Some owners who are worried about getting bad news from the veterinarian will avoid scheduling an appointment for as long as possible. But if your cat has begun to urinate outside the litter box, any underlying causes must be addressed before any other changes can be made.

If your cat has bladder stones, changing the type of cat litter you use is a waste of time and money, and in the meantime, your cat’s suffering continues. As we talked about in Peeing Outside the Box, a veterinary visit to rule out health problems is an absolute necessity. And the sooner the better, because once a cat has made the decision to urinate outside the litter box, it is not always easy to change his mind.

Remember that some of the medical causes of inappropriate urination can be easily and inexpensively cured, particularly when diagnosed early. (Did you know that certain types of bladder stones can be dissolved with dietary modifications alone? See Treatment Options for Bladder Stones.) Other problems may be more difficult to address, but it is better to know what you are facing than to try to deal with a health concern without adequate information.

In most cases, once an underlying medical problem is appropriately treated, cats begin to use their litter boxes again. However, if they have begun to think that the carpet, tile, couch, etc. is their "new" litter box, or if they have received a clean bill of health and you are dealing with a behavioral cause for inappropriate urination, it is time to take a look at the cat’s environment.

Our goal is to make litter boxes as appealing as possible (for cats, not necessarily for us). Try the following approaches:

• Make sure you have thoroughly cleaned up every spot where a cat has urinated outside the box with a product that eliminates the smell of cat urine. This makes these areas less attractive as toilets.

• Clumping cat litter is best. Use your cat’s favorite brand or an unscented litter containing activated charcoal (a recent study showed that most cats prefer this latter type).

• Keep the boxes impeccably clean. Scoop them out once or twice a day and dump, wash, and fill them with clean litter once a month.

• Always have at least one more litter box than the number of cats in the house. Having multiple boxes not only spreads the waste around keeping each box cleaner until you get a chance to scoop, it also helps reduce conflicts between cats around the boxes.

• Place extra litter boxes over the areas that have been soiled and then gradually move them where you want them. Once litter box use has been reestablished, you can remove any boxes that are rarely used.

• Most cats prefer large, uncovered litter boxes. A traditional enclosed box can be claustrophobic, smelly, and difficult to turn around in. Also, make sure that the sides of the box are low enough for cats to easily step in and out.

Large, plastic storage boxes can be easily turned into litter boxes that cats seem to adore. Simply cut a hole in one side of the container leaving enough of a lip at the bottom to hold the litter in. These improvised boxes have the advantage of having tall sides to help eliminate “splatter,” and an open top to prevent odors from building up and allow light inside. If you absolutely have to have a covered litter box, drill some large holes in the top that came with it for ventilation and light.

I made one of these huge litter boxes for my 17-year-old, shall we say, "large boned" kitty, who wasn’t especially concerned about where he peed. It is more than twice as big as our other boxes, and it immediately became the favorite "toilette" for both of my cats. I strongly recommend switching to this type of box if you are having issues with litter box use.

Dr. Jennifer Coates

Image: Sergio Castelli / via Shutterstock