Defecation outside box before and after anal gland expression

Annie has started to defecate small amounts outside of her litter box -- but only after she has had a normal BM inside her box. She is over 16 years old and has always been fastidious about using her box, and I always keep it very clean and I make no changes to her type of litter. There was also "scooting" behavior. I took her to the vet. Her anal glands were impacted. Her glands were expressed and she was given an antibiotic shot and tested for worms (negative).

But the behavior (small "deposit" outside potty box after normal usage in box) continued. I took her back to the vet about a week later -- her anal glands were OK this time, not filled up. The tech suggested that perhaps this was a new learned behavior. I am hesitant to think this is behavioral and wonder if there could be either (1) Residual discomfort from the originally impacted glands, or (2) An additional problem.  

[Jim Humphries, B.S., D.V.M.]

Annie is lucky to have you!  You take great care of her.  

I think both of your presumptions are correct.  This probably started with the very mildy painful defecation from the anal glands, then as is often the case, a behavior pattern is set. Cats are creatures of habit - that's what makes them go good about litter box behavior.  

It may also be that it is still slightly painful and she leaves the box only to finish the process outside of the box. (probably taking too long to evacuate the bowl and she leaves thinking it is done, only to find out a bit later, oops, need to go a little more)

Finally I've seen many older cats just get a bit forgetful and begin to go outside their box for "geriatric" reasons.  

Solutions:  

If it is a residual medical pain or funny feeling in her perianal area, then over time hopefully this will go away and she will return to normal full defecation in the box.  

If it is a new behavior pattern we simply try to "re-train" her.  And this is the same process we would use no matter what the cause.  

Pick up where she has gone, place it in the box for about a day.  Clean the spots well (usually does not need much) and use some enzyme stain and odor remover.

If the spots are near the box, you can make those spots unappealing by using aluminum foil on the surface, or some other material that is not attractive for defecation.  (you'll have to experiment.. some use plastic garbage bags, astro turf, etc.)  

There is, of course and I don't think you would do this, any need to scold her.  

It is a minor "glitch" in her habits caused by geriatric medical problems and we certainly try to re-train them, but it is sometimes the case where we just can't.  Then you just make the environment easy to clean and care for her best you can.  

Best of luck with her, she sounds special.  

[LynneAV]

Thank you very much, Dr. Humphries. Yes, Annie is very special indeed. She outlived her life-long companion kitty who we lost to lymphoma when they were both 13, and so Annie is extremely needy now about human companionship. She especially dotes on my husband, but she recognizes me as her caretaker and does not want me out of her sight.

My intuition is that she wants to be a "good kitty" and she is trying to show me something is bothering her. I think you are correct in the assessment that defecation is uncomfortable and/or too time-consuming now for her, and she is realizing later there is "more."  I'm thinking just now that perhaps she does not want to go back into a dirty smelly box -- she's used to me cleaning it immediately.  I'm going to go out right now and get her a secondary litter box.

She goes in different spots in different rooms, so it appears to me that it is more of a convenience matter about where she is at the moment, rather than a new behavior ... but I've certainly been wrong before. Mainly I don't want her to suffer from some condition we could correct. She does have discomfort with BM's and they sometime accompany nausea -- I'm told that isn't uncommon with kidney cats. I give  her 1/4 tab Pepcid (per her vet) when she looks nauseous (licking lips, etc.), but I don't want to dose her continuously unless it becomes absolutely necessary.

Thank you again. Off to PetSmart I go ...  

[LynneAV]

Update. Annie is simply delighted to have a second litterbox -- I keep both boxes perfectly clean -- and now she is using both of them with a preference for the new one (probably just because it is new).  Thursday evening, she used her new box for a BM, then came out into the living room where my husband was watching TV, gave a cry (I didn't hear this myself), scooted, and then squatted in front of  him and made a second deposit on the carpet. By the time I arrived on the scene to clean up, she seemed fine and was off happily eating her dinner.  

This morning, I was able to catch Annie after she had a BM in her new box (she is typically on an every-other-day schedule), just as she was coming out into the living room looking for a place to squat. I picked her up and carried her back to her room, first to the first litter box that still contained the first deposit. That revolted her, so I put her in the second, clean box. She wanted to get out, but she didn't really fight it. Eventually, after nothing happened for a couple of minutes, I let her climb out leisurely and she went out to her food tray and cleaned her plate, then went into her condo for a nap. It was like, "OK, never mind then." If this is a re-training issue rather than a medical problem, I can only hope that I can catch her each time, but that is not likely.

[Judy Karnia, D.V.M.]

I just wanted to add a couple of ideas that might help your kitty. I see that you have blood work done regularly to monitor her kidney levels. Has her thyroid level been tested?  Many older cats develop hyperthyroidism and some of them will defecate outside their litterbox.  

I have seen this happen with older cats with kidney failure due to their stool being very dry and firm causing them to have difficulty pushing it out.  They may start in the litter box but then finish elsewhere.  Talk to your veterinarian about whether you should increase the amount of fluids you give her, add water to her food, and/or start giving a hairball remedy or mild laxative.

Have you started anything for the arthritis?  Arthritis pain can affect how they feel when getting into the defecation stance.  (Urination stance is easier.)  You might try building a small mound of litter in the box to help her get into the stance easier.  You veterinarian would be able to prescribe a glucosamine product or pain medications depending on what he/she thinks is appropriate to help the arthritis discomfort.

A couple other things that can help behaviorally: make sure her food and water are not near the litter box.  If she tends to defecate in a particular spot on the carpet, placing a dish with a small amount of her food may deter her from that spot.

You are doing a great job taking care of her and trying to fix this problem.  I hope she continues to do well.

Judy Karnia, DVM
Scottsdale Cat Clinic

[LynneAV]

I am *extremely* grateful for your input.

I would have no hesitancy about trotting Annie back to her vet repeatedly until this problem is solved -- if not for the fact she has to be sedated into unconsciousness before anybody can even take her out of the carrier to look at her, much less *do* anything to her.  I always have to weigh the danger of repeated anesthesia and the stress of her extreme angst (growling, screaming, hissing, slashing and trying to spill blood and kill everybody in the room) on her heart and whole body, against the severity of a medical problem. She is a little pistol and often I just do not know what to do in her best interests.  

-- "Has her thyroid level been tested?" ... Recently (2008 and 2009), the only thyroid number I am finding on her lab tests is T4 and it has been "low-normal."   In 2007:  T3 = 49 (40-150), T4 = 2.91 (0.8-4.0) and Free T4 = 0.98  (0.5-2.5).

-- BTW, Annie's kidney numbers: Phosphorus and Potassium have remained within normal range over past four years. BUN varies, 48 in 2006 to 52 July 09, with 40 and 42 registered in between. Creatinine was 2.2 in 2006, 3.0 July 09, with 1.5 and 1.4 in between.  I didn't think these were very bad kidney numbers considering her age and length of time since they read high ... I aim for around 75ml of lactated ringers/day (the measurement markings on the bags are not very exact), and her vet told me to maintain that amount. Annie is on the small side, currently a little over 7 pounds.

--" ... stool being very dry and firm causing them to have difficulty pushing it out."  ... Actually, her stool currently seems on the *soft* side to me, and I'm wondering if that is what bothers her. I have noticed other times when Annie is "opposite kitty," totally reverse from normal cats.  She *did* suffer from severe constipation *before* we discovered/treated the cyst and dental problems and *before* this problem evidenced itself. Hmmm.

-- "Have you started anything for the arthritis?" ... No, but I will ask her vet about it. She is jumping up on and down off bar stools and other high furniture, but that may be entirely different than a crouching position for her hip.

-- " A couple other things that can help behaviorally: make sure her food and water are not near the litter box.  If she tends to defecate in a particular spot on the carpet, placing a dish with a small amount of her food may deter her from that spot." ... Her food tray is out in the dining room so she can eat "with" us, and her litter boxes are in opposite private corners in "her" room. The original box is X-Large, covered and lined as usual, and her new box is smaller, lower, uncovered, unlined, and filled to the brim with litter. She is using both of them for urination and lately, the new one for BMs. She leaves her second deposit in a different place and/or room each time, and unrelated to whether we are watching her or not. This morning I caught her in the act (darn, wish I'd come in 30 seconds earlier)  in the dining room, I picked her up and carried her to her box. She struggled mildly to leave, and after a minute I let her go -- she just left the room and proceeded to eat her lunch -- it was a "never mind" to her, and she obviously did not *have* to go.

I think I need to learn how to examine/express her anal glands myself, just so I don't miss something that could be hurting her if I don't run her to the vet every week. Aside from that, perhaps it is arthritis pain, perhaps the unfamiliarity of soft stools, perhaps other digesting discomfort. Or something else entirely.

Again, thank you very much, I really, really appreciate your input.

[Judy Karnia, D.V.M.]

It does make things more difficult if your cat gets that stressed going to the veterinary clinic.  I see many patients like that.  You may not be able to express her anal sacs, they can be difficult to do in a cat.  But your vet may be able to show you how to feel for distension.  

Those thyroid numbers sound fine and the kidney values are not bad.

Soft stool can cause discomfort leading to the defecating out of the box.  Ask your vet about trying a fiber supplement like pumpkin or metamucil or if you should try Fortiflora (a probiotic that helps intestinal health).

Keep up the good work with her.

[LynneAV]

Thank you very much.  I will call Annie's vet and ask about the supplements.

In the meantime, the patient at least appears very happy and interested in everything in her little world. Last night a monster cricket got inside the house and she went berserk jumping after it, zig-zagging all over the house and leaping up in the air -- Until I saw the cricket, I was alarmed that she was having a seizure or the like, heh.

[Dr. Carol Osborne, DVM]

I agree with all of the above comments and wanted to specifically note that in older cats with arthritis this is a very common issue and a natural vitamin supplement with Glucosamine and MSM should be quite helpful.
Thank you
Dr Carol Osborne, DVM

[LynneAV]

Thank you Dr. Osborne. I bought Cosequin for cats from Annie's vet and started her on that. I hope that is a good product, it's the only glucosamine supplement they carry.

I just want to verify, fiber supplement is appropriate for soft stool as well as constipation? I can get her some flavorless Metamucil powder, what do you think for dosage, not more than 1/8 tsp/day? I'm always trying to stuff her with food, so pumpkin would be one more thing she has to get into her stomach and would probably annoy her greatly.

[Judy Karnia, D.V.M.]

Fiber is appropriate for soft stool and constipation.  However, we cannot give medical advice, so ask your veterinarian if fiber would be appropriate for your cat and in what form.

[LynneAV]

OK, will do, thank you.

[LynneAV]

Update: Crossing fingers ... we have had two consecutive correct litter box experiences.  Tonight the routine was perfectly normal, like the old days, with no "looking around for a good place on the carpet" behavior afterwards or symptoms of discomfort. I'm not announcing a cure yet, but when behavior was happening every single time and you have succeeded in ceasing it twice in a row, this is a good sign. I was working on both normalizing stool consistency with diet alterations (we had gone overboard treating the constipation)  and also breaking the new undesirable habit. I am relieved for Annie because I worried that she could be in a physical discomfort we could not diagnose. I also always have it in the back of my mind that if something happened to me, nobody will take in a pet who has a habit like this, sad to say, but have to face the truth. I won't uncross my fingers for a few weeks probably. Thank you for all the excellent and useful advice.

[Judy Karnia, D.V.M.]

Good to hear!  I'll keep my fingers crossed too.  I am glad she is feeling better.