea!), a different enzymatic cleaner. The stairs and litter box area are the easiest surface in the house to clean (sealed concrete), so I would rather her pee there than on hardwood floors (or rugs, or couches, etc). Hopefully the solensia helps, but if not I may give the anxiety meds a try.
posted by Shal at 2:51 PM on April 19, 2023