Why Is My Cat Peeing Everywhere?

There are a number of reasons why cats might start peeing outside the litterbox, and actually in young, otherwise healthy male cats, infection is one of the lowest on the list. (It’s more common in female cats, diabetic cats, in cats with kidney disease, with FIV or feline leukemia virus, or who are on steroids like prednisolone to help manage a health issue.) 

Your vet can help to rule out infection, diabetes, kidney disease, and bladder stones, all physical issues we can see in cats who suddenly stop urinating in the litterbox. Arthritis or an injury can be another cause, especially if the litterbox is tall-sided or up or down a set of stairs.

Once an underlying medical condition has been ruled out, then it’s time to consider whether this is the very common stress-induced bladder inflammation commonly referred to as either FIC (Feline Interstitial Cystitis) or FLUTD (Feline Lower Urinary Tract Disorder). Some cats with FLUTD have visible or microscopic blood in their urine. A urine test may also show microscopic crystals; sometimes they make so many of these the urine feels gritty! They may also be urinating more often, straining to urinate, or leaving small drops of urine places. We also will see these cats licking their genital area more often at times, or sometimes vocalizing while or after urinating.

The cause of FLUTD was poorly understood for a long time, but newer research is shedding some light on it. What they’ve found is that it is more common in cats who have had a traumatic kittenhood (yes, really). They may have been sick as kittens, been rejected by their mother or abandoned by their human, had a heavy parasite load, or been bottle fed. 

These kittens grow up to have an imbalance in their stress hormones. Basically, when a mammal is stressed, their adrenal glands release two hormones: a rapid acting one called epinephrine (adrenaline), to deal with the immediate crisis, and a slower acting one called cortisol, which helps to balance out the inflammatory response caused by the stress and adrenaline release. In a healthy cat exposed to a stressor, the adrenaline spikes quickly and comes down quickly, and the cortisol rises more slowly and stays elevated for longer.

In cats prone to FLUTD (and possibly some other stress-related disorders as well), the adrenaline spike goes up much higher than in healthy cats, and stays elevated for a very long time. The cortisol has a delayed onset, and doesn’t get as high as it should. It also returns to baseline very quickly. This means that the anti-inflammatory effect of the cortisol is much less effective. For some reason, in cats, that inflammation tends to settle in the bladder.

Bladder inflammation feels like a urinary tract infection, but when we check a sample, there’s no bacteria. This means these cats have the same pain, urgency, and increased frequency to pee as a person with a UTI would feel. They start to associate using the litterbox with this pain, so seek out other areas to go. Clothing, plastic, and sinks or bathtubs seem to be the most common places they choose, but some cats will absolutely urinate on rugs or hard floors.

Cats who have FLUTD definitely benefit from a multi-pronged approach to their care. Many of these also help cats who are peeing inappropriately due to behavior as well.

• First, talk to your vet about pain medication. Cat-safe anti-inflammatories such as Onsior and pain relievers such as Gabapentin can work wonders for these cats.
• The medication Amitriptyline has been shown to help normalize the stress hormone response in cats with FLUTD. It also has some mild smooth-muscle relaxing properties, which can reduce spasm in the urethra, improving comfort and reducing the risk of urinary obstruction (more on that in a moment). Some vets will prescribe Fluoxetine instead, which does seem to benefit some cats as well.
• Feeding a high moisture diet. Studies have shown that feeding a diet >60% in moisture can help to reduce frequency and severity of FLUTD episodes. This requires the kitty to be willing to accept a canned or wet food diet, which some may not, at least not initially. For cats that are hard-core dry food eaters, there are prescription diets that may be of some benefit.
• There are some supplements and other supportive medications that can help. Glucosamine, generally thought of as a joint supplement, has been found to be active in the bladder lining and can help to reduce inflammation and improve comfort, though it is more of a chronic type of medication to reduce the risk of recurrence. We often use oral joint supplements, or injectable ones like Adequan, for these cats. Omega-3 fatty acids like fish oil can also be of general anti-inflammatory benefit, and in humans have even been shown to help reduce physiologic responses to stress!
• Litterbox management is also critical! Make sure the litterboxes are scooped out at least once a day. You also need to be sure you have enough litterboxes for your household. A general rule of thumb is one litterbox per cat, plus one. If you have multiple floors in your home, put one on each floor. Ideally, keep them uncovered, though some cats do actually prefer a covered box. Use unscented litter. Some cats may like the Cat Attract litter, which has a pheromone that draws the cat in. Consider trying different litters in different boxes, to see if your kitty has a preference. Initially, keep one box with your regular litter, but if you find he has a strong preference for one type you can use that in all the boxes.
• Environmental enrichment also helps to level out those stress hormones. Providing dedicated playtime, varying what toys your feline friend has access to, using puzzle feeders, and ensuring that your cat has high places and hidey-holes to escape to can all help reduce stress. Happy cat pheromone diffusers, like Feliway, can also be very helpful here. Some cats even enjoy doing some trick training! My cats come, sit, and high five for favored treats.
• Other general environmental control aiming to reduce stressors is also super helpful. Is your cat getting bullied by other cats in the home? Are there new neighborhood cats that they can see outside? Have there been recent changes in the home, like visitors, new pets, new furniture, or the like? Do you have a young child who has recently starting getting more mobile? Taking steps to mitigate these potential triggers can be very helpful. Discuss specifics with your vet so they can help you strategize.
• Clean up the areas where your cat has urinated thoroughly, using an enzymatic cleaner. Believe it or not, cats can smell urine even through bleach and Lysol in many cases. Enzymatic cleaners, like Zero Odor, Nature’s Miracle, and Anti-Icky-Poo, are all designed to break down organic matter rather than masking it. Follow instructions on the packaging, and use a black light to ensure you’ve gotten all the spots. Those can be purchased online pretty inexpensively, and organic matter glows in the dark to help you find it.