Vertical or Horizontal? Diagnosing and Treating Cats Who Urinate Outside the Box.

Feline elimination problems are commonly presented to general practitioners and behavioral medicine specialists. The correct diagnosis is often missed by veterinarians owing to individual variation and multifactorial cases. Three diagnostic umbrellas need to be considered: medical problems, toileting behavior outside of the litter box, and urine marking. The treatment plan for most cases, regardless of etiology, involves optimum litter box management, fulfilling cats' environmental needs, stress reduction, behavior therapy techniques, and trigger removal. Medical management with psychoactive medication might be necessary in cases where chronic stress, fear, and anxiety play a role in the feline patient's symptomatology.