There’s nothing more frustrating for a cat owner than a cat that urinates inappropriately all over the house.

The corollary: There’s nothing more frustrating for a veterinarian than dealing with a exasperated client who wants nothing less than a cure for this complicated, potentially cure-less problem.

This week was typical. I saw three cases of inappropriate elimination in cats. The saddest? The one I signed a health certificate for. She’s on her way to another home in Iowa. Her parents could no longer cope with her behavior.

These parents were not treading on this path lightly. They had agonized for months after careful and repeated testing had failed to find a medical reason for this kitty’s unwillingness or inability to contain her urine. An all-too common outcome for these cases ends with the dreaded words a client never wants to hear: behavioral inappropriate elimination.

It may sound like a euphemism but inappropriate elimination is a descriptive term that takes into consideration so-called fecal and urinary incontinence. In cats, however, true incontinence is rare. Deliberate urination and defecation are far more common. But to say a cat eliminates deliberately doesn’t always mean it’s simply a behavior she’s exhibiting, pure and simple. There may be medical reasons as well:

The most common non-medical reasons for inappropriate elimination:

• Litterbox aversion: Is it clean? Has its location changed? Is there some unsavory brand of litter that’s sullying your kitty’s perception of her once-favorite pee-pee spot? Did you install one of those new-fangled, mechanical self-cleaning cat boxes?

• Territoriality: Is there a relationship issue among your kitties? Does one bully another? Is there a subtle struggle for control of specific household areas? Is there an outdoor kitty prowling the environs of your home in a visual or olfactory way? Has your covered litterbox become a popular ambush site?

• What are kitty’s favorite humans doing? Have their hours changed? Does their new job require more travel time? Did their big trip to Europe cost them a sofa as well? Divorce? New baby? New food? New furniture? Renovation? Move? Houseguest? Anything at all new in the household?

• Generalized, non-specific stress: (How can my cat be stressed? She sleeps all day!) Cats get stressed by things we mere humans couldn’t possibly grasp the significance of. Some cats are impossible to fathom.

Sometimes it’s nearly impossible to determine whether the issue is a purely behavioral one or a behavioral manifestation of real disease. To figure it out we do the following:

1-We ask: Is kitty spraying vertically or urinating horizontally? Spraying? More likely behavioral. Merely urinating? Could be either purely behavioral and/or medical.

2-We perform a urinalysis. Is there blood in there? Protein? White blood cells? Bacteria?

3-If bacteria is present we usually save the urine for culture and sensitivity to see what kind of bugs are lurking there.

4-We take an X-ray to look at the bladder and check for stones. Sometimes we even put in a dye or air to outline the walls and check for hidden stones not visible on simple X-rays.

5-We take blood to see if kidneys are failing or potentially infected, check the liver function and rule out diabetes.

6-Sometimes we even do an ultrasound or special kidney studies.

The most common medical reasons for inappropriate elimination:

• Unneutered maleness: I`ve actually had clients bring me their eighteen-month-old male cat and ask me why he smelled so bad and wouldn’t stop peeing on the window. (You see those two little round things on his backside?)

• FLUTD (feline lower urinary tract disease): Colloquially known as a UTI (urinary tract infection or commonly referred to as cystitis (a bladder infection) this disease is far more complex and frustrating than anything you might imagine. It definitely deserves its own post. Blood in the urine is the hallmark.

• A simple UTI: Although always possible, this is common only among diabetic cats. Most cases are more complicated than this.

• umors of the bladder are not as uncommon as we’d like. The occasional (typically) older kitty might suffer from one of these nasty things.

• Non-specific stress disorders: If mental illness is a factor in almost 20% of humans what makes us think our cats are not similarly susceptible? Spraying or urinating might be a behavioral sign of organic brain disease the same way depression or OCD (obsessive compulsive disorder) leads humans to act

Cats are wonderful creatures but they’re not simple animals. Their ways (and their bodies) are profoundly mysterious to us. We don’t understand many of the mechanisms behind their disorders and probably never will.

Patience, dedication, and a willingness to rule out medical conditions before embarking upon a course of behavior modification and possible drug therapy is always the best approach. Not everyone can afford it but, given enough urine-soaked furniture, bedding and carpets, most people eventually manage. Those who don’t—or can’t—or try and don’t succeed—find their loved one a new home. Even if they have to fly across the country to find the right one.