My cat is very active in the middle of the night and urinates beside the litter box. What is causing these behaviours and what is the treatment?

Hi Lester,

Thanks for your question. This issue is as common as it is frustrating.

Whenever our pets are eliminating inappropriately, whether it be urination or defecation, it can be caused by two things: medical reasons or behavioural reasons. So the first thing we have to do is rule out medical problems.

I recommend you see your veterinarian and perform blood work and urine testing to make sure there is no medical issue causing this. Inappropriate urination can be caused by a urinary tract infection, diabetes, renal disease, hyperthyroidism, neurological disease or other ailments that can be found by running diagnostics. In your particular case, I strongly recommend your first step is to perform a ‘culture and sensitivity’ test on the urine sample. This will identify the bacteria that is present and indicate which antibiotic is necessary to eliminate it. Many veterinarians skip this step and if your cat has a resistant bacteria in its bladder, this could be the same infection as before and it will just keep repeating. An extremely important point to make here is that you have to make sure that the urine is collected directly from the bladder and not caught in the litterbox or a cup. Collecting the urine in something will contaminate the sample and put bacteria into it making the test results unreliable. If a medical condition is found, then the appropriate treatment can be implemented and the condition may resolve.

If no medical condition is found, then we have to consider behavioural reasons as a source. Cats are very in tune with their environment and so there are so many stimuli that can cause them to become anxious or change their behaviour. For example, I remember a patient that stopped going to the litter box because an owner started storing luggage near the litter box. Cats can also perceive things that we can’t, so a high-pitched sound that doesn’t bother us, may bother them and cause them fear around the litter box. Now you may go hunting for these things, but in the end, it’s rare to find. It doesn’t take much for a cat to start eliminating inappropriately and once they do, the reason they started doing it may be gone but they are now just continuing the behaviour. The longer you let this go on, the more it’s going to be ingrained and difficult to resolve.

There are some strategies you can employ to focus their attention on the litter box. I really encourage you to take a look at our video “How to Stop Cats Urinating Outside the Litter Box”.

In your case, there is something you said that intrigues me greatly. You said that your cat eliminates right beside the litter box. Honestly, I always love hearing that. Often it means that the cat doesn’t use the litter box because either the box is too small or the walls are too uncomfortable to walk over. When a cat is really overweight and large, they may no longer fit in the litter box and it may not be comfortable to use it. I often have owners buy a large bin, cut the sides really low, put it in a garbage bag and sprinkle litter on top of it creating their own litter box with a much larger surface area and low sides to it so it’s very easy to step in and out. If your cat has arthritis or back pain, this can be another reason why stepping over the walls of the litter box can be uncomfortable. This would be the first thing I would do after confirming that there are no medical conditions. I have great hope that this alone could fix the problem. Also, we have a great article where I address the arthritis issue more in-depth that you can take a look: “7 Strategies for Treating Arthritis in Pets”.

You can also start putting treats near the litter box but I always tell people not to let the cat know you’re putting them there. This way they just happen to find them there. They may start visiting in the litter box just to see if they’ve shown up again and since they’re there, they might as well use the litter box.

You can also place the litter box in various areas of the house. Keep in mind that cats can develop issues like arthritis which can make it difficult for them to go up and down the stairs and this may be the cause of why they’re not visiting the litter box.

There are also products that you can sprinkle in the litter that is supposed to attract them to it. These can work in some cases but not in others. In your question, you also mention this issue about wanting to go out in the middle of the night. There are medical conditions that cause cats to become active at unusual hours. Hyperthyroidism is one such condition and it would be found in blood work so this is more support for you to see your veterinarian and run diagnostics as a first step.

If anxiety is the cause, you may be able to improve this with environmental enrichment. Get your cat playing more and engaging it with toys. This will reduce stress. We have some interesting articles where you can get some ideas on: “Bored Kitty? How to Enrich Your Cat’s Home Life” and “The Top 10 Best Free Cat Toys”.

If they are eliminating in a particular spot, like on a bed or in a bedroom, you can restrict access to this area. Always clean the area where they have been eliminating very thoroughly. Even a small amount of debris or odour will make them return to that place and think it’s an appropriate place to eliminate.

Lastly, a lot of cases do take medication to solve these issues. I would have to say that anxiety, in general, is usually the cause of the problem. Whenever I say this to clients, I always get the same response. They say: you clearly don’t understand my cat, he or she is not stressed. But what clients don’t understand is that although you’re providing a very nice home for your pet, we have to remember that these were animals that lived in the outside environment and engaged their world by hunting and hiding. Many cats can develop stress just by being an indoor cat. You can speak to your veterinarian about anti-anxiety supplements and anti-anxiety medication to use as a trial if the aforementioned strategies do not work.

Lastly, I wanted to bring up one more point. In your question, you really focus on the fact that this cat was abused or in a terrible environment. I have so many clients say this and it may not be as true as you think. The problem you describe is much more common than you think and whenever I see problems like these, the cats rarely have a background like you describe. I actually think that if you are focusing on that history, it will prevent future success. You can’t change the past. Just work on the future and don’t use the past as a reason for things may not be working out. It may actually cause you to give up easier which I don’t want to see happen. I think this can be fixed and I have a great deal of optimism.

Thanks for your question and good luck!

Dr. Clayton Greenway