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Basic feline elimination behavior consists of searching for a quiet and secluded area, digging a small depression in an acceptable substrate, and covering the waste after elimination (Heath 2019). On closer inspection, the sequence is actually quite complex and may include up to 39 individual behaviors (McGowan et al. 2017). Cats are known to be fastidious, traveling to specific latrine areas located away from sleeping or feeding sites to eliminate. This limits the odor and reduces the risk of disease and parasite transmission (Hart and Hart 2014a).

Failure to provide an indoor cat with a litterbox environment that sufficiently mimics natural conditions can result in elimination outside of a designated box. Eliminations also serve a communication function, and waste found outside the litterboxes or latrine areas may be an indication of social or environmental stress. Several terms for elimination issues can be found in the literature. Broad descriptors that do not give any indication of the underlying motivation include inappropriate urination, housesoiling, and periuria (if specific to urination) (Barcelos et al. 2018; Borns‐Weil 2019). Some have recently argued for replacing the term “inappropriate” with “unacceptable” when referring to feline eliminations outside of designated areas because the cats are behaving normally in most instances, but the human caretakers have provided suboptimal conditions (Heath 2019). The physiologic need to empty the bladder or colon is referred to as toileting or elimination. Urine marking/spraying and middening are depositing urine or feces, respectively, outside of the box for communicative purposes. Risk factors for unacceptable elimination include living in a multi‐cat household, suboptimal litterbox facilities, stress and anxiety, and detection of unfamiliar outdoor cats (Borns‐Weil 2019; Heath 2019). Research findings warn against using any single factor to diagnose toileting or marking behavior (Barcelos et al. 2018).

Housesoiling is often a life‐threatening condition in cats due to the high risk of relinquishment or euthanasia of these cats. Proper diagnosis of medical problems, toileting, or marking begins with obtaining a thorough history, physical examination, blood work, urinalysis, and fecal analysis. Many cats with urinary toileting issues often have an underlying medical component such as bacterial infection or feline interstitial cystitis (Westropp et al. 2019). The substrate and location of the soiled area may be consistent or seem random but is usually a horizontal surface. Cats tend to prefer large, uncovered boxes with fine‐grained clumping litter and once‐daily cleaning (Guy et al. 2014; Landsberg et al. 2013). However, recent studies isolating individual factors bring into question some of these clinical impressions (Barcelos et al. 2018; Ellis et al. 2017; Grigg et al. 2012). Boxes located in areas that are too noisy or require a cat to come into contact with an aversive stimulus (e.g., stairs for arthritic cat, another aggressive cat) are common triggers for toileting away from the litterbox as well.

Marking cats often spray urine on vertical surfaces in socially prominent areas. Less commonly, marking is on a horizontal surface. Use of the litterbox to toilet usually remains consistent. Often social conflict with other cats, people, or animals in the home results in marking behavior. Some cats will mark near windows and walls, suggesting the presence of an outdoor cat. Treatment for marking focuses on alleviating the stress and anxiety experienced by the cat as well as maintaining a proper litterbox environment. Psychoactive medications are a primary therapy for marking and may be helpful in toileting cases that involve stressors as well (Mills et al. 2011). Cleaning of soiled areas with an enzyme‐based cleaner is a treatment for any form of unwanted elimination due to the cat’s natural inclination to gravitate toward previous soiled areas for elimination. All cats in the home with spraying cats have evidence of increased stress levels, and a global approach to reducing stress and anxiety should be undertaken (Ramos et al. 2020).