Top 5 Reasons for Fecal House Soiling in Senior Pets
Fecal house soiling in the geriatric pet population can be a clinical challenge. The number of patients seen in practice with this problem is difficult to estimate,1 but because house soiling can significantly impact the human–animal bond and sometimes lead to euthanasia of the pet, a fast, accurate diagnosis is vital.
The following 5 diseases and disorders that may lead to house soiling seem over-represented in the geriatric pet population. However, when evaluating a geriatric dog or cat for this problem, all possible differential diagnoses should be considered.2
1 Behavioral Disorders
In one study, 10% of dogs were presented to a referral behavior practice because of a house soiling problem, although most cases were the result of juvenile problems, including incomplete housebreaking.3 In contrast, as patients age, the underlying cause of fecal house soiling changes and disorders such as cognitive dysfunction and inappropriate toileting/box aversion become more common.4 Thus, clients with geriatric pets should be made aware the cause of house soiling is rarely a training issue.
Clients with geriatric pets should be made aware the cause of house soiling is rarely a training issue.
A thorough history and physical examination are important to help separate behavioral problems from other causes of fecal incontinence and inappropriate elimination. Questionnaires about recent onset behavioral changes and cognitive dysfunction can also help raise suspicion about this disorder and separate it from other behavior problems.5
Once a behavior disorder is diagnosed, behavior modification and medical therapy should be directed at specific diagnoses, with the understanding that incomplete housebreaking is an unlikely cause.
Canine cognitive dysfunction, a varied syndrome with multiple potential clinical signs associated with its presentation, is being recognized more frequently. Common signs include house soiling and the following6:
- Anxiety and/or irritability
- Changes in sleep-wake cycle
- Deficits in memory for familiar people or places
- Forgetfulness of learned behaviors and habits
- Reduced cognitive function
- Reduced reactivity to stimuli with decreased perception
- Spatial disorientation or confusion
Less is known regarding feline cognitive dysfunction; however, the disorder is increasingly recognized in older feline patients. Signs largely overlap with those seen in canine patients but may present slightly differently in cats, including these additional signs:
- Wandering from familiar territory
- Changes in appetite and drinking habits
Unfortunately, studies of long-term treatment and prognosis of this disorder are rare, and management is built on empirical evidence. The current foundation of treatment is medical therapy (eg, selegiline), providing stability to the environment, dietary management, and use of nutraceuticals.
In cats with suspected behavioral house soiling, questions should focus on litter-box hygiene and environmental changes, because inappropriate toileting/box aversion are common manifestations of stress-related behavioral disorders. Various resources are available to guide owners on at-home options for providing environmental enrichment to improve the behavioral well-being of their pets. In severe cases, consultation with a veterinary behaviorist on the use of behavioral medications is advisable. (See Resources.)
Negative reinforcement or punishment training strategies should be avoided for both dogs and cats.
Patients, particularly dogs, may be presented with a complaint of geriatric fecal house soiling related to orthopedic disease,4,7 which can be caused by a combination of pain related to the orthopedic disease and difficulty completely evacuating the bowels in an appropriate situation because the animal has trouble posturing. The animals will then defecate inappropriately at other times or locations.
Cats are also thought to have a significant amount of degenerative joint disease, although their symptoms may be more subtle.
Veterinarians and clients should be aware of this differential diagnosis in both dogs and cats. Veterinarians should perform a complete, thorough orthopedic examination on every fecal house soiling patient. Clients should understand that soiling episodes may wax and wane with the clinical severity of the orthopedic disease; for example, increased soiling problems may follow strenuous exercise or periods of increased orthopedic pain, or just vary from day to day. Treatment should be directed at the underlying orthopedic condition and include appropriate pain management.
3 Neurologic Disease
A thorough, complete neurologic examination is paramount for every fecal house soiling patient, both canine and feline, because a wide variety of neurologic disorders (eg, degenerative myelopathy, lumbosacral disease, intervertebral disk disease, infectious disease, neoplasia) are potential causes.8-12 Localization from the neurologic examination is vital for a definitive diagnosis and additional diagnostics, including imaging, will also be required in most cases.
Depending on the underlying cause of neurogenic fecal house soiling/incontinence, some therapies (eg, neuropathic pain medications, anti-inflammatories, surgery) may improve or resolve clinical signs. However, these treatments must be targeted toward a specific diagnosis.
4 Colorectal & Anorectal Diseases
Diseases affecting the colon, rectum, or anus may also cause fecal house soiling in dogs and cats. In most cases, the quality of the animal’s feces will change (eg, frequency, consistency [diarrhea, constipation], fecal characteristics [frank blood, mucus]) and gastrointestinal disorders should be the primary consideration. Physical examination should include careful inspection of the perineum and perianal area, and digital rectal examination for structural abnormalities. Gastrointestinal diseases that may be associated with inappropriate elimination include inflammatory enteropathies, perianal fistulas, neoplasia, pancreatitis, and others.13
5 Structural Disease
Structural abnormalities can also cause fecal house soiling, with complications following perianal surgery and prostatic disease the most common.13,14 However, prostatic disease seldom causes house soiling in dogs and is rarely seen in cats.
These diseases, and other structural abnormalities leading to fecal house soiling presentation, can be considered when either the history or physical examination increases clinical suspicion. Depending on the type of prostatic disease, treatment may be successful. Iatrogenic, neurologic, or structural injury carries a more varied prognosis.
Fecal house soiling by geriatric pets can be a difficult and frustrating problem for clients and the veterinary team. Each patient’s individual history and physical examination should be given emphasis to determine and prioritize the varied differential diagnoses. Therapy is equally varied and best directed at the primary problem, whether behavioral or medical. Clients should be counseled that an underlying problem, rather than a purposeful change in the pet’s attitude, almost always drives these cases.
Always take a complete history and conduct a thorough physical examination because they are the most important aspects of a fecal house soiling work-up in a geriatric dog or cat. The details acquired will allow development of a targeted list of the most likely differential diagnoses.
Owners may frequently misinterpret house soiling in a geriatric patient as lazy or spiteful behavior. Ensure the entire veterinary team and clients are on the same page for successful diagnosis and management by reinforcing that this problem almost always stems from a medical or medical/behavioral issue.
House soiling cases can be incredibly difficult and heartbreaking for clients with geriatric pets. Make frequent follow-up telephone calls to check on the patient and remind clients that even with management strategies implemented after diagnosis, improvement takes time. Be the communication bridge between veterinarians and clients so patients are managed optimally.