musculoskeletal pain or weakness can result in incomplete elimination, where a dog postures to eliminate but cannot maintain the posture until she has completely voided the bladder or bowels. The dog may then return indoors and need to eliminate shortly thereafter, resulting in housesoiling. Good observation skills are necessary to recognize this problem in a case where the cause may not be readily identified with radiographs.
Urine marking is another potential cause for housesoiling in the dog. Urine‐marking behavior is a normal form of communication. Intact male dogs urine mark more than castrated or female dogs but all dogs may urine mark. When neutered animals mark indoors, it is often due to situations involving conflict, frustration, or anxiety. However, this may also simply reflect incomplete house training. Regardless of the posture used for urination, medical conditions will need to be ruled out.
4.6.3.2 Cats
There are a variety of medical causes that may contribute to housesoiling in the cat, and housesoiling is likely one of the more common reasons for cats to be relinquished to shelters. If cats are placed in a cage in a shelter, they are likely to begin using the litterbox due to the lack of other preferable surfaces. However, some cats develop preferences for soft, absorbent substrates, so they may choose to eliminate on any bedding that is placed in their cages. If the cat has an aversion to the litterbox or the substrate offered in the box, it may eliminate on newspaper or other surfaces in the cage.
Cats housed in groups in rooms within the shelter may be more likely to eliminate outside the litterbox, and due to the presence of multiple cats, it may be challenging to determine which cat is not using the box. Fear or stress associated with interactions with unfamiliar cats may lead to urine‐marking behavior and possibly even feline interstitial cystitis, also known as feline idiopathic cystitis (FIC). If other cats block access to boxes (either overtly or covertly), or a cat is simply too afraid to approach a box out of fear that it may be ambushed by another cat, elimination outside the box may occur. However, any elimination outside the box should prompt exploration for an underlying medical condition first, before making the determination that it is purely a behavioral problem. Any medical condition resulting in polyuria, polydipsia, incontinence, constipation, diarrhea, pain associated with elimination, increased frequency and/or urgency to eliminate, orthopedic disease making it difficult or painful to climb into a box, and declining sensory capabilities making it difficult to locate the box can all lead to elimination outside the box. Caretakers should also be aware that an aversion to the litterbox may still exist long after the medical condition that promoted it is treated and eliminated.
Feline lower urinary tract disease (FLUTD) is a relatively common syndrome in the cat and often leads to the deposition of urine outside the box. FLUTD refers to disorders affecting the urethra and/or urinary bladder. Stranguria, dysuria, pollakiuria, hematuria, and urination outside the box are all signs that are consistent with FLUTD, but numerous underlying etiologies are possible. Common etiologies include UTI, uroliths, urethral plugs, idiopathic cystitis, bladder neoplasia, malformations, trauma, and urinary incontinence.
UTIs should first be ruled out with a urinalysis, preferably using urine collected by cystocentesis. One study demonstrated that clinical signs are, in fact, a poor predictor of UTI in cats and recommended urine culture as the best method for confirming the presence or absence of bacterial infections (Martinez‐Rustafa et al. 2012). The same study found that the best predictive factor for the presence of UTI was urinary incontinence (Martinez‐ Rustafa et al. 2012). UTIs are often associated with other underlying medical conditions and are rarely a primary disorder in cats. Good antibiotic stewardship requires that we avoid treating cats presumptively with antibiotics since the likelihood of infection in young cats is small.
FIC has been shown to be the most common cause of signs of FLUTD in the cat (Lekcharoensuk et al. 2001; Gerber et al. 2005; Saevik et al. 2011). However, FIC is a diagnosis of exclusion. FIC describes recurring cystitis when no underlying cause for signs can be identified; a variety of different causative factors are suspected. Cats with FIC appear to have altered bladder permeability, and several studies have documented its association with stress (Buffington et al. 2002; Westropp et al. 2006; Stella et al. 2013). Cats with FIC appear to have increased sympathetic activity (Buffington and Pacak 2001; Buffington et al. 2002), to be more sensitive to environmental stress, and to have a decreased ability to cope with changes in their environment. Research continues to support the hypothesis that stress is associated with the development of FIC. One study, published by Cameron et al. (2004), found that cats with FIC were more likely to live in multi‐cat households and to experience conflict with another cat in the household. Clearly, a shelter environment has the potential to negatively affect the welfare of cats that are prone to FIC, and appropriate treatment will involve the treatment of symptoms as well as an attempt to identify and reduce the stressors that may be affecting the cat.
Several different treatments for FIC have been investigated, and no single medication has been found to be consistently effective at treating the signs. Since FIC is likely a condition with a multifactorial etiology, it is likely that treatment will be multifactorial as well. One study that evaluated multi‐modal environmental modification (MEMO) in the management of cats with interstitial cystitis found that with MEMO there was a significant reduction in lower urinary tract signs, fearfulness, and nervousness (Buffington et al. 2006). MEMO was defined as changing the cat’s environment to decrease stress. Examples of these changes included avoidance of punishment, diet changes, techniques for increasing water consumption, changing to unscented clumping litter, improved litterbox management, provision of more structures for climbing and perches for resting and viewing, scratching posts, audio and visual stimuli when the owner was absent, increased client interactions with the cat, and identification and resolution of inter‐cat conflict in the household. See Chapters 16 and 17 for more information on feline housing and enrichment.
4.6.4 Gastrointestinal Disorders
The nervous system of the gastrointestinal (GI) tract and the central nervous system are linked in a bidirectional manner by the sympathetic and parasympathetic pathways, resulting in what is referred to as the brain–gut axis. Due to this interrelationship, chronic stress can have profound effects on the enteric nervous system (ENS). Severe life stressors have been associated with several GI tract conditions in humans (Bhatia and Tandon 2005), and the effects in animals are just now being explored. Chronic stress has been demonstrated to decrease gastric emptying, increase intestinal contractility, increase gut permeability, reduce water absorption in the gut, disrupt normal electrolyte absorption, and increase the colonic inflammatory response (Bhatia and Tandon 2005). Many gastrointestinal conditions such as chronic diarrhea and vomiting may be closely associated with stress. However, when presented with an animal with GI signs, the possibility of internal parasites and infectious organisms must also be ruled out. Newer polymerase chain reaction (PCR) tests can be helpful in ruling out some of these conditions. It is important to always keep in mind that nothing precludes an animal from having GI distress from multiple etiologies; therefore, both infectious causes and stress may need to be addressed.
Disruptions in the microbiome have been shown to play a role in anxiety and depression in many species (Foster and Neufeld 2013). In addition, studies in laboratory animals have shown that when young developing animals do not have normal gut microbiomes, they develop an exaggerated stress response and a dysregulated HPA axis (Sudo et al. 2004). Minimal work has been done on the role of the gut microbiome on behavior in dogs, but some limited research suggests that dogs demonstrating aggressive behavior may have distinctly different populations of gut bacteria compared to dogs that do not show aggression (Kirchoff et al. 2019; Mondo et al. 2020). More research is needed to identify what constitutes a healthy gut microbiome and how to adjust an “unhealthy” gut before we can apply what we have learned to companion animal care. Once again, the impact of stress on normal development and general health is clear and reminds us that it must not be overlooked.
Behavioral signs that may be associated with gastrointestinal disease include polyphagia, hyperphagia, polydipsia, coprophagia, and grass and plant eating.