Cats urinating outside their litter box is frustrating for owners, and can strain the cat-owner bond. A lack of understanding about how cats express fear, stress, and displeasure is a large part of that frustration. As a Cat Friendly Practice, Star Of Texas Veterinary Hospital evaluates all aspects of feline wellbeing to reach a clear diagnosis and successful treatment. 

Always begin with a medical assessment

Cats may seem mysterious and secretive, but advances in the feline medicine field show they actually are clear, deliberate communicators. Your cat’s litter box behavior is one of the strongest indicators of their physical health, environmental comfort, and social wellbeing. 

When a cat begins urinating outside their box, or showing other abnormal elimination behavior, the first step is always a medical assessment at our Star of Texas Veterinary Hospital. Our veterinary team will assess your cat’s physical health with a thorough examination, and possibly lab work and ultrasound, to evaluate kidney function and bladder health. In addition to the physical exam, we will ask key questions about your cat’s home life that may reveal the reasons behind your cat’s behavior.  Our medical assessment of your cat will be covered from three perspectives:

  • Your cat’s physical health —Cats can be plagued with several conditions that affect their lower urinary tract, and cause pain, increased frequency, difficulty urinating, and bloody urine. 
    • Urinary tract infections — These infections are a common reason why cats urinate outside their box.
    • Urinary stones — Stones are found mostly in male cats and can become lodged in the urethra. Urinary blockages are a veterinary emergency. If your cat is repeatedly straining to urinate, and vocalizing, call us immediately. 
    • Feline idiopathic cystitis (FIC) — An inflammation of the bladder lining, FIC can be chronic and may wax and wane. FIC can worsen if the cat is stressed or anxious, or because of environmental changes, such as diet or relocation. 

If your cat is diagnosed with a medical condition, our veterinarian will advise you on the proper treatment course. For FIC cases, we will help to determine the source(s), so you can alleviate your cat’s distress.

  • Your cat’s environmental comfort — Cats are territorial, and desire safety and security where they sleep, eat, and eliminate. When these conditions are unavailable or threatened, a cat will find their own solutions—often in ways that people find problematic. 
    • Location: Cats need a calm place to conduct their business, so check their box’s current location and assess the activity, noise, and exposure.
        • Can your dogs reach the box? 
        • Does your cat have an escape route, or are they cornered with no way out?
        • Do you step over the box to reach cabinets? 
        • Is the box in a pass-through to another room with a lot of foot traffic?
        • Is your cat’s food and water near their litter box, or in a separate location?
    • Box design — Most cats appreciate a basic, uncovered litter box. The box should be one and a half times the cat’s length, and wide enough for them to turn around. Cats do not appreciate litter liners, because their claws snag on the plastic.
    • Litter — Cats are naturally attracted to soft, medium-to-fine clumping litter that mirrors natural substrates like soil and sand. Select a low-dust, perfume-free formula, because dust and fragrance can trigger respiratory problems. As a general rule, cats find strong odors offensive, so keep your cat’s sleeping, eating, and eliminating areas fragrance-free.
    • Housekeeping — Cats are fastidious creatures who like their litter boxes neat and clean, so ensure you scoop the litter box at least once a day, and completely change the litter and thoroughly clean the box with mild soap and water once a week.


  • Your cat’s social health — Cats can be both solitary and social creatures, and are sensitive to the dynamics of hierarchy in their social group. Cats are also vigilant guardians of their territory, and respond to real and perceived threats, often by spraying or marking a surface with urine to signify ownership.
    • Social order — A common stressor in multi-cat households, the bully-victim social dynamic occurs when a dominant cat keeps another from accessing shared resources, such as litter boxes, food or water bowls, and prized resting places. The submissive cat may live in a constant state of stress, especially if alternative resources are not available.
    • Resource access — Have several locations for each resource in your house so submissive cats can satisfy their needs without stress. Always provide one litter box per cat, plus one additional box (i.e., two cats will need three boxes). Place food and water in a separate location, away from the litter box.
    • Outdoor cats — Outdoor cats or strays can be a source of stress, and cause your indoor cat to spray near windows and doors, as well as unfamiliar objects in the home. Clean all sprayed areas thoroughly and widely with an enzymatic cleaner to deter remarking, and talk to our veterinary team about humanely keeping outside cats from your yard.

Dismissing your cat’s litter box misbehavior as a strictly urinary issue may be accurate, but may also oversimplify a complex problem. Cats may appear aloof, but they are highly observant, with strong emotions about their home environment and resources, many of which manifest themselves through their litter box. If you have questions about your cat’s health or litter box behavior, contact the Star of Texas Veterinary Hospital team—we want your cat healthy and stress-free.