Hi Leslie,
Sorry to hear about how serious this is.
I would highly recommend you absolutely confirm it is the cat that is doing this. Maybe it’s possible both are if one of them is encouraged by the other. I see no point in all the work unless this is confirmed.
The other issue is that I’m surprised you haven’t discussed is medical intervention at this time. This actually could be an ongoing medical issue which would make all the work you’ve completed be in vain. Not only that, but the behaviour will continue to become ingrained further as it is allowed to persist if the medical issue is not resolved.
I agree that you have done a lot of things to address the environment, but that may not be the problem. First you need to perform diagnostic testing with your veterinarian such as a urinalysis, urine culture and sensitivity, and blood work. This will start to uncover any underlying medical issues. 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. 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 nearby. 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 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. You’ve already mentioned that you have done many of them.
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 stairs and this may be the cause of why they’re not visiting the litter box.
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.
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.
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.
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.
In the very worst cases of inappropriate urination, there is one last step I consider before an owner is ready to remove a cat from their home for the problem. I will discuss the option of restricting the cat to a confined space such as a bedroom or bathroom to retrain them on the litter box. This may sound cruel and I agree it’s not ideal, but it’s not a lot different than cats being boarded for weeks on end or cats that wait years in cages to be adopted and it is in the effort of saving their life if an owner is at their wit’s end. Absolutely critical is that you are given anti-anxiety medication and supplements by your veterinarian to give to your cat during this time to reduce the amount of stress caused by the confinement. If the litter boxes take up a large percentage of space in the confined area, it is likely that your cat will eliminate in them rather than on the floor.
There are couples of videos that I would recommend you to check out for more information on specific topics: “Signs of Arthritis in Cats and Dogs & 4 Key Factors to Prevent Lameness or Stiffness”, “When Indulge Leads to Bulge”, and “Bored Kitty? How to Enrich Your Cat’s Home Life”.
Thanks for your question and good luck!
Dr. Greenway